Anthrax letters: personal exposure, building contamination, and effectiveness of immediate mitigation measures.

This report is the first detailed and quantitative study of potential mitigation procedures intended to deal with anthrax letters using a simulated anthrax letter release within an actual office building. Spore aerosols were created by opening letters containing 0.1 g of dry powdered Bacillus atrophaeus spores. Culturable aerosol samples were collected using slit-to-agar and filter-based samplers. Five test scenarios were designed to determine whether simple mitigation procedures or activities carried out by the person who opened the letter made a significant difference to aerosol concentrations in comparison to a control scenario where no activity took place. Surface contamination of the letter opener was measured at 10 body points for Scenarios 1 to 4. A sixth scenario, based on published Centers for Disease Control and Prevention anthrax letter response guidelines, used letters containing 1 g of spores. Results demonstrated that the spore aerosol spread throughout the building in less than 4.5 min. Potential mitigation techniques such as closing the office door or shutting off the ventilation system were not effective. Activities carried out by the letter opener including moving, walking to another location, and spraying water onto the contaminated desk with a hand sprayer all resulted in significantly higher aerosol concentrations in comparison to control. The potential total inhalational hazard for the letter opener during the five test scenarios ranged from 4.1 x 10(5) to 1.6 x 10(6) colony forming units (CFU) compared to 3.9 x 10(5) CFU for the control. Surface contamination of the letter opener (Scenarios 1 to 4) was highest on the right hip (4.8 x 10(4) to 1.0 x 10(5) CFU/cm(- 2)) and lowest on the right or left side of the head (2.2 x 10(2) to 3.7 x 10(3) CFU/cm(-2)). The statistically based methodology used in this study provided the means to objectively assess anthrax letter protocols to determine their effectiveness under realistic conditions. Potential mitigation procedures tested in this study did not reduce aerosol hazard or surface contamination.