Press Briefing Transcript

Anthrax Update:
Telebriefing Transcript

October 26, 2001

AT&T MODERATOR: Ladies and gentlemen, thank you for standing by. Welcome to the CDC anthrax conference call. At this time all participants are in a listen-only mode. Later, we will be having a question-and-answer session. Instructions will be given at that time.

If you should need any assistance during the call, please press zero, then the star key, and as a reminder, this conference is being recorded.

CDC MODERATOR: Thank you. This is Lisa Swarnarski at the CDC Media Relations Office. Thank you, everyone, for calling in. We hope you're finding these telebriefings useful and we're hoping to do them more regularly, possibly even on a daily basis, Monday through Friday.

I'd just like to say something about our media operations here. We've been trying to meet the great demand for information. We have doubled our press staff by bringing in press officers from the other centers at CDC, from about ten to twenty, working in two different shifts, four days a week on and three days off, working about 10 to 14 hours a day. We are open seven days a week.

I know despite this, some of you are having a hard time getting through. I ask for your patience, and to keep trying, and we really are trying our best to meet all of your needs.

Today, we have Dr. Jeffrey Koplan, Director of the CDC with us, as well as Dr. Julie Gerberding, Acting Deputy Director for the National Center for Infectious Diseases.

Just to spell those names--several of you called yesterday asking for the spelling of names. Koplan is K-o-p-l-a-n, and Gerberding is G-e-r-b-e-r-d-i-n-g.

Dr. Koplan's going to make a few initial statements and then we'll open it up to Q&A.

DR. KOPLAN: I have very little specifically to add this morning and will leave most of the time for your questions.

There's a fair amount of activity going on today in Washington, from both our staff and other public health personnel there in the D.C. Health Department, and in other parts of the Department of Health and Human Services, and in the Postal Authority, largely trying to get both prophylaxis out and some environmental testing done in a variety of what we're calling downstream facilities from the Brentwood mail facility, and that includes a large number of federal agencies with a number of mailrooms within those agencies, and the Postal Service is attending to their own postal substations with assistance from us, and then there are several private facilities that get mail directly shipped from the Brentwood mail facility, and our recommendations in all of those are consistent with each other, which are that the employees working in those facilities go on prophylaxis with an initial dose of ten days as a sample, pending the outcome of environmental testing in those various, that very large number of over 200 different substations that get their mail directly from Brentwood.

Obviously other investigative work continues in the other sites in New York and in Florida and New Jersey, and I'll be glad to answer, try to answer any questions you have.

CDC MODERATOR: Okay. We're ready for the first question.

AT&T MODERATOR: And brief instructions. Ladies and gentlemen, if you do have a question at this time, please press the one on your touchtone phone. You'll hear a tone indicating you've been placed in queue. You may remove yourself from queue at any time by pressing the pound key.

Once again, if you have a question, please press the one.

Our first question is from the line of Michael Smith with Postal World. Please go ahead.

MR. SMITH: Dr. Koplan, good to speak with you again, sir.

DR. KOPLAN: Thanks. Now I know what, where your letter goes.

MR. SMITH: Thank you, sir. The situation, sir, regarding the State Department employee who is ill, and another person in that area that is under observation, I understand, as well as the trace amounts being found, apparently almost--a number of locations around town, brings up the key question of cross-contamination of mail pieces.

I know we talked about this yesterday but this continues to be an issue that is very sensitive in the mailing community, and we need to know if there might be any tests or anything that you're able to do to give us an answer, whether this is a serious problem or there may be stray pieces that were deliberately contaminated, that were not accounted for, so to speak, that went to these facilities?

DR. KOPLAN: I think your point is well-taken. These well could be cross-contamination but we've really got no way to know, that we haven't--there is no test, but, you know, if it's positive for anthrax in culture, that's all we know, and whether it got there via a primary source letter, or one of these criminal mailings going through that particular mailroom, or whether it merely was in contact with a leaking porous letter that went elsewhere, we have no way to differentiate that at the moment.

Dr. Gerberding wanted to add something.

DR. GERBERDING: I think it's also important to realize that, to some extent, the quantity of contamination is a very relevant health issue. We would base our assessment on the environmental sampling that's going on. We find one or two, or very small numbers of organisms, then the possibility that any contaminated letter, cross-contaminated letter which poses a health risk is pretty small, and that's one of the things we're trying to straighten out right now.

AT&T MODERATOR: Thank you. Our next question is from the line of David Carvello with CBS News. Please go ahead.

MR. CARVELLO: Doctors, thank you for these conferences. For the last couple days--

DR. KOPLAN: You're a little distant. Could you maybe get closer to the phone or the mike.

MR. CARVELLO: Is this better, Doctor?

DR. KOPLAN: That is better. Thank you. Yes. I can hear you.

MR. CARVELLO: This question is about something you don't do formally, I gather, the size of the microbe, but my question is how many at CDC know that size, at all, and are any of them doctors, scientists, or policy people? Or is there no one at CDC that knows the size?

DR. KOPLAN: Well, it's not a case of--I think the important thing here is that we don't measure, we don't do the testing that measures size. Our laboratories are microbiologic, molecular, genetic, et cetera, and we don't do physical property testing.

However, we have gotten information on size that's been shared with us, from others who do that testing, and in terms of numbers of people, all of our folks are who are in leadership positions in this outbreak, and the people in our laboratory who are doing the work are aware of that. We share whatever information we get with all of our folks involved in the investigation.

AT&T MODERATOR: Thank you. Our next question is from Seth Bornstein [ph] with Knight Ridder. Please go ahead.

MR. BORNSTEIN: Yes, Doctors, thanks again, and let me echo how these are useful on a daily basis. On the cross-contamination possibility, can you explain how that would be--I understand how you could get a relative spore, here, too, as Dr. Gerberding says, but in terms of enough to infection someone with inhalation anthrax as in the State Department mailroom, one, are you looking at cross-contamination with quantities enough to contaminate other people?

And I guess to follow up on that, therefore, does that mean the public is more at risk, and besides the 200-some different substations, are you looking at expanding the prophylaxis to perhaps whole zip codes?

DR. KOPLAN: No, on that latter; just plain no. Let's get back to this issue of cross-contamination versus, you know, prim--whatever we're gonna call them--primary source criminal letters, or mailings. That where you indicated that there is an inhalation case in the State Department that's been reported, I think we all think that that would be highly unlikely to virtually impossible to occur, just by cross-contamination, and as well, without having these letters in hand, but based on what we've seen in other sites, there are probably multiple mailings that have gone out, and, you know, there may be several places in the Federal Government that have been deemed targets for these letters to go to.

So I guess my own personal working hypothesis would be that this is not cross-contamination. It just wouldn't be enough material, infectious material from cross-contamination to do that. Nevertheless some of these small amounts of positive material, and they're being cultured at various mail sites that we're hearing about say in Washington, and I believe one was reported out of Langley and out of Walter Reed, may well represent cross-contamination, but we don't have the luxury of just [inaudible] to that. I think until proven as such, we are taking the prudent and patient protective view that it is worth getting those people on antibiotics even if it's an overreaction or unnecessary or ultimately proven unnecessary, that at least get them started while we're trying to sort out how much contamination there is, and if it's very isolated, very small amounts and it can be cleaned up quickly and then attributed to cross-contamination, fine.

But your earlier part, which I reiterate again, it does not suggest larger population bodies would be at risk, such as a Zip code.

AT&T MODERATOR: Thank you. Our next question is from Kristin Reed with Bloomberg News. Please go ahead.

MS. REED: Hi. Thanks also very much for these briefings. I just wanted to actually ask a couple of follow-up questions on the idea of testing the vaccine for treatment, and was just trying to clarify whether your plans to use a vaccine on some people will be done as part of a study that would provide data for future sort of rationale of using it, and also when exactly was the IND filed?

DR. GERBERDING: The clarification, the primary interest in the vaccine is for pre-exposure prevention and post-exposure prevention of disease. It is not primarily a product that would be used for treatment of anthrax, nor would we expect it to offer much beyond the antimicrobial therapy because the disease itself is immunizing. So the presence of the bacteria in the patient as they are developing and coping with anthrax disease is a far greater immunogen than the vaccine would ever be.

So the emphasis right now is on preventing disease and using the vaccine for that purpose.

AT&T MODERATOR: Our next question is from Ellen Beck with United Press International. Please go ahead.

MS. BECK: Thank you. I appreciate these press conferences as well.

Could we go back to the cross-contamination at the State Department site in Virginia? Are you implying or saying that you have found something at that particular site, or just on the person, or can you be a little more clear as to where we are with that investigation?

DR. KOPLAN: No, we are not implying cross-contamination in a site where someone has disease. You know, again, while we are always learning things, there's no reason to think now that an amount of anthrax spores that could occur in an adjacent letter or in a pile of letters from cross-contamination would be at a dose sufficient or aerolizable enough to cause inhalation anthrax of the kind you're referring to in the State Department worker.

Nor do we have an incriminating letter there. I think that it's possible people may find them somewhere now that they're alert and viligant and looking for them, but, you know, we can--one feature of these different outbreaks has been some of them we have a sick patient with--who did something with mail and sometimes with suspect letters that have passed through but nothing in hand, as in Florida. In some cases we have people who--with very little illness around, but with an incriminating letter. And here's an instance which you just described at the State Department where we have an ill person, but no letter in hand at the moment. Some cases we've had both.

AT&T MODERATOR: Thank you. Our next question is from Lauren Nearguide with Associate Press. Please go ahead.

MS. NEARGUIDE: A couple of questions. Are you all doing any work in the labs perhaps with animals to test the assumption that perhaps with this particular form of anthrax, it could take less than 8000 spores to cause inhalation disease? And can you tell us, now that you've sort of widened the prophylactic net, how many people now are taking Cipro while you do a lot of this environmental testing? And do you have any of the environmental test sites results back from the Washington area yet?

DR. GERBERDING: This is all with respect to the third question. This is Dr. Gerberding. The amount of material that we have to work with here is essentially zero. We do not have the actual powder implicated in these situations, nor would that be appropriate for CDC to have the powder. We do have the isolates that we've obtained from the patients, and we can grow those in the laboratory, but putting those into animals would not really answer the question you are asking, because the capacity of the bacteria to cause aerosol disease is dependent not only on the specific bacterial spores but also the way they are suspended in material and pulverized into a powder and so forth.

So the previous animal studies that have been done using a variety of strains of anthrax are one of the ways that we derive these estimates, and we have no reason to believe that in and of itself this bacteria is more virulent than other strains of anthrax.

With respect to how many people are currently receiving prophylaxis for anthrax, it's a large number. We are working as we speak to complete getting the people in the Washington, D.C. area downstream from Brentwood on prophylaxis and likewise working in New Jersey to get all of those who have present in the Hamilton postal facility on prophylaxis, and ditto for New York. So we can't give you an updated number, but it's more than several thousand people.

AT&T MODERATOR: Thank you. Our next question is from Lori Garrett with Newsday. Please go ahead.

MS. GARRETT: Good morning, or afternoon, whichever it may be. I had never been informed of these press conferences before. I'm happy to find out that these exist, and hope I will be informed in the future.

My question has to do with the--again the whole question of cross-contamination in Washington, D.C. in particular. I wonder if you could tell us how many sites have actually been submitted to very detailed scrutinized sweep with Q-tips scraping over vents and so on and so forth, looking for spores? And of those that have been checked, how many have come up negative? This goes to a larger question which has been raised by some of the previous reporters on the line here, which is if you submitted more sites all over Washington, D.C. to the same rigorous testing that has been done in the mail rooms for the State Department and the CIA and so on, might we find that indeed spores have been dispersed far more widely in the Washington, D.C. area? And if that is so, and if it includes private businesses, private homes, would the same policies for Cipro prophylaxis be extended on a much larger basis outside of government employees?

DR. GERBERDING: I think the answer to your question, Lori, is that the environmental evaluation is ongoing. We have--we are working very close with the postal service to develop a list of absolutely every facility that receives mail from Brentwood, and that includes a large number of private sector places. Many of those people are already on antimicrobials, and to the extent that we are contacting them, they are lining up outside of D.C. General and Health and Human Services to receive their antibiotics as we speak.

The--there are a number of sites that we have data from the sampling. Most of those were, in the initial circle, were the postal facility sites because we knew about them and they were the easiest to get it into and out of. But both private sector and Federal sites are undergoing environmental assessment now.

We have negatives, we have some positives, as you know, and until we get the full counts completely, we can't really give you the numerator denominator information.

AT&T MODERATOR: Thank you. Our next question is from Megan Garvey with the LA Times. Please go ahead.

MS. GARVEY: Hi. I wondered if the onset of the disease in the State Department workers--worker, I guess, you know, almost a week after you had the deaths of the postal workers from Brentwood is any indication, further indication that it was not cross-contamination. Can you talk at all about when the disease appears in people and what that tells you about the source of the illness?

DR. KOPLAN: Well, I would just say again that an inhalational anthrax case, I think we would be hard-pressed to think of as cross-contamination, just in terms of the dose necessary to cause it. So again, without the incriminating letter in hand, my working assumption would be that there is such a letter somewhere that this person was exposed to.

AT&T MODERATOR: Our next question is from Carol Ann Campbell with the Star Ledger. Please go ahead.

MS. CAMPBELL: Thank you. Again, I appreciate these as much as anybody else here.

Yeah; that's great. My question is this is the first opportunity to study, for most public health doctors, to study anthrax firsthand. Can you tell me what you are doing to try and learn about this disease, autopsies, any kind of studies that you're doing to try to learn about anthrax. What have you learned so far, and what do you still need to know?

DR. KOPLAN: Well, I start, and add, first of all, it was, is an opportunity we would have been more than delighted and prayed for not to have had, but we've got it.

As you're hearing, almost on a daily basis, we are learning things. We're learning of both things epidemiologically and laboratory-wise. I'll give you some examples. In the unfortunate first case, the gentleman that died in Florida, we did have our own pathologist involved in the post-mortem exam in Florida, which did yield information in depth, both confirming what the disease was, but also aiding, I think, our understanding of what the pathology is and what goes on in the body.

In addition, the atypical cases we've seen have confirmed things that have been reported, historically, but I think lots of people, more recently, had forgotten that inhalational anthrax can present in a number of different ways, rather than just a classic way, and so that this has given us a much broader picture of how the disease can present.

Similarly, I think in the cutaneous cases that we've seen, yes, there have been the characteristic nodules with the central ASCAR [?], but some of these folks have presented in somewhat atypical ways as well, with more of a diffuse skin rash, and then leading to something, to the, to the nodule, and in some cases a less-defined lesion.

So these have altered our clinical view of the disease. Epidemiologically, of course, we are seeing something new to human experience, which is the wide--more widespread, not, not--still confined to a few cities, but the use of, in a criminal way, the mail to disseminate a toxic organism, and, you know, we're learning about that. In terms of the dynamics of the organism in different settings, through mail, letters, workplace, et cetera, yes, we've learned a lot more about that just in the last two weeks, and then even in the laboratory, even as our pathologists have been working 24 hours a day, and we don't have enough of them to work on shifts, most of them have just been in there continuously, getting cat naps, they have in the course of having a constant stream of biopsy specimens, and the post-mortem specimens, have developed a new test to better identify one of the antigens on the anthrax bacillus, to permit better diagnostics from biopsy specimens.

So the folks are both working hard in a service mode and in a investigational and diagnostic mode, and even through that are finding the chance to find, you know, to maybe develop some new information and some new techniques which they can then apply later the same day.

AT&T MODERATOR: Thank you. Our next question is from Janice Horowitz with Time magazine. Please go ahead.

MS. HOROWITZ: Hi. I share everybody's gratefulness, and this is the first time I have participated in one of these teleconferences, and forgive me if you went over some of this yesterday or the day before.

It seems that it's still controversial, whether irradiating the mail actually will kill the anthrax spores, and I'm wondering what studies you have to confirm that that will work.

I was told that the Defense Department had done some studies, but nobody was able to come up, make a specific citation. And also the issue of the masks, whether--what specific type of mask they are, and why the CDC is confident, I'm told 95 percent, it kills 95 percent of microbes, including anthrax. What gives the CDC or the Postal Service that kind of confidence?

And if I may, one other question is what sort of technology do you see potentially down the pike to sniff out anthrax in the air, or, you know, in a Postal Service setting?

DR. KOPLAN: Okay. Let me take a cut at your three-part question, at least a couple of the parts. One, on irradiation, we don't do irradiation testing here, nor accredit equipment. Most of our experience here, at CDC, with irradiation involves irradiation of food, and its value in sterilizing food, and what effect it has on the food from a health perspective. Obviously this is quite different.

Just as a note to all of you in the press, there are lots of claims being made about techniques, of everything from ultraviolet light, ozone, heat, steam, ironing, sunlight, which you're probably all hearing about.

I'm getting a stream of e-mails from people all over the world with sure-cure devices for this stuff. I'm not about to make a investment in any of these companies.

However, radiation has been shown to have an effect on bacteria and to kill bacteria. The postal department is looking into some specific technologies of which the companies assess that it's effective in both high-speed passage of material, and can do it to a considerable depth of several inches, which makes it suitable for essentially processing mail through, and they're looking both at that data, and I think we'll be in a position also to see what the results of using this are in terms of eliminating contamination.

So of all the things that we talked about, that's certainly probably the most promising, but there may be other inventive things that come out soon, or sooner or later, that are helpful as well.

The other things I mentioned, the ironing, the ultraviolet light, the sunlight, are not useful.

Your second point was masks. The reason we think these masks are effective is they have been extensively evaluated and used in large numbers of workplaces, and, remember, this is a physical removal, it's a size phenomenon, and so the reason we're able to say that there's a 90 percent reduction or a 99 percent reduction is because these masks filter out material, and, for example, the, one of the filters used filters out particles at the size of point three microns, considerably smaller than even the smallest of these spores, and so they are effective.

One point, though, is they do require a good fit. These are not the kind of face masks you might just pick up and use in woodworking, or something like that.

They are only as effective as the seal you get around your face, and so facial hair needs to be removed for many of the different types of filters, and they require being fitted ahead of time.

AT&T MODERATOR: Thank you. Our next question is from Tammy Smith with the Richmond Times-Dispatch. Please go ahead.

MS. SMITH: Hi, Dr. Koplan, again, I reiterate everybody's thanking you for allowing this. My question--I know you only have 15 or so people who have been diagnosed. Is there any underlying health condition or any kind of epidemiological studies, anything that ties these people together physically?

DR. KOPLAN: No; it's a good question. There really isn't. We've seen people of different ages, and clearly men and women, and, unfortunately, a young child as well, that have all had some form of this.

I think that what we may find with, even with this relatively, this relatively small cohort of cases to make an observation from, is that people may do better who are in better health, or who are younger, or who are treated in specific ways, and I think, again, it's unfortunate to have to be doing this at all, but one thing that may come out of this is some better approaches to treatment in people who have this disease, that can permit them to get better sooner. We're very pleased that the second inhalation case in Florida was able to go home from the hospital yesterday, and that was extremely gratifying to all of us, and he got very good clinical care there.

AT&T MODERATOR: Thank you. Our next question is from Miriam Felco [ph] with CNN. Please go ahead.

MS. FELCO: Hi. Thanks for these daily conferences, too. I hope they will be daily. They're most helpful, especially [inaudible].

I've got two quick questions. Number one, the mask you were just mentioning, if this was mentioned in previous calls, I apologize. This is the first one I got in on. Where, where, who can get these? Where can you get these?, and especially since they're not the ones that you would pick up in a normal store, it sounds like.

The other question is you mentioned at the very beginning that, again, the latest places where anthrax has, traces have been found, the folks in the immediate area are being given the dosage of ten days of Cipro.

Why ten days, when, in previous situations, you've been giving out three or five? Why has ten now become the magic number?

DR. KOPLAN: Well, it's convenience and accessibility, is the answer. To answer your last question, the basis for giving out a limited number of doses of Cipro, rather than 60 days, is that the vast majority of people being put on prophylaxis are shown in the course of our getting more environmental and epidemiologic information, to not need to be on it for the sixty days. So it's wasteful and unnecessary to have the larger amount. And costly.

The reason for varying, smaller amounts, has been in different sites, that the packs that are available for distribution have varied in some places, and in some it's been a seven-day supply and in some it's been a ten-day supply.

Frequently, they come in five day supplies and they've been given two of the fives for ten. In Florida, there is a specific reason for giving people a 14-day supply, because as part of that investigation, some blood tests were an important part of it, and people needed to come back 14 days later for the blood test, and then to be decided as to whether they needed to continue on prophylaxis.

So I recognize, we recognize that this is a little confusing, to have these different time periods. It's not based on medical need. People are taking the same dose every day, and if they need to take it longer, then they're given the full sixty days.

It's, in some instances, a case of when the environmental information can come back, such that they can be told, one way or the other, what they need to do. I think, largely now, it's probably going to be ten days that people will be given prophylaxis for, with then a decision made as to whether to continue or not.

Your first question on filters, I am not an expert on filter use. We have folks here who are, and these are widely used in many industries for different purposes, and the most common one that's being used, for example, in the Postal Service, is something called an N-95 filter, which provides a 90 percent reductions in particulate matter with it. It does require some fitting and it is available through a wide variety of industrial sources, and might even be available in other commercial sites, outlets, but it--again, it would be something that it would be recommended out of a workplace rather than for consumers, or I'm certainly not getting one or wearing one.

Please go ahead.

MS. : Yes, Dr. Koplan, can you give us a time frame on when you expect to get the environmental results from some of the D.C. facilities, also Sterling? And is CDC lab processing all those, or are they going to other places?

DR. GERBERDING: What I can tell you about the sampling right now is that we have teams of people who are attempting to get everything sampled that needs to be sampled so that we can get the results back within the 10-day framework of the treatment. So since we offered people, as Dr. Koplan was describing, 10 days of antibody prophylaxis, we want to get all of the environmental samples done in time to know whether they need to continue it or not. So I can't give you any information about specific sites other than to say we intend to include every one where we have people on therapy.

The--what was the second part of your question?

MS. : Now I forget.

DR. GERBERDING: Okay.

AT&T MODERATOR: Thank you. Our next question is from Alice Park with Time Magazine. Please go ahead.

MS. PARK: Good afternoon. My question refers to Cipro, and with, as you said, several thousand people now taking Cipro on a prophylactic basis, and potentially several thousand more going on it every time, you know, spores show up, what are the concerns here for resistance and side effects, and also why not, since so far we know fortunately that these strains are sensitive to other antibiotics, why not start with other antibiotics and then move to Cipro if test results show indeed that this is something that requires Cipro?

DR. KOPLAN: Good for you. That is a great idea and we wish more people were doing it. There has become something magical about this word Cipro, an antibiotic that's been around for a while, has never had a run like this, and now it's become the panacea.

Yes, it is one of the drugs we recommend, and we recommend it in the same breath as doxycycline, which would be just as good. They both have adverse reactions associated with them. They are a little different. And for someone who has to take it for a prolonged period of time, they can be significant. We have already had several severe adverse reactions in just the groups who have started taking it already, including some of our own staff who, after exposure, went on these medications, namely Cipro. And doxy, as well, can cause a skin sensitivity, et cetera, but it's one of these things that's well worth discussing, even with your own doctor, or with your--you know, the own experience you've had. Many of us have taken tetracyclines before. You know not to go outside or to keep your--for prolonged periods, or to keep your arms and legs covered, and it's a well tolerated drug. So either is good.

You're quite right, a lot of people are on it. It has implications more over the long haul for antibiotic resistance, and that is a serious concern, but already a number of organisms are resistant to Cipro in part, and this would only encourage that.

I think it would certainly be healthier, from a broad community sensitivity antibiotic perspective, to have some better balance of folks on different antibiotics. It's healthier over all and would certainly be perfectly healthy for the individuals who are taking prophylaxis.

AT&T MODERATOR: Thank you. Our next question is from Julie Dierdorf with the Chicago Tribune. Please go ahead.

MS. DIERDORF: Hi. Can you confirm the exact type of technology used to sanitize the mail? That's my first question, if it's the electron.

And the second is as we find out more about the sophistication level with the anthrax makers, does that mean these people have connections with smallpox, better connections?

DR. KOPLAN: I cannot confirm the specific technology. I believe it's--you had mentioned a proton electron something radiation. But it is--it's a gamma radiation, I believe that's what it is, but I pretend to no expertise in that, so I wouldn't quote me on that subject.

And on your second question, there's a wide range of potential agents that can be used. Because someone has one does not mean they are any more likely to have another. But, you know, our level of vigilance and concern remains high for every potential agent, both the one being used and every other one that could potentially be used as well.

AT&T MODERATOR: Thank you. Our next question is from Mary Manning with the Las Vegas Sun. Please go ahead.

MS. MANNING: Dr. Koplan, other than your investigation in Reno, Nevada at the Microsoft office building, are you doing any other investigations outside of the Northeast quadrant? And does the Brentwood post office deliver mail any place else outside the Northeast quadrant?

DR. KOPLAN: If I can say more broadly that we are in daily contact with all the state health departments, and they are getting, you know, letters, concerns, boxes, suspect cases, as they well--as we would like them to be reporting them to us, they are reporting them. And indeed we want a surveillance system where we're getting lots of reports of things that turn out not to be anthrax, and we are getting some of those. And where those occur, we are in regular consultation with the epidemiologists in the states or the cities, as we did in Nevada, and work with them. And if they are able to do the investigation themselves, which frequently they are, sometimes they will send us specimens, sometimes not, it gets resolved.

And so, yes, that's going on regularly all over, but in terms of an active investigation outside the ones we have talked about already where there's a potential or a probable case, no, that is not the case at the moment.

I'm sorry, your question about Brentwood was do those go to other sites? We think we have identified the sites where Brentwood mail goes. It is a large distribution center where mail goes what we are calling downstream, i.e., in the direction of end users, and we have identified those Federal agencies, substations of the postal service, and private facilities where that mail gets forward.

MS. STARK: John, do we have time for one more question?

AT&T MODERATOR: Certainly, and that's from Lisa Stark, with ABC News. Please go ahead.

MS. STARK: Hi. Thank you. Let me ask you two quick things, if I could. The trace amounts that we've heard about that are in the CIA and Walter Reed, how big a concern is that from a health standpoint, or is not that big a concern?

And secondly, do you know if any apartment buildings get mail in bulk from the Brentwood station? And if so, why wouldn't that be an area that you would also need to go take a look at?

DR. KOPLAN: The--your first question is, we are concerned wherever we see a positive in terms of wanting to follow up, do an investigation to determine what that means.

That doesn't necessarily translate into a significant risk health for anybody there, but it does mean we need to look and see what the story is and have discussion of cross-contamination, et cetera.

Do trace amounts confer a risk to individuals? Probably not, but nevertheless the folks in all of those facilities are on prophylaxis until we can better demonstrate that low risk.

The issue of bulk mail is, from what we've seen, obviously, that that's not where these criminal letters have been part of. Lots of bulk mail isn't sealed or in envelopes; some is. The postal service and postal inspectors are well aware, and I think are looking at their own bulk mail issues, but that doesn't seem to have been a part of this risk.

CDC MODERATOR: Okay. Thank you, everyone. We will hope to do this on Monday, and we will let you know through a media advisory.

AT&T MODERATOR: And, ladies and gentlemen, that does conclude your conference for today. We thank you for your participation, and you may now disconnect.

[End of conference.]

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES