Publications

Molecular epidemiology of anthrax cases associated with recreational use of animal hides and yarn in the United States.	To determine potential links between the clinical isolate to animal products and their geographic origin, we genotyped (MLVA-8, MVLA-15, and canSNP analysis) 80 environmental and 12 clinical isolates and 2 clinical specimens from five cases of anthrax (California in 1976 [n?=?1], New York in 2006 [n?=?1], Connecticut in 2007 [n?=?2], and New Hampshire in 2009[n?=?1]) resulting from recreational handling of animal products. For the California case, four clinical isolates were identified as MLVA-8 ...	2011	22174783
lessons learned from the investigation of a cluster of cutaneous anthrax cases in connecticut.	in 2007, two cases of cutaneous anthrax associated with west african drum making were reported in connecticut in a drum-maker and his child. although both cases were due to exposure to naturally occurring bacillus anthracis from imported animal hides, ensuing investigative and remediation efforts were affected by the intentional b anthracis attacks in 2001. to share our experience of responding to an outbreak of anthrax in the biologic terrorism preparedness era, we summarize connecticut's inves ...	2010	20357605
critical challenges ahead in bioterrorism preparedness training for clinicians.	a survey was distributed to determine physicians' confidence levels in recognizing potential category-a bioterrorism disease threats (e.g., smallpox, anthrax), preferred means of obtaining continuing medical education (cme) credits, and their knowledge of the connecticut department of public health's (dph) disease reporting requirements.	2009	19557957
evaluation of gram-positive rod surveillance for early anthrax detection.	since 2003, connecticut laboratories have reported gram-positive rod (gpr) isolates detected within 32 h of inoculation from blood or cerebrospinal fluid. the objectives were to rapidly identify inhalational anthrax and unusual clostridium spp. infections, and to establish round-the-clock laboratory reporting of potential indicators of bioterrorism. from 2003 to 2006, connecticut's gpr surveillance system identified 1134 isolates, including 657 bacillus spp. (none b. anthracis) and 241 clostridi ...	2009	19397835
medical toxicology and public health-update on research and activities at the centers for disease control and prevention and the agency for toxic substances and disease registry.	an extensive review of cdc epidemiological responses to human outbreaks of anthrax from occupational settings between the years of 1950 and 2001 documented a variety of approaches to mitigation and decontamination [2]. these approaches included taking no action, burning contaminated materials, chlorinating water supplies, instituting administrative and engineering controls and ppe, vaccinating potentially exposed individuals, and in 2 instances, fumigating with formaldehyde vapor (now considered ...	2008	19031383
cutaneous anthrax associated with drum making using goat hides from west africa--connecticut, 2007.	on august 29, 2007, the connecticut department of public health was notified by a physician of suspect cutaneous anthrax involving a drum maker and one of his three children. the drum maker had been working with untreated goat hides from guinea in west africa. this report summarizes results of the joint epidemiologic and environmental investigation conducted by public health officials, environmental agencies, and law enforcement authorities. the investigation revealed that the drum maker was exp ...	2008	18551098
unexplained deaths in connecticut, 2002-2003: failure to consider category a bioterrorism agents in differential diagnoses.	recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack.	2008	18525371
training needs of pediatricians facing the environmental health and bioterrorism consequences of september 11th.	the september 11, 2001, terrorist attacks have been called "the worst environmental disaster in the history of new york city." as a result of the extensive nature of the destruction, our objective as pediatricians was to determine the experience and training needs of tri-state child health professionals in responding to the environmental health and bioterrorism-related demands placed on their practices.	2006	17285216
gram-positive rod surveillance for early anthrax detection.	connecticut established telephone-based gram-positive rod (gpr) reporting primarily to detect inhalational anthrax cases more quickly. from march to december 2003, annualized incidence of blood isolates was 21.3/100,000 persons; reports included 293 corynebacterium spp., 193 bacillus spp., 73 clostridium spp., 26 lactobacillus spp., and 49 other genera. around-the-clock gpr reporting has described gpr epidemiology and enhanced rapid communication with clinical laboratories.	2005	16229790
hospital admissions syndromic surveillance--connecticut, september 200-november 2003.	on september 11, 2001, the connecticut department of public health (cdph) initiated daily, statewide syndromic surveillance based on unscheduled hospital admissions (hass). the system's objectives were to monitor for outbreaks caused by category a biologic agents and evaluate limits in space and time of identified outbreaks. thirty-two acute-care hospitals were required to report their previous day's unscheduled admissions for 11 syndromes (pneumonia, hemoptysis, respiratory distress, acute neur ...	2004	15714628
anthrax case timeline.		2003	14692564
bioterrorism-related inhalational anthrax in an elderly woman, connecticut, 2001.	on november 20, 2001, inhalational anthrax was confirmed in an elderly woman from rural connecticut. to determine her exposure source, we conducted an extensive epidemiologic, environmental, and laboratory investigation. molecular subtyping showed that her isolate was indistinguishable from isolates associated with intentionally contaminated letters. no samples from her home or community yielded bacillus anthracis, and she received no first-class letters from facilities known to have processed i ...	2003	12781007
inhalational anthrax and bioterrorism.	until recently, inhalational anthrax was considered an infectious disease curiosity for medical specialists and veterinarians. this attitude abruptly changed following the intentional release of bacillus anthracis spores via the us postal service in october 2001. because of its rarity, few physicians were familiar with its clinical manifestations, treatment and prophylaxis. in this report, we try to fill this informational gap by reviewing these issues based on additional data culled from this r ...	2003	12682568
night of two town meetings.		2002	12405129
anthrax postexposure prophylaxis in postal workers, connecticut, 2001.	after inhalational anthrax was diagnosed in a connecticut woman on november 20, 2001, postexposure prophylaxis was recommended for postal workers at the regional mail facility serving the patient's area. although environmental testing at the facility yielded negative results, subsequent testing confirmed the presence of bacillus anthracis. we distributed questionnaires to 100 randomly selected postal workers within 20 days of initial prophylaxis. ninety-four workers obtained antibiotics, 68 of w ...	2002	12396928
environmental sampling for spores of bacillus anthracis.	on november 11, 2001, following the bioterrorism-related anthrax attacks, the u.s. postal service collected samples at the southern connecticut processing and distribution center; all samples were negative for bacillus anthracis. after a patient in connecticut died from inhalational anthrax on november 19, the center was sampled again on november 21 and 25 by using dry and wet swabs. all samples were again negative for b. anthracis. on november 28, guided by information from epidemiologic invest ...	2002	12396920
bioterrorism-related anthrax surveillance, connecticut, september-december, 2001.	on november 19, 2001, a case of inhalational anthrax was identified in a 94-year-old connecticut woman, who later died. we conducted intensive surveillance for additional anthrax cases, which included collecting data from hospitals, emergency departments, private practitioners, death certificates, postal facilities, veterinarians, and the state medical examiner. no additional cases of anthrax were identified. the absence of additional anthrax cases argued against an intentional environmental rel ...	2002	12396919
public relations. straight talk.		2002	12355974
bioterrorism. student charged with possessing anthrax.		2002	12161620
20/20 hindsight. months after anthrax claimed the lives of several. americans, hospitals review their reaction to the event--and plan for future crises.	last fall, after a nation suffered the unthinkable attacks of sept. 11, a second wave of terror held americans in its grip. questions still surround a series of baffling cases of anthrax that shook new york and connecticut. each of the hospitals involved report that despite the unsolved mysteries posed by these events, they are more cautious and better-prepared for future bioterrorism attacks.	2002	11913044
fatal inhalational anthrax in a 94-year-old connecticut woman.	we describe the 11th case of bioterrorism-related inhalational anthrax reported in the united states. the presenting clinical features of this 94-year-old woman were subtle and nondistinctive. the diagnosis was recognized because blood cultures were obtained prior to administration of antibiotics, emphasizing the importance of this diagnostic test in evaluating ill patients who have been exposed to bacillus anthracis. the patient's clinical course was characterized by progression of respiratory ...	2002	11851578
update: investigation of bioterrorism-related inhalational anthrax--connecticut, 2001.	since october 3, 2001, cdc and state and local public health authorities have been investigating cases of bioterrorism-related anthrax. as of november 28, a total of 23 cases have been identified; 11 were confirmed as inhalational anthrax, and 12 (seven confirmed and five suspected) were cutaneous. epidemiologic investigations to identify the source of exposure to bacillus anthracis continue for a case of inhalational anthrax in a hospital stockroom worker in new york city (nyc) and, most recent ...	2001	11808925
from the centers for disease control and prevention. update: investigation of bioterrorism-related anthrax--connecticut, 2001.		2002	11797623
from the centers for disease control and prevention. update: investigation of bioterrorism-related inhalation anthrax--connecticut, 2001.		2001	11787482
update: investigation of bioterrorism-related anthrax--connecticut, 2001.	cdc and state and local health departments continue investigating cases of bioterrorism-related anthrax. this report revises the number of suspected cases and updates the investigation of a 94-year-old connecticut (ct) resident who died from inhalational anthrax.	2001	11770501