New Hampshire Woman Critical Because of Gastrointestinal Anthrax

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

http://www.nashuatelegraph.com/news...estions-in-anthrax-case-still-unanswered.html

Saturday, January 16, 2010 Many questions in anthrax case still unanswered; woman?s too sick
By DAVID BROOKS
Staff Writer
PrintShareComment DURHAM ? More low-level anthrax has been found in the building where a woman got sick after a drumming circle last month, but it?s still not clear exactly what caused the problem, partly because the woman is still too ill to be interviewed.

State epidemiologist Dr. Jose Montero said Friday that New Hampshire health officials will have a remediation plan by the end of next week for the United Campus Ministry building in Durham. They are waiting for the Centers for Disease Control to test some samples that were inconclusive, probably because they encountered anthrax at levels too low for state labs to detect.

The Strafford County woman who became sick after the Dec. 4 drumming circle remains hospitalized with an extremely rare case of gastrointestinal anthrax. She is in serious condition but is stable and has been removed from intensive care.

Montero said officials have not been able to talk to her to determine such things as whether she ate something during the drumming event that could have carried an anthrax spore into her digestive track.

The current hypothesis, Montero said, is that the woman is somehow susceptible to anthrax and swallowed a free-floating spore that had been loosened from the animal-hide surface of a drum during the event.

Cases of anthrax infection usually occur in the lungs, when a bacterium spore is inhaled, or on the skin.

The very few cases of gastrointestinal anthrax known to medical science before this one involved eating contaminated meat.

Montero said 73 more samples, mostly swabs from surfaces, were taken Jan. 7 from the common rooms of the building, where the 60 or so people mingled at the drumming circle.

Four were positive with ?low? levels of anthrax, said Montero.

Three samples ? two from a pair of drums and one from an electrical socket ? have previously been found to have low levels of anthrax.

All of the samples found strains of anthrax that are common in the environment but don?t regularly make people sick, which makes the woman?s illness all the more puzzling.

Montero said anthrax remediation protocols are still being developed but generally involve scrubbing and vacuuming rooms with specialized machines to gather up all anthrax spores.

David Brooks can be reached at 594-5831 or dbrooks@nashuatelegraph.com.

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

The moderator who wrote the bold text below is apparently on the right track - several of the articles indicate the woman is still too ill to interview.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80956

Archive Number 20100116.0190
Published Date 16-JAN-2010
Subject PRO/AH/EDR> Anthrax, human - USA (04): (NH)


ANTHRAX, HUMAN - USA (04): (NEW HAMPSHIRE)
******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 16 Jan 2010
Source: Fosters.com [edited]
<http://www.fosters.com/apps/pbcs.dll/article?AID=/20100116/GJNEWS_01/701169932/-1/FOSNEWS>


More samples show low levels of anthrax at ministry center in Durham
--------------------------------------------------------------------
A total of 4 additional samples containing low-levels of anthrax were
found inside the building where a Strafford County woman was exposed
to it last month [December 2009]. State Public Health Director Dr.
Jose Montero said a total of 73 samples were collected last week and
only 4 tested positive for a low-level of anthrax. All came from
common areas of the building's 1st floor, he said.

The samples were taken [on 7 Jan 2010 - MHJ] by the Environmental
Protection Agency during a round of testing at Waysmeet Center last
week, the Mill Road facility that houses the United Campus Ministry
for UNH. In addition to the 4 samples, there are 10 samples that were
inconclusive and are being sent to the Centers for Disease Control and
Prevention (CDC) for more specialized testing. Montero said the fact
some of the samples are inconclusive might indicate the level of
contamination is so low it's hard to detect.

The recent samples are in addition to 3 previous samples that tested
positive, one from an electrical outlet and 2 from separate drums
stored in the basement of the building.

Montero said officials would await the results of the additional
testing, which could come next week, before preparing a final report
and lifting the quarantine of the campus ministry building. Montero
stressed the building hasn't been condemned but will require some
cleaning before it can be reopened.

This cleaning could include soaking the building's surfaces with
bleach, but Montero said officials would need to evaluate the
situation before deciding what cleaning procedure will be used.

Montero said the Strafford County woman suffering from
gastrointestinal anthrax is out of intensive care and is in stable
condition at a Boston hospital. It's still unknown why anthrax spores
affected this particular victim. "There's no way we're going to be
able to answer that question, at least not yet," he said. Montero said
he hopes to get an answer some day and noted health officials haven't
been able to interview the woman yet.

The recent round of testing is reassuring to health officials because
it continues to support their belief that the risk of exposure and
additional cases is extremely unlikely, according to Montero. He said
the results also reaffirm health officials' hypothesis that the
patient became infected at a drumming circle event in the building on
4 Dec 2009. It's estimated more than half of the approximately 60
people who attended the drum circle have decided to take antibiotics
or get vaccinated against the disease, an option made available by the
state.

The African drums have been the focus of the state's investigation
because of similar cases involving animal hides used to make the drums.

[Byline: Aaron Sanborn <asanborn@fosters.com>]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[In that the new "4" do not mention drums makes me suspect that the
"10-to-be-tested drums" all came up negative. "Inconclusive" can,
unfortunately, mean anything you like, but thank God for
[confirmatory] PCR testing. One of the things we have learnt is that
the new hot-shot environmental [rapid] testing kits are seldom as
reliable as they are claimed to be.

If the contamination came from either or both of these drums or
similar circumstances in previous drumming meetings, there is no
knowing when this environmental contamination started. According to
the Washington Post
<http://www.washingtonpost.com/wp-dyn/content/article/2010/01/15/AR2010011502674.html>:
"Public Health Director Jose Montero said Friday the samples were
taken 7 Jan 2010 from the 1st floor of the United Campus Ministry in
Durham."

There is a strong hint that the investigation is flummoxed. But why oh
why has the single case yet to be interviewed? I presume that there
are sound clinical reasons if, for example, she were comatose --
meningeal infections are not uncommon in anthrax. But in the meanwhile
... - Mod.MHJ]

[see also:
Anthrax, human - USA (03): (NH) 20100111.0129
Anthrax, human - USA (02): (NH) 20100108.0094
Anthrax, human - USA: (NH) 20100107.0072
Anthrax - USA: (NH) 20100102.0020
2009
----
Anthrax, human - USA (03): (NH) 20091230.4390
Anthrax, human - USA (02): (NH) 20091229.4374
Anthrax, human - USA: (NH) 20091227.4360]
........................mhj/ejp/jw

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

http://www.fosters.com/apps/pbcs.dll/article?AID=/20100128/GJNEWS_01/701289720

Anthrax victim much better; Durham ministry building to be extensively cleaned

By Aaron Sanborn
asanborn@fosters.com
Thursday, January 28, 2010
DURHAM ? As a Strafford County woman continues to recover from gastrointestinal anthrax, the building in which she was exposed to spores of the disease will soon undergo extensive cleaning.

During a conference call with the media on Wednesday, Deputy State Epidemiologist Dr. Jodie Dionne-Odom, said the woman is doing much better and is now able to answer the questions of state health officials.

Dionne-Odom wouldn't comment on the specifics of the state's discussions with the woman, but did say the discussion further solidifies their hypothesis she swallowed anthrax spores from an African drum during a Dec. 4 drum circle event at Waysmeet Center, the United Campus Ministry for UNH.

Officials are now prepping for the decontamination of the Mill Road building.

The decontamination plan will include using bleach to scrub down the five common areas that tested positive for low-levels of anthrax. The cleaning will also include vacuuming each room, according to Dionne-Odom.

Dionne-Odom said the Environmental Protection Agency has recommended a list of companies experienced with this type of cleaning and it will be up to ministry officials to get prices and have the cleaning done.

The ministry will be responsible for paying the cleaning bill but Dionne-Odom didn't have any estimates about how much it will cost.

Dionne-Odom said this type of cleaning was done with similar anthrax cases in Connecticut and New York.

"This is an effective method of decontamination that both the EPA and CDC recommended," she said.

Once a cleaning company is hired, it will still take some time to clean the building, according to Dionne-Odom.

"It will be a period of a few weeks because several rooms need to be cleaned from top to bottom," she said.

Once the building is cleaned, the quarantine will be lifted.

Dionne-Odom also announced that 10 samples taken from the building that were previously inconclusive and sent to the Center for Disease Control for more specialized testing all came back negative.

This means that of the 75 samples taken from the building, only six came back positive for low-levels on anthrax, two from African drums stored in the building's basement and four low-level amounts found in some of the building's common rooms.

There will be no more testing inside the building and all the African drums turned in for testing have been returned to their owners, according to Dionne-Odom.

Since the Waysmeet Center was quarantined last month, the Rev. Larry Brickner-Wood has run the ministry from his home. The Cornucopia Food Pantry, which was housed in the Waysmeet Center, was relocated to the St. Thomas More Food Pantry at 6 Madbury Road.

Eight students who were living in the building have been temporarily relocated to on-campus housing. Dionne-Odom said the rooms the students stayed in were clean and didn't test positive for anthrax.

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

The red text is why we love ProMED. That information has not been in any previous article, and is likely inside information. That explains a lot.

As the woman is recovering, I think we should change the words "critical because of" to "recovering from" in the thread title.

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,81101

Archive Number 20100128.0303
Published Date 28-JAN-2010
Subject PRO/AH/EDR> Anthrax, human - USA (05): (NH)


ANTHRAX, HUMAN - USA (05): (NEW HAMPSHIRE)
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: 28 Jan 2010
Source: Foster's Daily Democrat [edited]
<http://www.fosters.com/apps/pbcs.dll/article?AID=/20100128/GJNEWS_01/701289720>


As a Strafford County woman continues to recover from
gastrointestinal anthrax, the building in which she was exposed to
spores of the disease will soon undergo extensive cleaning.

During a conference call with the media on Wednesday [27 Jan 2010],
Deputy State Epidemiologist Dr. Jodie Dionne-Odom said the woman is
doing much better and is now able to answer the questions of state
health officials. Dionne-Odom wouldn't comment on the specifics of
the state's discussions with the woman but did say the discussion
further solidifies their hypothesis she swallowed anthrax spores from
an African drum during a 4 Dec 2009 drum circle event at Waysmeet
Center, the United Campus Ministry for UNH.

Officials are now prepping for the decontamination of the Mill Road building.

The decontamination plan will include using bleach to scrub down the
5 common areas that tested positive for low-levels of anthrax. The
cleaning will also include vacuuming each room, according to
Dionne-Odom. Dionne-Odom said the Environmental Protection Agency has
recommended a list of companies experienced with this type of
cleaning, and it will be up to ministry officials to get prices and
have the cleaning done.

The ministry will be responsible for paying the cleaning bill, but
Dionne-Odom didn't have any estimates about how much it will cost.
Dionne-Odom said this type of cleaning was done with similar anthrax
cases in Connecticut and New York. "This is an effective method of
decontamination that both the EPA and CDC recommended," she said.

Once a cleaning company is hired, it will still take some time to
clean the building, according to Dionne-Odom. "It will be a period of
a few weeks because several rooms need to be cleaned from top to
bottom," she said.

Once the building is cleaned, the quarantine will be lifted.

Dionne-Odom also announced that 10 samples taken from the building
that were previously inconclusive and sent to the Center for Disease
Control for more specialized testing all came back negative. This
means that of the 75 samples taken from the building, only 6 came
back positive for low-levels on anthrax, 2 from African drums stored
in the building's basement and 4 low-level amounts found in some of
the building's common rooms.

There will be no more testing inside the building, and all the
African drums turned in for testing have been returned to their
owners, according to Dionne-Odom.

Since the Waysmeet Center was quarantined last month [December 2009],
the Rev. Larry Brickner-Wood has run the ministry from his home. The
Cornucopia Food Pantry, which was housed in the Waysmeet Center, was
relocated to the St. Thomas More Food Pantry at 6 Madbury Road. Eight
students who were living in the building have been temporarily
relocated to on-campus housing. Dionne-Odom said the rooms the
students stayed in were clean and didn't test positive for anthrax.

[Byline: Aaron Sanborn <asanborn@fosters.com>]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[2]
Date: Jan 27, 2010
Source: AP [edited]
<http://wbztv.com/wireapnewsnh/New.Hampshire.anthrax.2.1452669.html>


A woman who contracted a rare form of anthrax nearly 2 months ago
remains hospitalized but is now able to answer questions from state
health officials, the deputy state epidemiologist said Wednesday [27 Jan 2010].

Dr. Jodie Dionne-Odom wouldn't give details, but said the patient's
responses back up the theory that she swallowed anthrax spores
propelled into the air by drumming at the United Campus Ministry
building in Durham. The woman became ill shortly after the 4 Dec 2009
event and had been in critical condition with gastrointestinal anthrax.

Anthrax spores later were found on 2 animal skin-covered drums and 4
other locations in the ministry building, which houses 8 University
of New Hampshire students and a food pantry and is used as a meeting
place for numerous community groups. The ministry center's offices,
food pantry and students have been relocated since the anthrax
investigation began, but Dionne-Odom said they will be allowed to
return once the building is decontaminated.

The state has given the building's owners a detailed cleanup plan,
which includes hiring contractors to spend several weeks bleaching
and scrubbing 5 rooms in the building, and using special vacuum
cleaners, she said. "This is not cleaning anyone can do," she said.

Environmental Protection Agency investigators took more than 70
samples from the building earlier this month [January 2010].
Authorities had said previously that 4 came back with low levels of
anthrax and more than 10 were inconclusive. Those 10 have now been
determined to be negative, Dionne-Odom said.

Two recent U.S. anthrax cases also were traced to drums covered with
animal hides, but those involved spores that were either inhaled into
the lungs or entered through the skin of people who were exposed
while making drums. The gastrointestinal form usually occurs after
eating raw or undercooked meat.

[Byline: Holly Ramer]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[There is also a report in the Concord Monitor:
<http://www.concordmonitor.com/apps/pbcs.dll/article?AID=/20100128/NEWS01/128
0332/1001/NEWS01>, but it gives nothing not in either of the above reports.

From enquiries, one of the 2 positive drums was probably the source,
and, interestingly, it had been in use for some 10 years without any
problems. The present environmental contamination is minimal.
Somehow, spores got into this young lady's mouth and were swallowed.
It may be that a key factor is that she had a hookworm infection, and
the mucosal damage from this parasite feeding allowed spore entry
into the intestinal tissues. She was singularly unlucky. Fortunately,
when she presented herself with abdominal symptoms at the local
emergency clinic, they took a blood sample. Like many I expect, I
look forward to the full report when it is published. - Mod.MHJ]

[see also:
Anthrax, human - USA (04): (NH) 20100116.0190
Anthrax, human - USA (03): (NH) 20100111.0129
Anthrax, human - USA (02): (NH) 20100108.0094
Anthrax, human - USA: (NH) 20100107.0072
2009
----
Anthrax, human - USA (03): (NH) 20091230.4390
Anthrax, human - USA (02): (NH) 20091229.4374
Anthrax, human - USA: (NH) 20091227.4360]
......................................................mhj/msp/dk

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

http://www.idahostatesman.com/usnews/story/1062775.html

Despite anthrax, beat goes on for drum circle fans
By HOLLY RAMER - Associated Press Writer
Published: 01/31/10


Comments (0) | Recommend (0)
1/3


AP Photo
In this photo taken Saturday Jan. 23, 2010, Julie Corey leads a drum circle in Concord, N.H.
AP PhotoIn this photo taken Jan. 7, 2010 Rev. Larry Brickner-Wood is seen during an interview with The Associated Press in Durham, N.H. Brickner-Wood is the pastor at the United Campus Ministry where a woman contracted a rare form of anthrax at a drum circle.
AP PhotoIn this photo taken Saturday Jan. 23, 2010 Julie Corey leads a drum circle in Concord, N.H.
ADDITIONAL DETAILS
When is one more gadget just too many?
Baby Mama: Film critic takes son to the theater
Baby Mama: Film critic takes son to the theater
When is one more gadget just too many?
CONCORD, N.H. ? For drum circle devotees, the beat goes on.

The case of a young New Hampshire women who contracted a rare form of anthrax at a drum circle in December has done little to deter fans of the gatherings, which range from informal outdoor jam sessions to professionally run sessions in corporate conference rooms. Some focus on the music of specific cultures, while others promote spirituality, healing or a sense of community.

"I would never give it up," said Lois Emond, a registered nurse from Hooksett who drums as part of a women's chorus group. "I've been drumming for over 25 years and nothing's ever happened."

The Dec. 4 drum circle held at a campus ministry center in Durham was a monthly event advertised as "Good food! Fun music! Excellent company!" About 60 participants - most of them University of New Hampshire students - filled up on a pasta dinner then cleared away the tables in the center's great room to enjoy drumming games, music and dancing.

The woman who later became ill wasn't drumming that night. Instead, she was the first one to get up and dance, said Julie Corey, a drum circle facilitator hired to lead the session.

"I remember thanking her for that at the end of the night, because when she got up to dance, it inspired the other students," Corey said. "I know she was having a great time. We all were."

The woman became ill a few days later and by Christmas, had been diagnosed with gastrointestinal anthrax, an extremely rare form of the potentially fatal bacterial disease. Her condition has improved from critical, and as of this week, she was able to speak to state health officials.

Those conversations bolstered the theory that she likely swallowed anthrax spores propelled into the air by vigorous drumming, deputy state epidemiologist Dr. Jodie Dionne-Odom said Wednesday. Tests have confirmed that anthrax spores found on two of the center's drums and elsewhere in the building were the same strain that infected the woman.

Though there have been several recent U.S. anthrax cases linked to naturally occurring anthrax on animal hide-covered drums, this case is unusual because the spores didn't enter through the skin or lungs but through the woman's digestive system. And the other cases - in New York and Connecticut - involved people who made drums and had extensive exposure to the hides.

Corey, who sells drums, gives drumming lessons and leads drum circles in a variety of settings, said she doesn't worry about getting anthrax and hopes others won't either.

"We're living in a fear-based society right now. We've got the flu and terrorism ... it's just one more thing to shut down people's energy systems," she said.

"My intention is to just continue to support the positive aspects of drums and drumming."

Though drum circles have a reputation as hippie hangouts, they are becoming increasingly popular with other groups, said Jonathan Murray, president of the Drum Circle Facilitators Guild, which started with three members in 2003 and now has about 130. He said drum circles have expanded exponentially in the last decade and are used everywhere from prisons to cancer survivor support groups.

"It's a really fun, accessible activity, and anybody can do it. If you can bring your hand down on something, you can play a drum or a percussion instrument," he said.

In the corporate world, he said, drum circles can help illustrate the importance of communication, diversity and anticipating change. In schools, drums can promote awareness of other cultures.

"We tend to think of (music) as entertainment, but its roots go far beyond that, and its applications are much broader," Murray said.

A drum circle Corey recently organized to raise money earthquake victims in Haiti attracted about 50 people, including Emond, who said she had worried that the anthrax case would keep people away. The crowd ranged from a bearded man banging a tambourine on his knee to a 4-year-old girl twirling around the room with a teddy bear tucked under her arm. Corey later taught the group a Haitian drum rhythm, carefully explaining the different parts for shakers, bells and drums. At times, she resembled an orchestra conductor, gesturing to one section of drummers to increase their volume or tempo.

Mark Colby, 50, of Brentwood, said the experience was more than he had expected.

"You just kind of feel your soul open up," he said, characterizing the intense drumming as both tiring and energizing.

Paula MacLeod of Hampton said she was left feeling more connected to the world. Like Colby, she dismissed fears of anthrax.

"People can get hit by a bus," she said. "Joggers are out jogging and die of a heart attack. It's just life," she said.

Rev. Larry Brickner-Wood is the pastor at United Campus Ministry, where the Dec. 4 drum circle took place. He wasn't drumming that night, but one of the drums that tested positive for anthrax was one he often used. Even so, he wasn't alarmed.

"It's the kind of thing that comes through your mind, and you let it go," he said.

"I don't want to stop drumming. It's a wonderful thing."

But he has canceled his scheduled appearance at a United Church of Christ conference next month where he had planned to give a workshop on how to organize a drum circle, partly because he has a family wedding to attend but also because of the anthrax scare.

"I look forward to the day, though, when I can drum again and also to leading some circles at some point in the future," he said.

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

Not much interesting in a long article here, but this is the first mention of her age. Younger than I would have guessed.

http://www.foodconsumer.org/newsite/Non-food/Disease/understand_anthrax_3101100236.html

Last December it was reported on foodconsumer.org that a 25-year old New Hampshire woman came down with gastrointestinal anthrax after attending a monthly drum circle at United Campus Ministry.

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

This is also the first article that gives the onset date of Dec. 5, giving her an incubation period of less than 24 hours.

http://news.bostonherald.com/news/n..._and_walking_around/srvc=home&position=recent

NH anthrax patient up and walking around
By Associated Press
Friday, February 12, 2010 - Added 1h ago



E-mail Print (0) Comments Text size Share Buzz up!CONCORD, N.H. ? A woman who contracted a rare form of anthrax two months ago is able to get up and walk around but likely will remain hospitalized for some time, a state health official said today.

The young woman began feeling ill a day after attending a drum circle gathering in Durham on Dec. 4 and later was hospitalized in critical condition with gastrointestinal anthrax. Authorities believe she swallowed naturally occurring anthrax spores propelled into the air by vigorous drumming.

Dr. Jodie Dionne-Odom, deputy state epidemiologist, said the woman has been getting better and remains in stable condition in a Massachusetts hospital.

Meanwhile, two companies have submitted bids to decontaminate the United Campus Ministry center, where anthrax spores were found on two animal hide-covered drums and four other spots. Officials are waiting for one more bid before deciding who will do the several-week cleanup, which will involve scrubbing and bleaching five rooms.

The ministry center, which houses eight University of New Hampshire students and a food pantry, has been closed during the investigation.

Two recent U.S. anthrax cases also were traced to drums covered with animal hides, but those involved spores that were either inhaled into the lungs or entered through the skin of people who were exposed while making drums. The gastrointestinal form usually occurs after eating raw or undercooked meat

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,81364

Archive Number 20100213.0517
Published Date 13-FEB-2010
Subject PRO/AH/EDR> Anthrax, human - USA (06): (NH) recovering

ANTHRAX, HUMAN - USA (06): (NEW HAMPSHIRE) RECOVERING
*****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: 12 Feb 2010
Source: AP [edited]
<http://www.google.com/hostednews/ap/article/ALeqM5g0A8pyz_e49aMjynuUnVRBbr2ViQD9DQN7DO3>


NH anthrax patient up and walking around
----------------------------------------
Health officials say a New Hampshire woman who contracted a rare form
of anthrax 2 months ago is able to get up and walk around, but will
likely remain hospitalized for some time.

The young woman got sick a day after attending a drum circle in
Durham in December [2009]. Authorities believe she swallowed
naturally occurring anthrax spores propelled into the air by vigorous
drumming. She had been in critical condition with gastrointestinal
anthrax. Dr. Jodie Dionne-Odom, deputy state epidemiologist, says the
woman has been getting better and remains in stable condition.

Meanwhile, several companies have submitted bids to decontaminate the
United Campus Ministry building, where anthrax spores were found on 2
drums and 4 other places.

[Byline: Holly Ramer]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[This is good news. Recovery from this disease is frequently slow,
especially when the initial stages have been severe. - Mod.MHJ]

[see also:
Anthrax, human - USA (05): (NH) 20100128.0303
Anthrax, human - USA (04): (NH) 20100116.0190
Anthrax, human - USA (03): (NH) 20100111.0129
Anthrax, human - USA (02): (NH) 20100108.0094
Anthrax, human - USA: (NH) 20100107.0072
Anthrax - USA: (NH) 20100102.0020
2009
----
Anthrax, human - USA (03): (NH) Anthrax, human - USA (02): (NH) 20091229.4374
Anthrax, human - USA: (NH) 20091227.4360
Anthrax vaccine safety & efficacy - USA 19980103.0022]
.............................sb/mhj/ejp/mpp

 

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

http://www.promedmail.org/pls/otn/f..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,82333

Archive Number 20100419.1269
Published Date 19-APR-2010
Subject PRO/AH/EDR> Anthrax, human - USA (08): (NH)


ANTHRAX, HUMAN - USA (08): (NEW HAMPSHIRE)
******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sun 18 Apr 2010
Source: Nashua Telegraph [edited]
<http://www.nashuatelegraph.com/news/709412-196/anthrax-victim-fine-mystery-remains.html>


Anthrax victim fine, mystery remains
------------------------------------
The woman who came down with anthrax after taking part in a drumming circle
in December [2009] has recovered and is doing fine, while the building
where the infection took place has been cleaned and reopened to the public
-- but even so, the event remains as inexplicable as ever. "It is a
mystery," said Dr Jodie Dionne-Odom, deputy New Hampshire state
epidemiologist. "We really don't know why it happened."

The woman, whose identity hasn't been released, became critically ill some
days after taking part in a drum circle [on 4 Dec 2009] at the United
Campus Ministry building in Durham, an event that drew some 60 people. She
is now home and has returned to drumming, Dionne-Odom said.

The woman apparently inhaled anthrax [in spore form] that had been carried
into the room on the animal hide on one of the drums, and which was
released into the air when the drum was beaten. Anthrax spores were later
found on 2 drums and on various items around the room. It's unusual for a
person to be infected with anthrax in the US. This case drew enormous
attention, however, because the woman came down with gastrointestinal
anthrax rather than inhaled anthrax, which made her unique in American
medical history. [Well, no. Gastroenteric anthrax is infrequent in the US
but not unknown. - Mod.MHJ]

Anthrax is a disease caused by a bacterium that can infect people through
the lungs, intestines, or even skin. Most cases are associated with cattle
handling or processing, but it has occasionally been linked to imported
drums made with animal hides, particularly from West Africa. [In the latter
instance] anthrax is usually contracted by people who inhale the bacteria,
which lodges in their lungs. It leads to cold-like symptoms that quickly
worsen and produce mortality rates of more than 80 per cent.

Much more rarely, anthrax bacteria lodge in the intestines after a person
eats meat contaminated with anthrax spores. The resulting disease is also
fatal far more often than not. The Durham case was unique because the woman
inhaled the spore rather than eating it, but came down with
gastrointestinal anthrax. [See discussion below. - Mod.MHJ]

Despite 5 months of medical forensics, it's still unclear why this
happened, other than sheer bad luck. The woman has no genetic or medical
reason to be susceptible to gastrointestinal anthrax, Dionne-Odom said.
Further, the bacterium spore was "plain old garden variety" anthrax, "not a
hyper-virulent strain" that might have caused the unusual circumstances.
Officials at the Centers for Disease Control and Prevention did genetic
typing on the spore in an attempt to pin down the spore's country of
origin, but it was a type known as A1.a, found all over the world,
Dionne-Odom said.

Officials still believe drumming caused the spore to be aerosolized, or
broken up into a small piece that floated in the air and then somehow
infected the woman. Beyond that, the case is a mystery, although
Dionne-Odom said it was possible that further CDC tests would find some
underlying cause for the case.

[byline: David Brooks]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[I am presuming that at some point an official report will be issued but as
we are in an extended hiatus I am taking this opportunity to cut this
thread at least for now. Patently some investigations are more productive
than others. This has left a number of questions. If it came from an
infected drum and the spores were inhaled, the spores would have been
caught either in the nose, or the mucociliary blanket in the bronchi and
then pushed back up the bronchi and tipped into the oesophagous; something
which happens a lot and unless the initial dose was high, nothing untoward
would follow. Why this person was affected and not the many other people
during this and previous drumming sessions with this/these drum(s) would
suggest that the exposure dose was probably minimal. Not mentioned here but
in previous communications, this person had intestinal parasites, including
hookworms, and these could well have put her at risk as the spores made
their way through her damaged intestines. Remember, cutaneous anthrax
follows from allowing bacteraemic blood to cover a cut.

That it was an A1.a strain posits many questions in the absence of a more
exact genotyping. Knowing the origins of the contaminated drum hides would
go a long way to solving this question. To date A1.a is not known in West
Africa whose drum hides have been to blame for various recent outbreaks in
the US and the UK. - Mod.MHJ]

 

[Missouriwatcher]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

Gastrointestinal Anthrax after an Animal-Hide Drumming Event --- New Hampshire and Massachusetts, 2009
Weekly
July 23, 2010 / 59(28);872-877

On December 24, 2009, a woman aged 24 years from New Hampshire was confirmed to have gastrointestinal anthrax on the basis of clinical findings and a Bacillus anthracis blood culture isolate...

To identify other anthrax cases, NHDHHS queried statewide surveillance systems (Automated Hospital Emergency Department Data System and Vital Records Death Data) for clinical syndromes compatible with anthrax for the period October 1, 2009 through February 3, 2010. Clinical microbiology laboratories in the New Hampshire Laboratory Response Network (LRN) were asked to review all gram-positive rod isolates from October 1, 2009 through December 26, 2009. Neither search identified additional cases....

Three samples from the event site grew B. anthracis (two from drums and one from a composite sample of three electrical outlets in the room where the drumming circle took place). The patient denied direct contact with either of the contaminated drums during the event. One of the positive drums, estimated to be 10--15 years old, was made of cowhide, with hair on the top and bottom surfaces. It was nearly 3 feet tall, had been purchased 3--4 years earlier at an estate sale, and was thought to have been manufactured in Mali. It was meant to be played with mallets and had been stored in the basement since 2007. During 2007--2009, it was played approximately once a month. The second contaminated drum was a much smaller, tambourine-like drum (6 inches in diameter and 2 inches wide) that had been bought at an antique shop 12--15 years earlier, stored in the basement for the preceding 9 years, and was played only rarely. Neither of these drums had been repaired or altered since they were acquired. Investigators quarantined the event site on December 28, 2009.

B. anthracis isolates from the patient, drums, and environment were sent to CDC for genotyping using MLVA-8. They were identical and mapped within cluster A1.a, with a combination of alleles that was unique in the CDC database.

The epidemiologic investigation of persons associated with the drumming event began December 28. NHDHHS attempted to contact all 210 persons considered potentially associated with the event (168 guests, four workers, 28 volunteers, eight residents, and two overnight guests). Of these 210 persons, 23 did not respond and 187 were interviewed. Of the 187 persons interviewed, 84 were considered potentially exposed (i.e., being at the event, setting up just before the event, or living or working at the event site) and were offered postexposure prophylaxis (PEP) for anthrax, consisting of antimicrobial agents (oral doxycycline or ciprofloxacin for 60 days from last potential respiratory exposure) and anthrax vaccine adsorbed, the latter under an investigational new drug (IND) protocol. Of the 84 persons offered PEP, one (1%) accepted antibiotics and vaccine, 36 (43%) accepted antibiotics, 26 (31%) declined, and 21 (25%) were lost to follow-up.

...On January 7 and 8, 2010, samples were taken from drums with previous positive results plus untested drums from the community that had been used at the event (i.e., persons brought their drums in to be tested) and the event site...The results of final testing revealed six positive samples from the event site . MLVA-8 genotyping of all B. anthracis isolates from final testing matched previous isolates.

The patient was discharged from the hospital after nearly 2 months and was doing well at the time of this report...
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5928a3.htm?s_cid=mm5928a3_e