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Chapter Five: 2001 Anthrax Letters


The dissemination of Bacillus anthracis via the US Postal Service (USPS) in 2001 represented a new public health threat, the first intentional exposure to anthrax in the United States. The attacks resulted in 22 cases of anthrax—eleven inhalational and eleven cutaneous—five of which were fatal.1 Public health officials faced the challenge of communicating risk during rapidly evolving circumstances in response to terrorist attacks that affected numerous states and Washington, DC. A total of 21 USPS facilities were contaminated in the attacks, and 32,000 potentially exposed persons initiated post-exposure prophylaxis.2 These attacks followed closely after those of September 11th, further complicating the challenge of addressing a new threat in a nation still recovering from a traumatic event.3,4,5 Conflicting public health guidance across different government jurisdictions and changing directives about prophylaxis undermined public confidence in health authorities’ handling of the crisis and in the recommended personal protective actions, particularly among affected minority populations. READ FULL CHAPTER