Context Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection.
Objective To describe the relationship between anthrax infection and persistent
somatic symptoms among adults surviving bioterrorism-related anthrax disease
approximately 1 year after illness onset in 2001.
Design, Setting, and Participants Cross-sectional study of 15 of 16 adult survivors from September through
December 2002 using a clinical interview, a medical review-of-system questionnaire,
2 standardized self-administered questionnaires, and a review of available
Main Outcome Measures Health complaints summarized by the body system affected and by symptom
categories; psychological distress measured by the Revised 90-Item Symptom
Checklist; and health-related quality-of-life indices by the Medical Outcomes
Study 36-Item Short-Form Health Survey (version 2).
Results The anthrax survivors reported symptoms affecting multiple body systems,
significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life
indices compared with US referent populations. Eight survivors (53%) had not
returned to work since their infection. Comparing disease manifestations,
inhalational survivors reported significantly lower overall physical health
than cutaneous survivors (mean scores, 30 vs 41; P =
.02). Available medical records could not explain the persisting health complaints.
Conclusion The anthrax survivors continued to report significant health problems
and poor life adjustment 1 year after onset of bioterrorism–related