Beginning in mid-September 2001, the United States experienced unprecedented
biological attacks involving the intentional distribution of Bacillus anthracis spores through the postal system.1
The full impact of this bioterrorist activity has not been assessed, but already
the toll is large. A total of 22 persons have developed anthrax and 5 have
died as a direct result.2- 5
More than 10 000 persons were advised to take postexposure prophylactic
treatment because they were at known or potential risk for inhalational anthrax;
in addition, more than 20 000 others started such treatment until the
investigation provided reassurance that exposure was unlikely and treatment
could be stopped; thousands more were victims of hoaxes or false alarms, and
still more were worried coworkers, friends, and family members of those directly
affected.6 The impact was not limited to the
United States. Hoaxes involving threatening letters or powder-containing envelopes
were reported from several countries; mail cross-contaminated with B anthracis was distributed to some US embassies, and persons in remote
corners of the world were advised to take prophylactic antimicrobial treatment.
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