Anthrax the sequel

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Modified from N.Y. Dept. of Health
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Anthrax as a Biological Weapon (JAMA. 1999
2811735-1745)
Figure 4. Day of Onset of Inhalational Anthrax
Following Sverdlovsk Accident Figure is based on
data from Guillermin.68
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This curve approximates that of the accumulated
deaths more closely
(JAMA. 1999 2811735-1745)
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Lidia Tretyakova looks at the tombstone of her
father, Lazar Karsayev, at a cemetery in
Yekaterinburg, Russia, Thursday, Oct. 18, 2001. A
mysterious outbreak of anthrax killed at least 68
people, including Karsayev, 22 years ago in the
Russian industrial center of Sverdlovsk, today
known as Yekaterinburg. At the time, neither the
victims nor their families suspected they had
been hit by a biological weapon.
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Laboratory workers at the Sverdlovsk regional
epedemiological service put on the special suits
they wear when working with anthrax and other
dangerous bacteria in Yekaterinburg, Russia,
Wednesday, Oct. 17, 2001
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A general view of the Stepnogorsk Scientific
Experimental and Production Base (SEPB) in
Stepnogorsk, 220 km (100 miles) northwest of
Kazakstan's new capital of Astana, Monday, Oct.
22, 2001. The SEPB was the biggest
anthrax-manufacturing plant in the world.
(AP Photo)
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Scientists work in an environmental monitoring
laboratory of Stepnogorsk Scientific Experimental
and Production Base (SEPB) in Stepnogorsk, 220 km
( 100 miles) northwest of Kazakstan's new capital
of Astana, Monday, Oct. 22, 2001. The SEPB was
the biggest anthrax-manufacturing plant in the
world. (AP Photo)
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Review of some Consensus guidelines
J.A.M.A.1979. 281 1735-1745. Working Group on
Civilian Biodefense
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J.A.M.A.1979. 281 1735-1745. Working Group on
Civilian Biodefense
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J.A.M.A.1979. 281 1735-1745. Working Group on
Civilian Biodefense
Ratified in MMWR. 2001. 50 889-897. (Oct. 19,
2001)
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The recent Anthrax victims

• The victims of the recent terrorist use of
  anthrax bacilli started to appear in October
  2001. On October 2 the spinal fluid of a patient
  in Miami showed large Gram positive bacilli,
  confirmed on October 4 as Bacillus anthracis

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Ottilie Lundgren, 94 Inhaled Connecticut
farm Died, Nov.21, 2001
List of recent bioterrorism-related Anthrax
victims
Norma Wallace, 56
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Data mostly from Jernigan et al., Emerging
Infectious Diseases, 7 933-944, 2001 Patient
No. 11 is not presented in the Jernigan series
the data appeared in the news.
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Timeline of 10 cases of inhalational anthrax in
relation to onset of symptoms, October through
November 2001
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Jernigan et al., Emerging Infectious Diseases, 7
933-944, 2001
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Table 2, Jernigan et al., 2001. Emerging
Infectious Diseases, 7 933-944.
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Table 3, Jernigan et al., 2001. Emerging
Infectious Diseases, 7 933-944.
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Initial chest X-ray, Case 1 Prominent upper
mediastinum
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Gram stain, cerebrospinal fluid, Case 1 ? Clear
diagnosis, Oct. 2, 2001
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Chest X-ray, Case 2 Diffuse consolidation,
consistent with pneumonia of left lung No
mediastinal widening
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Computed tomography of chest, Case 2 Bilateral
pulmonary consolidation and pleural effusioins
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Chest X-ray, Case 7 Mediastinal widening, left
pleural effusion
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Chest computed tomography, Case 7
Mediastinal adenopathy,
bilateral pleural effusions