An ongoing investigation has identified a total of 5 mailroom employees with inhalational anthrax from two mailroom facilities (US Postal Service Washington DC Processing and Distribution Center at 900 Brentwood Road, NE, Washington; and Department of State Annex 32 mailroom facility) in the greater Washington DC Metropolitan area (Maryland, Virginia, and District of Columbia). Preliminary environmental sampling has also revealed contamination in mailrooms serving the Central Intelligence Agency, House of Representatives, Supreme Court, Walter Reed Army Institute of Research (WRAIR), and White House, and in the Southwest Postal Station. This is in addition to previous reports of contamination in the mailroom serving the Hart Senate Building, related to a Bacillus anthracis-laden letter received by a Senator.

No cases of inhalational or cutaneous anthrax have been reported among customers who entered any US Postal facility to purchase stamps or conduct other postal business.

The CDC continues to recommend that all people who have been in the non-public, mail operations areas of the Brentwood and State Department facilities (the two facilities with inhalation anthrax cases) since October 11, 2001, receive 60-days of prophylaxis for potential exposure to anthrax. These facilities remain closed pending the results of comprehensive environmental sampling and determination of requisite remediation. In addition, the mail facilities that supply the CIA, House office buildings, Supreme Court, WRAIR, White House, and Southwest postal facilities (with confirmed environmental swabs for B anthracis) have been closed for remediation. All workers in those buildings should complete a 60-day course of prophylaxis.

Health authorities in the Metropolitan Washington area, based on the Postal Service’s mailstream flow, also recommend prophylaxis for all personnel who have worked, since October 11, 2001, in the non-public, mail operations areas at any postal facility or unique private mailroom that receives incoming mail directly from the Brentwood facility. While these facilities may remain open, their employees should immediately receive 10 days of prophylaxis. Final recommendations regarding the completion of a full 60-days of prophylaxis will be forthcoming based on a careful risk assessment from environmental sampling from a portion of these facilities and from other clinical and epidemiologic data. Additionally, a set of protocols is being developed for facility managers in these and other facilities for the collection of environmental samples in their own facilities.

Results of the anti-microbial susceptibility profiles from Washington DC B. anthracis isolates, as well as prior CDC guidelines, support the use of doxycycline as the drug of choice for prophylaxis, both for newly identified individuals and for completion of the course in those previously started on ciprofloxacin.

A number of drug distribution sites have been established in the Washington DC Metropolitan area for persons in the above groups as listed below. Persons may also contact the Maryland and Virginia Health Departments for the sites of additional prophylaxis facilities. Times and places are subject to change. Those persons outside the Washington DC Metropolitan area should seek these services from their state or local health department, or private physician.

1) Washington, DC

a. DC General Hospital, 1900 Massachusetts Avenue, SE, from 9:00 am to 10:00 pm. DC General is accessible by Metrorail (Orange and Blue Lines, Armory Stadium Station).

b. Federal employees -- Hubert Humphrey Building, 200 Independence Avenue, SW.

2) Virginia

a. Fairfax County Government Center, 2nd floor, 12000 Government Center Pkwy, Fairfax, 9:00am to 10:00pm today.

b. Loudoun County Health Department, 102 Heritage Way, NE, Leesburg, 9:00am to 10:00pm today.

c. Prince William County Health Department, 9301 Lee Ave., Manassas, 9:00am to 10:00pm today.

d. For more information (in Virginia), call 703/246-3796.

3) Maryland

a. Prince George’s County Health Department Administration Bldg., 1701 McCormick, Largo, 10:00am to 2:00pm this weekend and noon to 7:00pm, M-F.

b. Suburban Maryland Processing and Distribution Center, Shady Grove Road, Gaithersburg, 10:00am to 2:00pm this weekend and noon to 7:00pm, M-F.

c. Federal employees -- Denis Avenue Health Center, 2000 Dennis Ave, Silver Spring, 10:00am to 2:00pm this weekend and noon to 7:00pm, M-F.

CDC’s investigation is ongoing. Future modifications to these recommendations may occur on the basis of new epidemiologic and laboratory information.