CDC has assisted authorities in other countries investigating cases of bioterrorism-related anthrax.

During October 12-November 13, CDC received 111 requests from 66 countries. Of these, 47 (42 percent) requests were laboratory related; 43 (39 percent) were general requests for bioterrorism information; 13 (12 percent) were for environmental or occupational health guidelines; and eight (7 percent) were about developing bioterrorism preparedness plans.

The largest proportion of requests were from Central and South America (26 percent). Of the 66 countries, 15 (23 percent) received laboratory assistance, including testing or arrangements for testing of suspected isolates at a CDC-supported laboratory or a reference laboratory in another country. Forty-two (64 percent) countries received telephone or email consultation regarding specific tests for suspected B. anthracis isolates.

CDC has confirmed two isolates from outside the United States as B. anthracis. These isolates were recovered from the outer surface of letters or packages sent in State Department pouches to the U.S. Embassy in Peru. These items were processed at the U.S. State Department mail sorting facility where a case of inhalational anthrax had occurred. No cases of bioterrorism-related anthrax have been confirmed in U.S. Embassy employees or in persons from other countries. Requests for information regarding bioterrorism-related issues outside the United States should be directed to the International Team of CDC's Emergency Operations Center (telephone: (770) 488-7100; e-mail: eocinternational@cdc.gov).

Editorial Note:

Since the previous report, all patients with bioterrorism-related anthrax who were hospitalized have been discharged and continue to recover; no new cases have been reported. The source of these bioterrorist attacks has not been identified, and additional cases might occur. Public health authorities, health-care providers, and laboratorians should remain vigilant for cases of anthrax.

Antimicrobial prophylaxis is indicated to prevent inhalational anthrax after a confirmed or suspected aerosol exposure. Persons recommended to receive prophylaxis should complete the 60-day regimen. Public health programs should work with health-care providers and patients to promote completion of antimicrobial prophylaxis and to monitor the occurrence of adverse events (1).

CDC continues to respond to inquiries about anthrax and bioterrorism. The CDC Public Response Hotline was established to provide the public with information about anthrax and other biologic and chemical agents. During November 1--12, CDC received approximately 4,400 calls through the hotline and to the Emergency Operations Center. The hotline is available in English (888-246-2675) and Spanish (888-246-2857). CDC also receives requests for information by e-mail through the Health Alert Network (), MMWR (), and other public health communications systems.