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Accuracy of Screening for Inhalational Anthrax after a Bioterrorist Attack

Nathaniel Hupert, MD, MPH; Gonzalo M.L. Bearman, MD, MPH; Alvin I. Mushlin, MD, ScM; and Mark A. Callahan, MD
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From Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, New York.

Acknowledgments: The authors thank Bruce R. Schackman, PhD, and R. Graham Barr, MD, MPH, for their comments on earlier drafts of this paper and the New York City Department of Health and Mental Hygiene for assistance with Chinese translation.

Grant Support: Drs. Hupert, Mushlin, and Callahan were supported by contract #290-00-0013 from the Agency for Healthcare Research and Quality and by a grant from the Fritz and Adelaide Kauffmann Foundation, New York, New York.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Nathaniel Hupert, MD, MPH, Department of Public Health, Weill Medical College of Cornell University, 3rd Floor, 411 East 69th Street, New York, NY 10021; e-mail, nah2005@med.cornell.edu.

Current Author Addresses: Drs. Hupert, Mushlin, and Callahan: Department of Public Health, Weill Medical College of Cornell University, 411 East 69th Street, 3rd Floor, New York, NY 10021.

Dr. Bearman: Department of Epidemiology, Medical College of Virginia–Virginia Commonwealth University, West Hospital, Room 6-202B, 1200 East Broad Street, PO Box 980019, Richmond, VA 23298-0019.

Author Contributions: Conception and design: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.

Analysis and interpretation of the data: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.

Drafting of the article: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.

Critical revision of the article for important intellectual content: N. Hupert, A.I. Mushlin, M.A. Callahan.

Final approval of the article: N. Hupert, G.M.L. Bearman, A.I. Mushlin, M.A. Callahan.

Statistical expertise: N. Hupert, A.I. Mushlin.

Obtaining of funding: N. Hupert, A.I. Mushlin, M.A. Callahan.

Administrative, technical, or logistic support: A.I. Mushlin, M.A. Callahan.

Collection and assembly of the data: N. Hupert, G.M.L. Bearman.

Ann Intern Med. 2003;139(5_Part_1):337-345. doi:10.7326/0003-4819-139-5_Part_1-200309020-00009
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Clinical data on the 11 inhalational anthrax cases of 2001 are now widely available (34, 1720). Because of the small number of cases in the contemporary attack, we performed a systematic literature review to identify additional original case reports of inhalational anthrax in the English-language medical literature. We searched two computerized databases (MEDLINE and Web of Science) for adult human case reports of anthrax infection between 1960 and 2000 using the keywords anthrax and case report. This yielded 44 references; 4 contained sufficient clinical data on inhalational anthrax to permit comparison with the 11 contemporary cases (2124). Tracing bibliographies of these articles and a recent review article (25) produced an additional 7 articles that were appropriate for inclusion, for a total of 11 reports on 17 cases (2632). Two of the cases involved patients from outside of the United States (22, 24).

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Grahic Jump Location
Figure 1. Different proportions in the left and right columns for case-patients without neurologic symptoms reflect a change in the denominator only. Percentages may add up to more than 100% because of rounding. ENT = ear, nose, and throat.
Presenting clinical symptoms of inhalational anthrax for case-patients with and without nonheadache neurologic symptoms between 1920 and 2001.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Proposed three-tier screening protocol to identify potential early inhalational anthrax cases in the setting of a large-scale anthrax attack.
Grahic Jump Location




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Summary for Patients

Screening for Inhalational Anthrax after a Bioterrorist Attack

The summary below is from the full report titled “Accuracy of Screening for Inhalational Anthrax after a Bioterrorist Attack.” It is in the 2 September 2003 issue of Annals of Internal Medicine (volume 139, pages 337-345). The authors are N. Hupert, G.M.L. Bearman, A.I. Mushlin, and M.A. Callahan.


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