Lessons learned from the investigation of a cluster of cutaneous anthrax cases in Connecticut

In 2007, two cases of cutaneous anthrax associated with West African drum making were reported in Connecticut in a drum-maker and his child. Although both cases were due to exposure to naturally occurring Bacillus anthracis from imported animal hides, ensuing investigative and remediation efforts were affected by the intentional B anthracis attacks in 2001. To share our experience of responding to an outbreak of anthrax in the biologic terrorism preparedness era, we summarize Connecticut's investigation and describe lessons learned. Laboratory capacity to rapidly assist in diagnosing anthrax, collaborative associations between epidemiologists and law enforcement personnel, and training in use of the Incident Command System, all these a result of public health preparedness, enhanced the initial recognition and subsequent investigation of these anthrax cases. However, without established guidelines for environmental risk assessment and remediation of private residences contaminated by B anthracis, challenges were encountered that resulted in a conservative and expensive approach to remediation. Without a more rigorous approach to ensuring that B anthracis spore-free hides are used, the making of animal hide drums is likely to pose a continuing risk for anthrax to those working with contaminated hides and those exposed to subsequently contaminated environments.