WASHINGTON, Oct. 31 (UPI) -- An additional suspected case of cutaneous anthrax infection was discovered Wednesday as FBI investigators poured through travel records and interviewed friends and co-workers of a New York hospital worker who became the fourth person to die from the inhaled form of the infection.
A second regional mail processing center in New Jersey was closed Wednesday after a 54-year-old man who operated a sorting machine tested positive for anthrax. The Bellmawr facility is about 35 miles from the Trenton regional center in Hamilton.
Investigators were testing the Bellmawr plant for anthrax spores. The Hamilton facility, which was closed after it tested positive for anthrax, is believed to have processed at least three pieces of mail containing anthrax -- letters sent to NBC and the New York Post in New York and Senate Majority Leader Tom Daschle in Washington.
New York health officials said Kathy Nguyen, 61, of the Bronx, who had worked in the supply room of Manhattan Eye, Ear and Throat Hospital died around 1:15 a.m. Wednesday.
Officials said Nguyen, the fourth inhalation anthrax death in the nation, had lived alone, had no family in New York and had been too ill to be able to provide investigators clues to where she might have come in contact with anthrax.
"As we speak, the FBI in New York and elsewhere is doing everything they can to find out the cause of this," White House Press Secretary Ari Fleischer said Wednesday morning. He said there would be an autopsy for a scientific analysis of the anthrax bacteria so that investigators could "compare that to the three other instances."
As part of her work duties, New York officials said, Nguyen accepted deliveries and assigned equipment, so almost everyone working in the hospital was in contact with her. The hospital remained closed and the staff was given antibiotics.
Gladys Geroge, president of Lenox Hill Hospital, the parent company of the Manhattan Eye, Ear and Throat Hospital, said so far, 1,116 individuals have been placed on antibiotics as a precautionary measure. Up to 2,000 people may have to be treated in all.
"Usually with inhalation anthrax, the vast majority of people have had their exposure within a two-week period though theoretically, in the literature, exposure can occur in up to 60 days," said Dr. Neal Cohen, New York City health commissioner. "Up to 90 percent to 95 percent of the exposures occur with 14 days so we are looking at the people who entered building during that period and we're comfortable that it's the highest likelihood of exposure."
The woman did not handle mail but New York Mayor Rudolph Giuliani said the basement room where she worked was near the mailroom. Ten of 40 environmental samples for anthrax came back negative and officials were waiting for the results of the remaining 30. Nguyen, an immigrant from Vietnam 24 years ago, worked in the hospital for about 10 years. Her home also was tested for anthrax and initial results were negative.
The FBI said some 4,000 FBI agents and 3,000 support personnel were actively working the anthrax cases and the Sept. 11 terrorist attacks in New York and near Washington.
For health investigators, however, this first case of inhalation anthrax in New York -- plus the cutaneous infection diagnosed in a Trenton, N.J. bookkeeper -- have changed the playing field because both individuals appear too far removed from known sources of anthrax spores to have contracted the disease. Health officials had operated under the belief cross contamination of mail was very unlikely to cause anthrax infection in non-postal workers downstream because too few spores would be involved in such as transfer.
Dr. Anthony S. Fauci of the National Institutes of Health said Tuesday officials were rethinking their opinions on cross contamination and how many anthrax spores were required for an anthrax infection. The number of spores required for inhalation infection has been pegged at between 5,000 and 10,000.
Two Washington, D.C. postal workers died from inhalation infection, apparently from spores shed during mail processing of a letter sent to Daschle's Hart Office Building office. Officials are also searching for a second letter at the House of Representatives.
A spokesman for Rep. Mike Pence, R-Ind., whose office was one of three in the Longworth House Office Building found to be infected with anthrax, said they were informed by Capitol Hill Police Wednesday the office had "spores that numbered in the hundreds or thousands, much like the exposures in the Hart Office Building elevator."
Also dead from inhalation anthrax is a photo editor for American Media Inc., of Boca Raton, Fla., who was the first victim Oct. 5. Investigators have found anthrax spores at the AMI building. About 900 AMI employees and visitors to its headquarters building, where the first anthrax was found, have undergone second blood tests.
The results of those tests are still inconclusive however. In fact, there is no truly accurate way to screen for anthrax before it becomes an infection. Though a positive result does help investigators, especially when combined with information on spore sources, the Palm Beach County health director said blood tests and nasal swabs from employees have been of little use in diagnosing anthrax infections there.
Dr. Jean Malecki, director of the county health department, said the tests "really didn't give any clear-cut information to make a clinical decision about whether someone should be treated. Right now we can't use them to make medical decisions. It's going to have to be refined."
If treatment is delayed, however, until the onset of symptoms -- especially in the case of inhalation anthrax -- it can be fatal. Fortunately three people hospitalized in the Washington area for inhalation anthrax are reported to be responding to a combination treatment involving three antibiotics, including Cipro, according to Centers for Disease Control and Prevention officials in Atlanta.
The failure of the testing does not pose any danger to the American Media and South Florida postal employees, however, because they were given treatment with antibiotics as a precaution. Traces of anthrax have been found in five postal facilities in Palm Beach County, and the Environmental Protection Agency is testing three others -- two mail distribution centers in Miami and one in the Fort Lauderdale area. Investigators in Florida have not, however, identified any one piece of mail that contained anthrax.
David Pecker, AMI chairman, took exception to remarks by Mark Merchant of EPA that the firm should "step up to the plate" and help pay for the anthrax cleanup. Pecker said there had never been any discussion of the issue.
"For a government official to say that AMI should 'stand up to the plate' after what we have gone through for the last several weeks and what this country has gone through, I think that statement should be corrected," Pecker said.
He noted that one of his employees was dead, another mailroom worker hospitalized for weeks and more than 300 employees were taking antibiotics that were making many of them dizzy and nauseous.
The CDC said there have been 16 confirmed cases of anthrax infection, including six cutaneous and 10 inhalation. Three cutaneous were in New York and three were in New Jersey. Inhalation infections included two in Florida, one in New York, two in New Jersey and five in Washington. It said there also are four suspected cases of cutaneous infection, three in New York and one in New Jersey. The CDC figures do not include the latest suspect case in New Jersey.
(With additional reporting by Alex Cukan in Albany, N.Y., Frances Burns in Trenton, N.J., Les Kjos in Miami and Mitch Prothero in Washington.)