WASHINGTON, Oct. 31 (UPI) -- An additional suspected case of cutaneous, or skin, 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 for testing Wednesday after a 54-year-old man, who operated a sorting machine, preliminarily tested positive for anthrax. The man is a Delaware resident and health officials said his skin lesion developed Oct. 13, which coincides with the time anthrax letters to NBC, the New York Post and Senate Majority Leader Tom Daschle in Washington are believed to have passed through the Hamilton, N.J., regional center.
The South Jersey Processing and Distribution Facility is about 35 miles from the Trenton. N.J., regional center in Hamilton, which was closed after it tested positive for anthrax.
New York health officials said Kathy Nguyen, 61, of the Bronx, who worked in the supply room of Manhattan Eye, Ear and Throat Hospital died around 1:15 a.m. Wednesday. Officials also were investigating whether a second person at the hospital also might have anthrax infection -- this however, was a potential case of cutaneous or skin anthrax.
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 for further anthrax testing and the staff was given antibiotics.
Gladys George, president of Lenox Hill Hospital, the parent company of the Manhattan Eye, Ear and Throat Hospital, said so far, 1,116 individuals had 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."
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 on the anthrax cases and the Sept. 11 terror 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 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 a transfer.
Dr. Anthony S. Fauci of the National Institutes of Health said 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 Senate 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.
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.
In other anthrax developments Wednesday:
-- The Supreme Court said all nasal swab tests conducted on its employees earlier this week have come back negative. The Supreme Court building on Capitol Hill will remain closed while additional tests are conducted Thursday.
-- Indiana Gov. Frank O'Bannon confirmed anthrax spores turned up on equipment sent to a postal repair facility in Indianapolis. Dr. Greg Wilson, state health commissioner, said the number of spores detected was minimal. "Anthrax is not a threat to human health in Indiana," O'Bannon told a news conference. He said the spores were detected on a piece of equipment that had been sent from either Trenton or from Washington's Brentwood facility.
-- Preliminary tests reveal two mailbags in the U.S. embassy in Vilnius, Lithuania contain trace levels of anthrax, but the State Department is conducting further tests to be sure. Officials said the State Department would conduct further environmental samples throughout the main building in addition to sampling mailrooms.
-- In the Washington area, retesting of Southwest Station, Friendship Station and Dulles Retail Unit postal facilities found no additional anthrax spores so the sites reopened. Postal official Jerry Lane told reporters, "Employees at those sites did receive their antibiotics and are back at work."
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 were 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 Marcy Kreiter in Chicago, Alex Cukan in Albany, N.Y., Frances Burns in Trenton, N.J., Les Kjos in Miami and Michael Kirkland, Eli J. Lake and Mitch Prothero in Washington.)