October 18, 2001

Dear Students:

The brief but ultimately discredited anthrax scare that occurred in Baltimore on October 17 has understandably heightened concerns about the possibility of anthrax exposures among students. Some have called the Student Health and Wellness Center for more information or to inquire about what plans have been put into place on the Homewood campus to respond to a possible exposure. I want to take this opportunity to outline how the Student Health and Wellness Center is preparing.

In outlining our plans, I want to emphasize, as have University and City officials, that there have been no suggestions that the University, including students, has been targeted for a possible bioterrorism attack. Nonetheless, we are doing everything we can to position ourselves to respond quickly and effectively to any possibility of such an occurrence.

First, we are all fortunate to be part of a University community that counts among its faculty and staff some of the foremost experts in the nation and the world on public health, infectious diseases and bioterrorism. We can and will avail ourselves of these resources as the need arises.

Second, I have asked that all our staff familiarize themselves with the various presentations of anthrax disease and their clinical course. They have already begun this task and will continue to do so over the next few weeks. Some of our staff will be participating in a Centers for Disease Control and Prevention (CDC) teleconference on "What Every Physician Should Know About Anthrax." This will occur on Thursday, 10/19 and again on Monday, 10/22. We will share the information among everyone on the staff so that all are knowledgeable about anthrax.

The cutaneous and intestinal forms of anthrax are sufficiently distinctive such that they can be readily suspected and identified when a high index of suspicion is maintained. Because cases of anthrax have been reported in several geographic areas in the United States, you can be certain that we will be mindful of this diagnosis under the appropriate conditions. You should not be surprised if, during clinical encounters at the Health and Wellness Center, you are queried about your possible exposure to any unusual letters or packages containing powdery substances. Anthrax spread through contaminated food would likely cause many students to become ill over a relatively short period of time. Since such circumstances always trigger the concern about "food poisoning," it takes little additional effort to add the possibility of intestinal anthrax to the list of possible causes. In suspected cases of food poisoning on a widespread scale, our current policy already includes contacting public health officials.

Pulmonary anthrax poses more of a diagnostic challenge, since during the initial phases of the illness, symptoms may mimic those of the "flu" (influenza). Again, we will certainly be inquiring whether any individual with such symptoms may have handled a suspicious envelope. A more widespread distribution of the organism by air or through a ventilation system would result in many students and staff becoming ill at the same time, triggering a more in-depth public health investigation. Once the cold weather settles in, we routinely perform surveillance to identify cases of influenza. We will certainly watch these results closely to detect any possible "flu-like" outbreak that is unaccompanied by positive viral cultures.

At the present time, we are following public health recommendations and declining to offer prophylactic doses of ciprofloxacin to students. Overuse of antibiotics has already led to increasing bacterial resistance. Ciprofloxacin, as do all medications, carries its own set of potential adverse reactions and self-medicating with this drug could potentially delay or obscure the diagnosis of other serious diseases. The antibiotic is available if the need arises. Last night, Channel 11 news stated that Baltimore City has stockpiled enough ciprofloxacin to treat 100,000 individuals.

We recognize that the events since September 11 have been anxiety-provoking and that recent developments have further heightened your concerns. I want to assure you that we are taking the appropriate steps to prepare ourselves and the campus to respond to any potential biologic threat. We will continue to educate ourselves and update you with any significant developments.

Sincerely,
Alain Joffe, MD, MPH
Director
Student Health and Wellness Center