Health problems linger for survivors of the anthrax attacks/PA's Courier Times

The following article talks about an important finding, which I mentioned back in a 2002 NY Times interview:  the people who developed inhalation anthrax (or cutaneous anthrax that became generalized) were likely to suffer from the identical symptoms as those who became very ill after anthrax vaccinations.  These symptoms have now lingered for ten years in those who got the disease anthrax, and for ten years or more in those I have treated for anthrax vaccine exposures.  The symptoms are fatigue, impaired cognition, psychological problems and muscle/joint pains.  Perhaps not coincidentally, these symptoms also define Gulf War Syndrome.  Many of my patients have developed hormone deficiencies as well (both Gulf War and anthrax vaccine-injured patients) and it appears from the article that research physician Mary Wright at NIH is finding hormonal problems in her anthrax survivors as well.

How can you explain why people who got the vaccine have a similar chronic illness as those who caught the disease?  I don't believe any research has been published on this interesting fact, but it isn't hard to speculate.  This is particularly important for several reasons:  people who are cured of anthrax may never become well, unlike those who recover from most other infectious diseases.  What is fundamentally different about anthrax infection in this regard?  Furthermore, many monkeys who were given anthrax vaccine, then exposed to anthrax, actually got the disease but survived.  (See the July 18, 2000 Washington Post article by Tom Ricks, "Anthrax Shots' Effects Challenged:  Army Disputes Expert Who Reviewed Vaccine Tests.")

If people get the same level of protection afforded by the vaccine as the monkeys did, it may not prevent them developing chronic illness, although it may prevent their death. That doesn't speak well for the vaccine, and suggests a better vaccine is needed: both to be more effective at preventing anthrax, in addition to being more safe.

The licensed human anthrax vaccine, produced by Emergent BioSolutions, contains many anthrax proteins and other anthrax molecules produced during bacterial fermentation, and one or more of these probably cause[s] the symptoms, or cause[s] some type of deregulation that not only causes the symptoms, but allows them to persist, apparently forever.  The persistence of these symptoms--after the disease is long gone--is another issue crying out for study.

In the 10 years since 17 people survived the deadly anthrax attacks that terrorized the nation in the weeks following 9/11, little recent information is known about their health.
But the National Institute of Health has quietly monitored the health of seven of the those survivors, including Falls resident Patrick O’Donnell. The group represents the largest pool of anthrax survivors U.S. researchers have studied.
The ongoing study will provide the first comprehensive data on the long-term health effects of anthrax exposure, the project’s head researcher said recently.
“No one has ever documented followup in anthrax survivors,” said Dr. Mary Wright, the principal investigator with the NIH’s National Institute of Allergy and Infectious Disease.
Before 2001, the last reported U.S. anthrax case occurred in 1976, and it was reported two years later, according to the NIH. The only previous anthrax studies were 50 years old and contained little data about long-term effects or possible complications.
In fall 2001, 22 people in the U.S. were exposed to anthrax through tainted letters sent through the U.S. mail. Five died. Many of those affected were U.S. Postal Service workers, who either inhaled anthrax spores or were exposed to it through skin contact.
NIAD is the only research agency that is following the health of anthrax attack survivors, a project that started in February 2002.
The study participants include two with inhaled exposure, and all but one are regularly tested and evaluated every one to two years, Wright said. The testing includes neuropsychological, blood and hormone level tests. The study will continue as long as the participants are willing. And one survivor, a woman who has not recently participated, can return at any time, Wright said.
The most recently released information about the health of the survivors came in 2004. It was based on a one-year followup study of 15 of the 17 survivors conducted by the Centers for Disease Control and Prevention. That study used medical interviews, standardized self-administered questionnaires, and a review of available medical records.
The study found that eight of the participants hadn’t returned to work more than a year after the attacks, all were under psychiatric care, and most reported symptoms ranging from chronic cough, fatigue and memory problems to depression, anxiety and hostility. Eight survivors also reported moderate to severe joint problems and decreased physical functioning.
But diagnostic tests performed on six of the eight patients showed no signs of immune or inflammatory disorders or other common medical explanations for the symptoms.
Nearly nine years later, Wright says her data shows the survivors who were the sickest in 2001 continue to experience the most persistent symptoms, including memory trouble and chronic fatigue. These survivors either inhaled anthrax or had it enter their bloodstream after they contracted the skin form.
The sickest patients also have had the most difficulty returning to work. Though some have returned, they can’t perform at the same level as before, Wright said. Those with less severe symptoms appear to have returned to their regular lives.
Wright added that researchers know some survivors will develop common age-related medical problems, but there likely will be no way to prove a cause-effect relationship with the anthrax exposure.
“We are hoping what we learn, once we publish, is if there are new cases, including natural cases, that they can learn from this experience and monitor some of these variables, like hormone levels and memory testing and offer some support to folks,” Wright said.
O’Donnell, now 45 and a U.S. postal worker, was the 12th of the 22 anthrax attack victims. Four coworkers also were exposed and survived.
He returned to his job at the Hamilton, N.J., office in 2005, where he continued to work a “modified schedule” through Workers’ Compensation, according to a recent post on the PostalWorker News Blog, which isn’t affiliated with the U.S. Postal Service.
The Courier Times was unsuccessful in attempts to reach O’Donnell for comment.
O’Donnell came in contact with one of the tainted envelopes, a letter addressed to then Senate Majority Leader Thomas Daschle, while working overtime on Columbus Day 2001. Normally, he didn’t sort first-class mail.
Five days later, O’Donnell noticed a welt-like sore on his neck where he had nicked himself shaving the day he worked the overtime. He was treated at an emergency room for a suspected spider bite and released. The next morning, though, O’Donnell woke to find his neck had swelled to 27 inches around. The welt was now a pus-filled boil and a softball-size lump protruded from his chest.
He returned to the emergency room, where doctors confirmed he had an anthrax infection, triggering emergency infectious disease protocols. After five days in isolation with antibiotic treatments, O’Donnell was released.
O’Donnell last spoke to the newspaper in 2008, after he attended a private FBI briefing discussing Bruce Ivins, the late Army scientist the government said was responsible for the anthrax attacks. At the time, O’Donnell complained of symptoms that he believed were the lingering effects of the anthrax — stuffy head, achy joints, throbbing headaches, insomnia and panic attacks.
In an Aug. 6 post on the PostalWorker blog, O’Donnell wrote that he still suffers severe post traumatic stress disorder, which a doctor has diagnosed. He said his condition has been worsened because he continues to work at a postal center 300 yards from the building where he was exposed to anthrax and he’s required to sort and throw away waste mail.
He added that his repeated requests for a job transfer closer to home have gone nowhere.
“Without having been through this experience, it has been impossible for others, including U.S. Post officials, to comprehend the mental and physical toll I face each day driving back and forth to work and seeing the postal facility, a constant reminder of this terrible, near-fatal exposure I suffered,” O’Donnell’s post said. “This has proven to be no help whatsoever in me trying to obtain closure and getting on with my life. I just want to spend my last years of service at a facility with a less stressful, remindful environment.”
The USPS cannot comment on employee claims without the employee’s written permission, spokesman Ray Daiutolo said.
But Daiutolo said that if an injured worker disagrees with the offered position, that employee can provide supporting documentation to the Office of Workers’ Compensation Programs, which makes the final decision.
If an employee is returned to duty in a “suitable position” and subsequently experiences a worsening of his/her condition or has a change in work tolerances, that employee has the right to submit a claim for recurrence, Daiutolo added.