In March of 2001, I joined the State of Connecticut Department of Public Health as a Bioterrorism (BT) Coordinator in the Public Health Laboratory. My primary responsibility focused on training hospital microbiology laboratory staff to spot potential bioterrorist threats.

My role would drastically change in a matter of a few months, after Ottilie Lundgren, a citizen of Oxford, Connecticut, became the last known victim of the anthrax attacks in November of2001. Instead of focusing on training, I became an integral part of the investigation and response team. At the time, the late Dr. Katie Kelly was the Laboratory Director. She had previously been the Chief of the Laboratory Practice Training Branch at the Centers for Disease Control and Prevention (CDC) and had participated in bioterrorism preparedness. She was instrumental in coordinating the laboratory response to the anthrax mailings in Connecticut.

In just a short time, the training conducted in Connecticut hospitals paid off, as we quickly identified Bacillus anthracis from specimens of the suspect anthrax case. CDC flew to Connecticut to pick up our samples for further testing, which confirmed our results and worst fear— a Connecticut resident died due to inhalational anthrax.

The Connecticut Department of Public Health quickly became part of a multidisciplinary response team that included representatives from public health, CDC, law enforcement, the U.S. Postal Service and others working together to determine the source of the anthrax and prevent further contamination and infection.

How Ms. Lungren was exposed was a mystery then and now. Our epidemiologists scoured Ms. Lundgren’s home and the places she frequented such as her church, beauty salon, a restaurant and even the cars she had traveled in, taking hundreds of samples. These samples were transported to the Public Health Laboratory for testing. The death of a nearby Connecticut resident was investigated and it was concluded that he died of natural causes, however, the laboratory tested mail recently received by the deceased and it was positive for B. anthracis.

This led the investigation to the local postal distribution center, where we found anthrax in the processing machines. Subsequently, 450 postal employees had nasal cultures performed to ensure no one else was exposed to the deadly anthrax spores, all of which tested negative. Once we determined which machines were involved, decontamination was necessary. Using validation methods available at the time to confirm decontamination, there were no additional traces of anthrax recovered. However, in April of 2002, we found anthrax had remained in the facility and a more extensive building-wide decontamination was done.

After we offered testing to the public, the public samples started flooding in to the laboratory. We accepted new samples from 8:00 a.m. to 9:00p.m. Samples included everything from grocery store floors to confetti, packing peanuts and white powder contained in malicious letters. We also processed postal samples from New York and New Jersey and uncovered yet more positives. In all, we processed 50 or more samples a day, every day for several weeks.

My staff was great, working long hours under great pressure. We had six staff that performed the testing and virtually the rest of the entire laboratory staff provided support services for everything else. I will always remember the Thanksgiving dinner we shared that year in the Public Health Laboratory. One of our administration staff and his wife cooked a turkey for us with all the trimmings. It was not exactly where I wanted to be during Thanksgiving, but it was one that I’ll always remember.

We learned how to manage this crisis as we went along, and realized we needed some additional expertise. For example, we hired an evidence control officer to manage chain of custody control and associated law enforcement issues. He taught us how to receive samples correctly and preserve evidence. He also helped develop and deploy the emergency response kit that is in every emergency room in acute care hospitals in Connecticut today for the collection of biological, chemical and radiological samples.

Looking back over the past 10 years, we have come a long way in regard to our ability to respond to a bioterrorism event. Biosafety Level 3laboratory space was not a standard feature instate public health laboratories, as it is today. We built a modern Biosafety Level 3 laboratory, significantly increasing our capacity to process potentially weaponized samples. We train regularly with first responders and law enforcement, and have systems in place to properly manage and preserve evidence. In all hospitals in the state, laboratory staff receive annual proficiency training to recognize select agents and emergency rooms receive training on what to do when they encounter a suspect bioterrorism agent.

In 2007, there was a naturally occurring case of anthrax in Danbury, Connecticut. This time, our response went much smoother than in 2001.We knew how to correctly process the samples, had state of the art testing methods and the necessary reagents and had strong relationships with law enforcement and other partners.

When I came to the Department of Public Health in 2001, I didn’t think I would be on the front lines of responding to a major bioterrorist incident, and I hope I don’t have to go through a similar experience in the future. But I’m proud of our response and the work we’ve done since 2001 to enhance Connecticut’s capacity to respond to future threats.

By Diane Barden, Bioterrorism Response Laboratory Supervisor, Connecticut Department of Public Health —Public Health Laboratory

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