anthracis isolates were collected from four powder-containing envelopes, 17 clinical specimens from case-patients, and 106 environmental samples collected along the mail path of the implicated envelopes in Florida, District of Columbia metropolitan area, New Jersey, New York City, and Connecticut.
Cases of anthrax occurred in persons near those targeted for infection and also in those along the mail path of spore-containing envelopes.
We found most cases of anthrax to be epidemiologically linked to sites contaminated by implicated envelopes; however, not all cases had direct exposures to targeted worksites, implicated envelopes, or mail-processing facilities along the mail path. Two cutaneous anthrax patients, a mail carrier and a bookkeeper in New Jersey, were not exposed to contaminated postal facilities or media companies.