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One-Year Health Assessment of Adult Survivors of Bacillus anthracis Infection
Dori B. Reissman, MD, MPH;
Ellen A. S. Whitney, MPH;
Thomas H. Taylor, Jr, MS;
James A. Hayslett, PharmD;
Peter M. Dull, MD;
Ileana Arias, PhD;
David A. Ashford, DVM, MPH, DSc;
Eddy A. Bresnitz, MD;
Christina Tan, MD;
Nancy Rosenstein, MD;
Bradley A. Perkins, MD
JAMA. 2004;291:1994-1998.
Context Little is known about potential long-term health effects of bioterrorism-related Bacillus anthracis infection.
Objective To describe the relationship between anthrax infection and persistent somatic symptoms among adults surviving bioterrorism-related anthrax disease approximately 1 year after illness onset in 2001.
Design, Setting, and Participants Cross-sectional study of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records.
Main Outcome Measures Health complaints summarized by the body system affected and by symptom categories; psychological distress measured by the Revised 90-Item Symptom Checklist; and health-related quality-of-life indices by the Medical Outcomes Study 36-Item Short-Form Health Survey (version 2).
Results The anthrax survivors reported symptoms affecting multiple body systems, significantly greater overall psychological distress (P<.001), and significantly reduced health-related quality-of-life indices compared with US referent populations. Eight survivors (53%) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors (mean scores, 30 vs 41; P = .02). Available medical records could not explain the persisting health complaints.
Conclusion The anthrax survivors continued to report significant health problems and poor life adjustment 1 year after onset of bioterrorism–related anthrax disease.
Author Affiliations: Office of the Director (Dr Reissman) and Epidemiology and Surveillance Branch (Dr Arias), Division of Violence Prevention, National Center for Injury Prevention and Control (Drs Reissman and Arias), Bioterrorism Preparedness and Response Program, Office of the Director, National Center for Infectious Diseases (Dr Reissman); Meningitis and Special Pathogens Branch (Drs Dull, Rosenstein, Perkins, Hayslett, and Ashford and Ms Whitney) and Biostatistics Information Branch (Mr Taylor), Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Epidemic Intelligence Service Program, Division of Applied Public Health Training, Epidemiology Program Office (Drs Dull, Tan, and Hayslett), Centers for Disease Control and Prevention, Atlanta, Ga; and the New Jersey Department of Health and Senior Services, Trenton (Drs Bresnitz and Tan).
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