Medical toxicology and public health—Update on research and activities at the Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry

An extensive review of CDC epidemiological responses to human outbreaks of anthrax from occupational settings between the years of 1950 and 2001 documented a variety of approaches to mitigation and decontamination [2]. These approaches included taking no action, burning contaminated materials, chlorinating water supplies, instituting administrative and engineering controls and PPE, vaccinating potentially exposed individuals, and in 2 instances, fumigating with formaldehyde vapor (now considered to be a human carcinogen). Secondary contamination of a worker's home was documented in 1 case, but not felt to be clinically significant to warrant any decontamination efforts. In response to the B. anthracis attacks in 2001, chlorine dioxide fumigation, vaporous hydrogen peroxide fumigation, and a combination of HEPA vacuuming, cleaning, and bleach application were all techniques used successfully to clean B. anthracis spore contamination.