In addition, a 60-day course of antimicrobial prophylaxis is recommended for other workers with specified risks for inhalational anthrax. In some areas, local health authorities facilitated access to a 60-day course of antimicrobial prophylaxis for persons who handled mail in facilities from which B. anthracis was isolated but did not have exposures for which antimicrobial prophylaxis is recommended.² These persons may choose or may be directed by local health authorities to discontinue antimicrobial prophylaxis before completing a 60-day course.

CDC Assistance to Other Countries
CDC has assisted authorities in other countries investigating cases of bioterrorism-related anthrax. During October 12-November 13, CDC received 111 requests from 66 countries. Of these, 47 (42%) requests were laboratory related; 43 (39%) were general requests for bioterrorism information; 13 (12%) were for environmental or occupational health guidelines; and eight (7%) were about developing bioterrorism preparedness plans. The largest proportion of requests were from Central and South America (26%). Of the 66 countries, 15 (23%) received laboratory assistance, including testing or arrangements for testing of suspected isolates at a CDCsupported laboratory or a reference laboratory in another country. Forty-two (64%) countries received telephone or e-mail consultation regarding specific tests for suspected B. anthracis isolates. CDC has confirmed two isolates from outside the United States as B. anthracis. These isolates were recovered from the outer surface of letters or packages sent in State Department pouches to the U.S. Embassy in Peru. These items were processed at the U.S. State Department mail sorting facility where a case of inhalational anthrax had occurred.¹ No cases of bioterrorism related anthrax have been confirmed in U.S. Embassy employees or in persons from other countries. Requests for information regarding bioterrorism-related issues outside the United States should be directed to the International Team of CDC's Emergency Operations Center (telephone, [770] 488-7100, e-mail, eocinternational{at}cdc.gov).

Reported by:
J Malecki, MD, Palm Beach County Health Dept, West Palm Beach; S Wiersma, MD, State Epidemiologist, Florida Dept of Health. New York City Dept of Health. E Bresnitz, MD, State Epidemiologist, G DiFerdinando, MD, New Jersey Dept of Health and Senior Svcs. P Lurie, MD, K Nalluswami, MD, Pennsylvania Dept of Health. L Hathcock, PhD, State Epidemiologist, Delaware Div of Public Health. L Siegel, MD, S Adams, I Walks, MD, J Davies-Coles, PhD, M Richardson, MD, District of Columbia Dept of Health. R Brechner, MD, State Epidemiologist, Maryland Dept of Health and Hygiene. R Stroube, MD, State Epidemiologist, Virginia Dept of Health. J Burans, US Naval Research Center Detachment, Lima, Peru. US Dept of Defense. EIS officers, CDC.

CDC Editorial Note:
Since the previous report, all patients with bioterrorism-related anthrax who were hospitalized have been discharged and continue to recover; no new cases have been reported. The source of these bioterrorist attacks has not been identified, and additional cases might occur. Public health authorities, health-care providers, and laboratorians should remain vigilant for cases of anthrax.

Antimicrobial prophylaxis is indicated to prevent inhalational anthrax after a confirmed or suspected aerosol exposure. Persons recommended to receive prophylaxis should complete the 60-day regimen. Public health programs should work with health-care providers and patients to promote completion of antimicrobial prophylaxis and to monitor the occurrence of adverse events.¹

CDC continues to respond to inquiries about anthrax and bioterrorism. The CDC Public Response Hotline was established to provide the public with information about anthrax and other biologic and chemical agents. During November 1-12, CDC received approximately 4,400 calls through the hotline and to the Emergency Operations Center. The hotline is available in English (888-246-2675) and Spanish (888246-2857). CDC also receives requests for information by e-mail through the Health Alert Network (healthalert{at}cdc.gov), MMWR (http://www.cdc/gov/mmwr/contact.html), and other public health communications systems.

Additional information about anthrax is available at http://www.bt.cdc.gov. A compendium of MMWR reports and recommendations related to anthrax and bioterrorism is available at http://www.cdc.gov/mmwr.