New Hampshire Woman Critical Because of Gastrointestinal Anthrax

[Shiloh]

Source: http://topnews.us/content/29299-new-...stinal-anthrax

New Hampshire Woman Critical Because of Gastrointestinal Anthrax
Submitted by Jason Ramsey on Sun, 12/27/2009

A New Hampshire woman is currently in critical condition because of gastrointestinal anthrax, and State and Federal Authorities are confused and continually looking for naturally occurring source of the anthrax.

Dr. Jose Montero, the State Public Health Director, has shared that the Strafford County resident started experiencing problems and fell ill during early December. Authorities have confirmed that she indeed is suffering fromgastrointestinal anthrax , and investigations are currently on about whether the virus came from an African drum that she had taken to a drum circle event which was being held at the United Campus Ministry at the University of New Hampshire.

Dr. Montero has shared that the drum is being investigated as there have been two very recent cases of anthrax in New York and Connecticut, solely related to animal hide. He has, however, stressed that residents do not need to panic as the disease is not transmitted from one person to another and "the public is not at risk".

[Shiloh]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

Source: http://www.themoneytimes.com/feature...d-1095213.html

Strafford County woman diagnosed with anthrax

Strafford, NH, December 27 -- Health officials at New Hampshire have confirmed a case of gastrointestinal anthrax in a woman from Strafford County.

The woman, who fell sick early December, is now in a critical state.

The Department of Health and Human Services (DPHS) in New Hampshire and Centers for Disease Control and Prevention (CDC) are investigating how the woman contracted the disease.

Suspected source of anthrax
Though the cause of anthrax has yet not been determined, the investigators believe that the source of disease could be African drums.

The woman took part in a drumming circle recently at the Waysmeet Center in Durham, leading to suspicion that she contracted the deadly infection from spores on the drums.

The drums are made of animal hides, which may be the source of naturally occurring anthrax.

Though there are no other case of anthrax reported, the health officials are urging African drum owners to have their drums tested for bacterial spores.

About the disease
Anthrax is an acute disease that affects both humans and animals, especially goats, cattle, sheep, and horses.

The cause of anthrax is a bacterium called bacillus anthracis. Under the microscope, the bacterium looks like large rods. However, they exist in form of spores, which are hardy and difficult to destroy.

There are three types of anthrax infections: respiratory or inhalational, cutaneous and gastroenteric.

Gastroenteric anthrax is mostly caused by eating undercooked, anthrax-infected meat and is characterized by extreme gastrointestinal difficulty, vomiting of blood, severe diarrhea, fever, abdominal pain, and loss of appetite.

The infection spreads throughout the body through the bloodstream carrying deadly toxicity.

Anthrax is not transmitted from humans. The infection is caused by spore that is ingested, inhaled or it enters through a cut in the skin.

Anthrax cases reported so far
Over the years, this form of disease has received a lot of attention as it has been found that the bacteria can also be transmitted by a boi-terrorist attack.

In 2001, anthrax attack took place in the nation, when anthrax-laced letters were sent to several journalists and two US Senators. The incident killed five people and infected 17 others.

Besides the terrorist attack, there have been 12 cases of naturally occurring anthrax reported in the nation since 1957.

In 1957, an outbreak occurred in a New Hampshire goat-hair processing plant, where nine cases of anthrax were reported. These included five cases of inhalational and four of cutaneous infection.

In 2006, a New York dancer and drum maker contracted the infection from African drums made with goat skin.

Again in 2007, two members of a family from Connecticut were treated for cutaneous anthrax. They also contacted the disease from the hides brought from Africa to make drums.

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

http://www.promedmail.org/pls/otn/f?p=2400:1001:747000751311471::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80634

Archive Number 20091227.4360
Published Date 27-DEC-2009
Subject PRO/AH/EDR> Anthrax, human - USA: (NH)


ANTHRAX, HUMAN - USA: (NEW HAMPSHIRE)
****************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: 26 Dec 2009
Source: New Hampshire Department of Health & Human Services [edited]
<http://www.dhhs.nh.gov/NR/rdonlyres/er36rgrbm6kgnzxl4cmrwhkv4ojb2aazwincqc6k7hosxhl3xj oeprhdmvubm346je4ddlh54jltjwbzcyy725m3dbd/anthrax.pdf>


FOR IMMEDIATE RELEASE Public Information Office 26 Dec 2009 603-271-4051:

DHHS Announces Case of Gastrointestinal Anthrax in Concord, NH


The New Hampshire Department of Health and Human Services (DHHS) has
confirmed a case of gastrointestinal anthrax in an adult female from
Strafford County. The patient is currently in critical condition.
DHHS's Division of Public Health Services (DPHS) along with the
Centers for Disease Control and Prevention (CDC) are investigating
the source of the anthrax. The source of the anthrax is not yet
clear, but DPHS believes the anthrax to be naturally occurring from
the environment. There is no risk to the public, but DPHS and its
partners are taking every step possible to find the source.

"Our thoughts and concerns are with this patient and her family,"
said DHHS Commissioner Nicholas Toumpas. "This is a difficult and
unusual situation, and we are committing all possible resources to
determining the cause of this exposure as quickly as possible."

There are 3 types of anthrax infections: inhalation, cutaneous, and
gastrointestinal. Gastrointestinal anthrax is characterized by acute
inflammation of the intestinal tract. Initial signs of nausea, loss
of appetite, vomiting, and fever are followed by abdominal pain,
vomiting of blood, and severe diarrhea. The incubation period can be
anywhere from 3-60 days.

There have been 11 cases of naturally occurring anthrax in the United
States since 1957. One occurred recently in New York City and one in
Connecticut that were related to animal hides. Approximately 2000
cases of cutaneous naturally occurring disease are reported annually
worldwide. Person-to-person transmission of anthrax is extremely
unlikely, as the disease is caused by a spore that is ingested,
inhaled or enters through a cut in the skin. The last cases of
anthrax that were diagnosed in New Hampshire were back in 1957, when
there were 9 cases (4 cutaneous and 5 inhalation) in employees of a
textile mill in Manchester.

"We are working with many partners to conduct a thorough
investigation," said Public Health Director Dr. Jose Montero. "At
this point, we've alerted physicians; we have increased our
surveillance measures, and we are talking with our federal partners
as well to look at all possible sources that may play a part in this
case." One of the possibilities being examined are African drums.
"Even though it is a remote possibility for transmission, public
health officials are requesting owners of African drums who attended
African drummers circle events at the UNH campus ministries from
October to early December 2009 to contact DPHS at 271-4496 to discuss
the possibility of having their drums tested."

For more information about anthrax, visit
<http://www.emergency.cdc.gov/agent/anthrax/> or
<http://www.dhhs.nh.gov>. Anyone with questions about anthrax can
call DHHS's Division of Public Health Services at 271-4496 or the
Centers for Disease Control at 1-800-CDC-INFO.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[2]
Date: 27 Dec 2009
Source: Fosater's Daily Democrat [edited]
<http://www.fosters.com/apps/pbcs.dll/article?AID=/20091227/GJNEWS_01/712279975>


An adult Strafford County woman is in critical condition with a case
of gastrointestinal anthrax, health officials announced Saturday [26 Dec 2009].

While officials from the state Department of Health and Human
Services have yet to determine the source of the anthrax, they said
they believe the disease was naturally occurring.

The young woman owns an African drum and reportedly participated in a
community drum circle at Waysmeet Center in Durham, the ecumenical
United Campus Ministry for the University of New Hampshire community,
between October and early December 2009, state officials said. Animal
hides may sometimes be the source of naturally occurring anthrax, and
state officials are requesting that owners of African drums who
attended a drum circle during that time call DHHS at 271-4496.

While there is no need for individuals to be tested, the state wants
to conduct testing on any drums, as they are one of several possible
sources of the anthrax, according to Public Health Director Dr. Jose
Montero. Montero said the drums are being considered because the 2
most recent U.S. cases of anthrax involved drums.

In 2007, 2 members of a Connecticut family were treated for cutaneous
anthrax traced to animal hides used to make African drums. In 2006, a
New York dancer and drum maker recovered from the 1st case of
naturally occurring inhalation anthrax in the United States since 1976.

"Since we know that it happened before and was involved in this case,
we are following those leads," Montero said.

He said the victim tested positive for anthrax earlier this month
[December 2009], and the state was notified by Massachusetts health
officials about the positive test on 24 Dec 2009. The victim was
taken to an undisclosed Massachusetts hospital when her condition got
worse, Montero added.

He wouldn't say what Strafford County community the woman lived in or
give her age. The woman is not a UNH student, but the school said in
a statement that they are "cooperating fully with DHHS and their
thoughts and concerns are with the young woman and her family."

Montero stressed that health officials are focused on testing the
drums, not people, because person-to-person transmission of anthrax
is extremely unlikely, as the disease is caused by a spore that is
ingested, inhaled, or enters through a cut in the skin. "It's so
unusual that we don't expect more cases. Still, we're going to
conduct an extensive investigation," he said.

He said the state has alerted physicians, increased surveillance
measures and is working with its federal partners.

[Byline: Aaron Sanborn]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Other reports have appeared on this event:
<http://www.nashuatelegraph.com/news/statenewengland/500356-227/drums-a-possible-source-of-anthrax-in.html>;
<http://www.necn.com/Boston/New-England/2009/12/26/DHHS-announces-case-of/1261845337.html>;
<http://www1.whdh.com/news/articles/local/BO132489/>;
<http://www.emaxhealth.com/1020/39/34932/woman-nh-contracts-anthrax-possibly-african-drums.html>.

There are a number of odd things about this, starting with:

[1] How did it get recognised/diagnosed;

[2] G/E anthrax is uncommon; it is about 1/200th the incidence of
human cutaneous anthrax, and you have to have oral/oesophageal
exposure, e.g., normally from contaminated meat from a moribund or dead animal.

[3] G/E anthrax happens in a subset of pneumonic exposures from the
contaminated bronchial mucus swept up from the bronchioles and then
dumped into the esophagus, a different pathology from the normal feed
exposure, as there can be oesophageal lesions as well as lesions in
the intestines. So, if there was an infected aerosol, where are the
other pneumonic exposures?

This young lady's doctors are to be commended for thinking far
outside the box when presented with this case and for taking samples
before initiating any antibiotic treatment. Logic would presuppose,
if the drum hypothesis is correct, that she bought all her meat from
a recognized supermarket and that she was not exposed to meat derived
from a sick beast, which might have been butchered by a relative.
This would force an alternative exposure source, e.g., an African
drum. For confirmation, the genomic analysis of her cultures should
be identical with either her drum if contaminated or that of a
colleague's at the same performance. And if it were her drum, why did
she not get infected sooner from it when practicing at home? Ditto
her colleague. - Mod.MHJ]
[see also:
Anthrax, human, 2006 - UK (02): (Scotland), background 20090421.1499
Anthrax, human, 2006 - UK: (Scotland) inquest report 20090206.0530
2008
----
Anthrax, human, 2006 - UK (05): (Scotland), inquest 20081203.3801
Anthrax, human, 2006 - UK (04): (Scotland), inquest 20081128.3750
Anthrax, human, 2006 - UK (03): (Scotland), inquest 20081126.3730
Anthrax, human, 2006 - UK (02): (Scotland) inquest 20081121.3682
Anthrax, human, 2006 - UK: (Scotland), inquest 20081119.3650
2007
----
Anthrax, human - UK (02): (Scotland) 20071028.3505
Anthrax, human - UK (Scotland) 20070312.0877
2006
----
Anthrax, inhalation, human - USA (PA,NY) (03) 20060227.0634
Anthrax, inhalational, human - USA (PA,NY) (02) 20060223.0586
Anthrax, inhalation, human - USA (PA, NY) ex Cote d'Ivoire 20060222.0574
Anthrax, human - UK (Scotland) (04) 20061122.3326
Anthrax, human - UK (Scotland) (03) 20061012.2926
Anthrax, human, fatal - UK (Scotland)(02) 20060824.2391
Anthrax, human, fatal - UK (Scotland) 20060816.2294]
...............................................mpp/mhj/msp/mpp

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

And two drums test positive for anthrax. This obviously has something to do with the drums, but exactly what is not yet clear. The fact that more than one drum has tested positive might mean that someone (not necesarily the case we are currently aware of) played an anthrax infected drum, and aerosolized spores, contaminating other drums, and possibly other people.

Possible the DNA sequences will give something away. The CDC does have history of being able to trace anthrax by its DNA sequences (but unlike flu sequences, I doubt they will be published globally, and even if they were, they would be of no use to FT).

http://www.unionleader.com/article.aspx?headline=Anthrax+found+in+drums+used+at+UNH&articleId=4299e2f0-93d6-4e12-950f-0cd7555a1d2a

Anthrax found in drums used at UNH
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By DAN TUOHY
Union Leader Staff
1 hour, 52 minutes ago


Concord – Two African drums stored at the University of New Hampshire United Campus Ministry have tested positive for anthrax, public health investigators confirmed today.

The young woman with gastrointestinal anthrax who attended a drum circle at the Durham center remains in critical condition, state Public Health Director Jose Montero said.

The state has closed the Campus Ministry, which is unaffiliated with the university, continues to test drums and is asking drum owners who attended the events to call in for possible testing.

Montero said the state lab has sent some samples, including DNA samples, for further testing at the U.S. Centers for Disease Control.

About a half dozen attendees have contacted the state health officials, when more than 50 people may have attended the most recent drum circle. Thirty or more drums were stored at the Durham building.

Montero said the unidentified Strafford County woman brought her own drum, which was a synthetic drum, and not one of goat animal skin used in a typical West African drum.

Investigators are probing other possible sources of contamination, including soil, drug and food the woman may have ingested.

►Woman from NH being treated for anthrax (10)
►Alma Langlois: Anthrax once struck in Manchester

The following press release was issued by the state this afternoon:

The New Hampshire Department of Health and Human Services (DHHS) Division of Public Health Services (DPHS) continues to investigate the source of the anthrax that infected a woman from Strafford County. While the investigation continues, the United Campus Ministry building located in Durham has been closed under an order from DHHS Commissioner Nicholas Toumpas until further notice.

Over the weekend, the New Hampshire National Guard, the New HampshireDepartment of Environmental Services, and the US Environmental Protection Agency collected environmental samples from the United Campus Ministry building and African drums stored there. One possible source of exposure could be drums used in a drumming circle in which the patient participated.

The samples are being tested at the New Hampshire Public Health Labs. Test samples from two of the drums from the Ministry building have come back positive for anthrax. However, this has not been determined as the source of the infection, and additional testing is being done, the results of which are pending.

Even though it is a remote possibility for transmission, because of the possible link to the African drums, DHHS is asking anyone who brought their own drum to one of the events held at the United Campus Ministry between October 1st and early December 2009 to call DPHS at 271-4496 to discuss the possibility of having their drum tested.

“Gastrointestinal anthrax is very unusual,” said Public Health Director Dr. Jos&#233; Montero. “We have not yet been able to confirm that the drums are the cause of the patient’s illness and we are continuing to follow up many leads. Anthrax is not an illness that you can catch from someone else.”


The Mill Road building. (UNH FILE PHOTO)
There are three types of anthrax infections: inhalation, cutaneous, and gastrointestinal.

Gastrointestinal anthrax is characterized by acute inflammation of the intestinal tract. Initial signs of nausea, loss of appetite, vomiting, and fever are followed by abdominal pain, vomiting of blood, and severe diarrhea.

The incubation period can be anywhere from 3-60 days. At this point, DPHS believes this is to be an environmental exposure possibly related to the drums, but food, animal products and soil are also possible sources of naturally occuring anthrax.

“We want to assure the public that we are doing everything we can to find the source,” said DHHS Commissioner Nicholas Toumpas.

“This is a very complex investigation with many roads to go down, many leads to follow, and many people to interview. Because of this, we are relying on the expertise of our public health staff as well as numerous federal, state, and local partners.”

There have been only 11 cases of naturally occurring anthrax in the United States since 1957. The last cases of anthrax that were diagnosed in New Hampshire were in 1957 when there were 9 cases (4 cutaneous and 5 inhalation) in employees of a textile mill in Manchester. One occurred recently in New York City and one in Connecticut that were related to animal hides. Approximately 2000 cases of cutaneous naturally occurring disease are reported annually worldwide.

For more information about anthrax, visit www.emergency.cdc.gov/agent/anthrax/ or www.dhhs.nh.gov.

Anyone with questions about anthrax can call DHHS’ Division of Public Health Services at 271-4496 or the Centers for Disease Control at 1-800-CDC-INFO

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

I tend to agree with the moderators here - things don't add up. I think there may be more cases discovered.

http://www.promedmail.org/pls/otn/f?p=2400:1001:90347888426474::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80644

Archive Number 20091229.4374
Published Date 29-DEC-2009
Subject PRO/AH/EDR> Anthrax, human - USA (02): (NH)

ANTHRAX, HUMAN - USA (02): (NEW HAMSPHIRE)
******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: 28 Dec 2009
Source: UnionLeader.com [edited]
<http://tinyurl.com/yegfpnc>


Anthrax found in drums used at UNH
----------------------------------
Two African drums stored at the United Campus Ministry in Durham, New
Hampshire, have tested positive for anthrax, the state confirmed
yesterday as it continues to investigate the nation's 1st known case
of gastrointestinal anthrax. The state ordered the ministry, which
serves but is not part of the University of New Hampshire, closed for
further testing. As many as 30 drums are stored at the 15 Mill Road
building.

The young woman with the disease, who attended a drum circle at the
center, remains in critical condition, state Public Health Director
Jose Montero said. Montero said the unidentified Strafford County
woman brought her own drum, which had a synthetic covering and not
one of animal skin typically used on an African drum.

Montero continues to ask drum owners who attended the drum circle
events since October [2009] to call his office for possible drum
tests. The state lab has sent some samples, including DNA samples,
for further testing at the U.S. Centers for Disease Control (CDC).
About a half-dozen attendees have contacted the state health
officials since the anthrax case was announced Saturday [26 Dec
2009], when more than 50 people may have attended the most recent
drum circle.

Investigators have not yet confirmed that the 2 drums are the source
of anthrax exposure. Technicians are still trying to match strains
between the patient and the drums. They are probing other possible
sources of contamination, including soil, animal products, and food
possibly ingested by the woman, who is in an undisclosed,
out-of-state hospital. "We have not yet been able to confirm that the
drums are the cause of the patient's illness and we are continuing to
follow up many leads," Montero said. "Anthrax is not an illness that
you can catch from someone else." Montero and state Health and Human
Services Commissioner Nicholas Toumpas emphasized that there is no
risk to the public. The state Division of Public Health has increased
surveillance at hospitals and health care providers across the state.

It is possible tests may never fully identify the point of infection
transmission, according to Montero. Investigators are interviewing
the woman's family and her friends to try to identify eating habits
and any other link for possible point of transmission.

Samples at the United Campus Ministry building were collected over
the weekend by the New Hampshire National Guard, state Department of
Environmental Services, and the U.S. Environmental Protection Agency.
Additional samples will be collected and tested.

The African drum connection is a source under investigation after
contaminated animal hides on drums were involved in anthrax
infections in New York City in 2006 and in 2 Connecticut residents in
2007. Those cases were types of inhalation anthrax and cutaneous
anthrax, not GI anthrax, according to the U.S. Centers for Disease
Control.

Julie Corey of Village Drum Shop in Hooksett, who facilitated the
most recent drum circle at the United Campus Ministry, said she has
been in touch with the state and with the woman's family. Corey and
the Rev. Larry Brickner-Wood, executive director of the United Campus
Ministry, were alerted to the anthrax case and possible connection by
investigators on Christmas eve. "Obviously I'm very upset about the
situation," said Corey, who knows the woman and her family. "We need
to pray for her and pray that she gets through this." Brickner-Wood
said he has also reached out to participants of recent drum circles.
He said his thoughts and prayers go out to the young woman and her
family. "It's terrible and scary and all that," he said.

There have been only 11 cases of naturally occurring anthrax in the
country (USA) since 1957. The last anthrax cases in New Hampshire
were 9 involving employees at a textile mill in Manchester.

[Byline: Dan Tuohy, Union Leader Staff]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Curiouser and curiouser. DNA analyses will show whether her
strain(s) are the same or different from those associated with the 2
drums testing positive. I say strains-plural because in my experience
livestock infected from contaminated feed not infrequently have
multiple strains. This results from the very nature of how sun-dried
bones are collected in Africa and elsewhere, crushed, shipped, and
processed resulting in a mix of strains all in the same sack.

It would be nice and tidy if at least one of the strains associated
with these drums were the same as that affecting this young woman.
The next question then would be were the 2 (or 3 or many) drummers
playing their drums next to each other. If yes, why did she come down
with this infection and not they? If they were spatially separated
the question gets more difficult. And if it is clear that one or both
of the drums were the source, why were cases not seen following
earlier drumming sessions. Room ventilation differences?

One must also keep in mind that New Hampshire has acid soil -- from
the NH samples I have handled recently around 4.6 pH -- and anthrax
spores cannot survive in acid soils. Since the mills and tanneries
handling imported materials shut down in New England there have been
no livestock cases in that region.

The most recent press release by the NH DHHS can be read at:
<http://www.dhhs.nh.gov/DHHS/PIO/LIBRARY/Press+Release/cdcs_anthraxinvestigation.htm>

An interesting puzzle. Let us hope it does not involve tragedy. - Mod.MHJ]

[The interactive HealthMap/ProMED map of New Hampshire is available at:
<http://healthmap.org/r/00-3> - CopyEd.EJP]

[see also:
Anthrax, human - USA: (NH) 20091227.4360]
....................mhj/ejp/lm

[Pathfinder]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

Anthrax vaccine, antibiotics offered in NH

<!--//Byline box//-->By Associated Press
Tuesday, December 29, 2009

CONCORD, N.H. ? Antibiotics and vaccines are being offered to about 80 people as New Hampshire authorities continue to investigate the nation?s first known case of gastrointestinal anthrax.

Officials still don?t know how the woman contracted the disease but are focusing on a drum playing gathering she attended last month. Anthrax spores have been found on two drums and an electrical outlet at the United Campus Ministry center in Durham, prompting officials to shut down the building and offer vaccines and antibiotics to those who attended the drum circle or live or work in the building.

Dr. Elizabeth Talbot, an adviser to the state?s public health division, says one theory is that vigorous drum playing sent the spores into the air, and the woman then swallowed them.

http://www.bostonherald.com/news/national/northeast/view/20091229anthrax_vaccine_antibiotics_offered_in_nh/srvc=home&position=recent

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

We will have to see exactly where else anthrax was found as we try to solve this mystery.

http://sentinelsource.com/articles/2009/12/30/news/local/free/doc4b3b715c3fb20342115507.txt

More traces of anthrax turn up in the state

But authorities feel the deadly condition is limited to an African drum circle in Durham early this month, and is not widespread.

One woman remains in critical condition in a Massachusetts hospital with the first case of gastrointestinal anthrax reported in the United States.

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

These two articles describe the same thing, but somewhat differently. Apparently the additional positive sample was from an electrical outlet (who would think to test that?) in the drumming room. Someone obviously played an infected drum.

http://www.bioprepwatch.com/news/211459-three-samples-test-positive-for-anthrax-in-nh

Three samples test positive for anthrax in N.H.
by Nick Rees on December 30, 2009
Anthrax
Three samples tested by the New Hampshire Department of Health and Human services have now been confirmed as positive for anthrax.

The tests follow the recent contraction of bacterial anthrax by a New Hampshire woman who is currently in critical condition in a New Hampshire hospital.

The Stafford County woman is believed to have contracted the anthrax infection following a drum circle she attended at the University of New Hampshire. Hazmat employees have been collecting samples from the United Campus Ministry to determine the source of the infection.

The third sample - an environmental sample - was collected from a Durham, N.H., United Campus Ministry building over the weekend.

The building has been shut down by officials following the discovery of two drums and electrical outlet found to be positive for anthrax spores. Department of Health and Human Services Commissioner Nicholas Toumpas ordered the closing.

The two drums, which were stored at the Ministry building, were found earlier to be positive for anthrax. Further samples have been submitted by the Public Health Labs from the drums and from the patient to determine if they are the same.

"This new information indicates there is a low level of contamination in the drum room at the Ministry building," Dr. Elizabeth Talbot, medical advisor to DPHS, told MyFOXBoston.com.

---------------------

http://www.mpbn.net/Home/tabid/36/ctl/ViewItem/mid/3483/ItemId/10374/Default.aspx

Rare Form of Anthrax Sickens New Hampshire Woman
12/30/2009 10:51 AM ET
The woman likely got sick while participating in a drumming circle in New Hampshire, authorities say.


A New Hampshire woman sicked by a rare form of anthrax likely contracted the illness while participating in a drumming circle in Durham, officials say. The woman, who has not been identified, was among about 60 people who attended the session December 4 at the United Campus Ministry near the University of New Hampshire in Durham, according to the New York Times.

The case is the first reported incidence of so-called gastrointestinal anthrax in the United States, according to the Associated Press. The extremely rare form of the disease typically occurs in people who eat infected meat, but can also sicken people who work with animal hides. Anthrax is usually contracted through cuts on the skin or by breathing in spores, health officials say.

Investigators found traces of anthrax on two African drums and an electrical outlet in the room where the drumming circle was held, the paper reports. They speculate that the drumming might have released anthrax spores into the air that the woman then swallowed.

Officials told the paper that the form of anthrax found on the drums is a naturally occurring strain that's often found in soil. Animals that ingest contaminated soil can pass the disease to people who handle their hides. Most of the drums at the event were made out of animal hides.

While it's unlikely that others will get sick from the event, authorities are offering antibiotics and vaccines to those who attended the session. Anthrax is more often contracted through cuts on the skin or by breathing in spores, health officials say.

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

A whole mess of info here. Apparently the victim was not drumming and the drum circle. The electrical outlet looks like an important clue. I had assumed it was airborne spread from a beaten drum, but the moderator here might be right - mechanical transfer by hand while plugging in an appliance might be a more likely source.

Also not clear is the type of drums involved. There is mention that some of the drums are synthetic, that is not made fro animals at all. It is not clear that any of the drums were recently imported from West Africa.

I'm not sure there are no other cases - perhaps someone else was misdiagnosed. Anthrax is not exactly common in that area.

http://www.promedmail.org/pls/otn/f?p=2400:1001:2393262913189066::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80695

Archive Number 20091230.4390
Published Date 30-DEC-2009
Subject PRO/AH/EDR> Anthrax, human - USA (03): (NH)

ANTHRAX, HUMAN - USA (03): (NEW HAMPSHIRE)
********************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: 29 Dec 2009
Source: New Hampshire DHHS Division of Public Health Services [edited]
<http://www.dhhs.nh.gov/DHHS/PIO/LIBRARY/Press+Release/cdcs_anthraxfindings.htm>


(DHHS) Division of Public Health Services (DPHS)
has confirmed a 3rd sample has tested positive
for anthrax. This 3rd sample is an environmental
sample collected from the United Campus Ministry
building in Durham over the weekend. The building
has been closed until further notice under an
order from DHHS Commissioner Nicholas Toumpas.

Earlier test results confirmed that 2 separate
drums stored at the Ministry building are
contaminated with anthrax. The Public Health Labs
have submitted samples from the drums and the
patient to the Centers for Disease Control and
Prevention (CDC) to determine if they are the
same.

"This new information indicates there is a low
level of contamination in the drum room at the
Ministry building," said Dr. Elizabeth Talbot,
Medical Advisor to DPHS. "This has prompted us to
offer antibiotics and the anthrax vaccine to
anyone who was at the drumming circle on 4 Dec
2009. We are contacting these individuals and
discussing possible treatment options with them.
Even though the risk of being infected remains
low for these individuals, we're taking these
precautionary measures." At this point, public
health officials believe the patient may have
become infected at a drumming circle that took
place in the Ministry building in Durham on 4 Dec
2009.

Because of the possible link to the African
drums, DHHS is asking anyone who brought their
own drum to the drumming circle held at the
United Campus Ministry on 4 Dec 2009 to call DPHS
at 271-4496 to discuss the possibility of having
their drum tested.

DPHS, along with the Department of Environmental
Services and the US Environmental Protection
Agency, are working closely with Durham public
safety officials and officials at the University
of New Hampshire on a location where residents
can drop off their drums in the coming days and
weeks for testing.

The patient from Strafford County was confirmed
with gastrointestinal anthrax, which is very
unusual. Of the 3 types of anthrax infections:
inhalation, cutaneous, and gastrointestinal, it
is the most rare. Anthrax is not an illness that
you can catch from someone else.

Contact Information:
Public Information Office: 603-271-4051

For more information about anthrax, visit
<http://www.emergency.cdc.gov/agent/anthrax/> or
<http://www.dhhs.nh.gov>. Anyone with questions
about anthrax can call DHHS? Division of Public
Health Services at 271-4496 or the Centers for
Disease Control at 1-800-CDC-INFO.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[2]
Date: 30 Dec 2009
Source: 9&10 News [edited]
<http://www.9and10news.com/category/story/?id=194661>


About 80 people are being offered antibiotics and
vaccines after a New Hampshire woman was
diagnosed with a rare gastrointestinal anthrax. A
state health expert says the woman may have
swallowed spores during a drum circle. About 60
people who attended the circle and students who
live and work at the University of New Hampshire
United Campus Ministry center are being offered
the medication.

See: <http://www.msnbc.msn.com/id/34624110/ns/health-more_health_news/>.

--
Communicated by:
ProMED-mail <promed@promedmail.org>

******
[3]
Date: 30 Dec 2009
Source: Seacostonline.com [edited]
<http://www.seacoastonline.com/articles/20091230-NEWS-912300362>


A New Hampshire woman diagnosed with a rare
gastrointestinal anthrax case may have swallowed
spores propelled into the air by vigorous
drumming, a state health expert said. Officials
haven't confirmed how the woman contracted the
disease but are focusing on a drum circle
gathering she attended on 4 Dec 2009 at the
United Campus Ministry center in Durham shortly
before becoming ill. Public health officials who
learned of her diagnosis last week immediately
began investigating, and earlier this week shut
down the ministry center after anthrax spores
were found on 2 drums.

Some health officials believe it's the nation's
1st case of gastrointestinal anthrax, but the
Centers for Disease Control and Prevention is
unsure. [I doubt that it is the 1st G/E case,
though it might be the 1st in the past few
decades. - Mod.MHJ]

Dr. Elizabeth Talbot, an adviser to the state's
public health division, said one theory is that
the woman ingested airborne spores from a drum's
animal-hide covering. "This was a wild type of
anthrax that is found ubiquitously in our
environment. It can become stirred up or agitated
to a place where it briefly suspends in the air,
and this patient likely contacted it on her
fingers and introduced it into her mouth or
inhaled a ... spore into her mouth, and then
swallowed it," she said.

Two recent U.S. anthrax cases involved African
drums covered with animal hides, but those
involved spores that were inhaled or entered
through the skin.

On Tuesday [29 Dec 2009], officials said spores
also were found on an electrical outlet at the
United Campus Ministry center and that
antibiotics and vaccines would be offered to
about 80 people, including about 60 who attended
the drum circle as well as University of New
Hampshire students who lived in the building and
those who worked there. Samples have been sent to
the CDC to determine whether the patient's
anthrax strain matches that found on the drums or
electrical outlet.

The ministry center is not part of the
university, but it houses students and runs a
variety of campus-based programs. Pastor Larry
Brickner-Wood, the center's director, said the
monthly drum circles involve people playing hand
drums and other percussion instruments to build
community spirit and promote well-being. "Our
thoughts and prayers remain with this young woman
and her family," he said.

[Byline: Holly Ramer]

--
Communicated by:
ProMED-mail <promed@promedmail.org>

[Some points need to be raised: One: The strain
genotypes have yet to be revealed. Two: _Bacillus
anthracis_ is not enzootic in New Hampshire or
anywhere else in New England. It isn't there
except on or in imported objects, such as West
African hides used for drum making. Therefore, it
is neither ubiquitous nor readily stirred up,
except maybe momentarily from a beaten
contaminated drum head. That an electrical outlet
was contaminated would suggest that spores had
gotten onto the hand (singular) of one of the
musicians [drummer?] when he or she was plugging
in an electrical device. Three: One needs a very
significant number of spores to induce an
infection in humans, especially in young adults.
One spore won't do it. - Mod.MHJ]

******
[4]
Date: 29 Dec 2009
Source: New York Times [edited]
<http://www.nytimes.com/2009/12/30/us/30anthrax.html>


A New Hampshire woman who is critically ill with
gastrointestinal anthrax most likely swallowed
spores while participating in a community
drumming circle, state health officials said
Tuesday [29 Dec 2009]. The United Campus Ministry
in Durham, N.H. is closed after a case of
gastrointestinal anthrax.

Investigators found traces of anthrax on 2
African drums and an electrical outlet in the
room where the event took place.

The ministry advertised the 4 Dec 2009 event on
its website as a drum circle and pasta supper.
Julie Corey, a drumming teacher who led the
session, said the victim had danced that night
instead of drumming. "She was the 1st to get up
and dance," Ms. Corey recalled, adding that she
thought the woman was a graduate student at
another college. "She's a vital young woman, from
what I've seen of her, a strong-spirited person."

Kris Neilsen, a spokeswoman for the State
Department of Health and Human Services, said
that after consulting with the F.B.I., the state
had concluded the anthrax strain was naturally
occurring [see comments above - Mod.MHJ] and
unrelated to terrorism [agreed - Mod.MHJ].

Leonard A. Cole, an expert on biological weapons
at Rutgers University, said additional cases from
the drum circle were unlikely because people
would usually have to ingest thousands of spores
to be infected. "Maybe this woman was unusually
susceptible," he said. "There's a fair chance a
lot of the others did have some contact with
spores but did not become infected" [not unlikely
-Mod.MHJ].

Ms. Corey, for one, said she was reluctant to
take the antibiotics. "I'm not in a panic state
about it," she said. "I've been exposed to drum
hides for 15 years, so what is really the
likelihood that it's a concern for me?" She also
worried aloud that the incident would scare
people out of participating in drum circles. "We
don't need to take something that is so positive
and healing and uplifting and all of the sudden
get it linked to a horrific disease," she said.
"I guess what I'll have to do from now on is say:
'Don't worry, I'm bringing my synthetic drums.'"

--
Communicated by:
ProMED-mail <promed@promedmail.org>


[Rather like the recent UK and NY drumming
experiences, the more you look, the more you find
on your swabs. If this young person was not
drumming that evening but trotting and dancing
around, it is hard to imagine how she acquired
enough spores. Maybe she leant over the
contaminated drums during a hot bit of drumming.
But if that was it, why is the drummer not sick?
It increasingly looks like some host factors were
key to this infection. - Mod.MHJ]

[see also:
Anthrax, human - USA (02): (NH) 20091229.4374
Anthrax, human - USA: (NH) 20091227.4360]
.............................................mhj/msp/lm

[Marsey]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

From wikipedia:

Occupational exposure to infected animals or their products (such as skin, wool, and meat) is the usual pathway of exposure for humans. Workers who are exposed to dead animals and animal products are at the highest risk, especially in countries where anthrax is more common. Anthrax in livestock grazing on open range where they mix with wild animals still occasionally occurs in the United States and elsewhere. Many workers who deal with wool and animal hides are routinely exposed to low levels of anthrax spores but most exposures are not sufficient to develop anthrax infections. Presumably, the body's natural defenses can destroy low levels of exposure. These people usually contract cutaneous anthrax if they catch anything. Historically, the most dangerous form of inhalational anthrax was called Woolsorters' disease because it was an occupational hazard for people who sorted wool. Today this form of infection is extremely rare, as almost no infected animals remain. The last fatal case of natural inhalational anthrax in the United States occurred in California in 1976, when a home weaver died after working with infected wool imported from Pakistan. The autopsy was done at UCLA hospital. To minimize the chance of spreading the disease, the deceased was transported to UCLA in a sealed plastic body bag within a sealed metal container.[12]

In November 2008, a drum maker in the United Kingdom who worked with untreated animal skins became the latest person to die from anthrax.[13] In December 2009 The New Hampshire Department of Health and Human Services has confirmed a case of gastrointestinal anthrax in an adult female. The CDC is currently investigating the source and the possibility that it was contracted from an African drum recently used by the woman.[14]

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

We may know more in the next 24 hours. Perhaps the woman plugged something into that outlet, and then put her hands to her mouth. As her own drum was synthetic (and possibly not even played), it is not the source of the infection, but someone else's drum might be.

http://www.fosters.com/apps/pbcs.dll/article?AID=/20091231/GJNEWS_01/712319769/-1/FOSNEWS

Anthrax from drums at ministry center in Durham still only a logical assumption

By Adam D. Krauss
akrauss@fosters.com
Thursday, December 31, 2009
DURHAM ? Until the results of certain tests are known the state's "strongest hypothesis" of what caused a Strafford County woman to contract anthrax at a local ministry center remans just that ? a logical assumption.

The state's Division of Public Health Services is waiting for the Centers for Disease Control and Prevention to say whether the anthrax strains found on two drums, or on samples taken from electrical outlets at the Waysmeet Center, match the strain infecting the woman, who is in critical condition with the nation's first case of gastrointestinal anthrax.

"If the patient's strain does not match the environmental specimen we would imagine this may be a baseline of the presence of anthrax in our environment," Dr. Elizabeth Talbot, a state public health adviser, said in an interview Wednesday. "If the drums have the same strain between them" and the woman it's "highly suggestive of a drum-based aerosolization event."

Such an event is the basis for what Talbot described as "our strongest hypothesis" of how the woman contracted the potentially fatal disease. She has said the naturally occurring, wild-type anthrax could have become "stirred up or agitated" during a Dec. 4 African drumming event at the center, with the woman either inhaling and swallowing the spores or getting them on her fingers before transferring them to her mouth.

The woman brought her own, synthetic drum to the event.

Investigators focused on the center after learning the woman participated in a drum circle there, and in recent years there have been three cases in the U.S. where people handling African drums made of animal hides contracted either cutaneous or inhalation anthrax.

Given the nature of naturally occurring anthrax, the public shouldn't be shocked if the results of CDC testing, which could be available late Friday, suggest the anthrax spores existed at the center before the event, Talbot said.

"If we sample everybody's backyard and everybody's electrical outlet it's not known what we would find, but most certainly there would be some positive results," she said. Talbot said the number of pathogens circulating in the environment is "staggering" and "many more than we know about right now."

She continued to address Wednesday the paradox between the anthrax being a ubiquitous and naturally occurring disease that rarely infects people.

"We have an innate immunity to the environmental pathogens that we encounter on a daily basis," she said. "We are endowed with protections against the organisms in our environment."

Talbot previously said the state had "not identified" a health condition in the woman that could have made her more susceptible to the disease. But, out of respect for the woman's family, she declined to further discuss Wednesday whether the woman was more at risk for the disease than some 60 other drummers who took part in the Dec. 4 event.

"For the majority of people who live with anthrax in their environment ... they will never become ill of this disease," Talbot said.

The state's investigation remains "very active," with officials having researched "every lead" to see if the woman contracted the disease from food, soils or animals, Talbot said. But as of Wednesday "there are no leads that are active for an animal or farm source for her infection," she said.

Anthrax cannot be transmitted from person to person, Talbot said. The disease is an acute infectious and potentially fatal disease that most commonly occurs in wild and domestic animals such as cattle, goats and antelopes, but it can also occur in humans exposed to infected animals.

There are no "other suspect anthrax cases that we're aware of" connected to this episode, Talbot said.

As a precaution, the state is offering antibiotics and the anthrax vaccine to the 60 drummers and 20 others who had access to the center, along with two lab workers at risk of exposure.

The center is home to United Campus Ministry, an interfaith ministry on Mill Road that serves as an outlet for University of New Hampshire students and the community. The center hosts a monthly drum circle that the Rev. Larry Brickner-Wood, executive director of United Campus Ministry, said brings together people to build community spirit and promote well-being. The center was closed by the state until further notice.

The state was still reaching out to the drummers Wednesday and officials could not provide a number of how many had sought the medicine. Officials also ask those who brought their own drums to offer them for testing by calling 271-4496.

Along with the CDC samples, the state is waiting for results of samples taken from the drums stored at the center and other environmental tests. Some of the results could be available today.

The state was able to rule out the use of anthrax as bioterrorism because the woman contracted an "environmental strain" and not one of the weaponized strains cultivated in a lab, Talbot said.

Additional testing and possible decontamination at the site will take place in the coming days, she said.

The woman remains at an undisclosed out-of-state hospital after being transferred from a New Hampshire facility.

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

And there's our answer. Now we seem to have just about all the pieces of the puzzle.

http://www.nytimes.com/aponline/2009/12/31/us/AP-US-Anthrax-Case.html

CDC: Same Anthrax Strain in Drums, Sick NH Woman
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By THE ASSOCIATED PRESS
Published: December 31, 2009
Filed at 4:32 p.m. ET

CONCORD, N.H. (AP) -- Medical investigators have confirmed that the strain of anthrax that sickened a New Hampshire woman is the same strain found on an electrical outlet and two drums used at a gathering she attended earlier this month.

Dr. Elizabeth Talbot, an adviser to the state Department of Health and Human Services, said the test results received Thursday from the Centers for Disease Control and Prevention bolster the theory that the woman swallowed airborne anthrax spores during a Dec. 4 drum circle performance at the United Campus Ministry center in Durham.

The woman, who is hospitalized in critical condition, has an extremely rare form of anthrax involving the gastrointestinal system.

Health officials are offering antibiotics and vaccines to about 80 others who attended the drum circle.

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[Shiloh]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

Source: http://www.unionleader.com/article.a...4-f031360ebc55

Anthrax found inside ministry, on two drums
By BETH LAMONTAGNE HALL
New Hampshire Union Leader

Health officials have confirmed the strain of anthrax that infected a woman at a drum circle gathering at the United Campus Ministry in Durham matches the strain found inside the ministry and on two drums used at the event.

Dr. Elizabeth Talbot, medical advisor to the state's Public Health Services, said yesterday that the discover further backs the theory that the woman got the rare form of anthrax at the campus ministry's Dec. 4 drum circle gathering. Health officials believe the anthrax was on the animal skins of the drums and was released into the air and ingested by the woman during the drumming.

The woman, who has contracted the first known case of gastrointestinal anthrax in the United States, remains in critical condition. Because this is the first case, scientists are trying to determine why the woman got sick and doctors are seeking the best way to treat her, Talbot said.

The state is offering an optional anthrax vaccine to the more than 80 people who attended the event or lived at the ministry. The United Campus Ministry building has been quarantined, Talbot said, and the public should not be concerned about contracting the virus.

"This is a very unusual but low-risk situation," she said.

The state also continues to track down and test the 66 drums believed used at the event. Talbot said anyone who brought a drum to the ministry on Dec. 4 should contact the health department at 271-4496.

Talbot said people who are interested in learning more about the link between animal skin drums and various forms of anthrax should go to the Centers for Disease Control Web site at www.cdc.gov.

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

I agree with the moderator - someone must have handled food the woman ate after getting spores on here hands. I wonder if the explanations in the moderator's comments aren't needlessly complicated - why couldn't the woman have gotten spores on her own hands (after handling someone else's drum or via aerosol), and then touched both the outlet and her own food?

http://www.promedmail.org/pls/otn/f?p=2400:1001:1941785925421433::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,80736

Archive Number 20100102.0020
Published Date 02-JAN-2010
Subject PRO/AH/EDR> Anthrax - USA: (NH)

ANTHRAX - USA: (NEW HAMPSHIRE)
******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Fri 1 Jan 2010
Source: Concord Monitor [edited]
<http://www.concordmonitor.com/apps/pbcs.dll/article?AID=/20100101/NEWS01/1010325/1001>


The strain of anthrax found on a Strafford County woman has been
determined to be the same as the one found on 2 drums used during a
drum circle the woman attended, state public health officials said
yesterday. DNA tests returned yesterday [31 Dec 2009] from the
federal Centers for Disease Control and Prevention show 4 samples of
anthrax taken from the United Campus Ministry's Waysmeet Center in
Durham are all the same. One was found on an electrical outlet, 2
were found in drums used during the [4 Dec 2009] drumming circle, and
the last was taken from the woman's body.

The woman, whose name has not been released, was stricken with
gastrointestinal anthrax after taking part in the drumming circle,
according to Dr Elizabeth Talbot, an adviser to the state's public
health division. Authorities are still unsure if the woman. She
remains in critical condition in a Massachusetts hospital.

Talbot said of the 66 drums at the circle, about 56 have been tested.
She urged the remaining drum owners to contact the authorities to
arrange testing. She said investigators thought from the start the
woman contracted anthrax contained within a drum, possibly when
spores were suspended in the air through repeated banging. While
yesterday's [31 Dec 2009] tests confirmed part of their hypothesis,
one question still remains: Where did the anthrax come from? "Our
priority to date clearly has been protecting the public and making
sure there are no additional exposures," Talbot said.

Investigators are working to track down historical information about
the anthrax strain. "It does attest to how rare it is," Talbot said.

Talbot said the public is not in danger. Anthrax cannot be spread
between people.

Health officials are offering vaccines to dozens of other people who
passed through the campus ministry center, but none appears ill.
About half have already been contacted to discuss taking vaccines.
The remaining participants are being asked to call the state
Department of Health and Human Services. Vaccines consist of 3
injections over a 2-week period. "It is a personal choice made on a
case-by-case basis made with consultation with the patient and their
doctor," Talbot said.

Meanwhile, the Waysmeet Center is still under quarantine as federal
and state health agents determine the best way to clean the area.

[Byline: Trent Spiner]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[That all 4 isolates are the same simplifies the issues, but still
leaves open why she has g/e anthrax and not the pneumonic form. If
one argues that it might be dependent on the major particle size --
that is, optimum for the nasal turbinates and pharyngeal drainage --
why wasn't the actual drummer infected? I suspect he had a sufficient
exposure as it was probably his hand that contaminated the electrical
outlet. Could it be that repeated prior exposures had made him
immune? In fact, the more I think about this the more I think a
quasi-airborne route of infection can be rejected. If it were so, the
past history of outbreaks in mills, tanneries, and bone meal plants
would have shown similar cases in the past. They don't. Those cases
were limited to cutaneous and pneumonic forms of the disease. All of
which makes me, granted as an outsider a few thousand miles away from
New Hampshire, think that she got infected through some contaminated
food, such as, a sandwich placed on one of the drumheads or that had
been handled by the drummer.

The drummer or drummers for those 2 contaminated drum heads is/are
very lucky. Have they been bled for evidence of previous exposures
and the immunity from which protected them this time? Has someone
gone around to their apartment(s)/house(s) to check that they are not
dead -- a characteristic of g/e anthrax is that it can kill within
hours.


One must note that there are 10 more drums whose laboratory results
are still awaited. Also we are assuming that a drummer associated
with either of the known 2 contaminated drums contaminated the
electrical outlet. Did he? Or was it someone else?

That both drumheads were the same strain is not surprising if the raw
hides were purchased in the same street market in West Africa.
Unfortunately the genomics of West African _Bacillus anthracis_ are
essentially a closed book. There are very few properly located
isolates from that region in the various global collections. And
correcting that has proven to be difficult. These strains are not
"rare", they are merely little understood at this time. Elsewhere
there is enough information to locate genomic strains to most
probable locations (plural as they travel) even if a specific strain
has not been seen before.

I pray that this young person will make it through. - Mod.MHJ]

[Durham, New Hampshire, can be located via the HealthMap/ProMED-mail
interactive map at
<http://healthmap.org/r/00-3>. - Sr.Tech.Ed.MJ]

[see also:
2009
----
Anthrax, human - USA (03): (NH) 20091230.4390
Anthrax, human - USA (02): (NH) 20091229.4374
Anthrax, human - USA: (NH) 20091227.4360]
...................................mhj/mj/lm

[alert]

Re: New Hampshire Woman Critical Because of Gastrointestinal Anthrax

So the woman's own drum is synthetic, and thus not involved, but several of the other drums were made in West Africa out of anmial skins.

http://www.boston.com/news/health/articles/2010/01/04/nh_anthrax_case_linked_to_animal_skinned_drums/

Drummer?s anthrax case spurs a public health hunt
(AP Photo/Jim Cole)
Firefighters worked to decontaminate items from a campus ministry at the University of New Hampshire in Durham, N.H., Tuesday, Dec. 29, 2009. New Hampshire's state public health director Dr. Jose Montero said a woman from the state contracted a case of gastrointestinal anthrax and is in critical condition.

By Sarah Schweitzer
Globe Staff / January 4, 2010
E-mail this article To: Invalid E-mail address Add a personal message80 character limit) Your E-mail: Invalid E-mail address
Sending your articleYour article has been sent. E-mail| Print| Reprints| Yahoo! Buzz| ShareThisText size ? + DURHAM, N.H. - The monthly drum circle in this college town is always a big draw, with a pasta supper beforehand and plenty of tambourines and West African djembe drums to go around.

Discuss
COMMENTS (16)
The crowd on a Friday night early last month was unusually large, drawn by word that an expert drummer would lead the session, and the 60-some percussionists produced a powerfully resonant sound, spurring participants to leap to their feet and dance.

?A wonderful space of energy and stress release,?? said Larry Brickner-Wood, the executive director of United Campus Ministry, a nonprofit interfaith center, where the drumming sessions are held.

Now, the exposure of one of the drummers to anthrax spores - bringing to mind images of the 2001 poison letters aimed at congressmen and the media - has authorities scrambling.

State officials are trying to find everyone who attended the drum circle, offering to vaccinate them and hoping to gather information that will explain how one young woman contracted a case of gastrointestinal anthrax a short time after attending the event.

Officials suspect that the woman, who has not been identified and is in critical but stable condition at a Massachusetts hospital, ingested anthrax spores released from animal-skin-covered drums. Some drums used at the center were made in West Africa, though others came from the United States and Canada.

On Thursday, New Hampshire officials confirmed that the strain of anthrax spores found on two drums used at the Dec. 4 drumming circle, as well as on an electrical socket at the United Campus Ministry, matched the anthrax strain that infected the woman. The officials have taken 56 other drums for testing.

The woman, who is not a student, brought her own synthetic drum to the circle on Dec. 4.

Gastrointestinal anthrax is exceedingly rare in the United States, with only one case on record, reported in 1942, according to the Centers for Disease Control and Prevention. Anthrax is more often contracted by breathing the spores or by absorption through cuts or abrasions on the skin, but that is also rare, CDC officials said. There were 236 cases of anthrax reported to the CDC between 1955 and 1999.

?We have a very unusual situation,?? said Elizabeth Talbot, a professor of infectious diseases at Dartmouth Medical School who is acting as medical adviser to the state.

Officials cautioned that the anthrax contracted by the woman is different from weaponized anthrax, a manufactured variety that is treated so that it remains suspended in the air for long periods, creating a greater chance it will be inhaled. The anthrax involved in this case is nonweaponized or wild anthrax, Talbot said, adding that it is not contagious.

Still, the incident has concerned residents of Durham, home to the University of New Hampshire, where residents have been calling town offices with questions about the well-being of friends who might have attended the drum circles, and asking what they should do with their own animal-hide drums.


The town is working with the state to assign a location where residents will be able to bring their drums for evaluation, said Todd Selig, Durham?s town manager.

Discuss
COMMENTS (16)
Meanwhile, drummers from across the region, too, are asking questions.

?People who bought drums from me are contacting me because they want to know if they can get sick from it,?? said Alan Tauber, director of musical studies at the DrumConnection, which has offices in Arlington.

According to the CDC, the risk of acquiring anthrax from an animal-hide drum is very low. Only a handful of cases have been associated with animal-hide drums. The first documented case of anthrax linked to a hide drum occurred in Florida in 1974. In 2006, a 44-year-old New York man contracted inhalation anthrax while using unprocessed goat skins from Ivory Coast to make drums; he spent more than a month in the hospital but survived. In 2007, two Danbury, Conn., men contracted cutaneous anthrax while handling untanned animal hides.

Inhalation anthrax is generally more severe than gastrointestinal anthrax; cutaneous can be less or more severe, said Theresa L. Smith, a branch chief in the CDC?s division of foodborne, bacterial, and mycotic diseases

Anthrax spores are formed by naturally occurring bacteria in soil, according to the CDC. Animals that ingest the contaminated soil pass the disease to people who handle their hides or eat undercooked meat. While anthrax is rare in the United States, it is more common in other parts of the world, such as sub-Saharan Africa.

Symptoms of anthrax include nausea, loss of appetite, and fever, followed by abdominal pain and vomiting of blood. The incubation period is anywhere from three to 60 days, which has led New Hampshire state officials to offer antibiotics and a vaccine series, three shots given two weeks apart, to anyone who was present at the Dec. 4 event in Durham, or who lives or works at United Campus Ministries, even though they say that the risk to these individuals is very low.

For now, United Campus Ministries has been quarantined and this week, yellow police tape was wrapped around the building, while signs on the entry door warned people to stay out.

?It?s so bizarre that [anthrax] is right here in Durham,?? said Pam Hilton, a volunteer at a nonprofit with offices across the street.

Brickner-Wood said the center has been hosting monthly drumming events for about the last five years using drums, primarily djembes, that he has collected. Most of his drums are made from goat skin, he said.

?I just hope this doesn?t indict the act of drumming,?? he said.

? Copyright 2010 Globe Newspaper Company.