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On Thursday, October 4, 2001, just 24 days after the tragic events of September 11, the Florida Department of Health and the Centers for Disease Control and Prevention (CDC) confirmed the first case of inhalational anthrax in the United States in more than 25 years. Recognition of this unexpected case is attributed to the alertness of local infectious disease physician Larry Bush, who promptly notified Jean Malecki, director, Palm Beach County Health Department (1,2). By Saturday, October 6, a team of federal, state, and local public health and local law enforcement investigators identified intentional Bacillus anthracis spore contamination at the patient’s workplace. These events marked the beginning of the first U.S. outbreak of bioterrorism-related anthrax and (for many of us in clinical medicine, public health, and law enforcement) ushered in the transition from tabletop bioterrorism exercises to real-world investigation and response.

Public Health in the Time of Bioterrorism