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Anthrax Exposure, Belief in Exposure, and Postanthrax Symptoms Among Survivors of a Bioterrorist Attack on Capitol Hill

Published online by Cambridge University Press:  12 November 2018

Stephanie Chiao*
Department of Internal Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
Howard Kipen
Environmental and Occupational Health Sciences Institute and School of Public Health, Rutgers University, Piscataway, New Jersey
William K. Hallman
Department of Human Ecology, School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey
David E. Pollio
Department of Social Work, College of Arts and Sciences, University of Alabama Birmingham, Birmingham, Alabama
Carol S. North
The Altshuler Center for Education & Research at Metrocare Services and the Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, Texas
Correspondence and reprint requests to Stephanie Chiao, 525 E. 68th Street, Box 140, New York, NY, 10065 (e-mail:



Following chemical, biological, radiological, and nuclear disasters, medically unexplained symptoms have been observed among unexposed persons.


This study examined belief in exposure in relation to postdisaster symptoms in a volunteer sample of 137 congressional workers after the 2001 anthrax attacks on Capitol Hill.


Postdisaster symptoms, belief in exposure, and actual exposure status were obtained through structured diagnostic interviews and self-reported presence in offices officially designated as exposed through environmental sampling. Multivariate models were tested for associations of number of postdisaster symptoms with exposure and belief in exposure, controlling for sex and use of antibiotics.


The sample was divided into 3 main subgroups: exposed, 41%; unexposed but believed they were exposed, 17%; and unexposed and did not believe that they were exposed, 42%. Nearly two-thirds (64%) of the volunteers reported experiencing symptoms after the anthrax attacks. Belief in anthrax exposure was significantly associated with the number of ear/nose/throat, musculoskeletal, and all physical symptoms. No significant associations were found between anthrax exposure and the number of postdisaster symptoms.


Given the high incidence of these symptoms, these data suggest that even in the absence of physical injury or illness, there may be surges in health care utilization. (Disaster Med Public Health Preparedness. 2019;13:555-560)

Original Research
Copyright © 2018 Society for Disaster Medicine and Public Health, Inc. 

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