Addressing Residual Risk Issues at Anthrax Cleanups: How Clean is Safe?

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Abstract
Since the 2001 attacks in which Bacillus anthracisspores were mailed to various media offices and two U.S. Senators, considerable interest has focused on developing estimates of the risk of contracting inhalational anthrax from exposure to such spores. Credible risk estimates would have significant utility in establishing future cleanup goals for contaminated sites. To perform a meaningful risk assessment, one needs sufficient data to identify the hazards, conduct dose-response assessment, and assess exposure. This report reviews the existing data on mortality produced by Bacillus anthracisspores in laboratory animals and humans. In particular, it focuses on the 11 cases of inhalational anthrax resulting from the 2001 attacks and their impact on hazard identification activities. It also addresses factors that may contribute to increased risk among exposed populations and the sources of uncertainty in dose response analysis. The article examines the state of the science for assessing exposure levels to Bacillus anthracis spores and concludes that significant challenges exist to performing robust assessments of risk. This conclusion supports the policy position of the U.S. Environmental Protection Agency (EPA) that there should be no growth of Bacillus anthracis spores from all postremediation environmental samples, for the cleanup of a site to be judged effective and for that site to be considered safe for reoccupancy. This has been the ultimate criterion for efficacy of cleanups performed in response to the 2001 anthrax attacks.