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From the Centers for Disease Control and Prevention
November 21, 2001

Interim Recommendations for Protecting Workers From Exposure to Bacillus anthracis in Work Sites in Which Mail Is Handled or Processed

Author Affiliations

Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

JAMA. 2001;286(19):2397. doi:10.1001/jama.286.19.2397-JWR1121-4-1

MMWR. 2001;50:961

CDC has developed interim recommendations to assist personnel responsible for occupational health and safety in developing a comprehensive program to reduce potential cutaneous or inhalational exposures to Bacillus anthracis spores among workers in work sites in which mail is handled or processed. Such work sites include post offices, mail distribution/handling centers, bulk mail centers, air mail facilities, priority mail processing centers, public and private mail rooms, and other settings in which workers are responsible for handling and processing mail. The recommendations are based on the limited information available on methods to avoid infection and on the effectiveness of various prevention strategies. These recommendations will be updated as new information becomes available.

The recommendations are divided into the following hierarchical categories describing measures that should be implemented in distribution/handling centers to prevent potential exposures to B. anthracis spores:

  • Engineering controls to prevent or capture aerosolized spores

  • Administrative controls to limit the number of persons potentially exposed to spores

  • Housekeeping controls to further reduce the spread of spores

  • Personal protective equipment for workers to prevent cutaneous and inhalational exposure to spores

These control measures should be selected on the basis of an initial work site evaluation that focuses on determining which processes, operations, jobs, or tasks would be most likely to result in an exposure if a contaminated envelope or package enters the work site. The complete interim recommendations are available at