October 17, 2001

Dear Colleague:

The terrorist attacks of September 11 and the events that have occurred during subsequent weeks have challenged this country's basic assumptions about safety. Despite these challenges, the nation and this state remain strong and, with your help, will remain secure. As Gov. George H. Ryan said in his address this week, "Our innocence lies buried in the ruins of the World Trade Center, but not our hope and determination."

Recent acts by unknown persons using biological agents have led to the infection of people in Florida and New York with Bacillus anthracis (anthrax). This has caused concern throughout the nation. Since the first case was reported, numerous people have sought advice from their physicians, public health authorities, police and the media. As a result, the public health system as well as supplies of essential antibiotics are being stretched. In addition, the focus on anthrax may distract health professionals from being alert to other biological or chemical agents.

As a physician in this state, you are an important part of the national response system, the strength of which serves as the foundation of the country's preparedness. That strength is drawn from the physician-patient relationship and from the reliance on science-driven, evidence-based practice. Further, the ability to respond is based on the identification of a potential bioterrorism incident. The current system of reporting infectious diseases is the basis for surveillance during normal times; in the present situation, it is instrumental to national security.

I am sending this letter to request your support and cooperation, during this time of crisis, in three areas.

First, a physician's primary responsibility is to his/her patients. In the aftermath of the attacks and the daily headlines about anthrax, many people are afraid. If any of your patients have received a suspicious letter, package or substance, they should contact their local police. It is the role of law enforcement to determine the credibility and risk associated with such items.

However, you can expect your patients to ask for advice about prophylaxis or treatment for a suspected anthrax exposure. Enclosed with this letter are treatment and prophylaxis recommendations from the U.S. Centers for Disease Control and Prevention (Attachment 1). Antibiotics should not be prescribed for an asymptomatic individual unless there is an indication from the Illinois Department of Public Health or a local health department that a presumptive positive or confirmed positive exposure has occurred. The nation's supply of Cipro™ (ciprofloxacin) will be rapidly exhausted by clinicians who are prescribing the drug for non-indicated prophylaxis or to build a personal stockpile. Moreover, such action increases the likelihood that resistant strains of bacteria will emerge.

Your patients may be coming to see you because of excessive fear, depression or other reactions to the current emotional climate of the nation. Please keep this in mind as you respond to requests to screen patients. Appropriate referral for counseling services should be considered.

Second, please familiarize yourself with the signs and symptoms of organisms and agents that are considered to be likely weapons of mass destruction. A summary of those is included with this letter (Attachment 2) and additional information can be found at the following Web sites:

American College of Physicians
American Society for Microbiology
Association for Professionals in Infection Control
CDC Bioterrorism Preparedness and Response
Infectious Disease Society of America
Johns Hopkins Center for Civilian Biodefense
U.S. Army Medical Research Institute of Infectious Diseases
Consensus statements published in the Journal of the American Medical Association

Third, as never before, your participation in the infectious disease reporting system is absolutely essential to the security of this nation and this state. The detection of unusual patterns of illness is key to the identification of public health threats that may occur naturally or as acts of terror. I am enclosing the list of reportable illnesses and information about how to report (Attachment 3). I urge you to review this information and to cooperate in this critical disease reporting process. While I am aware that you are busy with many responsibilities, a robust surveillance system that draws on the full participation of health care professionals ensures that state and local health departments have accurate data on which to base their actions.

Thank you for your ongoing cooperation. What you do in your daily practice is key to this country's national defense as well as to the health and well-being of the people of this state. I look forward to a continuing partnership on behalf of the people of Illinois.


John R. Lumpkin, M.D.
Director of Public Health