Appendix

PRIVILEGED

Appendix: Special Session with Dr. V.N. Nikiforov
and Dr. Olga Yampolskaya

A special informal session was held with Dr. V.N. Nikiforov and
Dr. Olga Yampolskaya from 10:00 a.m. - 12:00 on Friday, October 10,
1986, at the Shemyakin Institute of Bioorganic Chemistry. Present at
the session were: Dr. Sverdlov, Dr. Lederberg, Dr. Bennett, Dr.
Marks, Dr. Woodward, Lynn Rusten and an interpreter from the Academy
of Sciences of the U.S.S.R. Dr. Nikiforov and Dr. Yampolskaya from
the Ministry of Health treated the victims of the 1979 Sverdlovsk
outbreak. This appendix summarizes the information they shared about
the Sverdlovsk epidemic.

Dr. V.N. Nikiforov said he was Chairman of the Department of
Infectious Diseases, Central Institute for Post-Graduate Training,
Moscow. His Department had 360 beds, and 280 M.D.'s were trained per
year in infectious disease. Twenty-eight thousand physicians were
trained per year in the Post-Graduate Institute which had 110
departments. Training periods were for 1 to 4 months. He said there
were 1,200,000 M.D.'s in the U.S.S.R. Olga Yampolskaya said she was
an assistant in Nikiforov's Department. She spent half of each day
caring for patients and half of each day providing practical
instruction for M.D.'s. She said her research was mostly involved in
clinical observations on virus hepatitis, and the Institute of
Virology performed the laboratory studies. Nikiforov's Department
had two docents, six assistants (of which Yampolskaya was one) and
twenty-two other M.D. 's.
Appendix

Nikiforov said he was generally called to consult on all
outbreaks of infectious disease in the U.S.S.R. In the Sverdlovsk
epidemic of 1979, Nikiforov was called by Professor Kortev, Chairman
of Infectious Disease. in the Sverdlovsk Medical Institute. Nikiforov
said he was called two to three days after the first two cases of
acute severe illness were seen. When Nikiforov arrived in Sverdlovsk
his first impression was that these patients had a very serious
disease which was strange. He said his first impression was that it
was due to an intoxication -=- but the high fever made him consider
infection. After being present at the first autopsy (on April 6 or
7), he thought it might be intestinal anthrax. Nikiforov said that
Dr. Peter Burgasov, Deputy Minister of Health for the U.S.S.R, was
involved in providing overall direction for dealing with the
epidemic. Burgasov had retired one week prior to this meeting. Dr.
Ivan Bezdenejnich, Chief Epidemiologist of the Russian Federation
Department of Health, was the epidemiologist called to Sverdlovsk and
responsible for acammulating the epidemiological data during the
Sverdlovsk anthrax epidemic. Nikiforov said Bezdenejnich died during
the month prior to this meeting. Yampolskaya said she learned about
the epidemiologic data when she heard Bezdenejnich's presentation to
Professor Matthew Meselson in August 1986.

In response to a question, Nikiforov indicated there were some
instances of miltiple cases in a single family, but did not have the
exact data. These data were obtained by Bezdenejnich. Nikiforov
said he had seen about 100 to 120 cases of gastrointestinal anthrax
prior to the Sverdlovsk outbreak, and all had died. Thus, he said
that fifteen of seventy-nine in the Sverdlovsk outbreak were saved
was unusual. He believed more individuals ate contaminated meat than
became ill and died. He believed illness was determined by dosage of
anthrax organism and state of health of the host. He said variation
in preparation of food might also be a determinant. Nikiforov said
the Sverdlovsk epidemic took on a political coloring for him only
when Meselson arrived in August 1986.
Appendix

3
Nikiforov said that only one child - a six year old girl - fell
ill. Yampolskaya gave the following age distribution of the
victims:

Age Number of Victims
under 20 (female child, age 6) 1
20 - 29 11
30 - 39 10
40 - 49 32
50 = 59 10
over 59 12

Nikiforov said there were 17 dermal cases, and out of those 6
became generalized. He said the usual percentage of dermal cases
that became generalized was 5%. He said that in the Soviet Union,
dermal cases which were not serious did not regularly go to the
hospital.

Of the lethal cases, none of the victims had skin lesions.
Nikiforov said there was nothing unusual about this particular strain
of anthrax. He said there were many degrees of virulence of strains
in the Soviet Union, and confirmed that there was a correlation
between the thickness of encapsulation and the virulence of the
strain.

When asked if any examples of this strain had been preserved,
Nikiforov said perhaps, but he did not know for sure. He did not
preserve the strain. He explained there was a special institute that
dealt with dangerous strains and that perhaps it had kept samples.

Nikiforov said he did not know how air samples had been taken in
the hospital rooms of the victims, but said he thought the surfaces
and dust had been analyzed. He said cultures of air samples were
negative.

When asked if there had been other cases of anthrax in Sverdlovsk
since the 1979 incident, Nikiforov said there had been no cutaneous
. cases in the city of Sverdlovsk. However, he said that in Sverdlovsk
Appendix

4
oblast there were some cases every year, and that there had been
three cases of cutaneous anthrax and cases of gastrointestinal and
generalized form of the disease.

When asked if he had ever seen a case of pulmonary anthrax,
Nikiforov responded that he had seen such cases in Albania, where he
had worked for three years. When asked what the lungs looked like in
those cases, he said the main symptom was hemorrhagic edema of the
lungs, and that they did not resemble the brain shown in his autopsy
slides the previous day. When asked if he was surprised that the
patient with the severely affected brain did not have damaged lungs,
Nikiforov responded that in that case the lungs were affected partly,
that there was some hemorrhaging.

Woodward asked whether a vaccine program was begun. Nikiforov
explained that the Soviets vaccinate two million people every year
against anthrax. He said that thirty districts in the Sverdlovsk
region were regularly vaccinated in the spring, but that if there
were an outbreak, then the plan called for immediate vaccination
regardless of the time of year. Nikiforov said, then, that in this
case the vaccination time was changed to take place right after this
outbreak, but he emphasized that this was not a special program of
vaccination,- but an additional vaccine ditribution at that time, as
called for in their plan. (There was some confusion in Nikiforov's
answer to the questions on this topic.) When asked whether the
vaccine against anthrax was effective in people, Nikiforov said it
was his personal opinion that it was not effective.

Asked which antibiotics were used for prevention, Nikiforov said
that for the families of the victims it was his personal opinion that
antibiotics in the tetracycline family were most effective, though he
had no statistics to validate this. He said there were some people
who received antibiotics but fell ill. In fact, he said those people
had very severe symptoms and did not survive. In response to another
question, Nikiforov said there were variations in the time of onset
when there was more than one case in a family. As best he could
Appendix

5
recollect, Nikiforov said there were perhaps ten families which had
more than one case. He said he could look up the exact number
later. When asked by Marks if he had lectured about this outbreak,
Nikiforov responded that he had lectured many times in Sverdlovsk
about this epidemic and that he gave this lecture and the slides he
had shown this group to many Soviet doctors.

Lederberg urged Nikiforov to publish this information in detail
because it was so important and scientifically interesting.

Lederberg then spent a few minutes explaining to Nikiforov the news
sources (New York Times article of July 16, 1980, was given to
Nikiforov) of the rumors about the Sverdlovsk outbreak resulting from
an accidental release of anthrax spores from a closed BW facility.
Lederberg asked if they had heard these kinds of rumors when they
were in Sverdlovsk. Yampolskaya resporded that she did not hear
these rumors in Sverdlovsk, but did hear them afterwards in Moscow.

Lederberg asked them how these rumors might have started.
Sverdloy interjected with an anecdote of how he had taken in Soviet
evacuees, whom he did not know, from Kiev to stay with him after the
Chernobyl accident. One of these women was very concerned that her
hair would fall out, and she asked for daily blood tests. She
refused to believe that the results were negative, and insisted on
independent confirmation. She also told Sverdlov that she was sure
her friend in Kiev had lost her hair. Sverdlov reported that the
friend later came to visit, and had a full head of hair. He told
this story as an example of how rumors spread. Nikiforov agreed that
the New York Times article about the Sverdlovsk outbreak which
Lederberg showed him reflected similar kinds of rumors. Nikiforov
related a story about a cholera epidemic, during which he heard
reports of his own death over the radio.

In the New York Times article, a map of the Sverdlovsk region was
reproduced showing Sverdlovsk and a town, Kashino, 18 miles SE, which
was cited as a locale of additional cases of anthrax. Nikiforov said
he did not know of such a town. Yampolskaya also indicated she had
Appendix

6
not heard of any of the three towns indicated on the map reproduced
in the New York Times -- Polevskoi, Sysert or Kashino.

When asked about the sanitation measures that were taken,
Nikiforov said he did not know in great detail. He said they did
burn old buildings where the contaminated animals had been kept. He
said these were mostly in the suburbs, where people kept their
private animals. He said the diseased animals were also burned, not
buried. He said only one or two sheds within the city were burned,
but many in the suburbs were burned. Yampolskaya recalled that they
were in the south part of the city.

Lederberg said there were rumors that the hospital was taken over
by military personnel. Nikiforov adamantly said there was not one
military person there, not even one policeman. He said he thought
the epidemic station did the burning, not the military. In response
to a question, Nikiforov said these sheds were burned in the middle
and end of April.

Sverdlov noted that it was not umusual for the military to be
requested to help in some cases. He referred to a fire that took
place in Zagorsk just a few days ago, at which he said military men
were used to help fight it. Sverdlov said that was a natural thing
and did not mean that the burned structures were military properties.

Woodward asked how dermal anthrax was treated. Nikiforov
indicated he treated dermal lesions with penicillin -- 30 million
units every 24 hours, until the fever disappeared and the dermal
lesions regressed, usually in seven to ten days. Nikiforov said he
believed patients with dermal lesions did not gain immunity to future
infections.

Lederberg expressed his gratitude to Nikiforov and Yampolskaya
for their time and willingness to discuss this outbreak in such great
detail. The session adjourned at 12:00 p.m.

Lynn Rusten