Several U.S. anthrax infections have been identified since the 2001 Amerithrax attacks. These cases were investigated by a number of local, state and federal agencies, and most were subsequently associated with exposure to imported animal hides contaminated with anthrax spores of natural origin (5Á7). Each incident presented a unique diagnostic challenge since all three forms of the disease (inhalation, cutaneous and gastrointestinal) were identified. All of the cases were reviewed to determine which laboratory and surveillance systems were used to first identify possible cases and the number of days required to confirm the diagnosis of anthrax. The role of syndromic surveillance and other advanced surveillance systems in identifying these cases and searching for additional cases was evaluated. Efforts to coordinate surveillance and communication efforts among the various jurisdictions involved in the investigation of these cases were also noted.