Table 6.
Scoring system for early orientation and differentiation between natural and deliberate epidemics
| Category | Type of Variable | Indicator | Scorea |
|---|---|---|---|
| Cases (person) | Qualitative | Unusual/atypical disease/manifestation (symptoms/signs) or unexpected fulminant course of disease in humans and/or animals | |
| Failure of patient to respond to usual therapy or illness in a population (human, animal) despite immunizations | |||
| Several unusual/unexplained syndromes coexisting in the same case without any other explanation | |||
| Quantitative | Sudden unexplainable increase in the number of cases or deaths in human and/or animal populations | ||
| Morbidity and/or mortality higher than expected | |||
| Clustering of patients with fever and/or fever and respiratory symptoms and/or lymphadenopathy | |||
| Spatial distribution (place) | Qualitative | Disease with an unusual geographic distribution | |
| Occurrence of a nonendemic (imported) or previously eradicated disease | |||
| Epidemiologic data suggesting a common exposure | |||
| Quantitative | Simultaneous epidemics and/or epizootics occur at different locations | ||
| Time distribution (time) | Qualitative | Disease identified in the region for the first time ever or again after a long period | |
| Disease with an unusual/atypical seasonal distribution | |||
| Quantitative | Simultaneous occurrence of epidemics and/or epizootics | ||
| Explosive epidemics and/or epizootics with indicators on a point source origin | |||
| Totalb | |||
a
Score each indicator as present/yes = 1 or absent/no = 0.
b
Total = 1–4, natural epidemic; 5–9, probable deliberate or accidental outbreak; 10–14, highly probable deliberate or accidental outbreak.
Data from Radosavljevic V, Belojevic G. Unusual epidemic events: a new method of early orientation and differentiation between natural and deliberate epidemics. Public Health 2012;126(1):77–81.