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1.
Single case of disease caused by an uncommon agent (e.g., glanders, smallpox, viral hemorrhagic fever, inhalation or cutaneous anthrax) without adequate epidemiologic explanation
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2.
Unusual, atypical, genetically engineered, or antiquated strain of an agent (or antibiotic-resistance pattern)
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3.
Higher morbidity and mortality in association with a common disease or syndrome or failure of such patients to respond to usual therapy
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4.
Unusual disease presentation (e.g., inhalation anthrax or pneumonic plague)
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5.
Disease with an unusual geographic or seasonal distribution (e.g., plague in a nonendemic area, influenza in the summer)
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6.
Stable endemic disease with an unexplained increase in incidence (e.g., tularemia, plague)
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7.
Atypical disease transmission through aerosols, food, or water, in a mode suggesting sabotage (i.e., no other possible physical explanation)
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8.
No illness in persons who are not exposed to common ventilation systems (have separate closed ventilation systems) when illness is seen in persons in close proximity who have a common ventilation system
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9.
Several unusual or unexplained diseases coexisting in the same patient without any other explanation
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10.
Unusual illness that affects a large, disparate population (e.g., respiratory disease in a large heterogeneous population may suggest exposure to an inhaled pathogen or chemical agent)
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11.
Illness that is unusual (or atypical) for a given population or age group (e.g., outbreak of measles-like rash in adults)
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12.
Unusual pattern of death or illness among animals (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in humans
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13.
Unusual pattern of death or illness in humans that precedes or accompanies illness or death in animals (which may be unexplained or attributed to an agent of bioterrorism)
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14.
Ill persons who seek treatment at about the same time (point source with compressed epidemic curve)
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15.
Similar genetic type among agents isolated from temporally or spatially distinct sources
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16.
Simultaneous clusters of similar illness in noncontiguous areas, domestic or foreign
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17.
Large numbers of cases of unexplained diseases or deaths
