TABLE 8.4.

Recommendations for level of public health involvement for investigation of potential biologic or chemical terrorism

Initial investigation at the local level a.Higher morbidity and mortality than expected, associated with a common disease or syndrome b.Disease with an unusual geographic or seasonal distribution c.Multiple unusual or unexplained disease entities coexisting in the same patient d.Unusual illness in a population (e.g., renal disease in a large population which may be suggestive of toxic exposure to an agent such as mercury) e.Ill persons seeking treatment at about the same time f.Illness in persons suggesting a common exposure (e.g., same office building, meal, sporting event, or social event)

Continued investigation with involvement of the state health department and/or Centers for Disease Control and Prevention a. At least a single, definitively diagnosed case(s) with one of the following: —Uncommon agent or disease —Illnessdue to a genetically altered organism b.Unusual, atypical, or antiquated strain of agent c.Disease with unusual geographic, seasonal, or “typical patient” distribution d.Endemic disease with unexplained increase in incidence e.No illness in persons not exposed to common ventilation systems f.Simultaneous clusters of similar illness in non-contiguous areas, domestic or foreign g.Cluster of patients with similar genetic type among agents isolated from temporally or spatially distinct sources

(modified from ref. 17)