In Washington

Purpose of Reporting and Surveillance

• To notify appropriate agencies and mobilize necessary resources for public health response and possible criminal investigation.

Reporting Requirements

• Health care providers: immediately notifiable to Local Health Jurisdiction
• Hospitals: immediately notifiable to Local Health Jurisdiction
• Laboratories: see disease-specific requirements
• Local health jurisdictions: suspected or confirmed cases are immediately notifiable to DOH Communicable Disease Epidemiology: 1-877-539-4344

Clinical Criteria for Diagnosis

See disease-specific guidelines.

Epidemiologic Clues That May Signal A Possible Bioterrorism Event

• Large numbers of ill persons with a similar disease or syndrome.
• Large numbers of cases of unexplained diseases or deaths.
• Unusual illness in a population (e.g., renal disease in a large population may suggest exposure to a toxic agent such as mercury).
• Higher morbidity and mortality in association with a common disease or syndrome or failure of such patients to respond to usual therapy.
• Single case of disease caused by an uncommon agent (e.g., Burkholderia mallei or B. pseudomallei, smallpox, viral hemorrhagic fever, pulmonary anthrax)
• Several unusual or unexplained diseases coexisting in the same patient without any other explanation.
• Disease with an unusual geographic or seasonal distribution (e.g., tularemia in a nonendemic area, influenza in the summer).
• Illness that is unusual (or atypical) for a given population or age group (e.g., outbreak of measles-like rash in adults).
• Unusual disease presentation, (e.g., pulmonary instead of cutaneous anthrax).
• Similar genetic type among agents isolated from distinct sources at different times or locations.
• Unusual, atypical, genetically engineered, or antiquated strain of an agent (or antibiotic resistance pattern).
• Stable endemic disease with an unexplained increase in incidence (e.g., tularemia, plague).
• Simultaneous clusters of similar illness in noncontiguous areas, domestic or foreign.
• Aerosol route of infection or other atypical pattern of disease transmission.
• Ill persons who seek treatment at about the same time (point source with compressed epidemic curve).
• 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.
• 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.

Reference:  Biological Warfare & Terrorism, The Military and Public Health Response, Satellite Broadcast, September 21-23, 1999.

Bioterrorism Agent Categories

Category A
The US public health system and primary healthcare providers must be prepared to address varied biological agents, including pathogens that are rarely seen in the United States. High-priority agents include organisms that pose a risk to national security because they:

• can be easily disseminated or transmitted person-to-person,
• result in high mortality rates and have the potential for major public health impact,
• might cause public panic and social disruption, and
• require special action for public health preparedness.

Category A agents include:

• Anthrax (Bacillus anthracis)
• Smallpox (variola major)
• Plague (Yersinia pestis)
• Botulism (Clostridium botulinum toxin)
• Tularemia (Francisella tularensis)
• Filoviruses (e.g., ebola hemorrhagic fever, marburg hemorrhagic fever)
• Arenaviruses (e.g., Lassa (Lassa Fever), Junin (Argentine hemorrhagic fever) and related viruses)

Category B

The second highest priority agents include those that:

• are moderately easy to disseminate,
• result in moderate morbidity rates and low mortality rates, and
• require specific enhancements of CDC’s diagnostic capacity and enhanced disease surveillance.

Category B agents include:

• Brucellosis (Brucella species)

• Epsilon toxin of Clostridium perfringens

• Food safety threats (e.g., Salmonella species, Escherichia coli O157:H7, Shigella)

• Glanders (Burkholderia mallei)

• Melioidosis (Burkholderia pseudomallei)

• Psittacosis (Chlamydia psittaci)

• Q Fever (Coxiella burnetti)

• Ricin toxin from Ricinus communis (castor beans)

• Staphylococcal enterotoxin B

• Typhus fever (Rickettsia prowazekii)

• Viral encephalitis (e.g., Venezuelan equine encephalitis, eastern and western equine encephalitis)

• Water safety threats (e.g., Vibrio cholerae, Cryptosporidium parvum)

Category C

Third highest priority agents include emerging pathogens that could be engineered for mass dissemination in the future because of:

• availability,
• ease of production and dissemination, and
• potential for high morbidity and mortality rates and major health impact.

Category C agents include:

• emerging infectious disease threats such as Nipah virus and hantavirus

Preparedness for List C agents requires ongoing research to improve disease detection, diagnosis, treatment, and prevention. Knowing in advance which newly emergent pathogens might be employed by terrorists is not possible; therefore, linking bioterrorism preparedness efforts with ongoing disease surveillance and outbreak response activities as defined in CDC's emerging infectious disease strategy is imperative.

Reference: www.bt.cdc.gov/agent/agentlist.asp