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Volume 9, Number 5—May 2003
Perspective

Planning against Biological Terrorism: Lessons from Outbreak Investigations

David A. Ashford*Comments to Author , Robyn M. Kaiser*, Michael E. Bales*, Kathleen Shutt*, Amee Patrawalla*, Andre McShan*, Jordan W. Tappero*, Bradley A. Perkins*, and Andrew L. Dannenberg*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA

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Table 3

Epidemic Intelligence Service investigations in which bioterrorism or intentional contamination was considered a cause

Report No. Outbreak Conclusion
84-093
 Salmonellosis, Oregon, 1984
 A total of 751 persons became ill with salmonella gastroenteritis. Religious group deliberately contaminated salad bars. Salmonella enterica Typhimurium strain found in laboratory at commune was indistinguishable from outbreak strain (5).
97-008
 Shigella dysenteriae type 2, Texas, 1996
 Diarrheal illness in hospital laboratory workers who ate pastries, anonymously placed in break room. Identical strains of S. dysenteriae type 2 were isolated from stool cultures of case patients, from recovered muffin, and from laboratory stock culture, part of which was missing.
98-006
 S. sonnei, New Hampshire, 1997
 Seven laboratory workers at local hospital became ill with gastroenteritis. Most cases caused by strain of S. sonnei that was highly related to a stock culture strain maintained by the hospital laboratory. Possibility that first two cases were caused by intentional contamination could not be excluded.
99-025
 Anthrax hoaxes, 1998
 Centers for Disease Control and Prevention received reports of alleged anthrax exposure; letters were sent to health clinics in Indiana, Kentucky, and Tennessee and to private business in Tennessee; three telephone threats of anthrax contamination of ventilation systems were made to public and private buildings; all threats were hoaxes.
99-059
 Unexplained critical illness, New Hampshire, 1999
 A 38-year-old woman was admitted to a hospital with fever, myalgia, and weakness; severe illness and death occurred 32 days after hospital admission; serum specimens indicated Brucella species. Patient’s history of multiple febrile illnesses suggested unspecified autoimmune process.
99-94-1 Encephalitis cluster, New York City, 1999 Several residents were hospitalized with illness of unknown etiology characterized by fever, encephalitis, axonal neuropathy, and flaccid paralysis (unpublished data: Epi-1 report); increase in deaths of New York City birds, especially crows; human and bird tissue samples were positive for West Nile-like virus.

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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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