Recognizing a Biological Attack

Recognizing a covert attack, and verifying the causative agent, requires collaboration. It is likely that individual care providers or emergency rooms will gather the first clues. It is also possible that first notification could come from less expected sources, like a pharmacist, laboratory tech or veterinarian, who notices something unusual in the frequency or character of a disease process.

The following list of epidemiological clues may indicate a covert bioterrorism attack and can serve to raise suspicion:

• A large discrete population with a similarly staged disease or syndrome
  
• An unusual number of people seeking care for fever, respiratory or gastrointestinal complaints
  
• Unusual rate or progression of disease or syndrome
  
• More severe disease than is usually expected for a specific pathogen or an unexpected resistance to therapy
  
• Unusual route of exposure for a pathogen
  
• A disease that is unusual for a given geographic area or season
  
• Disease normally transmitted by a vector that is not present in local area
  
• Multiple simultaneous or serial epidemics of different diseases in the same population
  
• A single case of a disease by an uncommon agent (smallpox, viral hemorrhagic fever, inhalation anthrax, pneumonic plague)
  
• A disease that is unusual for an age group
  
• Unusual strains of organisms or unusual antimicrobial resistance patterns
  
• A similar or exact genetic type among agents, isolated from distinct sources at different times and/or locations
  
• Higher attack rates among those exposed in certain areas, such as inside a building if agent released indoors, or lower rates in those inside a sealed building, if agent released outside
  
• Disease outbreaks of the same illness occurring in noncontiguous areas
  
• Disease outbreak that also effects animals in the area
  
• Intelligence of a potential attack or evidence of the intent to attack (Treadwell 2003)

Early recognition and treatment of a bioterror agent can be critical to saving lives. Some bioterror agents, including spores, viruses, fungi, and bacteria, may have an incubation period required to reproduce sufficient toxins or antigens to produce pathologic effects. The incubation period may permit time to treat with appropriate antibiotics, antisera, monoclonal antibodies, vaccination, etc. if done promptly following the exposure. Conversely, the disease may be fatal if treatment is delayed until the classic symptoms develop.

Nationally Notifiable Conditions including, Bacillus anthracis, Yersinia pestis, Francisella tularensis, Clostridium botulinum, etc. A suspected bioterrorism agent infection must be reported in compliance with the facility All-Hazard Emergency Management Plan.

More than 6,000 health care facilities covering 49 states and the District of Columbia contribute emergency department data to the Sentinel Surveillance System, BioSense Platform. The Sentinel Surveillance System collects and analyses emergency department data in real-time based on chief complaints to identify outbreaks that require public health investigation and response.

On-site laboratory screening procedures, including polymerase chain reactions (PCR), may be done to obtain a presumptive diagnosis for treatment.  These tests can take about 3-5 hours. A confirmatory test completed by Laboratory Response Network (LRN) lab will activate the local, state, and federal emergency response plan (CDC, Laboratory Response 2018).

Centers for Disease Control and Prevention’s Health Alert Network (HAN) is CDC’s primary method of sharing cleared information about urgent public health incidents with public information officers; federal, state, territorial, tribal, and local public health practitioners; clinicians; and public health laboratories.

References

Centers for Disease Control and Prevention. (2018). CDC's laboratory response to suspicious substances|laboratory information. Centers for Disease Control and Prevention. Retrieved August 30, 2022, from https://emergency.cdc.gov/labissues/substanceresponse.asp

Centers for Disease Control and Prevention. (2018) National Syndromic Surveillance Program. What is syndromic surveillance? about the NSSP community of Practice. (n.d.). Retrieved August 30, 2022, from https://www.cdc.gov/nssp/documents/NSSP-overview.pdf

Recognizing bioterrorism. Disease Prevention and Control, San Francisco Department of Public Health. (2018). Retrieved August 10, 2022, from https://www.sfcdcp.org/health-alerts-emergencies/recognize-an-illness-associated-with-bioterrorism/

Treadwell, T. A., Koo, D., Kuker, K., & Khan, A. S. (2003). Epidemiologic clues to bioterrorism. Public health reports (Washington, D.C. : 1974), 118(2), 92–98. https://doi.org/10.1093/phr/118.2.92

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