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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 2

Trip reports, involving unknown infectious agents or potential agents of bioterrorism (ultimately not considered bioterrorism), the Centers for Disease Control and Prevention, January 1988–December 1999

Report no. Y Location Disease/agent Conclusion
90-56
1990
Texas, USA
Unknown
Rash and fever in children, no discernable cause
93-02
1992
Wyoming, USA
Coxiella burnetii
Q fever in two bentonite miners
94-02
1993
Georgia, USA
Clostridium botulinum
Botulism outbreak linked to contaminated food
94-32
1994
Five states, USA
Unknown
Cluster of cases, no discernable cause
94-42
1994
Texas, USA
C. botulinum
Botulism outbreak linked to contaminated food
94-86
1994
Connecticut, USA
Sabia virus
Accidental infection with Sabia virus in laboratory worker
94-88
1994
Bolivia
Machupo virus
Bolivian hemorrhagic fever outbreak
95-16
1994
Utah, USA
Unknown
Contaminated solution used in grafting procedure; source undefined
95-40
1995
Palau
Dengue type 4 virus
Dengue type 4 virus outbreak
95-55
1995
Kikwit, Zaire
Ebola virus
Ebola hemorrhagic fever outbreak
95-61
1995
South Dakota, USA
Francisella tularensis
Tick-borne tularemia
98-23
1998
Kenya; Somalia
Rift Valley fever virus
Rift Valley fever outbreak
98-28
1998
Argentina
C. botulinum toxin
Botulism outbreak linked to contaminated food
98-35
1998
Uganda
Rift Valley fever virus
Rift Valley fever virus outbreak
98-55
1998
Texas, USA
Bacillus anthracis
Exposure to live spore vaccine for anthrax
98-83
1998
Kazakhstan
B. anthracis
Reemergence of anthrax, Kazakhstan
11 investigations involving plague
Multiple
10 investigations in USA (Oklahoma, Arizona, New Mexico, Texas, California); one in India.
Yersinia pestis
Mostly in areas of endemic plague in animals
18 investigations involving cholera
Multiple
4 investigations in USA (Mississippi, Maryland, Hawaii, California), 14 elsewhere
Vibrio choleresis
Cholera in two nursing home patients, outbreak involving imported food, outbreak involving consumption of raw fish, and outbreak involving contaminated food on international flight
12 investigations involving unknown agent on cruise ships
Multiple
Cruise ships
Unknown
Gastroenteritis outbreaks in which infectious agent was not identified by laboratory testing
26 additional investigations involving unknown agent Multiple 24 in USA, 2 elsewhere Unknown Gastroenteritis outbreaks, acute illness after surgical procedures, and other outbreaks in which no infectious agent was identified by laboratory testing

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