Volume 9, Number 5—May 2003
Perspective
Planning against Biological Terrorism: Lessons from Outbreak Investigations
David A. Ashford*
, Robyn M. Kaiser*, Michael E. Bales*, Kathleen Shutt*, Amee Patrawalla*, Andre McShan*, Jordan W. Tappero*, Bradley A. Perkins*, and Andrew L. Dannenberg*
, Robyn M. Kaiser*, Michael E. Bales*, Kathleen Shutt*, Amee Patrawalla*, Andre McShan*, Jordan W. Tappero*, Bradley A. Perkins*, and Andrew L. Dannenberg*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 |
