Investigation of Suspicious Disease Outbreaks

Publisher Summary This chapter focuses on the investigation of covert attacks with biological weapons, in which signs and symptoms of clinical illness are usually delayed so that the scope of the problem grows over hours and days. Without physical evidence of an attack or a credible announcement, the deliberate nature of the incident may not be suspected or discovered for some time, if ever. Given the heightened national state of alert currently, almost all outbreaks of diseases, regardless of size, should be evaluated considering the possibility of bioterrorism or agro-terrorism. In many cases a rapid, well conducted etiologic and epidemiologic investigation paired with an analysis of the distribution and number of reported cases provides important clues regarding the source of infection. Because of the threat of the use of biological weapons, a criteria and data to differentiate natural and deliberate disease outbreaks must be developed. The best tool to help differentiate an intentional attack from a natural epidemic is a robust disease surveillance and reporting system. For instance, developed countries generally have a historical record of natural disease outbreaks sufficient to form a distinct background against which potential covert acts can be judged. Most outbreaks of high consequence pathogens and toxins are likely to have an explanation when all the data is evaluated‥ The investigation team should have broad scientic expertise to encompass the pathogen(s) likely to cause the outbreak, and should include appropriate law enforcement officials. The implications of a proven attack or biocrime are so far reaching that any investigation resulting in such a conclusion must be so thorough as to survive the most rigorous of examinations.