Planning against biological terrorism: lessons from outbreak investigations.
We examined outbreak investigations conducted around the world from 1988 to 1999 by the Centers for Disease Control and Prevention's Epidemic Intelligence Service. In 44 (4.0%) of 1,099 investigations, identified causative agents had bioterrorism potential. In six investigations, intentional use of infectious agents was considered. Healthcare providers reported 270 (24.6%) outbreaks and infection control practitioners reported 129 (11.7%); together they reported 399 (36.3%) of the outbreaks. Health departments reported 335 (30.5%) outbreaks. For six outbreaks in which bioterrorism or intentional contamination was possible, reporting was delayed for up to 26 days. We confirmed that the most critical component for bioterrorism outbreak detection and reporting is the frontline healthcare profession and the local health departments. Bioterrorism preparedness should emphasize education and support of this frontline as well as methods to shorten the time between outbreak and reporting.
Ashford
David A
DA
Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop C09, Atlanta, GA 30333, USA. dba4@cdc.gov
Kaiser
Robyn M
RM
Bales
Michael E
ME
Shutt
Kathleen
K
Patrawalla
Amee
A
McShan
Andre
A
Tappero
Jordan W
JW
Perkins
Bradley A
BA
Dannenberg
Andrew L
AL
D023482:Bioterrorism / Q000517:prevention & control*; D002487:Centers for Disease Control and Prevention, U.S.; D003140:Communicable Disease Control; D003141:Communicable Diseases / Q000175:diagnosis / Q000453:epidemiology; D004189:Disaster Planning / Q000458:organization & administration*; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D011159:Population Surveillance; D014481:United States