title: Public health investigation after the discovery of ricin in a South Carolina postal facility.
abstract: OBJECTIVE
  In October 2003, a package containing ricin and a note threatening to poison water supplies was discovered in a South Carolina postal facility, becoming the first potential chemical terrorism event involving ricin in the United States. We examined the comprehensive public health investigation that followed and discuss the lessons learned from it.
  
  
  METHODS
  An investigation consisting primarily of environmental sampling for ricin contamination, performance of health assessments on affected personnel, and local, regional, and national surveillance for ricin-associated illness.
  
  
  RESULTS
  Laboratory analysis of 75 environmental sampling specimens revealed no ricin contamination. Health assessments of 36 affected employees were completed. Local surveillance initially identified 3 suspected cases, and national surveillance identified 399 outliers during the 2-week period after the incident. No confirmed cases of ricin-associated illness were identified.
  
  
  CONCLUSIONS
  A multifaceted and multidisciplinary approach is required for an effective public health response to a chemical threat such as ricin. The results of all of the described activities were used to determine that the facility was safe to reopen and that no public health threat existed.
authors.affiliation: Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga 30341, USA. jschier@cdc.gov
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Schier
authors.forename: Manish M
authors.initials: MM
authors.lastname: Patel
authors.forename: Martin G
authors.initials: MG
authors.lastname: Belson
authors.forename: Amee
authors.initials: A
authors.lastname: Patel
authors.forename: Michael
authors.initials: M
authors.lastname: Schwartz
authors.forename: Nicole
authors.initials: N
authors.lastname: Fitzpatrick
authors.forename: Dan
authors.initials: D
authors.lastname: Drociuk
authors.forename: Scott
authors.initials: S
authors.lastname: Deitchman
authors.forename: Richard
authors.initials: R
authors.lastname: Meyer
authors.forename: Toby
authors.initials: T
authors.lastname: Litovitz
authors.forename: William A
authors.initials: WA
authors.lastname: Watson
authors.forename: Carol H
authors.initials: CH
authors.lastname: Rubin
authors.forename: Max
authors.initials: M
authors.lastname: Kiefer
mesh_terms: D004781:Environmental Exposure; D006801:Humans; D016273:Occupational Exposure; D011177:Postal Service; D015980:Public Health Practice; D012276:Ricin / Q000506:poisoning*; D013022:South Carolina; D023481:Terrorism
chemical_list: D012276:Ricin