Epidemiologic clues of biologic warfare

  • ANY single case of an uncommon agent (smallpox, some viral hemorrhagic fevers, anthrax)
  • The presence of an unusually large number of patients with similar disease or symptoms
  • Many cases of unexplained diseases or deaths
  • Dead or dying animals
  • More severe disease than is usual for a specific pathogen
  • Failure to respond to standard therapy for a specific pathogen
  • Disease that is unusual for the geographic area or season
  • Disease transmitted by a vector that usually is not present
  • Unusual route of exposure for a disease (inhalation anthrax or plague)
  • Multiple, simultaneous, or serial epidemics of different diseases
  • A disease that is unusual for an age group or population
  • Similar genetic pattern of diseases from distinct sources at different times or locations
  • Discrete attack rates among those in a particular building or at a specific event
  • Outbreak of disease in noncontiguous areas (not spread by travelers)
  • Intelligence report of a potential attack

Source: Adapted from a similar table found in the USAMRIID Medical Management of Biologic Casualties Handbook. USAMRIID 2001; Fort Detrick, MD.