No laboratory materials or biological hazards were found. Further epidemiologic investigation by federal and state public health authorities identified no common exposures among the three cases. The laboratory materials originally brought to hospital B by the family were cultured at MDPH and then sent to the Armed Forces Institute of Pathology for further testing, where they tested negative when screened for several potential bioterrorism agents, including Brucella species. On the same day at hospital B, the patient died from adult respiratory distress syndrome. Although this case did not represent an actual biological crime or terrorism event, and brucellosis was ruled out as a cause of the patient's illness, this report highlights several key aspects of effective public health response to a possible biological terrorism crime or terrorism threat involving a biological agent or other unusual or unexplained illness.
Early detection is essential to ensure a prompt response to a biological terrorist event.
Local public health authorities must rely on clinicians to recognize and report suspicious or unusual presentations of disease. However, correlating suspicious cases originating from diverse locations or discerning an increase in common presentations above the normal baseline is difficult. As in this case, public health practitioners coordinating disease surveillance may be able to receive reports of rare diseases and to determine whether they are occurring at a higher than normal rate in a large surveillance area. This is being accomplished by improving training of clinical, laboratory, and public health personnel in recognizing suspicious disease presentations and by expanding of existing, disease-specific surveillance infrastructure. In addition, surveillance is being improved for disease presentations such as acute respiratory distress, hemorrhagic, or meningeal symptoms normally caused by common infectious agents but that could indicate an increase in illnesses caused by a biological agent used in terrorism.