Possibility of Covert Exposure
Providers must be alert
to the possibility of both individual and community exposure
to hazardous material. The following are guidelines for detecting signs and
symptoms of a covert exposure.
obtain a careful travel and activity history, as well as dietary history.
Patients should be asked if they know of any other person with similar
If a healthcare provider suspects the possibility of a covert
exposure or finds an unusual cluster of symptoms, illnesses, or diseases,
the local health department should be notified immediately.
The following are features
that would suggest the possibility of a covert terrorist act:
- Large numbers of ill
persons with a similar disease, syndrome, or cluster of symptoms.
- Unexplainable sudden
increase in cases of a normally seen disease.
- An increase in unexplained
diseases or death.
- Patients failing to respond
to usual therapies or treatment for common illnesses.
- High morbidity and mortality
in association with a common disease or syndrome.
- Outbreak of a large number
of cases of acute flaccid paralysis with prominent bulbar palsies (botulism).
- Outbreak of botulism
with a common geographic factor among cases (i.e. airport, work location)
without a common dietary exposure (i.e. features suggestive of an aerosol
- Multiple simultaneous
outbreaks of similar illnesses with no common source.
- Unusual illness in a
population, for example, renal disease that could be caused by exposure to
a toxic agent like mercury.
- Single case of unusual
disease (i.e. smallpox, VHF, anthrax).
- Cases of unusual or unexplained
disease co-morbidities without any logical explanation.
- Illnesses or diseases
occurring outside of season, normal location, or normal age group
i.e. tularemia in a non-endemic area, influenza in the summer, or chicken
pox in adults.
- Possibility of sabotage
of food sources may create atypical disease transmission.
- Many ill patients seeking
similar treatment for similar symptoms at the same time.
care providers should be suspicious of terrorism when seeing even a single
case of: (click all 3 that apply)
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