Determining 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.

•Clinicians MUST 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 symptoms.
•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:

  1. Large numbers of ill persons with a similar disease, syndrome, or cluster of symptoms.
  2. Unexplainable sudden increase in cases of a normally seen disease.
  3. An increase in unexplained diseases or death.
  4. Patients failing to respond to usual therapies or treatment for common illnesses.
  5. High morbidity and mortality in association with a common disease or syndrome.
  6. Outbreak of a large number of cases of acute flaccid paralysis with prominent bulbar palsies (botulism).
  7. Outbreak of botulism with a common geographic factor among cases (i.e. airport, work location) but
    without a common dietary exposure (i.e. features suggestive of an aerosol attack).
  8. Multiple simultaneous outbreaks of similar illnesses with no common source.
  9. Unusual illness in a population, for example, renal disease that could be caused by exposure to a toxic agent like mercury.
  10. Single case of unusual disease (i.e. smallpox, VHF, anthrax).
  11. Cases of unusual or unexplained disease co-morbidities without any logical explanation.
  12. 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.
  13. Possibility of sabotage of food sources may create atypical disease transmission.
  14. Many ill patients seeking similar treatment for similar symptoms at the same time.

Instant Feedback:
Health care providers should be suspicious of terrorism when seeing even a single case of: (click all 3 that apply)
Variola virus
 VHF
 Varicella virus
 Bacillus anthracis

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