The first indication that a biological weapon attack has occurred may be the presence of one or more unexpected findings. Early recognition of an attack is essential to mount an appropriate response.
Findings suggesting a biological weapon attack:
(1) multiple cases of an infection not endemic for the region
(2) multiple cases of an unusual infectious agent
(3) presence of an infection that is typically vector-borne in an area lacking a competent vector
(4) multiple diseases in a single patient or a series of epidemics in a population
(5) mode of spread consistent with spread by aerosol, food or water supplies
(6) unexpectedly high morbidity and mortality in affected persons
(7) sudden rise in the number of unexplained illnesses or deaths
(8) high rate of infection limited to a population defined by a geographical region or recent participation at a social event
(9) simultaneous outbreaks in noncontiguous regions
(10) unexpected deaths in animals, especially if multiple species affected
(11) atypical clinical presentations
(12) absence or low incidence in persons in an area with closed ventilation or filtered air supplies
(13) unusual antibiotic resistance pattern in isolates or failure to respond to standard therapy
(14) high level of genotypic similarity in isolates collected at different times or locations
