Botulism: Suspected Intentional Release Overview for Clinicians

• The covert release of a biologic agent may not have an immediate impact because of the delay between exposure and illness onset. Also, outbreaks associated with intentional releases might closely resemble naturally occurring outbreaks.
• Indications of intentional release of a biologic agent include:
• Unusual temporal or geographic clustering of illness (e.g. persons who attended the same public event or gathering) or patients presenting with clinical signs and symptoms that suggest an infectious disease outbreak (e.g. more than 2 patients presenting with an unexplained febrile illness associated with sepsis, pneumonia, or respiratory failure).
• Rash or a botulism-like syndrome with flaccid muscle paralysis, especially occurring in otherwise healthy persons.
• Unusual age distribution for common diseases (e.g. an increase in what appears to be a chickenpox-like illness among adult patients but which might be smallpox).
• Large numbers of cases of acute flaccid paralysis with prominent bulbar palsies suggestive of a release of botulinum toxin.
• Strategies for responding to potential intentional release of botulism include:
  • Information or reminders for health care providers and clinical laboratories regarding how to report events to the appropriate public health authorities;
  • Implementation of a plan for 24-hour, 7-day capacity to receive and act on any positive report of events that suggest intentional release of a biologic agent;
  • Immediate investigation of any reports of clusters of illnesses or other events that suggests an intentional release of a biologic agent and request for CDC assistance when necessary;
  • Implementation of a plan, including accessing the Laboratory Response Network for Bioterrorism to collect, transport, and appropriately store specimens for laboratory analysis;
  • Immediate reporting to CDC if the results of an investigation suggest the release of a biologic agent.
• EID: Endemic, Notifiable Bioterrorism-Related Diseases, United States, 1992–1999