Citation

Palumbo JP, Meek JI, Fazio DM, Turner SB, Hadler JL, Sofair AN. Disaster Med. Public Health Prep. 2008; 2(2): 87-94.

Affiliation

CT Emerging InfectionsProgram, Yale University School of Medicine, Department of Epidemiology and Public Health, One Church Street, 7th Floor, New Haven, CT 06510, USA. john.palumbo@yale.edu

Copyright

(Copyright © 2008, Society for Disaster Medicine and Public Health, Publisher Cambridge University Press)

DOI

10.1097/DMP.0b013e318161315b

PMID

18525371

Abstract

BACKGROUND: Recognition of bioterrorism-related infections by hospital and emergency department clinicians may be the first line of defense in a bioterrorist attack. METHODS: We identified unexplained infectious deaths consistent with the clinical presentation of anthrax, tularemia, smallpox, and botulism using Connecticut death certificates and hospital chart information. Minimum work-up criteria were established to assess the completeness of diagnostic testing. RESULTS: Of 4558 unexplained infectious deaths, 133 were consistent with anthrax (2.9%) and 6 (0.13%) with tularemia. None were consistent with smallpox or botulism. No deaths had anthrax or tularemia listed in the differential diagnosis or had disease-specific serology performed. Minimum work-up criteria were met for only 53% of cases. CONCLUSIONS: Except for anthrax, few unexplained deaths in Connecticut could possibly be the result of the bioterrorism agents studied. In 47% of deaths from illnesses that could be anthrax, the diagnosis would likely have been missed. As of 2004, Connecticut physicians were not well prepared to intentionally or incidentally diagnose initial cases of anthrax or tularemia. More effective clinician education and surveillance strategies are needed to minimize the potential to miss initial cases in a bioterrorism attack.

Language: en