Endemic, notifiable bioterrorism-related diseases, United States, 1992-1999

Abstract

Little information is available in the United States regarding the incidence and distribution of diseases caused by critical microbiologic agents with the potential for use in acts of terrorism. We describe disease-specific, demographic, geographic, and seasonal distribution of selected bioterrorism-related conditions (anthrax, botulism, brucellosis, cholera, plague, tularemia, and viral encephalitides) reported to the National Notifiable Diseases Surveillance System in 1992 to 1999. Tularemia and brucellosis were the most frequently reported diseases. Anthrax, plague, western equine encephalitis, and eastern equine encephalitis were rare. Higher incidence rates for cholera and plague were noted in the western United States and for tularemia in the central United States. Overall, the incidence of conditions caused by these critical agents in the United States is low. Individual case reports should be considered sentinel events. For potential bioterrorism-related conditions that are endemic and have low incidence, the use of nontraditional surveillance methods and complementary data sources may enhance our ability to rapidly detect changes in disease incidence.

Figure

Reported cases of conditions caused by critical biologic agents, by month of onset, National Notifiable Disease Surveillance System, United States, 1992–1999. Cases are reported with one of the following types of dates: onset date, date of diagnosis, or date of laboratory result. Reports are from the 50 U.S. states, Washington, D.C., and New York City.