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Indicators of Possible Bioterrorism-Related Infections or Disease Clusters

Indicators	Examples
Occurrence of a disease that is unusual for a given geographic area or season	Plague in New York City A large cluster of influenza-like illnesses in July
Unusual clustering of illnesses by location or time	An increase in the number of influenza-like illnesses following a large public event
Atypical age distribution for common diseases	Chickenpox-like illness among adults An increase in severe acute gastroenteritis among adults
Growing numbers of increasingly serious illnesses	Previously healthy patients presenting with an unexplained febrile illness associated with sepsis, pneumonia, respiratory failure, or rash
More severe disease than expected for a given pathogen, or unusual routes of exposure	Salmonella causing meningitis or pneumonia in an otherwise healthy patient
Uncommon illness	Rapidly progressive descending flaccid paralysis
Illness associated with a pathognomonic sign for a biologic agent	Rapidly progressive pneumonia with a widened mediastinum on chest X-ray; pneumonia in an otherwise healthy patient
Serious illness that fails to respond to usual antibiotics	Pneumonia in an otherwise healthy person with an antibiotic resistance pattern that is significantly different from circulating strains

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