considered, including background suppression, cell desiccation, substance stabilization, viability after impaction, and other factors that can be affected by the choice of sampling approach. Sampling is discussed in detail in Chapter 8, which outlines presumptive identification made possible with the kits used by first responders and with other early microbial analysis methods, confirmatory identification methods, and the Laboratory Response Network.

The earlier contamination is detected the easier it will be to confine the contamination and limit the number of people exposed. Environmental monitoring and syndromic surveillance systems should be evaluated for the ability to provide information that can be used to detect and limit the spread of biothreat agents in a cost-effective manner.

Efforts to identify a biological agent following an act of bioterrorism can be both difficult and time consuming. If there are no witnesses and no group claims responsibility for a deliberate release, nobody other than the perpetrator might be aware that an event has occurred, particularly if there are no real-time environmental monitoring systems at the site. In some instances, identification could only occur as a result of epidemiological monitoring or through medical diagnosis, as was the case at the AMI building in 2001. In such situations, it is difficult to determine whether the symptoms are the result of a natural outbreak or an intentional attack. That problem could be compounded by a lack of timely communication between epidemiologists and forensics experts.

A major bioterrorist attack could be unannounced or covert, and the source of the release might need to be identified through an extensive epidemiological investigation. Finding a confirmed case of the suspected disease is critical to many of those investigations. The definition may be clinical, with laboratory confirmation, or it could be done on the basis of laboratory evidence confirmed by one or two supportive laboratory tests. Suspected cases or clinically compatible cases linked to a confirmed environmental exposure, but without corroborative laboratory evidence of exposure or infection, may also be defined in an epidemiological investigation. Laboratory criteria for diagnosis must be defined as well. Follow-up includes enhanced case finding; retrospective and prospective surveillance systems; and environmental assessments and sampling of patients’ homes, work sites, and travel destinations over the period preceding symptom onset and consistent with the incubation period of the suspected disease. Investigations can take weeks, during which time the released agent could be widely disseminated, in the case of spores, or transmitted, in the case of communicable diseases.

Front Matter (R1-R14)

Executive Summary (1-10)

1 Introduction (11-22)

2 Infectious Disease Threats (23-41)

3 Policy Precedents in Decontamination (42-55)

4 Anthrax Decontamination After the 2001 Attacks: Social and Political Context (56-73)

5 Framework for Event Management (74-79)

6 Hazard Identification and Assessment (80-88)

7 Factors Influencing Exposure to Harmful Biological Agents in Indoor Environments (89-104)

8 Analyzing Health Risks (105-119)

9 Sampling Strategies and Technologies (120-136)

10 Decontamination Practices and Principles (137-156)

11 Safe Reoccupation of a Facility (157-169)

12 Harmful Biological Agents in a Public Facility: The Airport Scenario (170-176)

Appendix A: Statement of Task (177-178)

Appendix B: Presentations to the Committee (179-181)

Appendix C: All Findings and Recommendations (182-192)

Appendix D: Other Relevant Case Studies (193-198)

Appendix E: Were the 2001 Anthrax Exposures Consistent with Dose-Response: The Case of the AMI Building (199-203)

Appendix F: Biographical Sketches of Committee Members (204-210)