(STEC) contact their local health department to report their concerns about possible clusters of this disease. As stool cultures become positive for STEC over 2 to 3 days, laboratories report the positive tests to health departments, in some instances using new electronic reporting capacities.

Over the following week, some clinical laboratories forward specimens to state public health laboratories, which perform DNA fingerprint testing (PFGE testing) and share this information with the national PulseNet system. In other instances, health department syndromic surveillance systems that include monitoring for patients with symptoms of “bloody diarrhea” detect an increase in such illness. As state health departments begin to recognize and assess this situation, because of its severity, they are likely to notify CDC and post their concerns on the Epi-X network (a confidential information-sharing network used by local, state, and federal public health officials). As CDC begins to assess the situation, it enlists FDA and USDA counterparts in a joint investigation.

Simultaneously, local media in some communities are alerted to the situation by parents of ill children, and reporters who contact local hospitals learn of additional cases of similar illness. A wire service editor notes the occurrence of similar reports in multiple local or regional newspapers and publishes a national report, speculating about the possibility of a common cause. Within a few hours of the national wire service feed, Al Qaeda in the Arabian Peninsula claims responsibility, asserting specifically that sleeper cells in the United States were the perpetrators but being ambiguous regarding how the infections were introduced. This announcement triggers widespread coverage by television, radio, and print media.

NBIC, through its daily monitoring of media reports and other open-source information outlets, takes note of the wire service report and the Al Qaeda claim and decides to seek, obtain, and analyze pertinent surveillance information. That same day, CDC, FDA, and USDA apprise NBIC that they are investigating whether the cases in the various cities are related and, in particular, whether they are the result of a foodborne pathogen from a common source.


The first move of the scenario involves tracking the relevant mortality and morbidity, which continues for the duration of the incident. This move also includes investigation of the terrorists’ claims of responsibility.

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