Joshua G. Schier ^1*, Manish M. Patel MD ², Martin G. Belson ², Amee Patel ³, Michael Schwartz ², Nicole Fitzpatrick ⁴, Dan Drociuk ⁴, Scott Deitchman ³, Richard Meyer ², Toby Litovitz ⁵, William A. Watson ⁵, Carol H. Rubin ², Max Kiefer ³

¹ Centers for Disease Control and Prevention
² CDC
³ National Institute for Occupational Safety and Health, CDC
⁴ South Carolina Department of Health and Environmental Control
⁵ American Association of Poison Control Centers (Affiliation at time of investigation only)

^* To whom correspondence should be addressed. E-mail: jschier{at}cdc.gov.

	Abstract

Objectives. In October 2003, a package containing ricin and a note threatening to poison water supplies was discovered in a South Carolina postal facility, becoming the first potential chemical terrorism event involving ricin in the United States. We examined the comprehensive public health investigation that followed and discuss the lessons learned from it.

Methods. An investigation consisting primarily of environmental sampling for ricin contamination, performance of health assessments on affected personnel, and local, regional, and national surveillance for ricin-associated illness.

Results. Laboratory analysis of 75 environmental sampling specimens revealed no ricin contamination. Health assessments of 36 affected employees were completed. Local surveillance initially identified 3 suspected cases, and national surveillance identified 399 outliers during the 2-week period after the incident. No confirmed cases of ricin-associated illness were identified.

Conclusions. A multifaceted and multidisciplinary approach is required for an effective public health response to a chemical threat such as ricin. The results of all of the described activities were used to determine that the facility was safe to reopen and that no public health threat existed.

Key Words: Environment, Public Health Practice, Surveillance