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This Article Full Text Full Text (PDF) All Versions of this Article: AJPH.2006.099903v1 97/Supplement_1/S152    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schier, J. G. Articles by Kiefer, M. Search for Related Content PubMed PubMed Citation Articles by Schier, J. G. Articles by Kiefer, M.

Joshua G. Schier, MD, Manish M. Patel, MD, MSc, Martin G. Belson, MD, Amee Patel, MPH, Michael Schwartz, MD, Nicole Fitzpatrick, MPH, Dan Drociuk, MT, Scott Deitchman, MD, Richard Meyer, PhD, Toby Litovitz, MD, William A. Watson, PharmD, Carol H. Rubin, DVM, MPH and Max Kiefer, MS

At the time of the study Joshua G. Schier, Manish M. Patel, Martin G. Belson, and Carol H. Rubin were with the Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Ga. Dan Drociuk and Nicole Fitzpatrick were with the South Carolina Department of Health and Environmental Control, Columbia. Richard Meyer was with the Bioterrorism Rapid Response and Advanced Technology Laboratory, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta. Michael Schwartz was with the Office of the Director, Agency for Toxic Substances and Disease Registry, Atlanta. Toby Litovitz and William A. Watson were with the American Association of Poison Control Centers, Washington, DC. Max Kiefer, Scott Deitchman, and Amee Patel were with the National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Atlanta.

Correspondence: Requests for reprints should be sent to Joshua G. Schier, CDC/NCEH/EHHE/HSB Mail Stop F46, 4770 Buford Highway, NE, Chamblee, GA 30341 (e-mail: jschier{at}cdc.gov).

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.