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Ricin: Surveillance & Reporting Overview for Clinicians

Case Definition

Case Classification

  • Ricin Inhalation
    • Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for ricin exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
    • Confirmed: A clinically compatible case with laboratory confirmation.
  • Ricin Ingestion
    • Probable: A clinically compatible case in which a high index of suspicion (credible threat or patient history regarding location and time) exists for ricin exposure, or an epidemiologic link exists between this case and a laboratory-confirmed case.
    • Confirmed: A clinically compatible case with laboratory confirmation.
  • Clinical diagnosis is the foundation for early recognition of and response to a potential ricin release or terrorist attack.
  • Suspicion and clinical diagnosis of ricin poisoning should occur when clinically compatible illness is present in conjunction with a highly suspected or known exposure, a credible threat, or an applicable epidemiologic clue.
  • A case should not be considered ricin poisoning if another confirmed diagnosis exists to explain the signs and symptoms.

Surveillance

  • Because ricin poisoning might resemble typical gastroenteritis or respiratory illness, maintain heightened awareness to facilitate recognition of ricin poisoning in conjunction with:
    • Epidemiologic clues suggestive of chemical/biological release (e.g., an unusual increase in the number of patients seeking care or unexpected progression of symptoms in a group of patients).
    • History of a credible threat/known terrorism agent release in the community.
  • In collaboration with state health departments and regional poison control centers, CDC maintains surveillance for ricin cases in the U.S.

Risk Groups

  • If ricin poisoning is suspected or known, cannot be ruled out, and/or when a terrorist event is suspected or known, follow healthcare facility policies and immediately notify:
    • Hospital epidemiologist and infection control professional, or other designated healthcare facility personnel.
    • Healthcare facility laboratory director or designee.
    • Regional poison control center.
    • Local and state public health departments/health officers. The state public health department will notify local FBI agents as appropriate.
  • To reach the public health department(s) consult:
    • The healthcare facility list for local and state health department phone numbers
    • The local telephone operator
    • The telephone directory under “government listings”
    • The Internet:
    • If the local and/or state health departments cannot be reached, contact the Centers for Disease Control and Prevention (CDC) Emergency Operations Center at 770-488-7100
    • CDC NCEH/ATSDR contact for chemical emergencies: 888-232-4636; Agency for Toxic Substances & Disease Registry
  • To reach the regional poison control center, call 1-800-222-1222.

For additional information:

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