Distinguishing Natural Disease vs Bioterrorism

Natural Disease

• Recent endemic exposure by handling the carcasses of wild animals, especially burrowing rodents, rabbits or hares, coyotes, or other carnivores.
• Handling of a sick cat or history of flea bites in endemic area.
• Recent history of travel in an endemic plague area (western United States, as well as international locations).
• Cases are sporadic, infrequent, and typically occur in the rural endemic areas of the western United States.
• In the U.S., bubonic plague is the most common clinical presentation.