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Ricin: Surveillance & Reporting Overview for Clinicians

Case Definition

Case Classification

  • Ricin Inhalation
    • Probable: A clinically compatible case with a high index of suspicion (reliable intelligence or patient history) for ricin exposure or with an epidemiological link to a laboratory-confirmed case.
    • Confirmed: A clinically compatible case with laboratory confirmation.
      • Laboratory criteria: Detection of ricin in environmental samples.
  • Ricin Ingestion
    • Probable: A clinically compatible case with a high index of suspicion (reliable intelligence or patient history) for ricin exposure or with an epidemiological link to a laboratory-confirmed case.
    • Confirmed: A clinically compatible case with laboratory confirmation.
      • Laboratory criteria: Detection of ricin in environmental samples.
  • 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:
  • To reach the regional poison control center, call 1-800-222-1212.

For additional information:

  • Page last reviewed February 29, 2008
  • Page last updated April 17, 2006
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