Rickettsiae in Ixodid Ticks, Sicily

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 11, No. 3, March 2005 509 dling guidelines. A facility inspection and review of the caterer’s procedures identified improper holding temperatures for potentially hazardous foods as the likely cause of the outbreak. In this incident, prompt action by the police department, which employed an agency-wide radio communications system to warn officers not to eat lunches obtained for later consumption, reduced the number of persons who would have become ill from staphylococcal foodborne infection. In spite of this effort, the outbreak still had a considerable impact on the staff of the police department. The attack rate for those exposed was high, and three quarters of those who became ill missed >1 days of work. If an agent causing greater severity of illness, e.g., botulinum toxin, had been introduced into the bento lunches instead of S. aureus, the ensuing outbreak might have strongly compromised the department’s ability to ensure public safety. Despite modifications in food security industry regulations because of the Bioterrorism Act of 2002, intentional contamination of food items on a smaller scale remains a potential danger that needs to be addressed. As the incident we described demonstrates, under certain circumstances, terrorists may be able to substantially impair first response agencies, including police departments, through a limited but targeted foodborne attack. By incapacitating first responders, terrorists might maximize the impact of a larger, coordinated event. Just as maintaining the physical security of the Strategic National Stockpile is a priority in preventing a secondary attack, reasonable steps must be taken to ensure that our emergency workforce is protected from a targeted foodborne assault. As a result of this outbreak, we have recommended that whenever entire units, departments, or shifts of first responders in our jurisdiction are involved in shared dining activities, efforts should be made to obtain food items from more than 1 caterer for each meal. If departmentwide events necessitate using a single caterer, efforts should be taken to identify and mitigate the threat of intentional food tampering and there should be rigorous adherence to standard safe foodhandling procedures to minimize the potential for naturally occurring outbreaks (7). Our recommendations here are similar to those employed by airlines to protect pilots and copilots on long flights by serving separate meals prepared in different kitchens (11). Our intention is to share with other preparedness agencies our observation that first response assets might be compromised by something as seemingly innocuous as a holiday party. Appropriate planning may reduce the risk of intentional food contamination that targets security forces or first responders, either as an isolated strike or as part of a larger, coordinated terrorist attack.