Ricin: Surveillance & Reporting Overview for Clinicians
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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.
- See case definition for ricin poisoning by inhalation, http://emergency.cdc.gov/agent/ricin/ricininhcasedef.asp
- 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.
- See case definition for ricin poisoning by ingestion, http://emergency.cdc.gov/agent/ricin/riciningcasedef.asp
- 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:
- Case Definition: Ricin Ingestion
- Case Definition: Ricin Inhalation
- MMWR: Investigation of a Ricin-Containing Envelope at a Postal Facility --- South Carolina, 2003
- State Health Departments
- Agency for Toxic Substances & Disease Registry
- MMWR: Recognition of Illness Associated With Exposure to Chemical Agents --- United States, 2003
- MMWR: Recognition of Illness Associated with the Intentional Release of a Biologic Agent
- Page last reviewed: May 8, 2013
- Page last updated: March 31, 2016
- Content source: National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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