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  The case study demonstrates how difficult it will be to distinguish a naturally occurring outbreak from one that is intentional. Clues that this might not be a typical influenza outbreak include the fact that normally healthy individuals are affected as are greater numbers of patients than usual.

- Symptoms that would develop after a BW attack would be delayed and nonspecific, making the initial diagnosis difficult. Healthcare providers should seek a number of clues when trying to identify the cause of an unusual infectious outbreak. A BW attack should be considered if any of the above are present.