Appendix B: Examples of a Biological Pathogen Detection, Verification, and Information Sharing

Information Sources	Examples of Initial Intelligence Received	Verification Process	Methods of Information Sharing
Individual practitioner or healthcare facility lab	Suspected or confirmed sentinel case reported through local public health	Private sector, Laboratory Response Network (LRN), or HHS CDC laboratory confirmation may be required	Health Alert Network (HAN), National Public Health Information Coalition (NPHIC), Clinician Outreach and Communication Activity (COCA)
Individual facility, local or state health department surveillance systems	Influx of patients with similar symptoms indicating potential new disease pathogen	Private sector, LRN, or HHS CDC laboratory confirmation may be required Epidemiologic investigation to confirm patterns of similarity	HAN, National Incident Coordination Conference Line (NICCL), COCA, National Poison Data System
Identification of novel or atypical pathogen in FSLTT, or private sector laboratory	Individual not originally suspected; “unexpected” diagnosis received through secondary testing	Private sector, LRN, or HHS CDC laboratory confirmation may be required	HAN, COCA, NPHIC, Public Affairs Conference Line (PACL), NBIS Protocol
Novel emerging infection reported under IHR from overseas source	New pathogen or pathogen of concern evolving in a situation in which spread to U.S. is possible	Multiple international partners as well as international assistance provided by U.S. Government (USG)	HAN, COCA, NPHIC, PACL, National Biosurveillance Integration System (NBIS) Protocol
Zoonotic outbreak identified by private sector, SLTT, or federal providers or laboratories	Zoonotic pathogen identified in an animal population with potential for causing human disease	USDA, HHS CDC, SLTT, National Animal Health Laboratory Network (NAHLN), or private sector laboratory confirm all possible	HAN, COCA, NPHIC, PACL, NBIS Protocol
Law enforcement intelligence	Credible threat of deployment of pathogen of concern	Law enforcement investigations paired with public health expertise	Law Enforcement Sensitive (LES) Bulletin, NSC Process, NICCL
Public media	Announced release of pathogen of concern	Multiple entities/processes at various levels potentially involved	NSC Process, NICCL, follow-on HAN, NPHIC, PACL