Threat

Several recent books, including Emerging Infections: Microbial Threats to Health in the United States, edited by Joshua Lederberg, Robert E. Shope, and Stanley C. Oaks, Jr., for the Committee on Emerging Microbial Threats to Health of the Institute of Medicine, The Hot Zone by Richard Preston, The Coming Plague by Laurie Garrett, and Man and Microbes by Arno Karlen, each describe the occurrence of significant outbreaks of disease worldwide and over time and describe a future in which emerging infectious diseases will challenge the current arsenal of prophylaxis and treatment. Recent press features have highlighted issues of exotic disease, including the emergence of antibiotic-resistant strains of disease as a result of improper use of antibiotics, and the nearly inevitable prospect of the emergence of a pandemic new strain of influenza.

The study by the Institute of Medicine offers a working definition of emerging infectious disease as "clinically distinct conditions whose incidence in humans has increased, ... [particularly] within the last two decades." In this study, "emergence ... [is also] used to describe the reappearance of a known disease after a decline in incidence."

Among the examples of emerging disease cited in the report are those listed below.

In addition, naturally occurring outbreaks of disease can provide ammunition for use by biological weapons terrorists. For example, 40 members of the Aum cult are known to have traveled to Zaire during the most recent outbreak of Ebola. Although scientifically problematic, the successful culture of the hemorrhagic Ebola virus would constitute a formidable weapon in the hands of a group with a demonstrated willingness to use it.

Response

Lederberg and colleagues cite four fundamental problem areas that must be addressed to moderate the threat of emerging disease:

• Perceiving the threats: increase awareness by public, policy makers, and health care providers
• Detecting the threats: surveillance of disease outbreaks domestically and internationally
• Understanding the threats: resolve fundamental gaps in knowledge with basic research and development
• Responding to the threats: improve emergency recognition and response mechanisms to control outbreaks when they occur.

In response to these fundamental problems, the Institute of Medicine study recommendations focus on mitigating efforts directed to the areas below to prepare for the impact of emerging disease.

• Recognition
• Intervention
  • U.S. Public Health System
  • Research and Training
  • Vaccine and Drug Development
  • Vector Control
  • Public Education and Behavioral Change

References and Links

• "Emerging And Reemerging Infectious Diseases," Chapter 8. Population and Human Development, World Resources 1996-97,World Resources Institute.
• Emerging Infections: Microbial Threats to Health in the United States, Joshua Lederberg, Robert E. Shope, and Stanley C. Oaks, Jr., Editors; Committee on Emerging Microbial Threats to Health, Institute of Medicine.