Factors Contributing to the Emergence of Infectious Diseases

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1992
2003
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Factors Contributing to theEmergence of
Infectious Diseases

• Human demographics and behavior
• Technology and industry
• Economic development and land use
• International travel and commerce
• Microbial adaptation and change
• Breakdown of public health measures

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Factors Contributing to theEmergence of
Infectious Diseases

• Human susceptibility to infection
• Climate and weather
• Changing ecosystems
• Poverty and social inequality
• War and famine
• Lack of political will
• Intent to harm

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NY Times, Oct. 16, 1999
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Florida Index Inhalational Anthrax Case CSF
Grams Stain
AnthraxOctober 2001
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NEJM 20013451607-10.
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2001 Anthrax AttacksIssues Not Confronted

• Multiple agents
• Multiple drug resistance
• Genetic engineering
• Transmission to animals
• Multiple modes of transmission
• Clinical surge capacity
• Multiple time zones
• Cases in other countries
• Cyberterrorism

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Other Issues Related to Other Agents

• Organism difficult to isolate or identify
• Person-to-person transmission
• Vectorborne transmission

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Infectious DiseasesNew Public Health Perspective

• Infectious disease outbreaks can impact national
  security and global economy
• Local outbreaks/problems now recognized as having
  much wider implications
• Rapid and collaborative responses essential and
  expected

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CDCs Bioterrorism Program

• Begun in 1999
• Encompasses multiple centers and programs
• Concept of dual or full use
• Focus areas
• Preparedness planning
• Epidemiology and surveillance
• Biological / chemical laboratories
• Communications (Health Alert Network)
• Education and training
• Strategic National Stockpile

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Category A Biological Agents
Variola major (Smallpox) Bacillus anthracis
(Anthrax) Yersinia pestis (Plague) Franciscella
tularensis (Tularemia) Clostridium botulinum
toxin (Botulism) Hemorrhagic fever viruses
(Ebola, Marburg)
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Ongoing Bioterrorism Initiatives

• BioShield rapid development of countermeasures
  including vaccines, therapeutics, and diagnostics
  
• BioWatch deployment of environmental air
  samplers in key locations to detect releases of
  biological agents supported by LRN
• BioSense enhanced detection of bioterrorism by
  accessing and analyzing diagnostic and
  pre-diagnostic health data

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Laboratory Response Network

• Agent-Specific Protocols
• Standardized Reagents
• Lab Referral Directory
• Secure Communications
• Training
• Proficiency Testing
• Appropriate Immunizations

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Examples of Recent LRN System Enhancements

• PCRs to detect
• Six biothreat agents as part of BioWatch
• Variola major nucleic acid in clinical specimens
• SARS coronavirus RNA in respiratory specimens,
  blood, and stool
• Expanded use of non-variola Orthopox-virus
  real-time PCR for monkeypox detection

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The Strategic National Stockpile Program

• 12 push packages ready to arrive anywhere in the
  U.S. within 12 hrs of deployment
• Vendor Managed Inventory (VMI) follow-on stores
  of medical supplies to augment push packages that
  arrive within 24-36 hours of activation

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Fauci AS. Nature 2003421787.
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Environmental Microbiology Issues

• Detecting and quantitating BT agents on surfaces,
  in water systems, and in other environments
• Determining survival times, recovery, and
  pathogenicity of BT agents in the environment
• Developing rapid methods to detect resistance in
  BT agents
• Determining the efficiency of disinfectants in
  various environments

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Confronting the Dual Use Dilemma
Examples of experiments of concern include those
that would

• Demonstrate how to render vaccine ineffective
• Confer resistance to therapeutically useful
  antibiotics or antiviral agents
• Enhance virulence or render a nonpathogen
  virulent
• Increase transmissibility
• Alter host range
• Enable evasion of diagnostic/detection modalities
• Enable weaponization of biological agent or toxin

Fink GR, et al. Natl Res Council, 2004.
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Improving Preparedness and Response Lessons
Learned from Recent Outbreaks
JAMA 2002287898
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Increased Collaborations between Human and Animal
Health
We have a new world in terms of the
epidemiological convergence of animal health and
human health. . . Its an epidemiologic
collision.
Avian influenza
SARS
Monkeypox
West Nile virusinfection
Lonnie J. KingDeanCollege of Veterinary
MedicineMichigan State University Associated
Press, 4-9-04
Nipah and Hendravirus infection
Plague
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International Partnerships
WHO Collaborative Centers on SARS Diagnosis
WHO Collaborating Centers for Influenza
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Proactive Communications
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Vigilance

• The Alert Clinician
• The Alert Laboratorian
• The Alert Veterinarian
• The Alert Research Scientist