Five postulates for resolving outbreaks of infectious disease

Outbreaks of infection challenge the surveillance of infectious disease, but they also offer opportunities to improve and refine it. An outbreak may be the first sign of an emerging pathogen or it may draw attention to a new risk group or route of infection. Postulates analogous to those used a century ago by Robert Koch to prove the microbial aetiology of infectious diseases can be employed to verify the existence of an outbreak, demonstrate its cause and pinpoint its origins. In doing this, high-resolution molecular finger printing of micro-organisms has now assumed a crucial role. Without formal analysis based on postulates, the existence, extent and source of outbreaks may be overlooked and public health interventions misapplied or lost.