Emerging Infectious Diseases: A CDC Perspective

Dr. Jeffrey Koplan, Director of the Centers for DiseaseControl and Prevention (CDC), has set four goals for theagency to accomplish. Each is directly related to issues beingdiscussed at the 2000 ICEID conference. The first goal is tostrengthen the science base for public health action. Thesecond goal is to collaborate with healthcare partners fordisease prevention; it is essential that individuals in clinicaland academic medicine work closely with colleagues in publichealth to address these issues. The third goal is to promotehealthy living for people at every stage of life. Finally, and veryimportantly to participants in this conference, the fourth goal forthe agency is to work with partners to improve global health.An article in Morbidity and Mortality Weekly Report in1999 contains a summary of progress made in infectiousdisease control in the United States during the 20th centurywhen the number of deaths resulting from infectious diseasesdecreased dramatically (1). However, the dramatic spike inthe number of deaths from 1918 to 1919 resulting from thefirst of three influenza pandemics, is clearly evident (Figure1). In addition, the number of deaths caused by infectiousdiseases increased between 1980 and 1995. Because of theexcellent progress made against infectious diseases duringmuch of the 20th century, many people felt that the problemof infectious diseases had been sufficiently addressed. Nearly40 years ago, Sir MacFarlane Burnett wrote, “One can thinkof the middle of the twentieth century as the end of one of themost important social revolutions in history, the virtualelimination of the infectious disease as a significant factor insocial life” (2). This quotation reveals the complacency that hasexisted since and goes a long way toward explaining why we havegotten behind both nationally and globally in terms of capacityrequired to deal with the problems of infectious diseases.The current problems we face as a result were highlightedin a very important 1992 Institute of Medicine (IOM) report,Emerging Infections: Microbial Threats to Health in theUnited States (3). This seminal work represents the effort ofan expert committee cochaired by Dr. Joshua Lederberg andDr. Robert Shope. This committee defined emerging infections as“new, reemerging, or drug-resistant infections whose incidencein humans has increased within the past two decades or whoseincidence threatens to increase in the near future.”The committee also identified six major factors thatcontribute to disease emergence and reemergence: 1) changesin human demographics and behavior, 2) advances intechnology and changes in industry practices, 3) economicdevelopment and changes in land-use patterns, 4) dramaticincreases in volume and speed of international travel andcommerce—movement not only of people but of animals,foodstuffs, and other commodities, 5) microbial adaptationand change (a factor that makes infectious diseases uniqueand particularly challenging), and 6) breakdown of publichealth capacity required for infectious diseases at the local,state, national, and global levels. In most cases, more thanone of these factors are applicable to the emergence orreemergence of an individual disease or syndrome.The IOM report contains 15 recommendations, many ofwhich we felt were directed specifically to CDC. We respondedto that report by developing a CDC Emerging Infections Plan,issued in 1994 (4), and an updated version, published in 1998(5), that outlines a strategy for CDC to work with manypartners throughout the country and around the world toaddress these issues. The plan contains four goals. The firstemphasizes the need to strengthen infectious diseasesurveillance and response; this approach is necessary toensure timely detection and control of diseases and theiragents. Second, many research issues raised by thesechallenges need to be addressed. Third, the public healthsystem is in urgent need of repair so that it can deal with theseissues; the CDC strategy emphasizes the training needsassociated with human resource development, an importantgoal of this conference. The final, ultimate goal stresses theneed to strengthen prevention and control programs locally,nationally, and globally.This conference has several dominant themes. The first isantimicrobial resistance. The IOM has maintained a strong