Emerging infectious diseases: a CDC perspective.

Dr. Jeffrey Koplan, Director of the Centers for Disease Control and Prevention (CDC), has set four goals for the agency to accomplish. Each is directly related to issues being discussed at the 2000 ICEID conference. The first goal is to strengthen the science base for public health action. The second goal is to collaborate with healthcare partners for disease prevention; it is essential that individuals in clinical and academic medicine work closely with colleagues in public health to address these issues. The third goal is to promote healthy living for people at every stage of life. Finally, and very importantly to participants in this conference, the fourth goal for the agency is to work with partners to improve global health. An article in Morbidity and Mortality Weekly Report in 1999 contains a summary of progress made in infectious disease control in the United States during the 20th century when the number of deaths resulting from infectious diseases decreased dramatically (1). However, the dramatic spike in the number of deaths from 1918 to 1919 resulting from the first of three influenza pandemics, is clearly evident (Figure 1). In addition, the number of deaths caused by infectious diseases increased between 1980 and 1995. Because of the excellent progress made against infectious diseases during much of the 20th century, many people felt that the problem of infectious diseases had been sufficiently addressed. Nearly 40 years ago, Sir MacFarlane Burnett wrote, “One can think of the middle of the twentieth century as the end of one of the most important social revolutions in history, the virtual elimination of the infectious disease as a significant factor in social life” (2). This quotation reveals the complacency that has existed since and goes a long way toward explaining why we have gotten behind both nationally and globally in terms of capacity required to deal with the problems of infectious diseases. The current problems we face as a result were highlighted in a very important 1992 Institute of Medicine (IOM) report, Emerging Infections: Microbial Threats to Health in the United States (3). This seminal work represents the effort of an expert committee cochaired by Dr. Joshua Lederberg and Dr. Robert Shope. This committee defined emerging infections as “new, reemerging, or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.” The committee also identified six major factors that contribute to disease emergence and reemergence: 1) changes in human demographics and behavior, 2) advances in technology and changes in industry practices, 3) economic development and changes in land-use patterns, 4) dramatic increases in volume and speed of international travel and commerce—movement not only of people but of animals, foodstuffs, and other commodities, 5) microbial adaptation and change (a factor that makes infectious diseases unique and particularly challenging), and 6) breakdown of public health capacity required for infectious diseases at the local, state, national, and global levels. In most cases, more than one of these factors are applicable to the emergence or reemergence of an individual disease or syndrome. The IOM report contains 15 recommendations, many of which we felt were directed specifically to CDC. We responded to 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 many partners throughout the country and around the world to address these issues. The plan contains four goals. The first emphasizes the need to strengthen infectious disease surveillance and response; this approach is necessary to ensure timely detection and control of diseases and their agents. Second, many research issues raised by these challenges need to be addressed. Third, the public health system is in urgent need of repair so that it can deal with these issues; the CDC strategy emphasizes the training needs associated with human resource development, an important goal of this conference. The final, ultimate goal stresses the need to strengthen prevention and control programs locally, nationally, and globally. This conference has several dominant themes. The first is antimicrobial resistance. The IOM has maintained a strong Emerging Infectious Diseases: A CDC Perspective