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Volume 4, Number 3—September 1998

Volume 4, Number 3—September 1998   PDF Version [PDF - 9.44 MB - 168 pages]

THEME ISSUE
ICEID 1998

Introduction

About Emerging Infectious Diseases

New Agents and Disease Associations

  • Detection and Identification of Previously Unrecognized Microbial Pathogens PDF Version [PDF - 570 KB - 8 pages]
    D. A. Relman
       View Abstract

    Features of a number of important but poorly explained human clinical syndromes strongly indicate a microbial etiology. In these syndromes, the failure of cultivation-dependent microbial detection methods reveals our ignorance of microbial growth requirements. Sequence-based molecular methods, however, offer alternative approaches for microbial identification directly from host specimens found in the setting of unexplained acute illnesses, chronic inflammatory disease, and from anatomic sites that contain commensal microflora. The rapid expansion of genome sequence databases and advances in biotechnology present opportunities and challenges: identification of consensus sequences from which reliable, specific phylogenetic information can be inferred for all taxonomic groups of pathogens, broad-range pathogen identification on the basis of virulence-associated gene families, and use of host gene expression response profiles as specific signatures of microbial infection.

  • The Emergence of Bovine Spongiform Encephalopathy and Related Diseases PDF Version [PDF - 217 KB - 5 pages]
    S. J. Pattison
       View Abstract

    Since 1986, approximately 170,000 cases of bovine spongiform encephalopathy (BSE) have occurred among approximately one million animals infected by contaminated feed in the United Kingdom. A ruminant feed ban in 1988 resulted in the rapid decline of the epidemic. Transmissible spongiform encephalopathies due to agents indistinguishable from BSE have appeared in small numbers of exotic zoo animals; a small outbreak among domestic cats is declining. Creutzfeldt-Jakob disease (CJD) has been intensively monitored since 1990 because of the risk BSE could pose to public health. In 1995, two adolescents in the United Kingdom died of CJD, and through the early part of 1996, other relatively young people had cases of what became known as new variant CJD, whose transmissible agent (indistinguishable from that of BSE) is responsible for 26 cases in the United Kingdom and one in France. Areas of concern include how many cases will appear in the future and whether or not use of human blood and blood products may cause a second cycle of human infections.

  • Explaining the Unexplained in Clinical Infectious Diseases: Looking Forward PDF Version [PDF - 241 KB - 3 pages]
    B. A. Perkins and D. Relman

The Global Threat

Populations at Risk

  • Nosocomial Infection Update PDF Version [PDF - 424 KB - 5 pages]
    R. A. Weinstein
       View Abstract

    Historically, staphylococci, pseudomonads, and Escherichia coli have been the nosocomial infection troika; nosocomial pneumonia, surgical wound infections, and vascular accessrelated bacteremia have caused the most illness and death in hospitalized patients; and intensive care units have been the epicenters of antibiotic resistance. Acquired antimicrobial resistance is the major problem, and vancomycin-resistant Staphylococcus aureus is the pathogen of greatest concern. The shift to outpatient care is leaving the most vulnerable patients in hospitals. Aging of our population and increasingly aggressive medical and surgical interventions, including implanted foreign bodies, organ transplantations, and xenotransplantation, create a cohort of particularly susceptible persons. Renovation of aging hospitals increases risk of airborne fungal and other infections. To prevent and control these emerging nosocomial infections, we need to increase national surveillance, "risk adjust" infection rates so that interhospital comparisons are valid, develop more noninvasive infection-resistant devices, and work with health-care workers on better implementation of existing control measures such as hand washing.

  • Opportunistic Infections in Immunodeficient Populations PDF Version [PDF - 236 KB - 2 pages]
    J. E. Kaplan et al.
  • Host Genes and Infectious Diseases PDF Version [PDF - 246 KB - 4 pages]
    J. McNicholl
  • Immigrant and Refugee Health PDF Version [PDF - 202 KB - 2 pages]
    S. Cookson et al.

Zoonotic and Vector-borne Issues

  • Emerging Zoonoses PDF Version [PDF - 408 KB - 7 pages]
    F. A. Murphy
       View Abstract

    In the past few years, emergent disease episodes have increased; nearly all have involved zoonotic or species-jumping infectious agents. Because there is no way to predict when or where the next important new zoonotic pathogen will emerge or what its ultimate importance might be, investigation at the first sign of emergence of a new zoonotic disease is particularly important. Such investigation may be described in terms of a discovery-to-control continuum: from recognition of a new disease in a new setting to complex phases involving the hard science disciplines pertaining to discovery, the epidemiologic sciences pertaining to risk assessment, and activities pertaining to risk management. Today, many activities involving zoonotic disease control are at risk because of a failed investigative infrastructure or financial base. Because zoonotic diseases are distinct, their prevention and control will require unique strategies, based more on fundamental research than on traditional approaches. Such strategies require that we rebuild a cadre of career-committed professionals with a holistic appreciation of several medical and biologic sciences.

  • Influenza: An Emerging Disease PDF Version [PDF - 255 KB - 6 pages]
    R. G. Webster
       View Abstract

    Because all known influenza A subtypes exist in the aquatic bird reservoir, influenza is not an eradicable disease; prevention and control are the only realistic goals. If people, pigs, and aquatic birds are the principal variables associated with interspecies transfer of influenza virus and the emergence of new human pandemic strains, influenza surveillance in these species is indicated. Live-bird markets housing a wide variety of avian species together (chickens, ducks, geese, pigeon, turkeys, pheasants, guinea fowl), occasionally with pigs, for sale directly to the public provide outstanding conditions for genetic mixing and spreading of influenza viruses; therefore, these birds should be monitored for influenza viruses. Moreover, if pigs are the mixing vessel for influenza viruses, surveillance in this population may also provide an early warning system for humans.

  • Resurgent Vector-Borne Diseases as a Global Health Problem PDF Version [PDF - 681 KB - 9 pages]
    D. J. Gubler
       View Abstract

    Vector-borne infectious diseases are emerging or resurging as a result of changes in public health policy, insecticide and drug resistance, shift in emphasis from prevention to emergency response, demographic and societal changes, and genetic changes in pathogens. Effective prevention strategies can reverse this trend. Research on vaccines, environmentally safe insecticides, alternative approaches to vector control, and training programs for health-care workers are needed.

  • Global Climate Change and Infectious Diseases PDF Version [PDF - 337 KB - 2 pages]
    R. Colwell et al.
  • Emerging Zoonoses PDF Version [PDF - 237 KB - 2 pages]
    J. Childs et al.

Emerging Foodborne Pathogens

Communicating the Threat

Critical Issues for the Future

  • Controversies in the Prevention and Control of Antimicrobial Drug Resistance PDF Version [PDF - 204 KB - 2 pages]
    D. Bell
  • Infectious Causes of Chronic Inflammatory Diseases and Cancer PDF Version [PDF - 293 KB - 13 pages]
    G. H. Cassell
       View Abstract

    Powerful diagnostic technology, plus the realization that organisms of otherwise unimpressive virulence can produce slowly progressive chronic disease with a wide spectrum of clinical manifestations and disease outcomes, has resulted in the discovery of new infectious agents and new concepts of infectious diseases. The demonstration that final outcome of infection is as much determined by the genetic background of the patient as by the genetic makeup of the infecting agent is indicating that a number of chronic diseases of unknown etiology are caused by one or more infectious agents. One well-known example is the discovery that stomach ulcers are due to Helicobacter pylori. Mycoplasmas may cause chronic lung disease in newborns and chronic asthma in adults, and Chlamydia pneumoniae, a recently identified common cause of acute respiratory infection, has been associated with atherosclerosis. A number of infectious agents that cause or contribute to neoplastic diseases in humans have been documented in the past 6 years. The association and causal role of infectious agents in chronic inflammatory diseases and cancer have major implications for public health, treatment, and prevention.

  • Bioterrorism as a Public Health Threat PDF Version [PDF - 218 KB - 5 pages]
    D. Henderson
       View Abstract

    The threat of bioterrorism, long ignored and denied, has heightened over the past few years. Recent events in Iraq, Japan, and Russia cast an ominous shadow. Two candidate agents are of special concern: smallpox and anthrax. The magnitude of the problems and the gravity of the scenarios associated with release of these organisms have been vividly portrayed by two epidemics of smallpox in Europe during the 1970s and by an accidental release of aerosolized anthrax from a Russian bioweapons facility in 1979. Efforts in the United States to deal with possible incidents involving bioweapons in the civilian sector have only recently begun and have made only limited progress. Only with substantial additional resources at the federal, state, and local levels can a credible and meaningful response be mounted. For longer-term solutions, the medical community must educate both the public and policy makers about bioterrorism and build a global consensus condemning its use.

  • Bioterrorism as a Public Health Threat PDF Version [PDF - 622 KB - 2 pages]
    J. E. McDade and D. Franz
  • Who Speaks for the Microbes? PDF Version [PDF - 336 KB - 3 pages]
    S. Falkow
  • Emerging Diseases–What Now? PDF Version [PDF - 209 KB - 3 pages]
    G. A. Alleyne

Summaries from satellite partnership meetings (March 8-12)

Volume 4, Number 3—September 1998 - Continued

Letters

Books and Media

About the Cover

Corrections

News and Notes

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