Emerging infectious diseases, the leading cause of death worldwide, continue to pose difficult challenges to clinicians, public health professionals, and biomedical researchers in academic settings and industry. Addressing these challenges requires a cohesive effort to develop prevention strategies and to communicate them effectively to the health care community, the public, and policy makers.

On June 5-6, 1995, the New York Academy of Medicine and the New York State Department of Health convened to examine the problem of emerging infections. The speakers addressed four themes: 1) emerging infectious diseases: why and why now? 2) transmission of emerging infectious diseases: old modes, new agents; 3) surveillance and sentinel systems for infectious diseases; and 4) emerging infectious diseases: what is to be done?

The first three themes were addressed through presentations by 20 experts. The fourth was divided into six segments focusing on diagnosis, the role of the microbiology laboratory in surveillance, other surveillance issues, approaches to epidemic investigations, risk perception, and global issues.

Speakers consistently alluded to recent complacency about infectious diseases in the United States and stressed the need for the clinical, public health, and research communities to work with the biomedical industry in confronting emerging infectious disease challenges in this era of transition to managed health care. In his opening address Joshua Lederberg from Rockefeller University reminded participants that the struggle between humans and microbes could be characterized as a battle of "wits versus genes." Margaret Hamburg, Commissioner of the New York City Department of Health, emphasized that plague in India and Ebola virus infection in Zaire were reminders that the world is a global village, that considering domestic and international diseases as separate entities is an outmoded concept, and that many conditions that contribute to disease emergence or reemergence in the developing world are also present in the United States, adding to our domestic vulnerability to emerging infections.

Other speakers focused on the evolution of virulence, the molecular basis of pathogenesis, observations on factors contributing to the plague epidemic in India in 1994 and the Ebola outbreak in Zaire in 1976; foodborne and waterborne diseases; airborne diseases; zoonoses; sexually transmitted and blood-borne diseases and the increasing problem of antimicrobial resistance in both hospital and community settings. Concerns were expressed about the possibility of a "post-antimicrobial era" in which available drugs are no longer effective against common bacterial infections. Other speakers focused on innovative approaches to surveillance at the local, state, national, and international levels. James LeDuc from the World Health Organization (WHO) provided an update on the emerging infections resolution passed by the World Health Assembly in May 1995 and other WHO activities related to detecting and responding to emerging and reemerging diseases.

Among the themes recurring throughout the conference were the challenges that microbes will continue to pose; the critical role of the modern microbiology laboratory in detecting and responding to emerging and reemerging infections; and the limitations of existing capacity at the local, state, national, and international level to respond to these challenges. Human resource, equipment, diagnostic reagent, and facility needs were addressed, and resource needs were emphasized. Training needs of medical students, clinicians, epidemiologists, microbiologists, entomologists, mammalogists, behavioral scientists, and other researchers were also stressed. Additional emphasis was placed on the critical importance of communicating alerts about clusters of illness, data on disease trends, and guidelines for disease prevention; the need for educating professionals, the public, and policy makers about the critical importance of these issues; the need for strengthening existing partnerships and developing new ones, particularly with health maintenance organizations, the pharmaceutical industry, and nongovernmental organizations (including medical missionary organizations); and the need to carefully identify priorities.

Conference participants resounded the message of the 1992 Institute of Medicine Report, Emerging Infections: Microbial Threats to Health in the United States, "Pathogenic microbes can be resilient, dangerous foes. Although it is impossible to predict their individual emergence in time and place, we can be confident that new microbial diseases will emerge." Particular future concerns included a possible influenza pandemic, the emergence of vancomycin resistance in Staphylococcus aureus, the occurrence of large dengue hemorrhagic fever epidemics in the Western Hemisphere, and the likelihood that additional chronic diseases will be found to have infectious etiologies. Concerns were also expressed about the possibility of a terrorist incident involving an infectious agent and the potential difficulties in detecting and responding to such an episode.

The New York Academy of Medicine plans to use the discussions during the conference in formulating an agenda for further action.

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