Microbial Threats to Health Emergence, Detection, and Response (2003) / Chapter Skim
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Executive Summary
Executive Summary
Pages 1-18
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Certainly, humankind remains ignorant of the full scope of diseases caused by microbial threats, as only a small portion of all microbes have been identified by currently available technologies. Microbial threats continue to emerge, reemerge, and persist.
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We also are cognizant of the need to rebuild public health infrastructure locally and globally as an indispensable means of reacting to such threats. Can a focus on naturally occurring microbial threats be maintained in the face of expanded efforts to contain the threat of intentional biological attacks?
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In 2001, the Committee on Emerging Microbial Threats to Health in the 21st Century was charged to identify, review, and assess the current state of knowledge regarding factors in the emergence of infectious diseases; to assess the capacity of the United States to respond to emerging microbial threats to health; and to identify potential challenges and opportunities for domestic and international public health actions to strengthen the detection and prevention of, and response to, microbial threats to human health. The committee acknowledges that infectious diseases in animals and agriculture have indirect effects on human health (e.g., reductions in available food sources, economic and psychological hardships for food-animal producers due to culling)
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was developed to illustrate how the convergence of factors in four domains impacts on the human-microbe interaction and results in infectious disease (see Figure ES-1. Ultimately, the emergence of a microbial threat derives from the convergence of (1)
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A growing number of emerging infectious diseases arise from increased human contact with animal reservoirs as a result of changing land use patterns.
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A breakdown or absence of public health measures especially a lack of potable water, unsanitary conditions, and poor hygiene has had a dramatic effect on the emergence and persistence of infectious diseases throughout the world. The breakdown of public health measures in the United States has resulted in an increase in nosocomial infections, difficulties in maintaining adequate supplies of vaccines in recent years, immunization rates that are far below national targets for many population groups (e.g., influenza and pneumococcal immunizations in adults)
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Recognizing and addressing the ways in which the factors in emergence converge to change vulnerability to infectious diseases is essential to the development and implementation of effective prevention and control strategies. Detecting and responding to global infectious disease threats is in the economic, humanitarian, and national security interests of the United States and essential to the health of its people.
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Investments should take the form of financial and technical assistance, operational research, enhanced surveillance, and efforts to share both knowledge and best public health practices across national boundaries. Improving Global Infectious Disease Surveillance Global surveillance, especially for newly recognized infectious diseases, Is crucial to responding to and containing microbial threats before isolated outbreaks develop into regional or worldwide pandemics.
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The public health capacity in the United States must be sufficient to respond quickly to emerging microbial threats and monitor infectious disease trends. Prevention and control measures in response to microbial threats must be expanded at the local, state, and national levels and be executed by an adequately trained and competent workforce.
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CDC should take the necessary actions to enhance infectious disease reporting by medical health care and veterinary health care providers. Innovative strategies to improve communication between health care providers and public health authorities should be developed by working with other public health agencies (e.g., the Food and Drug Administration fFDA]
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CDC and NIH should work with FDA, other government agencies (e.g., DOD, USDA, the national laboratories) , and industry on the development, assessment, and validation of rapid, inexpensive and costeffective, sensitive, and specific etiologic diagnostic tests for microbial threats of public health importance.
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CDC, DOD, and NIH should develop new and expand upon current intramural and extramural programs that train health professionals in applied epidemiology and field-based research and training in the United States and abroad. Research and training should combine field and laboratory approaches to infectious disease prevention and control.
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population from endemic and emerging microbial threats. Only by focusing leadership, authority, and accountability at the cabinet level can the federal government meet its national responsibility for ensuring an innovative and adequately funded research base for existing and emerging infectious diseases and the development of an ample supply of routinely recommended vaccines.
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Secretary of Homeland Security should protect our national security by ensuring the stockpiling and distribution of antibiotics, antivirals (e.g., for influenza) , and antitoxins for naturally occurring or intentionally introduced microbial threats.
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CDC, DOD, NIH, and USDA should work with academia, private organizations, and foundations to support efforts at rebuilding the human resource capacity at both academic centers and public health agencies in the relevant sciences such as medical entomology, vector and reservoir biology, vector and reservoir ecology, and zoonosesnecessary to control vector-borne and zoonotic diseases. DOD and NIH should develop new and expand upon current research efforts to enhance the armamentarium for vector control.
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This agenda should also include the development and assessment of public health measures to address microbial threats. A sustained commitment to a robust research agenda must be a high priority if the United States is to dramatically reduce the threat of naturally occurring infectious diseases and intentional uses of biological agents.
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One can safely predict that infectious diseases will continue to emerge, and that we will encounter unpleasant surprises, as well as increases in already worrisome trends. Depending on present policies and actions, this situation could lead to a catastrophic storm of microbial threats.
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Comprehensive Infectious Disease Research Agenda To ensure that the United States is strategically poised to protect itself against the threat of infectious diseases and to maximize its assistance in global efforts to combat these diseases, further investments must be made to support a diverse array of multidisciplinary research domains. These new investments must be part of an overall strategy for improved public health preparedness and protection against infectious disease threats.
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