Volume 21, No. 2                           August 1996

Many infectious disease agents, previously considered eliminated as major public health problems, are reemerging, according to Robert Pinner, MD, Special Assistant for Surveillance in the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC). "With dramatic changes in our society and environment, infectious diseases have rapidly emerged and reemerged," said Dr. Pinner. In addition, he cited the Cryptosporidium outbreak of 1993 in Milwaukee which caused the largest waterborne disease outbreak ever recognized in this country, the Hantavirus outbreak in the American Southwest in 1993, and the meningococcal meningitis outbreak in Oregon in 1994.

Dr. Pinner was one of several infectious disease experts speaking to about 40 journalists at the first Richard J. Duma/NFID Annual Press Conference and Symposium on Infectious Diseases May 16, 1996, in Washington, DC, sponsored by the National Foundation for Infectious Diseases (NFID).

Speakers focused on issues such as new and reemerging infections, antimicrobial resistance, new tools to detect pathogens, and bovine spongiform encephalopathy (BSE), commonly known as mad cow disease.

Stuart B. Levy, MD, Professor of Medicine and of Molecular Biology and Microbiology and Director, Center for Adaptation Genetics and Drug Resistance, Tufts University School of Medicine, Boston, blames a legacy of years of antibiotic misuse for the problems now being faced with antimicrobial resistance. "Misconceptions about antibiotics have allowed them to be prescribed and dispensed casually, demanded and stockpiled by consumers, and to be taken without the advice of a physician," he said. He also said large numbers of pharmaceutical companies left the antibiotic field in the mid-1980s and are only gradually coming back. "Since drug development takes years, reliance must be placed on the antibiotics that are currently available," Dr. Levy added. With no new antibiotics in production, resistance problems will only continue to grow, Levy warned.

Since 1987, the National Academy of Science's Institute of Medicine has published three reports documenting the urgent need for improvement in identifying infectious diseases threats and responding to them effectively. "To meet this urgent need, we must improve the public health infrastructure at the local, state, and federal levels and recognize that global surveillance and response for emerging infections is vital to public health," Dr. Pinner said.

Infectious diseases now rank third among all causes of death in the United States, increasing from fifth place in 1980, according to a recent article written by Dr. Pinner and published in the Journal of the American Medical Association. In 1994, CDC developed and published a comprehensive road map for the prevention and control of emerging infectious disease threats. The CDC recommendations focus on four key areas: surveillance, research, prevention and control, and infrastructure.

But the battle against infectious diseases is not without successes. Newer genetic detection techniques have led to the discovery of the causes of bacillary angiomatosis, cat scratch disease, human ehrlichiosis, Whipple's disease, Hantavirus pulmonary syndrome, Kaposi's sarcoma, and new hepatitis agents, said David A. Relman, MD, Assistant Professor of Medicine, Microbiology and Immunology, Stanford University School of Medicine and the Veterans Administration Palo Alto Health Care System, Palo Alto, CA. "The advantages of these new molecular methods include a more rapid, sensitive, and specific detection of known microbial pathogens, as well as the identification of novel, previously uncharacterized microorganisms," he said.

Dr. Relman also said that widespread use of these methods may reveal new microbial pathogens as well as help in understanding microbial diversity. In addition, the methods may be automated for hospital and commercial clinical microbiology laboratories.

The recent emergence of BSE and the occurrence of a new variant of Creutzfeldt-Jakob disease (CJD) in the United Kingdom have focused attention on a potential new human health hazard, noted Frank O. Bastian, MD, Professor of Pathology and Director of Neuropathology, University of South Alabama, Mobile. CJD is a rare but uniformly fatal neurological illness in humans which is similar to transmissible spongiform encephalopathies (TSE) affecting animals. The infectious agent or agents responsible for CJD and related TSE are currently an area of active research investigation.

"The recent BSE stories from England bring attention to the potential threat of this disease to livestock herds and the threat of related diseases to humans," Dr. Bastian warned. "An economic impact is already being felt in this country," he added. However, according to Linda Detwiler, DVM, Animal and Plant Health Inspection Service, US Department of Agriculture, "BSE has never been diagnosed in the United States." She added that measures taken to ensure livestock safety have been in surveillance, prevention, and education. "Import restrictions on British beef and cattle have been in place since 1989, and active surveillance efforts began in 1990," she said.

The Richard J. Duma/NFID Annual Press Conference and Symposium on Infectious Diseases was named to honor Richard J. Duma, MD, PhD, the foundation's former President and Executive Director. Dr. Duma is currently a Trustee of the foundation as well as the current Director of the Division of Infectious Diseases, Halifax Medical Center, Daytona Beach, FL.

NFID developed the idea for the press conference and symposium to keep in line with its mission--to educate the public about infectious diseases. "One of the first defenses against infectious diseases is an educated public," said NFID Senior Executive Director William J. Martone, MD. "Through an educated public we can effectively apply and utilize the wealth of prevention tools we have at our disposal," he added.

"The public deserves and needs to know as much as possible about infectious diseases, since these diseases are often preventable, or if identified early, potentially curable," added Dr. Duma.

The conference and symposium were supported in part through unrestricted educational grants from Eli Lilly and Company and Pfizer Inc.