as ELISA, would receive a low ranking, whereas successful culture of a known biological agent from a sample would receive the highest ranking. Informed decisions on public action could be made based on the quality of the result rather than simply on the presence of a positive result.

Recommendation 3.2: Federal agencies should work cooperatively and in collaboration with industry to develop and evaluate rapid, sensitive, and specific early-detection technologies.

The types of identification systems needed are likely to be developed by industry, not in an academic laboratory. Federal funding agencies can speed this process by supporting the early stages of the work. The same kind of milestones should be applied to this kind of work as are used in industry to ensure that the technology is valid and meets the expected specifications. There is a role for the mobilization of established detection procedures and for those that might be second-generation detecting devices sometime in the future. The immediate need is acute and very attainable.

Surveillance and Diagnosis of Infection and Disease

Early diagnosis of patients infected with potential biological warfare (BW) agents is complicated by the lack of relevant medical experience with most of these agents in the United States and by the nonspecific symptoms of their associated diseases (e.g., many cause flulike symptoms in the early stages). Systems for effective surveillance and diagnosis of biothreat agents, as well as of many naturally occurring and emerging pathogens, are either unavailable at present or inadequate.

Many of the current challenges in surveillance and diagnosis are quite similar to those described above for identification of pathogens. Surveillance and diagnosis must also address the important distinction between infection and disease—that is, between the colonization or contamination of a host with a potential biothreat agent and the actual manifestation of pathology (disease). Sensitive and specific diagnostic tests are important adjuncts to clinical diagnosis; however, such tests cannot substitute for astute clinical recognition of symptoms to raise the suspicion of a particular diagnosis. Equally vital is the role of classical epidemiological analysis in assessment and recognition of human- and animal-disease patterns.

Preclinical Surveillance and Diagnosis

It would be critical, in the event of a biothreat agent attack, to be able to recognize or identify infected persons, animals, or plants before they develop overt disease. Great benefit could be achieved by rapid intervention in those persons, animals, or plants known to be infected, while avoiding unnecessary



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