BOX 2-1 The End of Infectious Diseases in the United States?

At the start of the twentieth century, tuberculosis, pneumonia, and diarrheal diseases caused 30 percent of all deaths in the United States. Infectious diseases resulted in such high mortality among infants and children that the average life expectancy at birth in the United States was only 47 years in 1900 (NCHS, 2001). During the first few decades of the 1900s, improved hygiene and sanitation, cleaner water and safer food, improved housing and nutrition, and advanced vector control led to a significant decline in infectious disease mortality in the United States. With the introduction of antibiotics in the middle of the century, the downward trend accelerated even further. Deaths from infectious disease, particularly tuberculosis and pneumonia, declined more than 8 percent each year from 1938 to 1952 (Armstrong et al., 1999). By the mid-1960s, effective pertussis, polio, smallpox, tetanus, and diphtheria vaccines had become widely available. As a result, deaths from numerous infectious diseases were prevented. For example, the number of cases of paralytic poliomyelitis in the United States dropped from more than 57,000 in 1952 to only 72 in 1965 (CDC, 2002a) and the last case of smallpox was documented in the United States in 1949 (CDC, 2002b; IOM, 1999a).

These exhilarating accomplishments of the mid–twentieth century were fueled by an unprecedented outlay of government resources, a vast network of field epidemiologists and research scientists, and extensive cooperation from private industry (Garrett, 1995). The eradication of smallpox in 1980 was a testament to the success of comprehensive vaccine coverage, and indeed has been praised by many as the greatest achievement in public health history. From 1900 to 1980, annual deaths from infectious disease had dropped from 797 to 36 per 100,000 persons (Armstrong et al., 1999). By the turn of the 21st century, the average life expectancy in the United States had increased to over 76 years.

As a result of this apparent reprieve from infectious diseases, the United States government moved research funding away from infectious diseases toward the “new dimensions” of public health—noncommunicable disorders such as heart disease and lung cancer. The government closed “virtually every tropical and infectious disease outpost run by the U.S. military and Public Health Service” (Garrett, 1989, p. 1). Infectious disease surveillance and control activities were deemphasized. Research, development, and production of new antibiotics and vaccines declined. The potentially devastating impact of infectious diseases was either relegated to the memory of previous generations or left to the imagination of science fiction enthusiasts. Americans could all

tions, acquired immunodeficiency syndrome (AIDS), diarrheal diseases, tuberculosis (TB), malaria, and measles (see Table 2-1).

This chapter begins by reviewing the global burden imposed by three of today’s most devastating infectious diseases: AIDS, TB, and malaria. Other emerging infectious diseases and antimicrobial-resistant infections are discussed in the subsequent two sections. Chronic diseases with infectious etiology are then reviewed. The chapter ends with a brief discussion of microbes potentially used for intentional harm.

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