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an infectious disease outbreak and typically accompanies the persistent burden due to endemic infectious diseases can be a major destabilizing force for any nation. The challenge is to keep our concerns and responses in reasonable balance. This report contains prescriptions for acting wisely to integrate our surveillance, control, and prevention efforts aimed at natural scourges with enhanced security from intentional biological attacks.
Throughout history, humans have struggled to control both the causes and the consequences of infectious diseases, and we will continue to do so into the foreseeable future. Disease control for many pathogens includes vaccines and pharmaceuticals, but how long these controls will remain effective or even available is uncertain. We appear less able (or willing) to develop new antimicrobials and vaccines than once was the case, especially for infectious diseases that affect developing countries disproportionately. A variety of technical, political, social, and economic issues challenge our ability to develop and deploy new antimicrobials and vaccines. The burden of infectious diseases has become further compounded as resistance to vector-control agents and antimicrobials has grown pervasive not only in the United States, but also worldwide.
The 1992 Institute of Medicine report Emerging Infections: Microbial Threats to Health in the United States took a fresh look at the impact of new and reemerging infectious diseases on the United States. 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), and are an important component of the overall assessment of infectious disease response and control. The scope of this report, however, was limited to infectious diseases in humans.
SPECTRUM OF MICROBIAL THREATS
The spectrum of microbial threats is a continuum that comprises the emergence of newly recognized infectious diseases, the resurgence of endemic diseases, the appearance of new antimicrobial-resistant forms of diseases, the recognition of the infectious etiology of chronic diseases, and the intentional use of biological agents for harm.