strains of E. coli and Salmonella to tracking the spread of HIV/AIDS and brucellosis, for example; and (3) identifying the presence of those microbes and viruses of particular bioterrorism concern (CDC, 1998a, 1998b).

Responding to warning signals from surveillance activities is also essential for protecting the population. The response may be limited to confirming initial reports and then ensuring that authorities are taking appropriate control measures, or it may entail a broad international response to threats that cross national borders. A response may require special localized surveillance and control efforts or wider-scale efforts as the likelihood of disease proliferation becomes clear. Additionally, it may depend on a country’s surge capacity to quickly deploy resources without interrupting routine activities. Finally, surveillance responses will probably generate considerable scientific information that may be useful for addressing similar problems in the future.

The Russian Ministry of Health and Social Development devotes much of its attention to socially significant diseases (see Appendix E). It receives frequent reminders of their importance, such as the nationwide outbreak of diphtheria in 1993-1996; the emergence of polio in Chechnya in 1995; the surging incidence nationwide of tuberculosis, syphilis, and hepatitis B; and even continuing malaria infections in some localities. At the top of the list of the newer diseases of concern are HIV, followed by hemorrhagic fever, Lyme disease, and 25 other potentially dangerous infections (Onishchenko, 2002). These realities force health authorities to improve preventive measures to combat common infectious diseases, generally within the framework of national immunization strategies and policies (see Appendix I).

The Russian government has not hesitated to respond promptly and vigorously, within the constraints of available specialists and funds, to disease threats once they have been identified. As an example of Russian capabilities, the government response to the severe acute respiratory syndrome (SARS) outbreak in China was impressive. Attendants on Russian passenger trains leaving China and personnel at Russia’s international airports were important components of this response. These personnel, who had been routinely trained to cope with sick travelers, were quickly given supplemental information to enable them to identify travelers who might be infected with SARS. Those travelers then had immediate access to public health personnel for professional health examinations when needed. Despite the long Russia-China border, SARS did not infect the Russian population with the possible exception of one questionable case in the Far East.

The government is also organized to respond to an incident of bioterrorism, particularly in Moscow, which is considered by many Russians the most likely target of such an attack. Special medical manuals have been prepared. Special organizations have been designated to provide the needed health-related tech-