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we were brought into the present day by the emergence of several important diseases. The IOM has done a great deal in bringing these issues to the forefront.

A Tale of Two Emerging Diseases

Let us consider two emerging diseases, one before the birth of the Internet and one after it became a mature entity. The first was detected in 1981 (CDC, 1981). An article in Morbidity and Mortality Weekly Report (MMWR) was published recognizing a cluster of Pneumocystis pneumonia in gay men in Los Angeles. This outbreak became apparent only because treatment for Pneumocystis carinii was only available from the Centers for Disease Control and Prevention (CDC). CDC investigators noted this cluster of an unusual pathogen in an unusual patient population and that was the first recognition of what came to be known as HIV/AIDS.

However, we know well that HIV infection did not start in 1981 and that the epidemic had been going on for many years, largely in Africa, but also in other parts of the world. Certainly, HIV was widespread throughout Africa at the time it became apparent in the United States and yet, although this was not a subtle disease that could easily be missed, it was essentially unknown in the West.

What if we had known earlier? Two trends were visible in the early 1990s. One was the growth and popularization of the Internet, as it was coming out of the exclusive domain of the military and a few academic centers. This was the age, for example, when America Online (AOL) was born. The second was the recognition of the importance of emerging infectious diseases as HIV, Legionnaire’s disease, and resurgent rheumatic fever became evident. Many clinicians and scientists soon had access to electronic mail and some began to wonder whether this medium could be used as a way of speeding the transmission of information about emerging diseases.

A group of very prescient individuals, Steve Morse, Jack Woodall, and Barbara Hatch-Rosenberg, met at a UN-sponsored conference on detection of the use of biological weapons and began an email list among the attendees at the meeting. This mailing list became the nidus of the forum, the beginning of what was to become ProMED-mail (for Program for Monitoring Emerging Diseases). They began sending each other reports of emerging diseases, some of which might have involved the accidental or intentional release of biological weapons material. Soon many people wanted to share this information and join this mailing list, and from the initial group of about forty individuals, ProMED-mail was born (Madoff, 2004; Madoff and Woodall, 2005).

The outbreak referred to in this report and reproduced in Box A9-1 on the following page, of course, was the beginning of the pandemic that would become known as severe acute respiratory syndrome (SARS), the second disease in our tale. The report was in many ways typical of a ProMED report: an email from a reader who had overheard a rumor of what was going on in Guanzhou. Comments in an informal online source said that there were hospitals that had been



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