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diagnoses. This particular system, which focuses on unusual diseases, is limited by the weight it places on country of disease origin and requires a database that might not be initially available.

An improved system with refinements in diagnostic decisionmaking that offers the untrained or inexperienced clinician assistance in considering a chemical or biological exposure would be of great value. For any system this would necessitate a complex, multiple search mechanism that includes early signs and symptoms of atypical disorders caused by biological or chemical terrorists agents.

R&D Needs

The committee recognizes that the first of the following recommendations is a recommendation, not for research itself, but for the prerequisites for productive R&D. The committee strongly believes that no research effort, no matter how important or sophisticated, will be productive until the nation rebuilds the public health infrastructure to a level at which the results of appropriate research can be properly applied. This infrastructure improvement would have enormous value to the average citizen on a day-to-day basis and would generate significant health benefits beyond readiness for terrorist events.


Immediately undertake improvements in CDC, state, and local disease and exposure surveillance and epidemiologic investigation infrastructure, and support them on a long-term basis. These improvements must focus on communicable disease epidemiology and laboratory programs and on poison control centers.


Evaluate the current educational/training needs of state and local health departments regarding all aspects of a biological or chemical terrorist incident. Develop and put in place programs and materials based on the research findings and aimed at preparing these departments and their health care partners to adequately identify and respond to such an incident.


Conduct research on new, faster, and more complete methods of electronic disease reporting to enhance surveillance at all levels, including the health care provider, local, state, national, and global surveillance levels. Such research should include evaluating the benefits of utilizing Internet and electronic mail technologies to improve reporting and access to expertise concerning biological or chemical weapons before, and during a release.


Enhance research efforts to develop nucleic acid fingerprinting techniques capable of tracking microbes likely to be used by terrorists. A library of these fingerprints, and the laboratory techniques to develop and use them should be available to a network of cooperating regional laboratories.


Conduct research into the development of symptom-based, automated decision aids that would assist clinicians in the early consideration and identification of unusual diseases related to biological and chemical terrorism.

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