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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions

Workshop Summary

Rapporteurs: Stanley M. Lemon, Margaret A. Hamburg, P. Frederick Sparling, Eileen R. Choffnes, and Alison Mack

Forum on Microbial Threats

Board on Global Health

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This project was supported by contracts between the National Academy of Sciences and the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense: Global Emerging Infections Surveillance and Response System, Walter Reed Army Institute of Research, and Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; Lawrence Livermore National Laboratory; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

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COVER: A detailed section of a stained glass window 21" 56" depicting the natural history of influenza viruses and zoonotic exchange in the emergence of new strains was used to design the front cover. Based on the work done at St. Jude Children’s Research Hospital supported by American Lebanese Syrian Associated Charities (ALSAC) and the National Institute of Allergy and Infectious Diseases (NIAID). Artist: Jenny Hammond, Highgreenleycleugh, Northumberland, England.

Suggested citation:

Institute of Medicine. 2007. Global infectious disease surveillance and detection: Assessing the challenges—finding solutions. Workshop summary. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine


The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.


The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.


The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.


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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

FORUM ON MICROBIAL THREATS

STANLEY M. LEMON (Chair),

School of Medicine, University of Texas Medical Branch, Galveston

MARGARET A. HAMBURG (Vice-chair),

Nuclear Threat Initiative/Global Health & Security Initiative, Washington, DC

P. FREDERICK SPARLING (Vice-chair),

University of North Carolina, Chapel Hill

DAVID W. K. ACHESON,

Center for Food Safety and Applied Nutrition, Food and Drug Administration, Rockville, Maryland

RUTH L. BERKELMAN,

Emory University, Center for Public Health Preparedness and Research, Rollins School of Public Health, Atlanta, Georgia

ENRIQUETA C. BOND,

Burroughs Wellcome Fund, Research Triangle Park, North Carolina

ROGER G. BREEZE,

Centaur Science Group, Washington, DC

STEVEN J. BRICKNER,

Pfizer Global Research and Development, Pfizer Inc., Groton, Connecticut

NANCY CARTER-FOSTER,

Program for Emerging Infections and HIV/AIDS, U.S. Department of State, Washington, DC

GAIL H. CASSELL,

Eli Lilly & Company, Indianapolis, Indiana

BILL COLSTON,

Lawrence Livermore National Laboratory, Livermore, California

RALPH L. ERICKSON,

Global Emerging Infections Surveillance and Response System, Department of Defense, Silver Spring, Maryland

MARK B. FEINBERG,

Merck Vaccine Division, Merck & Co., West Point, Pennsylvania

J. PATRICK FITCH,

National Biodefense Analysis and Countermeasures Center, Frederick, Maryland

DARRELL R. GALLOWAY,

Medical S&T Division, Defense Threat Reduction Agency, Fort Belvoir, Virginia

S. ELIZABETH GEORGE,

Biological and Chemical Countermeasures Program, Department of Homeland Security, Washington, DC

JESSE L. GOODMAN,

Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland

EDUARDO GOTUZZO,

Instituto de Medicina Tropical–Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Peru

JO HANDELSMAN,

College of Agricultural and Life Sciences, University of Wisconsin, Madison

CAROLE A. HEILMAN,

Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

DAVID L. HEYMANN,

Polio Eradication, World Health Organization, Geneva, Switzerland

PHIL HOSBACH,

New Products and Immunization Policy, Sanofi Pasteur, Swiftwater, Pennsylvania

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

JAMES M. HUGHES,

Global Infectious Diseases Program, Emory University, Atlanta, Georgia

STEPHEN A. JOHNSTON,

Arizona BioDesign Institute, Arizona State University, Tempe

GERALD T. KEUSCH,

Boston University School of Medicine and Boston University School of Public Health, Massachusetts

RIMA F. KHABBAZ,

National Center for Preparedness, Detection and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

LONNIE J. KING,

Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

GEORGE W. KORCH,

U.S. Army Medical Research Institute for Infectious Diseases, Fort Detrick, Maryland

JOSHUA LEDERBERG,

The Rockefeller University, New York

LYNN G. MARKS,

Medicine Development Center, GlaxoSmithKline, Collegeville, Pennsylvania

EDWARD McSWEEGAN,

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

STEPHEN S. MORSE,

Center for Public Health Preparedness, Columbia University, New York

MICHAEL T. OSTERHOLM,

Center for Infectious Disease Research and Policy, School of Public Health, University of Minnesota, Minneapolis

GEORGE POSTE,

Arizona BioDesign Institute, Arizona State University, Tempe

DAVID A. RELMAN,

Stanford University, Palo Alto, California

GARY A. ROSELLE,

Central Office, Veterans Health Administration, Department of Veterans Affairs, Washington, DC

JANET SHOEMAKER,

Office of Public Affairs, American Society for Microbiology, Washington, DC

BRIAN J. STASKAWICZ,

Department of Plant and Microbial Biology, University of California, Berkeley

TERENCE TAYLOR,

International Council for the Life Sciences, Washington, DC

Staff

EILEEN CHOFFNES, Forum Director

ALLISON BRANTLEY, Senior Program Assistant*

SARAH BRONKO, Senior Program Assistant

ALISON MACK, Science Writer

KATE SKOCZDOPOLE, Research Associate

*

Ending June 2007.

Beginning June 2007.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

BOARD ON GLOBAL HEALTH

Margaret Hamburg (Chair), Consultant,

Nuclear Threat Initiative, Washington, DC

George Alleyne, Director Emeritus,

Pan American Health Organization, Washington, DC

Donald Berwick, Clinical Professor of Pediatrics and Health Care Policy,

Harvard Medical School, and

President and Chief Executive Officer,

Institute of Healthcare Improvement, Boston, Massachusetts

Jo Ivey Boufford (IOM Foreign Secretary), President,

New York Academy of Medicine, New York

David R. Challoner, Vice President for Health Affairs, Emeritus,

University of Florida, Gainesville

Ciro de Quadros,

Albert B. Sabin Vaccine Institute, Washington, DC

Sue Goldie, Associate Professor of Health Decision Science,

Department of Health Policy and Management, Center for Risk Analysis, Harvard University School of Public Health, Boston, Massachusetts

Richard Guerrant, Thomas H. Hunter Professor of International Medicine and Director,

Center for Global Health, University of Virginia School of Medicine, Charlottesville

Gerald T. Keusch, Assistant Provost for Global Health,

Boston University School of Medicine, and

Associate Dean for Global Health,

Boston University School of Public Health, Massachusetts

Jeffrey Koplan, Vice President for Academic Health Affairs,

Emory University, Atlanta, Georgia

Sheila Leatherman, Research Professor,

University of North Carolina School of Public Health, Chapel Hill

Michael Merson, Director,

Duke Global Health Institute, Duke University, Durham, NC

Mark L. Rosenberg, Executive Director,

Task Force for Child Survival and Development, Emory University, Decatur, Georgia

Philip Russell, Professor Emeritus,

Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland

Staff

Patrick Kelley, Director

Allison Brantley, Senior Program Assistant

IOM boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the reports rests with the authors and the institution.

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Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

John Besser, Public Health Laboratory, Minnesota Department of Health

R. James Cook, Department of Plant Pathology, Washington State University

Charlotte A Gaydos, Division of Infectious Diseases, The Johns Hopkins University and International STD Reference Laboratory

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Melvin Worth, Scholar-in-Residence, Institute of Medicine. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
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×

Preface

The Forum on Emerging Infections was created by the Institute of Medicine (IOM) in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The purpose of the Forum is to provide structured opportunities for leaders from government, academia, and industry to meet and examine issues of shared concern regarding research, prevention, detection, and management of emerging or reemerging infectious diseases. In pursuing this task, the Forum provides a venue to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them; for this reason, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its value derives instead from the diversity of its membership and from the contributions that individual members make throughout the activities of the Forum. In September 2003, the Forum changed its name to the Forum on Microbial Threats.

ABOUT THE WORKSHOP

Early detection is essential to the control of emerging, reemerging, and novel infectious diseases, including agents of bioterrorism. Containing the spread of such a disease in a profoundly interconnected world requires active vigilance for signs of an outbreak, rapid recognition of its presence, and diagnosis of its microbial cause, as well as strategies and resources for an appropriate and efficient response. While often viewed in terms of public health, the challenges

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

of detecting natural and intentionally introduced disease outbreaks are equally shared by the plant and animal health communities.

Currently, disease surveillance and detection relies heavily on the astute individual: the clinician, veterinarian, grower, livestock manager, or agricultural extension agent who notices atypical or suspicious symptoms and brings them to the attention of public health, veterinary medicine, or agricultural officials—including academicians and zoological parks. While most developed countries have a surveillance system in place and the ability to detect and diagnose human, animal, and plant diseases, many developing countries—where most of the global population resides—may not have the resources or infrastructure to support such activities. Under such circumstances, disease detection occurs on the local level and depends entirely on the early recognition of both known and novel infectious diseases.

Technological advances in disease surveillance and detection such as regional syndromic surveillance, bioinformatics, and new rapid diagnostic methods have the potential to improve infectious disease control and prevention efforts. Further improvements are likely to result from ongoing innovations in infectious disease diagnostics, reporting, and surveillance. However, a number of challenges remain to be met before deployment of rapid, low-cost, sensitive, and specific point-of-care disease diagnostics become a reality.

The Forum on Microbial Threats of the Institute of Medicine hosted a public workshop in Washington, DC, on December 12 and 13, 2006, to consider the scientific and policy issues—some of them long standing, others more recently arisen—relevant to the practice of disease surveillance and detection. Through invited presentations and discussions, participants examined current and emerging methods and strategies for the surveillance and detection of human, animal, and plant diseases, and assessed the resource needs and opportunities for improving and coordinating infectious disease surveillance, detection, and reporting.

ACKNOWLEDGMENTS

The Forum on Microbial Threats and the IOM wish to express their warmest appreciation to the individuals and organizations who gave their valuable time to provide information and advice to the Forum through their participation in this workshop. A full list of presenters can be found in Appendix A.

The Forum is indebted to the IOM staff who contributed during the course of the workshop and the production of this workshop summary. On behalf of the Forum, we gratefully acknowledge the efforts led by Eileen Choffnes, director of the Forum, and Kate Skoczdopole, research associate, for dedicating much effort and time to developing this workshop’s agenda and for their thoughtful and insightful approach and skill in translating the workshop’s proceedings and discussion into this workshop summary. We would also like to thank the following IOM staff and consultants for their valuable contributions to this activity: Patrick

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
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Kelley, Alison Mack, Sarah Bronko, Bronwyn Schrecker, Allison Brantley, Lara Andersen, and Laura Penny.

Finally, the Forum wishes to recognize the sponsors that supported this activity. Financial support for this project was provided by the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense: Global Emerging Infections Surveillance and Response System, Walter Reed Army Institute of Research, and Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; Lawrence Livermore National Laboratory; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. The views presented in this workshop summary report are those of the workshop participants and rapporteurs and are not necessarily those of the Forum on Microbial Threats or its sponsors.


Stanley M. Lemon, Chair

Margaret A. Hamburg, Vice-chair

P. Frederick Sparling, Vice-chair

Forum on Microbial Threats

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
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 Global Public Health Surveillance: The Role of Nontraditional Surveillance Tools,
Abla Mawudeku, M.P.H., M. Ruben, M.D., Ph.D., and R. Lemay, B.Sc., M.B.A.

 

116

   

 HealthMap: Internet-Based Emerging Infectious Disease Intelligence,
John S. Brownstein, Ph.D., Clark C. Freifeld, B.S., Ben Y. Reis, Ph.D., and Kenneth D. Mandl, M.D., M.P.H.

 

122

   

 Using Cell Phone Technology for Infectious Disease Surveillance in Low-Resource Environments: A Case Study from Peru,
Pamela R. Johnson, Ph.D., and David L. Blazes, M.D., M.P.H.Pamela R. Johnson, Ph.D., and David L. Blazes, M.D., M.P.H.

 

136

   

 References,

 

153

3

 

Detection and Diagnostics

 

158

   

 Overview,

 

158

   

 Partnering for Better Microbial Diagnostics,
Mark D. Perkins, M.D., and Peter M. Small, M.D.

 

160

   

 Rapid Infectious Disease Diagnostic Assays,
Mark J. Wolcott, Ph.D., Randal J. Schoepp, Ph.D., David A. Norwood, Ph.D., and David R. Shoemaker, Ph.D.

 

165

   

 Emerging Tools for Microbial Diagnosis, Surveillance, and Discovery,
W. Ian Lipkin, M.D., and Thomas Briese, Ph.D.

 

177

   

 The Potential Importance of Presymptomatic, Host-Based Diagnosis in Biodefense and Standard Health Care,
Stephen Albert Johnston, Ph.D.

 

193

   

 References,

 

207

4

 

Resource Needs and Opportunities

 

213

   

 Overview,

 

213

   

 Coordination of Disease Surveillance, Detection, Diagnostics, and Reporting,
William D. Hueston, D.V.M., Ph.D.

 

216

   

 Improving Infectious Disease Surveillance and Detection: A Public Health Laboratory Perspective,
Frances Pouch Downes, Dr.P.H.

 

224

   

 References,

 

230

 

 

Appendixes

 

 

A

 

Agenda

 

233

B

 

Acronyms

 

238

C

 

Forum Member Biographies

 

243

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

Tables, Figures, and Boxes

TABLES

SA-1

 

Animal Diseases Associated with Direct and Indirect Human Impacts,

 

12

SA-2

 

Current Public Health Paradigm and Alternative World View,

 

34

1-1

 

Sources for Syndromic Surveillance, 2003 and 2006 Annual Meeting Abstracts,

 

62

1-2

 

Potential Sources of Data for Syndromic Surveillance,

 

62

1-3

 

U.S. Select Agent List for Plants,

 

91

2-1

 

Top Infectious Disease Alerts from the HealthMap System, October 1, 2006–February 16, 2007,

 

128

3-1

 

Department of Defense (DoD) Acquisition Program for Diagnostic Devices,

 

168

3-2

 

Criteria for Proof of Causation,

 

179

4-1

 

Current Public Health Paradigm and Alternative World View,

 

221

FIGURES

SA-1

 

The economic impact of selected infectious diseases,

 

13

SA-2

 

Traditional public health reporting,

 

18

SA-3

 

The power of the ProMED surveillance network,

 

19

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Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

SA-4

 

Source of initial reporting of potential events of public health concern by WHO between January 1, 2001, and December 31, 2002,

 

21

SA-5

 

HealthMap alert volume by source,

 

23

SA-6

 

Telephone subscribers per 100 inhabitants, Africa 1995–2004,

 

24

SA-7

 

Star Trek medical tricorder,

 

30

1-1

 

Syndromic surveillance of U.S. marines for treated diarrheal syndromes during the lead-up to the Persian Gulf War, 1990–1991,

 

52

1-2

 

Conceptual steps in development and implementation of a syndromic surveillance system in a community,

 

53

1-3

 

The donut-hole effect,

 

55

1-4

 

Estimated sensitivity for West Nile virus by different surveillance methods,

 

57

1-5

 

E. coli O157:H7 spinach-associated outbreak, 2006,

 

58

1-6

 

Time associated with confirming spinach-related illness,

 

58

1-7

 

Locations of surveillance systems in abstracts for the 2006 International Society for Disease Surveillance (ISDS) meeting,

 

61

1-8

 

System requirements for public health surveillance,

 

63

1-9

 

Sensitivity of syndromic surveillance (probability of detection by day) for influenza-like illness at a typical urban hospital emergency room using four detection algorithms,

 

67

1-10

 

Electronic health monitoring components,

 

74

2-1

 

Epidemic intelligence framework,

 

117

2-2

 

Global Public Health Intelligence Network (GPHIN) flow of information,

 

119

2-3

 

Screenshot of the HealthMap system,

 

125

2-4

 

Framework for Internet-based surveillance,

 

126

2-5

 

HealthMap geographic coverage, October 1, 2006– February 16, 2007,

 

130

2-6

 

Distribution of the earth’s population,

 

138

2-7

 

Being able to enter and access data from any available communications channels can optimize the use of existing infrastructure,

 

141

2-8

 

Health-care personnel collect data,

 

146

2-9

 

Alerta network,

 

147

2-10

 

Data flow from the field,

 

148

2-11

 

Outbreak of diarrhea as reported by the system,

 

150

3-1

 

Product development path for microbial diagnostics,

 

164

3-2

 

Infection and response time course,

 

166

3-3

 

Orthogonal diagnostic testing,

 

167

3-4

 

Acquisition program—evolutionary strategy,

 

168

3-5

 

Diagnostic system architecture,

 

172

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
×

3-6

 

Comprehensive integrated diagnostic system,

 

176

3-7

 

A staged strategy for pathogen detection and discovery,

 

183

3-8

 

Schematic representation of MassTag PCR procedure,

 

183

3-9

 

Greene pathogen database,

 

186

3-10

 

The Bio-Maginot line,

 

195

3-11

 

Changing spectrum of biothreat risk,

 

196

3-12

 

Growth of GenBank, 1982–2005,

 

197

3-13

 

The combination of rapid knowledge and technological growth will create the potential to make new pathogens,

 

198

3-14

 

The threat space is becoming increasingly complex,

 

198

3-15

 

Biosignature pattern recognition in human diseases,

 

199

3-16

 

Personalized medicine based on biosignatures,

 

200

3-17

 

Biosignatures versus biomarkers,

 

201

3-18

 

Upper respiratory disease incubation periods,

 

202

3-19

 

Program to create DocInBox diagnosis,

 

203

3-20

 

Health-care spending projections,

 

204

3-21

 

In 2005, 18 percent of GDP was spent on health care,

 

205

3-22

 

Comparison of U.S. spending on energy and health care, 1970–2004,

 

206

3-23

 

Average annual health-care expenditures by age, 2005,

 

206

3-24

 

Human species needs to square life’s curve,

 

207

BOX

3-1

 

Example of Diagnostic Systems Validation Parameters,

 

173

Suggested Citation:"Front Matter." Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges–Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11996.
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Early detection is essential to the control of emerging, reemerging, and novel infectious diseases, whether naturally occurring or intentionally introduced. Containing the spread of such diseases in a profoundly interconnected world requires active vigilance for signs of an outbreak, rapid recognition of its presence, and diagnosis of its microbial cause, in addition to strategies and resources for an appropriate and efficient response. Although these actions are often viewed in terms of human public health, they also challenge the plant and animal health communities.

Surveillance, defined as "the continual scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control", involves the "systematic collection, analysis, interpretation, and dissemination of health data." Disease detection and diagnosis is the act of discovering a novel, emerging, or reemerging disease or disease event and identifying its cause. Diagnosis is "the cornerstone of effective disease control and prevention efforts, including surveillance."

Disease surveillance and detection relies heavily on the astute individual: the clinician, veterinarian, plant pathologist, farmer, livestock manager, or agricultural extension agent who notices something unusual, atypical, or suspicious and brings this discovery in a timely way to the attention of an appropriate representative of human public health, veterinary medicine, or agriculture. Most developed countries have the ability to detect and diagnose human, animal, and plant diseases.

Global Infectious Disease Surveillance and Detection: Assessing the Challenges -- Finding Solutions, Workshop Summary is part of a 10 book series and summarizes the recommendations and presentations of the workshop.

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