Implementation


This plan provides a comprehensive strategy for the prevention and control 
of emerging infectious diseases. The strategy is based upon the premise that
 it is far less costly, in both human suffering and economic terms, to 
anticipate and prevent infectious diseases than to react with expensive 
treatment or containment measures to unanticipated public health crises.

The plan is a first step in addressing the threats to health in the United 
States posed by emerging infections. The need to rapidly implement this plan
is made more urgent by a number of diseases that pose an immediate danger: 
methicillin-resistant Staphylococcus aureus, a common cause of hospital 
infections, may be developing resistance to vancomycin; penicillin 
resistance is emerging in Streptococcus pneumoniae; cholera is likely to be
introduced into the Caribbean islands from the current pandemic in the 
Southern Hemisphere, and the new strain, V. cholerae O139, is spreading 
rapidly in Asia; changing food industry practices and dietary choices of 
the American people will bring new challenges to providing a diet safe from 
pathogens, such as Salmonella sp. and E. coli O157:H7; and ongoing 
investigations of hantavirus pulmonary syndrome document that the geographic
distribution of this infection is much broader than the desert southwest. 
These infectious disease problems, which have already begun to affect the 
public's health, emphasize the need for expeditiously implementing this plan.

Some of the activities listed in this document are already in the planning 
stages and will be implemented soon. Most will require additional funds and 
personnel. Specific details of many of the proposed activities need further 
development in full cooperation with other federal agencies, state and local
health authorities, academic institutions, professional societies, private 
industry, and others. With this document as a guide and a first step, 
implementation will proceed according to public health needs and resource 
availability. This process will be approached in stages, as a long-term 
endeavor to ensure sustainable impact, and will involve major extramural 
efforts (Table 6).

The Health Security Act of 1993 addresses the need for community-based 
public health strategies in addition to the need for universal health care 
coverage. Prevention of future cases of infectious diseases of multidrug-
resistant TB, influenza, Lyme disease, opportunistic infections, hantavirus 
pulmonary syndrome, cryptosporidiosis, AIDS, and many other emerging 
diseases is a high priority. The health of a community is vital to the health
of individuals and must be maintained through effective public health 
approaches. Through the efforts proposed in this document, the public health
system in the United States will be better prepared to respond to the 
emerging infectious disease threats of the future.

Table 6.  Implementation: High Priorities for 1994-1996

Goal I: Surveillance

Strengthen notifiable disease surveillance at the state and local levels.

Establish two physician-based Sentinel Surveillance Networks to detect and 
monitor emerging diseases, such as unexplained adult respiratory distress 
syndrome, multidrug-resistant pneumococcal disease, and childhood illnesses 
characterized by fever and rash.

Establish four population-based Emerging Infections Epidemiology and 
Prevention Centers to conduct focused epidemiology/prevention projects 
emphasizing foodborne and waterborne infectious diseases and potentially 
vaccine preventable diseases.

Strengthen and link four existing sites for a global consortium to promote 
the detection, monitoring, and investigation of infections emerging 
internationally that could affect the health of Americans.

Goal II: Applied Research

Reestablish an extramural program to support emerging infectious disease 
prevention and control activities, such as evaluating the role of 
prescribing practices in the development of antimicrobial drug-resistant 
pathogens.

Initiate prevention effectiveness studies to assess the impact of food 
preparation guidelines on the incidence of foodborne infections such as 
E. coli O157:H7 and Salmonella enteritidis.

Goal III: Prevention and Control

Develop additional means to deliver laboratory and public health information
informing health professionals about emerging infections and antimicrobial 
drug resistance.

Develop and implement guidelines for the prevention of opportunistic 
infections in immunosuppressed persons.

Goal IV: Infrastructure

Provide state-of-the-art training in diagnostic evaluation and testing 
for medical laboratory personnel to ensure the diagnosis and surveillance of
emerging infections.

Establish a public health laboratory fellowship in infectious diseases that
will train medical microbiologists in public health approaches to diagnosis 
and molecular epidemiology.