THREE OUNCES OF PREVENTION
Scenarios Involving Avian Bird Flu,
Bioterrorism Using Smallpox
Novel and not-so-novel infectious diseases can appear quickly in human or animal populations. These diseases can wreak tremendous havoc before they are recognized or diagnosed by local public health officials. Most of the recent novel diseases that have appeared in the United States (e.g., hantavirus, cryptosporidiosis, and West Nile fever) were well established months or even decades before they appeared in numbers large enough to be identified by medical doctors and their colleagues in public health.
Yet, despite the painful lessons that these actual outbreaks have taught us, little has changed in public health surveillance of the human or animal population. We remain highly vulnerable to the inadvertent introduction of a serious new disease, such as foot-and-mouth disease in animals or newly evolved strains of adapted avian influenza in humans. Worse, we remain especially vulnerable to an intentionally introduced disease, which is possible as a terrorist act.
To illustrate the potential scope of the problem of each type of disease appearance, this chapter provides two speculative scenarios of what could happen in the United States. In one scenario, we show what can happen without a continuous, near-real-time syndrome surveillance system that physicians, veterinarians, and emergency rescue teams could use to notify public health officials and others with a “need to know” about an unusual