Biology Reference
In-Depth Information
of food, water, and bodily fluids (perhaps from close, intimate con-
tact with an ill person) that may have occurred during the suspected
period of exposure. Oftentimes, such a methodical approach, which
is founded on having a reliable laboratory test and familiarity with
the organism's likely routes of exposure, can produce results—
including detection of foodborne outbreaks of international ori-
gin—in a remarkably efficient and timely manner (CDC 1997).
2. Let the epidemiologic investigation refine your understanding of
potentially new and plausible routes of exposure:
Unfortunately, we do not live in the ideal. More so, the norm in first
responding to a putative disease outbreak is fragmentary and incom-
plete knowledge of both the cause of the epidemic, as well as likely
routes of exposure. In the anthrax outbreak of 2001, laboratory diagno-
sis (supported by training of personnel under the LRN efforts) of sys-
temic anthrax infection signaled the initial appearance of the disease
cluster. With well-understood familiarity with how humans become
ill from
B. anthracis
exposure, initial efforts to identify the source of
illness in the index case-patient had teams scouring the recent travel
routes in North Carolina for any possible contact with infectious live-
stock. Once environmental samples from the mailroom of a building
in South Florida tested positive, the route of exposure became clearer,
and efforts began in earnest to better understand how the U.S. postal
system distributed mail (Dewan 2002). Thus, a new mode of expo-
sure of a known pathogen was established. Meanwhile, other public
health investigators fanned out over Florida and other places where
subsequent laboratory-confirmed cases emerged to seek additional
cases. In such circumstances, these investigators, engaging in what
later become known as “situation awareness,” used a very broad, and
hence sensitive, but not very specific, case definition.
3. Support and maintain the laboratory capacity to develop rapid diag-
nostic tests for novel sources of infection and illness:
We have already illustrated important examples of having the labora-
tory capacity to develop new diagnostic tests for previously unrecog-
nized pathogens, both with our international experience with SARS
and, more recently, novel influenza A (H1N1) pandemic. The impor-
tance of a strong linkage between a well-trained workforce versed
in outbreak investigation and control and the capacity to systemati-
cally develop and distribute new, reliable diagnostic tests cannot be
overestimated. The marriage between shoe-leather epidemiology and
state-of-the-art diagnostic capabilities will continue to serve as our
strongest bulwark in addressing all of the new threats to health that
will surface and gain foothold in the upcoming century. The threats
will be new, but the well-regarded, tested paradigm is the same.
