New IOM report on microbial threats borne out by current events

WASHINGTON — Eleven years ago the Institute of Medicine (IOM) released a groundbreaking report detailing strategies recommended for guarding against infectious diseases. The report, entitled Emerging Infections: Microbial Threats to Health in the United States, was heralded as an important blueprint, one sorely needed to rebuild a medical infrastructure ill-equipped to handle a serious microbial outbreak. More than a decade later the IOM has revisited the issue, recently releasing a follow-up report on the subject: Microbial Threats to Health: Emergence Detection and Response.

In 1992 the CDC took the original report’s recommendations to heart – and the IOM’s findings were shown to be correct with outbreaks in the United States of foodborne Escherichia coli, a waterborne outbreak of cryptosporidiosis and an outbreak of Hantavirus pulmonary syndrome — all within a year’s time.

It is 2003, and events seem to be eerily similar — the IOM’s current report on the state of microbial threats and our country’s preparedness was greeted by a new emerging infectious disease — severe acute respiratory syndrome (SARS).

Two uncanny occurrences – spread a decade apart — seem to solidify a message of grave importance in the arena of infectious diseases. There is no doubt that once again the IOM has illustrated that as a country, as a world, as a global village, humanity is ill-equipped to combat an outbreak of infectious disease in a manner befitting the world’s medical skill and knowledge.

Updated findings

The current IOM report provides a composite review of public health knowledge and policies in response to emerging infectious diseases. It includes human demographics and behaviors, microbial adaptation and changes, control of vector-borne infectious diseases, influence of the environment on microbe distribution and viability, zoonosis, West Nile virus infection, impact of globalization and public health safety measures.

“We strongly believe that an effective national response to infectious diseases must be a global response,” said Margaret Hamburg, MD, co-chair of the Committee on Microbial Threats to Health in the 21st Century. “Therefore, our recommendations begin with a strong call for the United States to enhance global disease surveillance as well as the capacity to respond to infectious disease threats, recognizing the heightened need that exists in the developing world.” Hamburg, also the vice-president for biological programs for the Nuclear Threat Initiative, presented the opening statement at the IOM’s press conference to release the new report.

Hamburg said the U.S. public health infrastructure needed some help after suffering years of neglect. “Critical elements include surveillance, laboratory capacity, communication skills and systems to ensure the rapid use and sharing of information. Expanded prevention and control methods must be implemented by an adequately trained and competent work force.”

She added that the IOM report also addressed better research initiatives for the development of vaccines, the overuse of antibiotics — which in turn fuels resistance — including FDA bans of certain drugs, and support by the federal government for global surveillance through cutting-edge information technology.

Patricia Quinlisk, MD, MPH, Iowa state epidemiologist, Iowa department of public health and a member of the reporting committee, addressed the issue of funding. Although there has been an influx of monies at the state and local levels from the federal government since Sept. 11 (to battle biological warfare and disease), it is anticipated to take at least five years for the effects of said monies to begin to take place. These funds will not only help medical personnel prepare for man-made biological diseases that may occur, but naturally occuring microbial threats as well.

“Since the announcement of the smallpox initiative, large amounts of efforts at the state and local level have gone into smallpox preparation,” said Quinlisk, a member of the Infectious Disease News editorial board. “I wouldn't say that has taken away from other things, but it certainly has refocused. A lot of the things we are doing for smallpox will help us prepare for other things also. There is some concern that we don't forget the other issues: influenza, for example, killed thousands of Iowans this winter, we anticipate West Nile virus coming back next summer — we need to prepare for that. So it sometimes gets a stretch to ensure that you are addressing everything you need to address, and that is one of the reasons a robust public health infrastructure is so desperately needed and so important at the state and local level.”

So much of the IOM report had a resounding ring to it whenever severe acute respiratory syndrome (SARS) was mentioned during the conference. The context of this epidemiological nightmare fit soundly inside the recommendations of the Microbial Threats report

“The current outbreak of pneumonia, SARS, that is being talked about so much now, is a clear illustration of many of the points in the report: the need for global surveillance; the fact that the borders for organisms don’t stop by country,” explained Ruth Berkelman, MD, department of epidemiology, Rollins School of Public Health, Emory University and a member of the reporting committee.

In responding to SARS and the IOM’s report, James Hughes, MD, assistant surgeon general and director of the CDC’s National Center for Infectious Diseases, said, “This current ongoing experience drives home in spades the importance of the recommendations made in this report.”

According to Hughes, also a member of the Infectious Disease News editorial board, the CDC will be moving forward to develop an updated strategy to combat infectious disease based on the recommendations of the report. The CDC plans to coordinate these changes with other federal, state and local partners, including professional societies and WHO.

“This is not a time to be complacent,” said Julie Gerberding, MD, director of the CDC. “We have the knowledge to greatly reduce the threat of infectious diseases, and by taking a coordinated approach and using the technological resources now available, we can do just that.”