1. Microbial Threats to Health in the United States: Natural and Manmade Prof. Joshua Lederberg Raymond and Beverly Sackler Foundation Scholar Suite 400 (Founders Hall) The Rockefeller University 1230 York Avenue New York, NY 10021-6399

2. Objectives: 1.To demonstrate the importance of public health measures in combating the disease 2.To review some of the historical threats to health and newly emerging infections 3.Addressing the threats Recognition Intervention

3. Public Health and Sanitation Achievements of the 20 th century: Improvements in hygiene practices Improvements in food handling (refrigeration) Improvement in Water and sewage treatment Vaccination practices

5. Alone or in combination, economic collapse, war, and natural disasters, among other societal disruptions, have caused (and could again cause) the breakdown of public health measures and the emergence or reemergence of a number of deadly diseases volcano Ground Zero, May 2002

6. The threat of bioterrorism still exists "The cold reality is that it is almost impossible to enforce the existing biological weapons treaty. There is no biological weapons facility,which if shut down today could not be rebuilt tomorrow," http://news-service.stanford.edu/news/january21/lederberg.html http://news-service.stanford.edu/news/january21/lederberg.html

7. Several bacteria and viruses head the list of potential biological warfare agents, including anthrax, smallpox, plague, botulism, tularemia, glanders (from CDC website).

8. What is bioterrorism? Dispersal of microbes or their toxins to produce illness, death and terror Biological warfare is the use of agents of disease for hostile purposes

9. Biological weapons Biological weapons are characterized by low cost and ease of access; difficulty of detection, even after use until disease has advanced; unreliable but open-ended scale of predictable casualties, and clandestine stockpiles and delivery systems

10. Smallpox A systemic viral disease characterized by fever and the appearance of skin lesions, smallpox is believed by some to have been responsible for the death of more people than any other acute infectious disease.

11. Newly emerging conditions: Anthrax acute infectious disease caused by the spore- forming bacterium Bacillus anthracis most commonly occurs in wild and domestic animals including cattle, sheep, goats, camels, antelopes and other herbivores

12. Newly Emerging Conditions: Anthrax May naturally occur in humans when they are exposed to infected animals or tissue from infected animals. (MRO today) Anthrax can be used as the bioterrorism agent

13. Anthrax is misunderstood in one respect: it's not a contagious disease, and wouldn't spread the way smallpox would. In that sense people are more frightened of anthrax than is warranted. However, for a sophisticated attacker, anthrax is lamentably a very good agent. http://praxis.md/post/friendlyfire/071200/1 http://praxis.md/post/friendlyfire/071200/1

14. Is there a treatment for anthrax? Administration of appropriate antibiotics can protect the majority of those exposed to the agent

15. Risk of dying Smoking 10 cigarettes a day One in 200 Road accident One in 8,000 Playing soccer One in 25,000 Homicide One in 100,000 Terrorism attack in 2001 One in 100,000 Hit by lightning One in 10,000,000 Terrorism attack in 1990’s One in 50,000,000 Anthrax in 2001 One in 50,000, 000 Smallpox in 2001 Less than one in 50,000,000

16. Example: Use of bioterrorism tactics in the 14 th century by Mongol army (dates back to 1346) Is bioterrorism something new?

17. Addressing the threats Recognition The key to recognizing new or emerging infectious diseases, and to tracking the prevalence of more established ones, is surveillance.

18. What is Surveillance? Etymology: French, from surveiller to watch over, close watch kept over someone or something (from “Webster.com”)

19. Roles for infectious disease specialists 1. anticipation of threat agents and modalities of dissemination, and their public health impact. 2. assistance to local emergency authorities in planning for consequence management of a BW attack 3. participating in local public health teams in the epidemiological investigation and definitive diagnosis of suspicious outbreaks 4. as central agents in the medical and public health management of outbreaks, and of their further consequences for the life of the community

20. Roles for infectious disease specialists 5. Assisting other branches of government in authentic assurance and guidance to the public, in averting panic and chaos 6. Where appropriate, assisting in measures to limit the further spread of contagious agents, and to decontaminate impacted facilities. 7. Ongoing basic and translational research to sharpen the tools available for all these functions, and further training of colleagues and supporting personnel. 8. Instilling a globally shared ethos in condemnation of any possible use of BW, or offensive planning and preparation thereof

21. Addressing the threats Intervention The response to an emerging infectious agent or disease necessitates coordinated efforts by various individuals, organizations, and industries (vaccine development, vector control, continued research, education of the public, etc)

22. The Need for New Data….and new research Data are the building blocks of knowledge and the seeds of discovery. They challenge us to develop new concepts, theories, and models to make sense of the patterns we see in them.