"The increasing threat of bioterrorism and the growing emergence of infectious diseases worldwide prompt the demand for new surveillance systems to detect disease more rapidly. Integral to these systems is the active participation of front-line healthcare providers who will be among the first to detect the possibility of a disease outbreak."(1)

"Inhalational anthrax resembles common diagnoses in primary care. Surveillance systems for early detection of bioterrorism events that rely only on diagnostic codes will be hampered by false-positive alerts. Consequently, educating frontline physicians to recognize and respond to bioterrorism is of the highest priority." (2)

"Additionally, clinicians may benefit from diagnostic decision support systems, typically designed to generate a list of possible diagnoses for a given patient on the basis of clinical features, if these systems appropriately increase clinicians' consideration of bioterrorism agents." (3)

 An outbreak is "a sudden rise in the incidence of a disease <an outbreak of measles>" (4)

An outbreak is "Several or numerous cases in a short period of time, related in their acquisition." (5)

“An ‘outbreak’ is defined as an increase in the incidence of a given disease or symptom complex clearly in excess of the usual rate.” (6)

“Outbreak: an incident in which two or more people, thought to have a common exposure, experience a similar illness or proven infection, at least one of them being ill.” (7)

"Central to any response plan is early detection. . . . This same model advocated for bioterrorism also may apply to natural infectious disease epidemics, particularly of emerging or re-emerging diseases, that might not be optimally managed by reliance on the conventional public health strategy that requires physician-dependent definitive diagnosis and active reporting mechanism." (8)

"The most important part of preparation is a concerted medical education effort. These are diseases and intoxications that are not part of our everyday practice, medical conditions that many of us may have last thought about during medical school." (9)

"Even if a terror attack is never encountered society will benefit from attempting to solve the problems of a biological attack because we will always be faced by such attacks from nature. The efforts we make to respond will be useful in managing new epidemics or re-emerging infections." (10)

"The approach applies not only to infectious disease outbreaks but also to outbreaks due to noninfectious causes (e.g., toxic exposure)." (11)

"Infectious diseases are the leading cause of death worldwide and the third leading cause of death in the United States. Experiences with disease occurrence in other parts of the world repeatedly provide reminders that we live in a global village. A recent Institute of Medicine report observes that, 'Distinction between domestic and international health problems are losing their usefulness and are misleading.'" (12)

REFERENCES

1. Nierengarten MB, Lutwick L, Lutwick S. CME course published on the Medscape website: "Syndrome-Based Surveillance for Clinicians on the Frontlines of Healthcare: Focus on Rapid Diagnosis and Notification." http://www.medscape.com/viewprogram/2427
2. Temte JL, Zinkel AR. The primary care differential diagnosis of inhalational anthrax. Ann Fam Med. 2004 Sep-Oct;2(5):438-44.
3. Bravata DM et al. Evaluating Detection and Diagnostic Decision Support Systems for Bioterrorism Response. Emerg Infect Dis 2004;10:100.
4. Merriam-Webster Medical Dictionary available online at http://www.nlm.nih.gov/medlineplus/mplusdictionary.html
5. Guerrant RL, Walker DH, Weller PF (eds). Essentials of Tropical Infectious Diseases. Philadelphia: Churchill Livingston, 2001; p. 12.
6. Cohen & Powderly: Infectious Diseases, 2nd ed. Chap 50, p. 555
7. Lopman BA, AdakGK, Reacher MH, Brown DWG. Two Epidemiological Patterns of Norovirus Outbreaks: Surveillance in England and Wales, 1992-2000. Emerg Infect Dis 2003;9:71-7.
8. Henretig FM, Cieslak TJ, Kortepeter MG, Fleisher GR. Medical management of the suspected victim of bioterrorism: an algorithmic approach to the undifferentiated patient. Emerg Med Clin N Am 2002;20:351-364.
9. Eitzen E. Education is the Key to Defense Against Bioterrorism. Ann Emerg Med 1999;34:221-223.
10. Rosen P. Coping with bioterrorism. BMJ 2000;320:71-2.
11. Reingold AL. Outbreak Investigations—A Perspective. Emerg Infect Dis 1998;4:21-7.
12. Hughes JM. Raising Awareness of and Identifying Opportunities to Address Tropical Infectious Diseases. Am J Trop Med Hyg 1998;59:17-18.

Also see "Rand Study Finds Gaps in Public Health Agency Responsiveness to Reports of Suspicious Illnesses" and "Ability of Physicians to Diagnose and Manage Illness Due to Category A Bioterrorism Agents"

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