Stalking the next epidemic: ProMED tracks emerging diseases.

sk anyone today what infectious lA disease they fear the most, and chances are the reply will be not "AIDS" but "Ebola." The publicity given to the recent outbreaks of this disease has made the serpent-shaped virus the poster child for emerging diseases. But HIV and Ebola virus are not alone. We also have to fear hantaviruses, new strains of plague, and a whole host of other emerging or reemerging infections. Bioterrorism is another perceived threat that has been in the news in recent months. The continuing revelations of Iraq's extensive biowarfare program add to the concern. There have even been suggestions from some quarters in recent years that the dengue hemorrhagic fever epidemics in Cuba and Nicaragua and the 1994 plague outbreak in India were due to biological attacks. Would the 1995 outbreak of Ebola have come to the attention of the Zairian health authorities-let alone the world-if an Italian nun working at the hospital had not died of it? (Unfortunately, news services pick up the occasional unexplained death of an expatriate rather than the hundreds of similar deaths of local people.) And once word gets out of an outbreak, is there the local expertise to diagnose the cause so that specific countermeasures can be taken? It took months for the first recorded epidemic of yellow fever in Kenya, which occurred in 1992-1993, to be diagnosed locally. In contrast, the 1994 plague outbreak in India was hastily overdiagnosed, which resulted in needless panic in several neighboring and other countries. What is needed is a global network of reliable disease monitoring centers and a rapid communications system connecting them with health institutions around the world. Newly available technology now puts these lofty ideals within reach. It has been claimed that if we had only recognized HIV when it first appeared, we would have had several years' start on containing it and on the research we are now doing to identify preventive measures and treatment. If the world community is ever going to be able to nip emerging diseases in the bud, we have to be able to recognize the bud. The same applies to the use of biological agents such as anthrax in war or terrorist attacks or to accidents occurring during the production or transport of a biological weapons agent. The emerging infectious diseases and potential biological weapons agents we should be concerned about today include a new, more virulent, strain of influenza; anthrax; botulinum toxin; cholera; plague; yellow fever and other hemorrhagic fevers; Venezuelan equine encephalitis; bat rabies viruses; karnal bunt disease of wheat; and fungal diseases of potatoes. This list includes for good reason some agents that infect animals and plants; they affect our food security, and large scale outbreaks in livestock or crop plantswhether of natural or artificial origin-could produce economic destabilization in the victimized country. Remember the story of the Irish Newly New Viruses in the Global Village Identified Viruses