Interface 2003
Abstract

Early Diagnosis of Biological Threats: Progress and Challenges
Stephen S. Morse, (Columbia University), ssm20@columbia.edu

Abstract

The combination of recent advances in detection technology and molecular biology (such as automated real-time PCR), and in informatics and network communications, have made possible major improvements in agent detection and identification, with the potential to revolutionize both environmental detection and medical diagnostic capabilities (as discussed by Ritter). However, as demonstrated by the recent anthrax events, the first indication of a bioterrorist attack may well be the appearance in emergency rooms or doctors' offices of people sick with an unexpected illness, and the public health and medical responses may well be underway before the true nature of the event is recognized. Conceptually, many of the steps that the public health system needs to take in order to strengthen our national biodefense are very similar to what needs to be done to prepare for an unexpected naturally occurring outbreak of infectious disease (what we may call ''emerging infections plus''). Early recognition and treatment are essential to save lives, but many of these diseases are nonspecific in the early stages, often just resembling the flu, and the agent may be virtually absent in normal diagnostic samples collected early in infection. A major diagnostic challenge therefore remains identifying those who are exposed, and differentiating them from the larger number of ''worried well''. Despite the difficulties, some progress has been made recently in this ''pre-symptomatic'' or ''prodromal'' diagnosis. Some current strategies to be discussed include identification of early host responses to infection, and detection of agent or host response markers in breath or other easily accessed noninvasive samples. (Supported by grants from the Arts & Letters Foundation, the Achelis Foundation, and through CDC/ASPH cooperative agreement for the Centers for Public Health Preparedness.)


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