Polish up on past pestilence and present pathogens.

The cases presented here illustrate potential epidemic or pandemic events that once-silent pathogens portend. Developing countries, where defenses are limited, are primary targets. Of future concern are the developed countries that fail to use rigorous control measures established by the CDC, the WHO, and others to prevent the spread of infectious diseases. International travel has brought changes in demographics and a greater need for surveillance programs to control selective antibiotic resistance. In our first case, the patient's death would likely have been avoided if he had adhered to the CDC-recommended vaccine program. The fact remains that 20% to 60% of U.S. adults, including travelers to endemic areas, have not followed the diphtheria booster-vaccine schedule. Our second case demonstrates the ease of transmission through food and water that contribute to illness from cholera. The success of intravenous therapy or ORS treatment has reduced the number of deaths by approximately 3 million per year in Asia and Africa. Though development of oral vaccines may be promising, without water and sewage control, waterborne transmission of cholera is a continuing threat. The panic following our third case was a sample of the pandemonium an outbreak of XDR-TB would create. Lack of access to medical care and lack of funding in developing countries made selection of resistance from MDR- to XDR-TB a predictable event. The Global Plan to Stop TB 2006-2015, initiated to improve on the DOTS strategy to control TB/HIV and MDR-TB cases, targets 2015 for reducing overall prevalence and mortality from TB. Based on the principle that community healthcare is the best prevention, organizations that are dedicated to the control of emerging and re-emerging infection include the CDC, NIH, IDSA, ATS, and the National Academy of Science's Institute of Medicine, to mention a few. Recently, they have established plans and programs to address problems of communication among scientists and to improve surveillance in the detection and monitoring of dangerous pathogens. The remarkable and ever-changing dynamics of microbial adaptation, however, requires enormous vigilance and financial priorities worldwide. A coordinated effort by both scientists and public-health leaders is needed if the onslaught of infectious threats is to be controlled.