International Health Regulations--what gets measured gets done.

The global spread of severe acute respiratory syndrome highlighted the need to detect and control disease outbreaks at their source, as envisioned by the 2005 revised International Health Regulations (IHR). June 2012 marked the initial deadline by which all 194 World Health Organization (WHO) member states agreed to have IHR core capacities fully implemented for limiting the spread of public health emergencies of international concern. Many countries fell short of these implementation goals and requested a 2-year extension. The degree to which achieving IHR compliance will result in global health security is not clear, but what is clear is that progress against the threat of epidemic disease requires a focused approach that can be monitored and measured efficiently. We developed concrete goals and metrics for 4 of the 8 core capacities with other US government partners in consultation with WHO and national collaborators worldwide. The intent is to offer an example of an approach to implementing and monitoring IHR for consideration or adaptation by countries that complements other frameworks and goals of IHR. Without concrete metrics, IHR may waste its considerable promise as an instrument for global health security against public health emergencies.

Influenza pandemic epidemiologic and virologic diversity: reminding ourselves of the possibilities.

The 2009 influenza A (H1N1) pandemic serves as a stark reminder of the inherently unpredictable nature of influenza virus. Although most planning centered on the potential emergence of a wholly new influenza A subtype of avian origin causing the next pandemic, a very different scenario occurred: a mammalian-adapted reassortant drift variant of a familiar subtype caused the first pandemic of the 21st Century. This pandemic also reminds us of the variability possible with respect to the epidemiology of pandemic influenza, the effects of population immunity to novel influenza strains on age-specific morbidity and mortality, and the potential importance of domestic animals in the ecology of influenza and the formation of new virus strains with pandemic potential. Future pandemic preparedness planning should include addressing gaps in influenza surveillance among nonhuman mammalian species at the animal human interface as part of pandemic risk assessment.

Foodborne illness: new developments concerning an old problem.

Foodborne illnesses continue to cause substantial morbidity and mortality in the United States, primarily as gastroenteritis but occasionally as other syndromes as well. Most of these illnesses are caused by a variety of widely known infectious agents, principally viruses, and are probably the result of common mistakes in food handling in the home or in restaurants. The epidemiology of foodborne illness is evolving. Major changes in food production, distribution, and consumption have created opportunities for new pathogens to emerge and for old ones to reemerge, and the potential for widespread outbreaks is increasing. Antibiotic resistance in bacterial pathogens resulting from the widespread use of antimicrobial agents in animal husbandry is also an important concern. Clinicians must be aware of the changing epidemiology of foodborne illness to recognize and manage these conditions in the clinical setting. In addition, clinicians are critical in the reporting of recognized or suspected foodborne illness, so that public health authorities are able to investigate, understand, and ultimately better control them. A number of new techniques have been employed, and others under development will improve our ability to recognize and cope with foodborne diseases.