multidrug-resistant and appears more frequently in persons with HIV infection, has become endemic in New York (23 ). Scientific Findings • Scientists have found increasing evidence that certain infectious microbes cause or contribute to the development of some chronic diseases (24 ). • Many human genes have been discovered that influence a person’s susceptibility to infection, severity of infection, and responsiveness to vaccination or treatment (25 ). Tools and Technologies • Electronic communications are linking public health institutions in most areas of the world, providing a constant and enormous stream of information on infectious disease outbreaks and related health issues. • Innovations in biotechnology are making it easier to identify and track strains of infectious microbes and to determine the causes and sources of outbreaks as well as the routes of disease transmission. Changes in Health-Care Delivery • Large numbers of Americans have switched from fee-for-service medical insurance to various types of managed care. The shift to managed care has created new challenges and opportunities for disease prevention, surveillance, control, and research. Because of their structures, managed care organizations are in a good position to conduct surveillance, answer clinical research questions, and effect changes in medical practice (e.g., implementation of guidelines). 4 MMWR September 11, 1998 Goals and Objectives The objectives of Preventing Emerging Infectious Diseases: A Strategy for the 21st Century are organized under four goals: surveillance and response, applied research, infrastructure and training, and prevention and control. Under each objective, the plan describes in detail the many public health activities that must be conducted to implement CDC’s strategy. Goal I — Surveillance and Response. Detect, investigate, and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified. Objectives • Strengthen infectious disease surveillance and response. For example, this objective includes expanding and creating programs, networks, and surveillance systems that enable health departments nationwide to identify and respond to infectious disease threats. • Improve methods for gathering and evaluating surveillance data. • Ensure the use of surveillance data to improve public health practice and medical treatment. • Strengthen global capacity to monitor and respond to emerging infectious diseases. Events Prompting CDC to Update the 1994 Plan — Continued • Shortened hospital stays for some conditions have made it necessary to develop new ways to monitor certain patient outcomes, including hospital-acquired infections whose symptoms do not appear until after the patient has left the hospital. • Home health care has become the fastest growing sector of the U.S. health-care industry (26 ). New public health partnerships and new methods for assessment are needed to monitor the impact of treatments and to measure the occurrence of health-care– related infections in home health-care settings. Public and Policy Issues • Many Americans have learned about new diseases like Ebola hemorrhagic fever through media reports, films and television movies, and books (27–29 ). In addition, they might know somebody who has suffered from an emerging infectious disease or an antibiotic-resistant infection. • In 1995, a policy report issued by the Committee on International Science, Engineering, and Technology (CISET) of the National Science and Technology Council recommended governmentwide action to combat emerging infectious diseases (30 ). • In 1996, a Presidential Decision Directive on emerging infectious diseases established a new national policy to address the growing health and national security threat posed by infectious diseases, including the potential threat of bioterrorism (31 ). Vol. 47 / No. RR-15 MMWR 5 The objectives and activities of Goal I reflect recent changes in needs and capabilities for surveillance and response. For instance, outbreaks of foodborne illness used to be primarily local events that were easily recognized. Now, however, outbreaks often involve persons scattered over wide geographic areas — the consequence of regional, national, or international distribution of food products. In recent years, through various coordinated efforts including the 1997 National Food Safety Initiative, the U.S. Food and Drug Administration, U.S. Department of Agriculture, CDC, and other agencies have begun to enhance national capacity to track and respond to foodborne illnesses across the country. In mid-1998, the Secretary of Health and Human Services announced PulseNet — a national network of laboratories that perform DNA fingerprinting of bacteria isolated from patients and contaminated food. The network permits rapid comparison of molecular fingerprint patterns through an electronic database at CDC. When patterns submitted from different sites are identical, the computer alerts health agencies to a possible widespread outbreak of foodborne illness (see page 7, Pulsed-Field Gel Electrophoresis Patterns of Escherichia coli O157:H7 Isolates — Washington State, 1996). During the next several years, CDC will continue to develop PulseNet in partnership with state health departments and the Association of Public Health