Laboratories, increasing the number of participating laboratories and the number of organisms covered. PulseNet demonstrates how CDC and its partners can use modern laboratory techniques and electronic communications to strengthen disease surveillance and response. The objectives and activities described under Goal I address the need for a strong and coordinated system for surveillance and response in the United States and abroad, not only for foodborne diseases but for other emerging infectious diseases as well. They call for increased links among surveillance sites, improved tools and approaches for conducting surveillance, as well as prompt and effective translation of surveillance data into public health action. Goal II — Applied Research. Integrate laboratory science and epidemiology to optimize public health practice. Objectives • Develop, evaluate, and disseminate tools for identifying and understanding emerging infectious diseases. • Identify the behaviors, environments, and host factors that put persons at increased risk for infectious diseases and their sequelae. • Conduct research to develop and evaluate prevention and control strategies in nine target areas (see Target Areas). Research is essential in efforts to understand, prevent, control, and respond to new and reemerging infectious diseases. Much of CDC’s emerging infectious disease research is laboratory-based or epidemiologic, often performed in response to an emergency such as an outbreak of disease. In addition, CDC conducts studies in nonoutbreak settings to evaluate prevention strategies and identify factors that put persons at increased risk. 6 MMWR September 11, 1998 For example, between 1993 and 1995, in partnership with several other organizations, CDC conducted Project Respect — a randomized trial of alternative approaches to counseling persons who visit medical clinics about how to prevent HIV and other sexually transmitted diseases (STDs). One group received simple educational messages, and the other received intensive counseling that focused on the client’s personal situation. After 6 months, persons who received client-centered counseling were substantially more likely to use condoms 100% of the time and had substantially fewer new STDs (32 ). At 12 months, rates of condom use were similar in the two groups, but the reduced rate of new STDs persisted among persons who received client-centered counseling. CDC and other Project Respect investigators are translating these research findings into prevention programs that can be delivered in other clinical settings. Project Respect is an example of the type of prevention research efforts that will be conducted under Goal II. Pulsed-Field Gel Electrophoresis Patterns of Escherichia coli O157:H7 Isolates — Washington State, 1996 This illustration shows the relationships among DNA fingerprints of Escherichia coli O157:H7 isolates from Washington State. Patterns of the two isolates from apple juice are identical to patterns of isolates from patients who drank the contaminated juice but different from patterns of isolates from patients whose infections were not juice-related. This technology, known as pulsed-field gel electrophoresis (PFGE), has been useful in the investigation of many outbreaks of foodborne illnesses, especially those that involve clusters of cases that are too geographically or temporally scattered to come to public health attention through usual methods of surveillance. For example, in 1997, the Colorado Department of Public Health and Environment used PFGE to detect a small cluster of cases of E. coli O157:H7 infection. Each ill person had eaten the same brand of frozen hamburger patty. Twenty-five million pounds of ground beef were recalled, and a potentially nationwide outbreak was averted. E. coli isolates from patients whose infections were not juice-related E. coli isolates from patients who drank contaminated juice Juice isolates Den drogram* 80 90 100 80 90 100 *Vertical line at 100% represents isolates that are indistinguishable from each other. Lines farther away from 100% on the dendrogram represent isolates that are similar to the outbreak isolates but are not a perfect match. Vol. 47 / No. RR-15 MMWR 7 Goal III — Infrastructure and Training. Strengthen public health infrastructures to support surveillance and research and to implement prevention and control programs. Objectives • Enhance epidemiologic and laboratory capacity. • Improve CDC’s ability to communicate electronically with state and local health departments, U.S. quarantine stations, health-care professionals, and others. • Enhance the nation’s capacity to respond to complex infectious disease threats in the United States and internationally, including outbreaks that may result from bioterrorism. • Provide training opportunities in infectious disease epidemiology and diagnosis in the United States and throughout the world. The public health infrastructure is the underlying foundation that supports the planning, delivery, and evaluation of public health activities and practices. For example, a strong public health infrastructure is needed to ensure that the public is safe from vaccine-preventable diseases like polio, measles, and diphtheria, as well as rubella, an acute viral infection that can cause severe birth defects in babies born to infected mothers. Although no major epidemics of