childhood rubella have occurred in the United States since the introduction of rubella vaccine in 1969 (33 ), rubella cases have increased recently among adults, particularly among persons who come from countries without rubella vaccination programs (34 ). This increase places susceptible pregnant women and their fetuses at risk (34 ). The North Carolina Department of Environment, Health, and Natural Resources’ handling of a 1997 rubella outbreak exemplifies the kinds of activities called for under Goal III. The outbreak, which affected nine of the state’s counties, occurred shortly after a rubella surveillance system had been established, and the outbreak was detected early. Health workers visited the homes and workplaces of infected persons and vaccinated friends of patients, family members, and fellow employees. Pregnant women who potentially were exposed received medical follow-up. The outbreak was contained, and no cases of congenital rubella syndrome were reported. North Carolina’s rubella surveillance system was established with funding from CDC, which since 1994 has provided grants to state and large city health departments for establishing systems to monitor and track vaccine-preventable diseases. The objectives and activities described under Goal III will help ensure that in future years state and local health departments have the equipment, staff, and training to respond to emerging infectious disease threats in the Untied States, whether they be outbreaks of rubella, drug-resistant microbes, or acts of bioterrorism. Because microbes can cover wide geographic areas and span borders between nations, the objectives and activities of Goal III also address the need to help build global infrastructure to combat emerging infectious diseases. 8 MMWR September 11, 1998 Goal IV — Prevention and Control. Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases. Objectives • Implement, support, and evaluate programs for the prevention and control of emerging infectious diseases. • Develop, evaluate, and promote strategies to help health-care providers and other persons change behaviors that facilitate disease transmission. • Support and promote disease control and prevention internationally. All of the goals and objectives in this plan ultimately are directed at preventing and controlling infectious diseases. For example, a national effort to prevent the transmission of group B streptococcal infection to newborns is based on ongoing disease surveillance (Goal I), multidisciplinary research (Goal II), and strong local public health infrastructures (Goal III). One of five women carries group B streptococcal bacteria, although the infections are usually asymptomatic (35,36 ). When transmitted from an infected pregnant woman to her newborn during childbirth, however, the bacteria can cause severe health problems for the baby and even result in death (37 ). Although studies in the 1980s documented that administering antibiotics during childbirth to women at high risk could prevent group B streptococcal infection in newborns (36 ), a study completed in 1990 determined that thousands of U.S. babies continued to be infected each year, primarily because antibiotics were not always administered when needed (37 ). CDC has responded to this problem by working with public and private organizations to develop and distribute new recommendations for disease prevention (36 ). Between 1993 and 1995, as obstetricians adopted the new policies, the incidence of neonatal group B streptococcal infections declined by as much as 43% in some areas (38 ) and continued to decline through 1997 (personal communication, Anne Schuchat, M.D., CDC, 1998). CDC is continuing to work with community groups, health departments, and professional organizations to bring standardized prevention protocols to a wider audience (39 ). As demonstrated by this example, preventing and controlling emerging infectious diseases requires the combined and coordinated work of many persons and organizations. The objectives and activities in Goal IV emphasize the need for strong partnerships to address emerging infectious disease problems. Target Areas To accomplish these goals, objectives, and activities, Preventing Emerging Infectious Diseases: A Strategy for the 21st Century targets nine categories of problems that cause human suffering and place a burden on society: • Antimicrobial resistance. The emergence of drug resistance in bacteria, parasites, viruses, and fungi is reversing advances of the previous 50 years (Figure 1). As the 21st century approaches, many important drug choices for the treatment Vol. 47 / No. RR-15 MMWR 9 of common infections are becoming increasingly limited, expensive, and, in some cases, nonexistent. • Foodborne and waterborne diseases. Changes in the ways that food is processed and distributed are causing more multistate outbreaks of foodborne infections. In addition, a new group of waterborne pathogens has emerged that is unaffected by routine disinfection methods. • Vectorborne and zoonotic diseases. Many emerging or reemerging diseases are acquired from animals or are transmitted by arthropods. Environmental changes can affect the incidence of these diseases by altering the habitats of disease vectors. • Diseases