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I have just returned from the annual meeting of the Council of State and Territorial Epidemiologists (CSTE) which was held in Portland, Oregon (I was a guest of CSTE). As you probably know, CSTE has developed a strong role as an advisor to CDC and so has significant influence on the impact on public health policies and programs. On the long plane ride back, I took some time (interrupted by some terror over the Rockies) to reflect on how some of what I heard will or should influence communicable disease prevention efforts in Florida. My perspective is based on my attendance which was limited to communicable disease surveillance and epidemiology presentations.

Technology—The prospects of and planning for the electronic transmission of communicable disease related information was a high priority agenda. The CDC and states are working toward electronic case and laboratory results reporting, integrated database management and, in the long view, the electronic transmission of clinical data. We demonstrated the Merlin system, which was very well received. Under the auspices of the National Electronic Disease Surveillance System (NEDSS), the CDC is working on a "base system" (similar to Merlin) and modules for the various programs (STD, TB, HIV/AIDS). The Bureaus in the Division of Disease Control, the office of Health Planning Evaluation and Data Analysis and the information technology office are planning for the incorporation of the NEDSS architecture into the Florida DOH information systems.

Emerging and re-emerging infectious disease—The Director of the National Center for Infectious Diseases and several of the speakers made a clear and substantive case for the need to focus program attention on emerging infectious diseases: many chronic diseases have infectious origins (consider the recent discovery of the infectious cause of certain ulcers); there is significant potential for the international transmission of disease; and potential use as bioterrorist agents has renewed interest in several diseases. In addition, the development of antibiotic resistance by certain organisms is severely limiting the effectiveness of many therapies. Surveillance systems need to be able to identify and monitor the occurrence of all such problematic infectious diseases.

Epi-X—The CDC has developed an excellent web-based communications tool named Epi-X. This secure (by digital certificate) network allows registered public health professionals to post information that are expected to be useful to others. The purpose is to enable the communication of important public health data, as near real-time as possible without the restrictions of publication level data. Information may include outbreak notices that may begin with a suspect cluster and are followed through the intervention processes, epidemiologic data, and alerts. The alert function has a call-down feature that will contact key users through a variety of options. We, in the Bureau of Epidemiology, have asked CDC to assist us in the development of such a system for Florida. That network will connect hospitals, laboratories, major healthcare providers, county health departments and the state health office for the sharing of key public health information.

This meeting was superb; there was much more than I reported. When the slides from the presentations are available, we will share them with you.

ORLANDO (Reuters Health) - In a recent test, every medical laboratory that received a patient specimen containing the deadly anthrax bacterium failed to spot the organism or refer it to another lab, scientists report. The finding is worrisome, because "if Bacillus anthracis is used covertly in a bioterrorism attack, it will probably be first isolated in a clinical laboratory," according to Dr. Linda Nims and colleagues at the New Mexico State Laboratory in Albuquerque. Nims presented the findings here Monday at the annual meeting of the American Society for Microbiology. Speaking with Reuters Health, Nims explained that as a former clinical microbiologist, she suspected that most of her colleagues would dismiss an unexpected culture finding such as B. anthracis as an innocuous contaminant. "You feel like, 'well, it was on the skin but it's not causing the patient's infection," she said. The common response would be to abandon any further investigation of the bacillus. "I wanted to see if the laboratories in my city still did the same thing," Nims said. So, unannounced, she and her colleagues submitted four specimens-not from real patients-to four large New Mexico laboratories. Each contained a weakened form of B. anthracis. The result, Nims said, was "exactly what I thought-people just thought it was a contaminant. Three out of four laboratories turned it out as a contaminant or just 'Bacillus species.' One referred it to us--9 days after they first looked at the specimen." These types of mistakes and delays could have enormous public health consequences in the event of a real anthrax outbreak, the researchers warn.

Laboratories could "take a prolonged period of time to identify the organism or not identify it at all, which could result in increased illness and death in the population."

To address the problem locally, the New Mexico State Laboratory has presented training sessions in spotting and reporting B. anthracis for personnel at the four labs that flunked the test. The measure seems to have worked. In a second round of tests, all four labs correctly referred the bacillus to the state lab when it came across their desks, with three of the four doing so within a day. Nims believes this type of initiative may be needed nationwide, given the ongoing threat of bioterrorism. "I think that all laboratories have to be aware of it and probably ask their state health lab for help in training on it," she said.