Physicians in most developed countries are at a great disadvantage when confronted with geographic and tropical diseases. They may be faced with prevention for patients who are outward bound or with diagnosis and treatment on their return. The practitioners' difficulties relate to inade quate teaching in medical schools and to the infrequency with which they are confronted with these exotic diseases. It is quite surprising to realize the extent of travel by Americans to areas where the tropical diseases abound: in 1979 there were 3 million trips by U. S. residents to Central and South America and almost 1 million to Africa and Asia. I Further, the influx from the tropics to the United States in 1978 involved 4. 5 million visitors and more than half a million immigrants. I The single most danger ous ofthese infections is malaria, which is now averaging about 500 cases yearly in the United States; it is important to realize that infection with one species of this organism (Plasmodium falciparum) can be lethal within a few days of the onset of fever. Highly contagious infections such as the newly discovered and extremely lethal Lassa and Ebola fevers may be imported to our shores, plus cholera, antibiotic-resistant bacillary dys entery, and amebic dysentery and liver abscess. Chronic worm infections such as schistosomiasis, although rarely lethal, may have severe conse 2 quences such as paraplegia or hematemesis."

The Forum on Microbial Threats (previously named the Forum on Emerging Infections) was created in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The goal of the Forum is to provide structured opportunities for representatives from academia, industry, professional and interest groups, and government to examine and discuss scientific and policy issues that are of shared interest and that are specifically related to research and prevention, detection, and management of emerging infectious diseases. In accomplishing this task, the Forum provides the opportunity to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them directly; hence, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its strengths are the diversity of its membership and the contributions of individual members expressed throughout the activities of the Forum. Recent increased attention to both United States and international public health systems as well as the medical research and treatment infrastructure has revealed significant deficiencies in their capacity to respond to infectious diseases. Medical and public health professionals may be poorly equipped to detect, diagnose, and treat common infectious diseases as well as those diseases that pose an unexpected threat. The need for the development of domestic and international training programs in the expanding field of emerging and reemerging infectious diseases is well recognized. Well-trained infectious disease professionals form the basis of a strong national healthcare system. The Forum on Emerging Infections (now renamed the Forum on Microbial Threats) convened a 2-day workshop discussion--the subject of this summary--to examine the education and training needs to ensure an adequate infectious diseases workforce. The workshop reviewed trends in research training programs and discussed the requirements for establishing successful educational initiatives and training programs to ensure a competent and prepared workforce for current and future challenges in infectious diseases. Some key disciplines explored as case-study examinations included infectious disease epidemiology, vaccinology, vector biology, and public health laboratorians.

In the wake of September 11th and recent anthrax events, our nationa (TM)s bioterrorism response capability has become an imminent priority for policymakers, researchers, public health officials, academia, and the private sector. In a three-day workshop, convened by the Institute of Medicinea (TM)s Forum on Emerging Infections, experts from each of these communities came together to identify, clarify, and prioritize the next steps that need to be taken in order to prepare and strengthen bioterrorism response capabilities. From the discussions, it became clear that of utmost urgency is the need to cast the issue of a response in an appropriate framework in order to attract the attention of Congress and the public in order to garner sufficient and sustainable support for such initiatives. No matter how the issue is cast, numerous workshop participants agreed that there are many gaps in the public health infrastructure and countermeasure capabilities that must be prioritized and addressed in order to assure a rapid and effective response to another bioterrorist attack.

"The many diseases that are endemic in most of the developing nations of the world (and that may also affect travelers to these regions) are, at world levels, the most important sources of morbidity that affect the entire human race. The change in morbidity patterns in the more developed nations should not be permitted to blind the more affluent countries to the implications of this simple statement. Thus, direct and useful guides are needed to assure efficient and economical diagnosis and treatment of those infections that are endemic to the less affluent two-thirds of the earth.
"The algorithms in this book have been developed by Drs. Warren and Mahmoud, as the result of a systematic effort to produce such guides. The book is presented as another in the series "Studies in Infectious Disease Research" and is a most welcome addition, certain to supply a major and hitherto inadequately fulfilled need."--from the Foreword, by Edward H. Kass, M. D., Ph.D