CENTERSC FORD DISEASEC CONTROL AND PREVENTION Contents Emerging Infectious Diseases Volume 3 • Number 1 January—March 1997 Perspective Designing an International Policy and Legal Framework for 1 B.J. Plotkin and A.M. Kimball the Control of Emerging Infectious Diseases: First Steps Synopses Surface Antigens of the Syphilis Spirochete and Their 11 D.R. Blanco, J.N. Miller, and Potential as Virulence Determinants M.A. Lovett Mycoplasmas: Sophisticated, Reemerging, and Burdened 21 J.B. Baseman and J.G. Tully by Their Notoriety Fluoroquinolone Resistance in Neisseria gonorrhoeae 33 J.S. Knapp, K.K. Fox, D.L. Trees, and W.L. Whittington Infectious Diseases and Immunity: Special Reference to Major 41 N. Singh, S. Agrawal, and A.K. Rastogi Histocompatibility Complex Cryptosporidiosis: An Emerging, Highly Infectious Threat 51 R. L. Guerrant Dispatches Isolation and Phylogenetic Characterization of Ebola Viruses 59 M-C. Georges-Courbot, A. Sanchez, C-Y Causing Different Outbreaks in Gabon Lu, S. Baize, E. Leroy, J. Lansout- Soukate, C. Tévi-Bénissan, A.J.Georges, S.G. Trappier, S.R. Zaki, R. Swanepoel, P.A. Leman, P.E. Rollin, C.J. Peters, S.T. Nichol, and T.G. Ksiazek The Epidemiology of Creutzfeldt-Jakob Disease in Canada: 63 E. Stratton, M.N. Ricketts, and A Review of Mortality Data P.R. Gully Exudative Pharyngitis Possibly Due to Corynebacterium 65 H.S. Izurieta, P.M. Strebel, T. pseudodiptheriticum, a New Challenge in the Differential Youngblood, D.G. Hollis, and T. Popovic Diagnosis of Diphtheria Mycoplasmal Conjunctivitis in Wild Songbirds: The Spread 69 J.R. Fischer, D.E. Stallknecht, M.P. of a New Contagious Disease in a Mobile Host Population Luttrell,A.A. Dhondt, and K.A. Converse Knowledge-Based Patient Screening for Rare and Emerging 73 C.N. Carter, N.C. Ronald, J.H. Steele, Infectious/Parasitic Diseases: A Case Study of Brucellosis E. Young, J.P. Taylor, L.H. Russell, Jr., and Murine Typhus A.K. Eugster, and J.E. West Letters Emergence of Epidemic O’nyong-nyong Fever in 77 E.B. Rwaguma, J.J. Lutwama, S.D.K. Southwestern Uganda, After an Absence of 35 Years Sempala, N. Kiwanuka, J. Kamugisha, S. Okware, G. Bagambisa, R. Lanciotti, J.T. Roehrig, and D.J. Gubler Prostatitis and Benign Prostatic Hyperplasia: Emerging 77 B. Hennenfent Infectious Diseases? Risk Factors for Severe Leptospirosis in the Parish 78 C.P. Douglin, C. Jordan, R. Rock, of St. Andrew, Barbados A. Hurley, and P.N. Levett Electronic Communication and the Rapid Dissemination 80 C.B. Dalton, P.M. Griffin, and of Public Health Information L. Slutsker News and Notes Emerging Infectious Diseases Conference 82 “Emergent Illness and Public Scholarship” Fellowships 82 International Workshop on Molecular Epidemiology 82 and Evolutionary Genetics Cover photo: Immunostaining of Ebola virus antigens within subepithelial vascular endothelial cells in a skin biopsy from a chimpanzee that died during the 1996 Gabon outbreak; Dr. Sherif R. Zaki, Centers for Disease Control and Prevention, Atlanta, GA. Emerging Infectious Diseases Emerging Infectious Diseases is indexed in Index Medicus/Medline, Current Contents, and several other electronic databases. Liaison Representatives Editors Anthony I. Adams, M.D. William J. Martone, M.D. Editor Chief Medical Adviser Senior Executive Director Joseph E. McDade, Ph.D. Commonwealth Department of Human National Foundation for Infectious Diseases National Center for Infectious Diseases Services and Health Bethesda, Maryland, USA Centers for Disease Control and Prevention Canberra, Australia Atlanta, Georgia, USA Phillip P. Mortimer, M.D. David Brandling-Bennett, M.D. Director, Virus Reference Division Perspectives Editor Deputy Director Central Public Health Laboratory Stephen S. Morse, Ph.D. Pan American Health Organization London, United Kingdom The Rockefeller University World Health Organization New York, New York, USA Washington, D.C., USA Robert Shope, M.D. Professor of Research Synopses Editor Gail Cassell, Ph.D. University of Texas Medical Branch Phillip J. Baker, Ph.D. Liaison to American Society for Microbiology Galveston, Texas, USA Division of Microbiology and Infectious University of Alabama at Birmingham Diseases Birmingham, Alabama, USA Natalya B. 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Perspective Designing an International Policy and Legal Framework for the Control of Emerging Infectious Diseases: First Steps Bruce Jay Plotkin* and Ann Marie Kimball† *School of Law; †School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA As the pace of emergence and reemergence of infectious diseases quickens, the International Health Regulations, which have served as the legal and policy framework of epidemic control for 45 years, are being revised by the World Health Organization (WHO). In this article, we review the recent history, legal construction, and application of these regulations and related international treaty-based sanitary measures, especially the General Agreement on Tariffs and Trade and the Agreement on the Application of Sanitary and Phytosanitary Measures, and the history of applying the regulations in the maritime and aviation industries. This review indicates that revision efforts should address 1) the limited scope of disease syndromes (and reporters of these syndromes) now in the regulations and 2) the mismatch between multisectoral factors causing disease emergence and the single agency (WHO) administering the regulations. The revised regulations should expand the scope of reporting and simultaneously broaden international agency coordination. The Division of Emerging and Other Com- than the incubation period of the disease, is ren- municable Disease Surveillance and Control, dering border controls futile.