overview Gains in many areas of infectious disease control are seriously jeopardized by the spread of antimicrobial resistance, with extensively drug-resistant tuberculosis (XDR-TB)now a cause of great concern. Drug resistance is also evident in diarrhoeal diseases, hospital-acquired infections, malaria, meningitis, respiratory tract infections, and sexually transmitted infections, and is emerging in HIV. Foodborne diseases he food chain has undergone considerable and rapid changes over the last 50 years, becoming highly sophisticated and international. Although the safety of food as dramatically improved overall, progress is uneven and foodborne outbreaks from microbial contamination, chemicals and toxins are common in many countries. The trading of contaminated food between countries increases the potential that outbreaks will spread. In addition, the emergence of new foodborne diseases creates consider- ble concem, such as the recognition of the new variant of Creutzfeldt-Jakob disease (vCJD)associated with bovine spongiform encephalopathy(BSE) Accidental and deliberate outbreaks As activities related to infectious disease surveillance and laboratory research have increased in recent years, so too has the potential for outbreaks associated with the accidental release of infectious agents. Breaches in biosafety measures are often responsible for these accidents. At the same time, opportunities for malicious releases of dangerous pathogens, once unthinkable, have become a reality, as shown by the anthrax letters in the united states of america in 2001 In addition, the recent past has been marked by disturbing new health events that resulted from chemical or nuclear accidents and sudden environmental changes, causing major concerns in many parts of the world Toxic chemical accidents a West Africa, 2006: the dumping of approximately 500 tons of petrochemical waste in at least 15 sites around the city of Abidjan, Cote d'lvoire led to the deaths of eight people being attributed to exposure to the waste and to nearly 90 000 more people seeking medical help. Other countries were concerned that they could also have been put at risk as a result of dumping elsewhere or as a result of chemical contamination of transboundary rivers. I Southern Europe, 1981: 203 people died after consuming poisoned cooking oil that was adulterated with industrial rapeseed oil. a total of 15 000 people were ffected by the tainted oil and no cure to reverse the adverse effects of toxic oil syndrome was ever found Radionuclear accidents I Eastern Europe, 1986: the Chernobyl disaster is regarded as the worst accident in the history of nuclear power. The explosion at the plant resulted in the radioactive contamination of the surrounding geographical area, and a cloud of radioactive fallout drif ted over western parts of the former Soviet Union, eastern and western Europe, some Nordic countries and eastern North America. Large areas of Ukraine, the Republic of Belarus and the Russian Federation were badly contaminated resulting in the evacuation and resettlement of over 336 000 peopleGains in many areas of infectious disease control are seriously jeopardized by the spread of antimicrobial resistance, with extensively drug-resistant tuberculosis (XDR-TB) now a cause of great concern. Drug resistance is also evident in diarrhoeal diseases, hospital-acquired infections, malaria, meningitis, respiratory tract infections, and sexually transmitted infections, and is emerging in HIV. Foodborne diseases The food chain has undergone considerable and rapid changes over the last 50 years, becoming highly sophisticated and international. Although the safety of food has dramatically improved overall, progress is uneven and foodborne outbreaks from microbial contamination, chemicals and toxins are common in many countries. The trading of contaminated food between countries increases the potential that outbreaks will spread. In addition, the emergence of new foodborne diseases creates consider￾able concern, such as the recognition of the new variant of Creutzfeldt-Jakob disease (vCJD) associated with bovine spongiform encephalopathy (BSE). Accidental and deliberate outbreaks As activities related to infectious disease surveillance and laboratory research have increased in recent years, so too has the potential for outbreaks associated with the accidental release of infectious agents. Breaches in biosafety measures are often responsible for these accidents. At the same time, opportunities for malicious releases of dangerous pathogens, once unthinkable, have become a reality, as shown by the anthrax letters in the United States of America in 2001. In addition, the recent past has been marked by disturbing new health events that resulted from chemical or nuclear accidents and sudden environmental changes, causing major concerns in many parts of the world. Toxic chemical accidents ■ West Africa, 2006: the dumping of approximately 500 tons of petrochemical waste in at least 15 sites around the city of Abidjan, Côte d’Ivoire, led to the deaths of eight people being attributed to exposure to the waste and to nearly 90 000 more people seeking medical help. Other countries were concerned that they could also have been put at risk as a result of dumping elsewhere or as a result of chemical contamination of transboundary rivers. ■ Southern Europe, 1981: 203 people died after consuming poisoned cooking oil that was adulterated with industrial rapeseed oil. A total of 15 000 people were affected by the tainted oil and no cure to reverse the adverse effects of toxic oil syndrome was ever found. Radionuclear accidents ■ Eastern Europe, 1986: the Chernobyl disaster is regarded as the worst accident in the history of nuclear power. The explosion at the plant resulted in the radioactive contamination of the surrounding geographical area, and a cloud of radioactive fallout drifted over western parts of the former Soviet Union, eastern and western Europe, some Nordic countries and eastern North America. Large areas of Ukraine, the Republic of Belarus and the Russian Federation were badly contaminated, resulting in the evacuation and resettlement of over 336 000 people. overview xi