and Department of Defense) introduce measures to ensure the availability and usefulness of antimicrobials and to prevent the emergence of resistance. These measures should include the education of health care personnel, veterinarians, and users in the agricultural sector regarding the importance of rational use of antimicrobials (to preclude their unwarranted use), a peer review process to monitor the use of antimicrobials, and surveillance of newly resistant organisms. Where required, there should be a commitment to publicly financed rapid development and expedited approval of new antimicrobials.

Vector Control

The United States and other developed countries have been able to free themselves to a remarkable degree from the burden of vector-borne diseases using a variety of methods of vector control. If that level of vigilance is maintained, there is a chance of minimizing new outbreaks of vector-borne disease. The potential for vector-borne disease to emerge in the United States still exists, however, because of the abundance of certain vectors, such as Aedes albopictus mosquitoes. And even in Lyme disease, a vector-borne illness with a known vector—the Ixodes tick—there is currently no agreement on intervention strategies.

Vector control generally includes the use of one or more measures to reduce vector abundance, vector longevity, and human-vector contact. Depending on the type of vector, common control measures include, but are not limited to, indoor and outdoor spraying of chemical pesticides, application of biological control agents, destruction or treatment of larval development sites, and personal protective measures, such as covering exposed areas of the body, application of repellents, sleeping under bednets, or reducing human contact with infective insects by remaining away from areas inhabited by the vectors. Innovative methods of vector control, such as genetic modification of vectors, the development of antivector vaccines, and the use of biological control techniques are currently being examined, particularly for use in the control of mosquito vectors of malaria (Institute of Medicine, 1991a).

The transovarial transmission (from infected female vectors through their eggs to succeeding generations) of pathogens, such as arboviruses, poses some unique problems for the development of control programs. A transovarially infected adult mosquito vector can transmit infection immediately after it emerges. In the case of the LaCrosse virus, for example, it is important to preclude adult emergence and/or reduce the abundance of adult vectors that emerge in the spring or early summer. Any reduction in vector-control efforts is likely to be followed by a resurgence of the vector population.

For a disease agent that is known or suspected to be transmitted by an



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