The popularity of the online facility for participating in the multiple-choice questions relating to articles in the journal which attract continuing educational points has increased rapidly. For all subsequent issues we aim to make this activity only available online. This has the advantage of accessibility at all times, instant marking and something which we feel will be particularly exciting for our readers, instant award of credits. What could be more satisfying! Furthermore, a hardcopy certificate to record participation can be downloaded on completion of the MCQ activity. I do have to point out, and there is always a catch, that access to the MCQ’s will be available only to subscribers of the journal. There is no such thing as a free lunch!

This issue has some pertinent topics. New guidance relating to meningococcal prophylaxis is discussed by James Stuart. Stephanie Dancer looks at the evidence for the effect of hospital cleaning on infection control. Drs Honeybourne and Banerjee review Chlamydia pneumoniae. I try to encourage our junior doctors to make a clinical distinction between obvious lobar pneumococcal pneumonia and obvious atypical pneumonia and not to treat every patient with a lower respiratory infection with a cephalosporin and macrolide. This review suggests that mixed infection is common.

The question you have all been asking ‘Did Al-Quaeda have an irreconcilable difference with the Andover Inland Revenue Office?’. This seemed highly unlikely as we investigated the risk of the white power discovered in the mail at the tax office, one of several apparent bioterrorist attacks in north Hampshire in the wake of the anthrax attacks in the USA. This was not a credible threat to public health but a malicious prank from a disgruntled tax payer. Like many other copy-cat hoax attacks around the country, it highlighted the need for a more co-ordinated approach to outbreaks of infection, deliberate or otherwise.

Then it arrived. The Chief Medical Officers report “Getting Ahead of the Curve” appeared suddenly and without warning but it was not unwelcome. It was glossy, an interesting read and promised an exciting future. Who chose the title and what did it mean? Did it imply that we would be one step ahead of disaster and therefore in control of the threat or did it imply that a wave of contagion would soon come crashing down on us, or was it not “ahead of the curve”, but simply “round the bend”.

Why had the strategy emerged so suddenly? A radical overhaul of infection services had been spoken about for sometime but perhaps two things precipitated the early publication. The first was the perceived threat of chemical and biological terrorism after the enormity of the New York attack and then the wave of anthrax exposures. The second was an organisational event. With the dissolution of the existing health authorities and the transfer of most public health responsibilities to primary care trusts, Consultants in Communicable Disease and their teams were in limbo, without employer or place of work.

The strategy provides for their employment in a newly created agency which will encompass all the roles of the CCDC by combining the Public Health Laboratory Service with the National Radiological Protection Board, the Centre for Applied Microbiology and Research and the National Focus for Clinical Incidents. CCDC’s will become the agency’s field operatives providing a local health protection service against infection, chemical and radiological hazards.

In the process laboratory services will be ‘rationalised’. This spectacular NHS management euphemism is on a par with terms such as ‘cleansed’. There will be fewer public health laboratories and all laboratories will have a statutory responsibility for surveillance reporting. The reorganisation of the PHLS will tie in with that other initiative the ‘cleansing’, or was it ‘rationalisation’, no, the ‘modernisation’ of pathology.

The Agency will be in a position to develop and implement national strategies against priority infectious diseases such as tuberculosis, hospital acquired infection and sexually transmitted disease. The surveillance of existing infection threats and emerging infections will be enhanced. There will be a programme for new vaccine development and a review of the law on infection.

The future is exciting and it is always a challenge to live in interesting times.