THE EMERGENCE OF ZOONOTIC DISEASES

Understanding the Impact on Animal and Human Health

Workshop Summary

Tom Burroughs, Stacey Knobler, and Joshua Lederberg, Editors

Forum on Emerging Infections

Board on Global Health

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary THE EMERGENCE OF ZOONOTIC DISEASES Understanding the Impact on Animal and Human Health Workshop Summary Tom Burroughs, Stacey Knobler, and Joshua Lederberg, Editors Forum on Emerging Infections Board on Global Health INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. Support for this project was provided by the U.S. Department of Health and Human Services’ National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; Abbott Laboratories; American Society for Microbiology; Bristol-Myers Squibb Company; Burroughs Wellcome Fund; Eli Lilly & Company; Glaxo Wellcome; F. Hoffmann-La Roche AG; Pfizer, Inc.; SmithKline Beecham Corporation; and Wyeth-Ayerst Laboratories. The views presented in this report are those of the Institute of Medicine Forum on Emerging Infections and are not necessarily those of the funding agencies. This report is based on the proceedings of a workshop that was sponsored by the Forum on Emerging Infections. It is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Emerging Infections. The content of those sections is based on the presentations and the discussions that took place during the workshop. Library of Congress Cataloging-in-Publication Data The emergence of zoonotic diseases : understanding the impact on animal and human health : workshop summary / Tom Burroughs, Stacey Knobler, and Joshua Lederberg, editors ; Forum on Emerging Infections, Board on Global Health, Institute of Medicine. p. ; cm. Includes bibliographical references and index. ISBN 0-309-08327-3 (pbk.) 1. Zoonoses--Congresses. [DNLM: 1. Zoonoses--epidemiology--Congresses. 2. Communicable Diseases, Emerging--Congresses. WC 950 E53 2002] I. Burroughs, Tom. II. Knobler, Stacey. III. Lederberg, Joshua. IV. Institute of Medicine (U.S.). Forum on Emerging Infections. RA639 .E46 2002 614.5'6--dc21 2002002392 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. COVER: The background for the cover of this workshop summary is a photograph of a batik designed and printed specifically for the Malaysian Society of Parasitology and Tropical Medicine. The print contains drawings of various parasites and insects; it is used with the kind permission of the society.

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary FORUM ON EMERGING INFECTIONS JOSHUA LEDERBERG (Chair), Raymond and Beverly Sackler Foundation Scholar, The Rockefeller University, New York, New York VINCENT AHONKHAI, Vice President and Director, Anti-Infectives and Biologicals, SmithKline Beecham Corporation, Collegeville, Pennsylvania STEVEN BRICKNER, Research Advisor, Pfizer Global Research and Development, Pfizer Inc., Groton, Connecticut GAIL CASSELL, Vice President, Infectious Diseases, Eli Lilly & Company, Indianapolis, Indiana GARY CHRISTOPHERSON, Senior Advisor for Force Health Protection, Office of the Assistant Secretary of Defense, Department of Defense, Washington, D.C. GORDON DEFRIESE, Professor of Social Medicine, University of North Carolina, Chapel Hill, North Carolina CEDRIC DUMONT, Medical Director, U.S. Department of State and Foreign Service, Washington, D.C. JESSE GOODMAN, Deputy Director, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland RENU GUPTA, Vice President and Head, U.S. Clinical Research and Development, and Head, Global Cardiovascular, Metabolic, Endocrine, and G.I. Disorders, Novartis Corporation, East Hanover, New Jersey MARGARET HAMBURG, Vice President for Biological Programs, Nuclear Threat Initiative, Washington, D.C. CAROLE HEILMAN, Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland JAMES HUGHES, Assistant Surgeon General and Director, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia SAMUEL KATZ, Wilburt C. Davison Professor and Chairman Emeritus, Duke University Medical Center, Durham, North Carolina MARCELLE LAYTON, Assistant Commissioner, Bureau of Communicable Diseases, New York City Department of Health, New York, New York CARLOS LOPEZ, Research Fellow, Research Acquisitions, Eli Lilly Research Laboratories, Indianapolis, Indiana STEPHEN MORSE, Director, Center for Public Health Preparedness, Columbia University, New York, New York

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary MICHAEL OSTERHOLM, Director, Center for Infectious Disease Research and Policy and Professor, School of Public Health, University of Minnesota, Minneapolis, Minnesota MARC RUBIN, Vice President of Infectious Diseases Therapeutic Development Group, Glaxo Wellcome, Research Triangle Park, North Carolina DAVID SHLAES, Vice President, Infectious Disease Research, Wyeth, Pearl River, New York JANET SHOEMAKER, Director, Office of Public Affairs, American Society for Microbiology, Washington, D.C. P. FREDRICK SPARLING, J. Herbert Bate Professor Emeritus of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill, North Carolina KAYE WACHSMUTH, Deputy Administrator, Office of Public Health and Science, United States Department of Agriculture, Washington, D.C. C. DOUGLAS WEBB, Senior Medical Director, Bristol-Myers Squibb Company, Princeton, New Jersey CATHERINE WOTEKI, Undersecretary for Food Safety, U.S. Department of Agriculture, Washington, D.C. Liaisons to the Forum ENRIQUETA BOND, President, Burroughs Wellcome Fund, Research Triangle Park, North Carolina NANCY CARTER-FOSTER, Director, Program for Emerging Infections and HIV/AIDS, U.S. Department of State, Washington, D.C. MICHAEL HORAN, Associate Vice President of Clinical Affairs, Pharmaceutical Research and Manufacturers Association, Washington, D.C. PATRICK KELLEY, Colonel, Director, Department of Defense Global Emerging Infections System, Walter Reed Army Institute of Research, Silver Spring, Maryland EDWARD McSWEEGAN, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland STEPHEN OSTROFF, Associate Director for Epidemiologic Science, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia GARY ROSELLE, Program Director for Infectious Diseases, VA Central Office, Veterans Health Administration, Department of Veterans Affairs, Washington, D.C.

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary JAMES SIGG, Contract Liaison Officer, Office of Management and Contracts, Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland FRED TENOVER, Chief, Nosocomial Pathogens Laboratory Branch, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Staff JONATHAN DAVIS, Senior Program Officer (until May 2001) STACEY KNOBLER, Director, Forum on Emerging Infections MARJAN NAJAFI, Research Associate LAURIE SPINELLI, Project Assistant

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary BOARD ON GLOBAL HEALTH BARRY BLOOM (Co-chair), Dean, Harvard University School of Public Health, Boston, Massachusetts DEAN JAMISON (Co-chair), Director, Program on International Health, Education, and Environment, University of California at Los Angeles YVES BERGEVIN, Chief, Health Section, UNICEF, New York, New York DAVID CHALLONER (Institute of Medicine Foreign Secretary), Vice President for Health Affairs, University of Florida, Gainesville PATRICIA DANZON, Professor, Health Care Systems Development, University of Pennsylvania, Philadelphia HARVEY FINEBERG, Provost, Harvard University, Boston, Massachusetts JULIO FRENK, Secretary of Health, Government of Mexico, Mexico NOREEN GOLDMAN, Professor, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey EILEEN KENNEDY, Deputy Undersecretary, Research, Education, and Economics, U.S. Department of Agriculture, Washington, D.C. GERALD KEUSCH (Liaison) Director, Fogarty International Center, National Institutes of Health, Bethesda, Maryland ARTHUR KLEINMAN, Maude and Lillian Presley Professor of Medical Anthropology/Professor of Psychiatry and Social Medicine, Harvard Medical School, Boston, Massachusetts ADEL MAHMOUD, President, Merck Vaccines, Whitehouse Station, New Jersey JOHN WYN OWEN, Secretary, Nuffield Trust, London, United Kingdom ALLAN ROSENFIELD, Dean, Mailman School of Public Health, Columbia University, New York, New York SUSAN SCRIMSHAW, Dean, School of Public Health, University of Illinois at Chicago

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary Reviewers This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Bernadette Dunham, American Veterinary Medical Association, Washington, DC Rosemary Humes, Association of Public Health Laboratories, Washington, DC Arnold Weinberg, Harvard Medical School, Boston, MA Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Melvin Worth, National Academy of Sciences. Appointed by the National Research Council, he was

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary Contents     PREFACE   xv 1   INTRODUCTION   1     A Perspective on Emerging Zoonoses, Frederick A. Murphy   1 2   THE IMPORTANCE OF ZOONOTIC DISEASES   10     Pathogenesis and Virulence of Zoonotic Infections in Humans, Robert E. Shope   10     The Potential “Bioweaponization” of Zoonotic Diseases, David R. Franz   15     Xenotransplantation, Louisa E. Chapman   17     Economic and Trade Implications of Zoonotic Diseases, Peter Cowen and Roberta A. Morales   20 3   FACTORS OF EMERGENCE   26     Variation and Interspecies Transmission of Influenza A Viruses, Robert G. Webster   26     Assessing the Threat and the Opportunities Across the Spectrum of Zoonotic Diseases, Paul W. Ewald   30

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary     Practices and Policies to Protect Human Health from Antibiotic-Resistant Pathogens, Stephen F. Sundlof   35     Ecological Sources of Zoonotic Diseases, Robert B. Tesh   40     Vectorborne Zoonotic Diseases, John T. Roehrig   47     Mathematical Models and Predictors of Disease Outbreaks, Dana A. Focks   50     The Role of Native Birds and Other Wildlife on the Emergence of Zoonotic Diseases, Milton Friend and Robert G. McLean   52     Animal Husbandry Practices and Risk Factors, with Particular Reference to Bovine Spongiform Encephalopathy, Fred Brown   59     Natural History of Simian Immunodeficiency Viruses: Clues to the Emergence and Virulence of AIDS Viruses, Lisa Chakrabarti   61 4   DIAGNOSIS AND CONTROL OF ZOONOTIC INFECTIONS   64     Pathology and Early Recognition of Zoonotic Disease Outbreaks, Tracey S. McNamara   64     Molecular and Other Technologies for Rapid Diagnosis of Zoonotic Agents, Alfred D. Steinberg   67     Methods and Models for Pathogen Discovery, W. Ian Lipkin   69     Vaccines for Emerging Zoonoses: Marburg Virus Paradigm, Alan L. Schmaljohn   73 5   SURVEILLANCE AND MANAGEMENT OF ZOONOTIC DISEASE OUTBREAKS   79     Public Health Laboratory Surveillance, Mary J. R. Gilchrist   79     Challenges of Vectorborne Disease Surveillance from the Local Perspective: West Nile Virus Experience, Marcelle C. Layton   86     Veterinary Surveillance for Zoonotic Diseases in the United States, Randall L. Crom   90

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary     Petborne Zoonoses: Detection and Surveillance Challenges, Lisa Conti   98     Identification and Containment of Unknown and Rare Pathogens, C. J. Peters   101     Foodborne Zoonotic Agents: Salmonella Enteritidis in Eggs, Kaye Wachsmuth   105     Legislative and Policy Concerns in Protecting the Nation’s Health, David C. Bowen   109 6   SUMMARY AND ASSESSMENT Joshua Lederberg   113     APPENDIXES     A   Glossary and Acronyms   125 B   Workshop Agenda   132 C   Forum Member and Speaker Biographies   137

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary Preface The Forum on Emerging Infections was created in 1996 in response to a request from the Centers for Disease Control and Prevention and the National Institutes of Health. 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. *   Representatives of federal agencies serve in an ex officio capacity. An ex officio member of a group is one who is a member automatically by virtue of holding a particular office or membership in another body.

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary ABOUT THE WORKSHOP As defined by the World Health Organization, zoonoses are “those diseases and infections which are naturally transmitted between vertebrate animals and man, with or without an arthropod intermediate.” Outbreaks of zoonotic diseases emerge either by apparently new agents or by known microorganisms that appear in areas or species in which the disease was previously unknown. New animal diseases with an unknown host spectrum are also included in this definition. The specific causes of such diseases are varied and include complex interactions at the molecular level as well as more large-scale social and ecological dynamics affecting the growth and movement of populations and changes in the environment. Additional factors such as climate, technology, land use, and human behavior can converge in a manner favorable to the emergence of zoonotic diseases. Zoonotic diseases represent one of the leading causes of illness and death from infectious disease. Worldwide, zoonotic diseases have a negative impact on commerce, travel, and economies. In most developing countries, zoonotic diseases are of major public health significance and contribute to an already overly burdened public health system. In industrialized nations, zoonotic diseases are of particular concern for at-risk groups such as the elderly, children, pregnant women, and immunocompromised individuals. The potential use of zoonotic pathogens as bioterrorism agents should be considered as well. In an effort to increase knowledge and understanding of zoonotic diseases with current and probable future public health significance, the Institute of Medicine’s Forum on Emerging Infections hosted a 2-day workshop on June 7–8, 2000. The workshop, titled The Emergence of Zoonotic Diseases, explored the forces that drive zoonotic diseases to prominence and sought to identify more broad-based strategies and research programs that are needed to respond to these diseases. The goals of the workshop were to evaluate (1) the relative importance of zoonotic diseases against the overall backdrop of emerging infections, (2) the state of our understanding of zoonotic diseases, and (3) surveillance and response strategies to detect, prevent, and mitigate the impact of zoonotic diseases on human health. Issues pertaining to these three thematic areas were addressed through invited presentations and subsequent discussions, which highlighted the ongoing programs and actions being taken and identified the most important needs in this vital area. The agenda of the workshop appears in Appendix B. ORGANIZATION OF WORKSHOP SUMMARY This workshop summary report is prepared for the Forum membership in the name of the editors, with the assistance of staff and consultants, as an

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Emerging Infections’ sponsors, or the Insitute of Medicine. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop. The workshop summary is organized within chapters as a topic-by-topic description of the presentations and discussions. Its purpose is to present lessons from relevant experience, delineate a range of pivotal issues and their respective problems, and put forth some potential responses as described by the workshop participants. The Summary and Assessment chapter discusses the core messages that emerged from the speakers’ presentations and the ensuing discussions. Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and presents their beliefs on which areas may merit further attention. However, the reader should be aware that the material presented here expresses the views and opinions of those participating in the workshop and not the deliberations of a formally constituted Institute of Medicine study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter. ACKNOWLEDGMENTS The Forum on Emerging Infections and the Institute of Medicine (IOM) wish to express their warmest appreciation to the individuals and organizations who gave valuable time to provide information and advice to the Forum through participation in the workshop. The Forum is indebted to the IOM staff who contributed during the course of the workshop and the production of this workshop summary. On behalf of the Forum, I gratefully acknowledge the efforts led by Stacey Knobler and Jonathan Davis, who dedicated much effort and time to developing this workshop’s agenda and for their thoughtful and insightful approach and skill in translating the workshop proceedings and discussion into this workshop summary. I would also like to thank the following IOM staff for their valuable contributions to this activity: Tom Burroughs, Marjan Najafi, Laurie Spinelli, Judith Bale, Katherine Oberholtzer, Paige Baldwin, and Jennifer Otten. Finally, the Forum also thanks sponsors that supported this activity. Financial support for this project was provided by the U.S. Department of Health and Human Services’ National Institutes of Health, Centers for Disease Control and Prevention, and the Food and Drug Administration;

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The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health - Workshop Summary U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; Abbott Laboratories; American Society for Microbiology; Bristol-Myers Squibb Company; Burroughs Wellcome Fund; Eli Lilly & Company; Glaxo Wellcome; F. Hoffmann-La Roche AG; Pfizer; SmithKline Beecham Corporation; and Wyeth-Ayerst Laboratories. The views presented in this workshop summary are those of the editors and workshop participants and are not necessarily those of the funding organizations. Joshua Lederberg, Chair Forum on Emerging Infections