Appendix A
Workshop Agenda

LINKING INFECTIOUS AGENTS AND CHRONIC DISEASES:

Defining the Relationship, Enhancing the Research, and Mitigating the Effects

October 21–22, 2002

Room 100

The National Academies

500 Fifth Street, NW

Washington, DC 20001

AGENDA

MONDAY, OCTOBER 21, 2002

8:30 a.m.

Continental Breakfast

9:00

Welcome and Opening Remarks

Adel Mahmoud, Chair, Forum on Microbial Threats

Stanley Lemon, Vice Chair, Forum on Microbial Threats

Session I Case Studies of Infectious Agents Associated with Chronic Diseases

Evidence continues to mount implicating microorganisms as etiologic agents of chronic diseases that contribute to substantial mortality and morbidity. This session will examine definitive and emerging associations between infectious agents and chronic diseases with a range of pathogenic mechanisms and diversity in etiologic microbes. The review will explore advances in research, detection, and



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The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects - Workshop Summary Appendix A Workshop Agenda LINKING INFECTIOUS AGENTS AND CHRONIC DISEASES: Defining the Relationship, Enhancing the Research, and Mitigating the Effects October 21–22, 2002 Room 100 The National Academies 500 Fifth Street, NW Washington, DC 20001 AGENDA MONDAY, OCTOBER 21, 2002 8:30 a.m. Continental Breakfast 9:00 Welcome and Opening Remarks Adel Mahmoud, Chair, Forum on Microbial Threats Stanley Lemon, Vice Chair, Forum on Microbial Threats Session I Case Studies of Infectious Agents Associated with Chronic Diseases Evidence continues to mount implicating microorganisms as etiologic agents of chronic diseases that contribute to substantial mortality and morbidity. This session will examine definitive and emerging associations between infectious agents and chronic diseases with a range of pathogenic mechanisms and diversity in etiologic microbes. The review will explore advances in research, detection, and

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The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects - Workshop Summary screening that have contributed to these discoveries and some of the challenges that remain. 9:15 Human papillomavirus infection as the cause of cervical cancer Eduardo Franco, McGill University 9:45 Infectious agents and cardiovascular disease Michael Dunne, Pfizer, Inc. 10:15 Infectious agents and demyelinating diseases Richard Johnson, Johns Hopkins University School of Medicine 10:45 The role of infectious agents in schizophrenia, bipolar disorder, and other serious neuropsychiatric diseases Robert Yolken and E. Fuller Torrey, Johns Hopkins University School of Medicine and Stanley Foundation 11:15 BREAK 11:30 Common infections and uncommon disease: Elusive associations of enteroviruses and type I diabetes mellitus Mark Pallansch, Centers for Disease Control and Prevention 12:00 p.m. Chronic hepatitis B virus infections William Mason, Fox Chase Cancer Center 12:30 Retrovirus-induced lung cancer in sheep: Perspectives on the human disease Hung Fan, University of California, Irvine 1:00 LUNCH Session II Challenges in Framing the Research Identification and confirmation of the infectious causation of chronic diseases are complicated by several factors, which include detection of microbes at the time of diagnosis of the chronic condition, the lack of adequate methods to identify novel or rare microorganisms, and the influence of environmental and genetic factors on the etiology of the chronic diseases. This session will examine these challenges and identify existing and potential methods and technologies for overcoming these obstacles.

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The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects - Workshop Summary 2:00 Kaposi’s sarcoma, KSHV and causality: Koch’s postulates in the age of molecular biology Patrick Moore, Mailman School of Public Health, Columbia University 2:30 Microbial agents in chronic diseases: Guilt by association versus pathologic etiology Thomas Quinn, Johns Hopkins University School of Medicine 3:00 Novel diagnostic, therapeutic, and chemopreventive strategies David Persing, Corixa Corporation 3:30 BREAK Session III Discussion Panel: Shaping the Research and Development Agenda 3:45 Panel members, Forum members, and the audience will comment on and respond to considerations such as the role of industry in developing diagnostics; possibilities for the coordination between basic and clinical scientists, pathologists, and epidemiologists in developing standardized specific case definitions and specimens and the development of comparable methods of analysis; the lessons that can be learned about the microbes from the chronic sequelae they produce; and methods for funding the research.   David Morens, National Institute of Allergy and Infectious Diseases   Ian Lipkin, University of California, Irvine, and Mailman School of Public Health, Columbia University   Susan Swedo, National Institute of Mental Health 5:30 Adjournment of the first day TUESDAY, OCTOBER 22, 2002 8:30 a.m. Continental Breakfast 9:00 Opening Remarks

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The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects - Workshop Summary Session IV Implications for Developing Countries As researchers, clinicians, and policymakers have recognized the growing disease burden from chronic diseases in developing countries, understanding of the infectious etiology of these diseases becomes increasingly important in these areas where many infectious diseases still remain endemic. This session will review the consequences of highly prevalent infectious diseases linked to chronic diseases and explore the global and local response needed to combat these outcomes in resource-limited environments. 9:15 Interaction of multiple infectious agents in endemic areas Altaf Lal, Centers for Disease Control and Prevention 9:45 Progression of hepatitis C virus infection with and without schistosomiasis Sanaa Kamal, Ain Shams University, Cairo, Egypt 10:15 Infectious agents and epilepsy J.W.A.S. Sander, Institute of Neurology, University College, London 10:45 Potential long-term consequences of early childhood enteric and parasitic infections Richard Guerrant, University of Virginia School of Medicine 11:15 HTLV-1: Clinical impact of chronic infection Eduardo Gotuzzo, University of Peru, Lima, Peru 12:00 p.m. LUNCH Session V Barriers and Opportunities to Detect, Prevent, and Mitigate the Impact of Chronic Diseases Caused by Infectious Agents The complexity of the relationship between infectious agents and chronic diseases requires a multi-disciplinary approach to reveal the implications of early detection and prevention of chronic diseases caused by infectious agents. This session will summarize the advances and gaps in collaborative research on detection and diagnostic technologies, their integration with epidemiological studies and surveillance that can forward the efforts in this important area, and the implications for clinical management practices and priorities.

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The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects - Workshop Summary 1:00 Testing the reliability of the causal relationship: Considering genetic and environmental susceptibility Mikhail Pletnikov, Johns Hopkins University School of Medicine 1:30 DNA sequence analysis of a stealth-adapted simian cytomegalovirus W. John Martin, Center for Complex Infectious Diseases 2:00 Development of vaccines to prevent chronic disease P. Helena Mäkelä, National Public Health Institute, Helsinki, Finland 2:30 Integrating epidemiology, laboratory research, and surveillance Siobhán O’Connor, Centers for Disease Control and Prevention 3:00 BREAK Session VI Discussion Panel: The Next Steps for the Healthcare Community Panel members, Forum members, and the audience will comment on and respond to considerations such as the role of industry and academic research in developing treatments; the implications for the health care and prevention community in detecting and treating these diseases; and the benefits of managing acute infections vs. chronic diseases—the argument for vaccines and antimicrobials. 3:15 Kathryn Carbone, FDA, Center for Biologics Evaluation and Research Thomas Shinnick, Centers for Disease Control and Prevention 5:00 Closing Remarks / Adjournment