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NOTICE: The project that is the subject of this report 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.

This project was supported by the American Society for Microbiology; Burroughs Wellcome Fund; Defense Threat Reduction Agency; GlaxoSmithKline; Infectious Disease Society of America; Lawrence Livermore National Laboratory; Merck Company Foundation; Pfizer; Sanofi Pasteur; U.S. Department of Health and Human Services’ National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense’s Global Emerging Infections Surveillance and Response System and Walter Reed Army Institute of Research; U.S. Department of Homeland Security; U.S. Department of State; and U.S. Department of Veterans Affairs. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

International Standard Book Number-10 0-309-10043-7 (Book)

International Standard Book Number-13 978-0-309-10043-4 (Book)

International Standard Book Number-10 0-309-65457-2 (PDF)

International Standard Book Number-13 978-0-309-65457-9 (PDF)

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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: A detailed section of a stained glass window 21 × 56 depicting the natural history of influenza viruses and zoonotic exchange in the emergence of new strains was used to design the front cover. Based on the work done at St. Jude Children’s Research Hospital supported by American Lebanese Syrian Associated Charities (ALSAC) and the National Institute of Allergy and Infectious Diseases (NIAID). Artist: Jenny Hammond, Highgreenleycleugh, Northumberland, England.

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