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Appendix D
Glossary

Antibody: A protein produced by the immune system in response to the introduction of a substance (an antigen) recognized as foreign by the body’s immune system. Antibody interacts with the other components of the immune system and can render the antigen harmless, although for various reasons this may not always occur.

Antigen: A molecule capable of eliciting a specific antibody or T-cell response.

Antigenic: Having the properties of an antigen.

Antigenic drift: Random mutations in the genes of a virus, a process that changes the antigens of the virus. As these changes accumulate it may help the virus to evade the immune system since antigens are what the immune system recognizes (http://en.wikipedia.org/wiki/Antigenic_drift, accessed December 16, 2009).

Antigenic shift: The process by which at least two different strains of a virus (or different viruses), especially influenza, combine to form a new subtype having a mixture of the surface antigens of the two original strains (http://en.wikipedia.org/wiki/Antigenic_shift, accessed December 16, 2009).

Antiviral cytokine: A human or animal factor that is induced by interferon in virus-infected cells and mediates interferon inhibition of virus replication (http://medical-dictionary.thefreedictionary.com/antiviral+protein, accessed November 6, 2009).



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Appendix D Glossary Antibody: A protein produced by the immune system in response to the intro- duction of a substance (an antigen) recognized as foreign by the body’s immune system. Antibody interacts with the other components of the immune system and can render the antigen harmless, although for various reasons this may not always occur. Antigen: A molecule capable of eliciting a specific antibody or T-cell response. Antigenic: Having the properties of an antigen. Antigenic drift: Random mutations in the genes of a virus, a process that changes the antigens of the virus. As these changes accumulate it may help the virus to evade the immune system since antigens are what the immune system recognizes (http://en.wikipedia.org/wiki/Antigenic_drift, accessed December 16, 2009). Antigenic shift: The process by which at least two different strains of a virus (or different viruses), especially influenza, combine to form a new subtype having a mixture of the surface antigens of the two original strains (http://en.wikipedia. org/wiki/Antigenic_shift, accessed December 16, 2009). Antiviral cytokine: A human or animal factor that is induced by interferon in virus-infected cells and mediates interferon inhibition of virus replication (http:// medical-dictionary.thefreedictionary.com/antiviral+protein, accessed November 6, 2009). 389

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390 IMPACTS OF THE 2009-H1N1 INFLUENZA A PANDEMIC Cross-reactive cell-mediated immunity: An immune response that does not involve antibodies but rather involves the activation of macrophages, natural killer cells (NK), antigen-specific cytotoxic T-lymphocytes, and the release of various cytokines in response to an antigen (http://encyclopedia.thefreedictionary. com/cell-mediated+immunity, accessed November 5, 2009). Dilution: A method of obtaining a pure culture of bacteria or virus by sub - culturing from the highest dilution in which the organism is demonstrably present (http://medical-dictionary.thefreedictionary.com/limit+dilution, accessed Novem- ber 5, 2009). Distributive justice: Benefits and burdens imposed on the population when the emergency response measures and mitigations are shared equitably and fairly. Endemic: The constant presence of a disease or infectious agent within a given geographic area; it may also refer to the usual prevalence of a given disease within such area. Enzootic: A disease (can be either low or high morbidity) that is endemic in an animal community. Epidemic: The occurrence in a community or region of cases of an illness (or outbreak) with a frequency clearly in excess of normal expectancy. Epidemiology: The branch of science that deals with the incidence, distribution, and control of disease in a population; the sum of the factors controlling the pres- ence or abundance of a disease or pathogen. Epitopes: The surface portion of an antigen capable of eliciting an immune response and of combining with the antibody produced to counter that response (http:// medical-dictionary.thefreedictionary.com/epitopes, accessed November 5, 2009). Epi-X: Centers for Disease Control and Prevention’s Web-based communica- tions solution for public health professionals. Through Epi-X, CDC officials, state and local health departments, poison control centers, and other public health professionals can access and share preliminary health surveillance information— quickly and securely. Users can also be actively notified of breaking health events as they occur. For more information, see http://www.cdc.gov/epix/ (accessed November 5, 2009). Founder effect: Changes in gene frequencies that usually accompany starting a new population from a small number of individuals. The newly founded population is likely to have quite different gene frequencies than the source population because

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391 APPENDIX D of sampling error (i.e., genetic drift). The newly founded population is also likely to have a less genetic variation than the source population (http://evolution.berkeley. edu/evosite/glossary/glossary_browse.shtml, accessed December 17, 2009). Genome: The complete genetic composition of an organism (e.g., human, bac- terium, protozoan, helminth, or fungus), contained in a chromosome or set of chromosomes or in a DNA or RNA molecule (e.g., a virus). GeoSentinel: A worldwide communication and data collection network for the surveillance of travel related morbidity. It was initiated in 1995 by the International Society of Travel Medicine (ISTM) and the CDC as a network of ISTM member travel/tropical medicine clinics. GeoSentinel is based on the concept that these clinics are ideally situated to effectively detect geographic and temporal trends in morbidity among travelers, immigrants and refugees. For more information, see http://www.istm.org/geosentinel/main.html (accessed November 5, 2009). Global Outbreak Alert and Response Network (GOARN): A technical col- laboration of existing institutions and networks who pool human and technical resources for the rapid identification, confirmation and response to outbreaks of international importance. GOARN provides an operational framework to link this expertise and skill to keep the international community constantly alert to the threat of outbreaks and ready to respond. For more information, see http://www. who.int/csr/outbreaknetwork/en/ (accessed November 5, 2009). HealthMap: Brings together disparate data sources to achieve a unified and com- prehensive view of the current global state of infectious diseases and their effect on human and animal health. This freely available Web site integrates outbreak data of varying reliability, ranging from news sources (such as Google News) to curated personal accounts (such as ProMED) to validated official alerts (such as World Health Organization). Through an automated text processing system, the data is aggregated by disease and displayed by location for user-friendly access to the original alert. HealthMap provides a jumping-off point for real- time information on emerging infectious diseases and has particular interest for public health officials and international travelers. For more information, please see http://healthmap.org (accessed April 28, 2010). Hemagglutinin: A molecule, such as an antibody or lectin, that agglutinates red blood cells. Hemagglutinin (HA) protein: Species specific binding protein that allows for the virus to bind to the cell membrane of host respiratory cells and propagate through cellular processes (http://medical-dictionary.thefreedictionary.com/ epitopes, accessed November 5, 2009).

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392 IMPACTS OF THE 2009-H1N1 INFLUENZA A PANDEMIC ILInet: A nationwide surveillance program for influenza-like illness (ILI) con- ducted by the CDC in collaboration with state health departments. Over 2,700 phy- sicians in all 50 states were enrolled in this network during the 2008-2009 influenza season, during which they reported the total number of patient visits each week and number of patient visits for ILI by age group (0-4 years, 5-24 years, 25-49 years, 50-64 years, >65 years). These data are transmitted once a week to a central data repository at CDC via the Internet or fax (http://www.health.state.ny.us/diseases/ communicable/influenza/recruits.htm, accessed December 17, 2009). Immunocompromised: A condition (caused, for example, by the administration of immunosuppressive drugs or irradiation, malnutrition, aging, or a condition such as cancer or HIV disease) in which an individual’s immune system is unable to respond adequately to a foreign substance. Incidence rate: The number of new cases of a specified disease during a defined period of time divided by the number of persons in a stated population in which the cases occurred. International air-traffic patterns: The patterns of international air traffic include travel and trade routes as well as the volume of travel and travelers between nodes in the air traffic system. King County Healthcare Coalition: The Coalition is a network of healthcare organizations and providers that are committed to coordinating their emergency preparedness and response activities. The purpose is to develop and maintain a comprehensive system that assures effective communication, strategic acqui- sition and management of resources, and collaborative planning in response to emergencies and disasters (http://www.kingcounty.gov/healthservices/health/ preparedness/hccoalition.aspx, accessed December 17, 2009). M antigen: An antigen found in the cell of Streptococcus pyogenes; associated with virulence. Macrophage: A type of white blood cell that ingests foreign material and is a key player in the immune response to foreign invaders such as infectious microorganisms (http://www.medterms.com/script/main/art.asp?articlekey=4238, accessed November 5, 2009). Matrix protein: Structural proteins linking the viral envelope with the virus core (http://encyclopedia.thefreedictionary.com/matrix+protein, accessed November 5, 2009).

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393 APPENDIX D Mekong Basin Disease Surveillance Group: The Mekong Basin is home to six countries: Cambodia, China, Laos, Myanmar, Vietnam, and Thailand. In 1999, delegates from these countries agreed to start disease surveillance collaborations under the name Mekong Basin Disease Surveillance. For more information, see http://www.mbdsoffice.com/ (accessed November 17, 2009). National Influenza Program (P.L. 94-380): An act to amend the Public Health Service Act to authorize the establishment and implementation of an emergency national swine flu immunization program and to provide an exclusive remedy for personal injury or death arising out of the manufacture, distribution, or adminis- tration of the swine flu vaccine under such program. For more information, see http://thomas.loc.gov/cgi-bin/bdquery/z?d094:SN03735:@@@L&summ2=m& (accessed November 5, 2009). Neuraminidase: Sialidase; an enzyme that catalyzes the hydrolysis of glucosidic linkages between a sialic acid residue and a hexose or hexosamine residue in glycoproteins, glycolipids, and proteoglycans. Neuraminidase is a major antigen of myxoviruses. Neuraminidase (NA) surface protein: NA is involved in the release of viral progeny from the host (Morens, D. M., J. K. Taubenberger, and A. S. Fauci. 2009. The persistent legacy of the 1918 influenza virus. New England Journal of Medicine 361(3):225-229). Nucleoprotein: Any of a group of substances found in the nuclei of all living cells and in viruses and composed of a protein and a nucleic acid (http://medical- dictionary.thefreedictionary.com/nucleoprotein, accessed November 5, 2009). One Health: Health experts from around the world met on September 29, 2004, for a symposium focused on the current and potential movements of diseases among human, domestic animal, and wildlife populations organized by the Wild- life Conservation Society and hosted by The Rockefeller University. Using case studies on Ebola, avian influenza, and chronic wasting disease as examples, the assembled expert panelists delineated priorities for an international, inter- disciplinary approach for combating threats to the health of life on Earth. The product—called the “Manhattan Principles” by the organizers of the “One World, One Health®” event—lists 12 recommendations for establishing a more holistic approach to preventing epidemic/epizootic disease and for maintaining ecosystem integrity for the benefit of humans, their domesticated animals, and the founda- tional biodiversity that supports us all. For more information, see http://www. oneworldonehealth.org/ (accessed July 16, 2009).

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394 IMPACTS OF THE 2009-H1N1 INFLUENZA A PANDEMIC Pandemic: Disease outbreak occurring over a wide geographic area and affecting an exceptionally high proportion of the population. Pathogen: A specific causative agent (such as a bacterium or virus) of disease. Pathogenicity: Reflects the ongoing evolution between a parasite and host, and disease is the product of a microbial adaptive strategy for survival. Pathogenicity islands: Large genomic regions encoding for virulence factors of pathogenic bacteria, present on the genomes of pathogenic strains but absent from the genomes of nonpathogenic members of the same or related species. Prevalence rate: The total number of persons sick or portraying a certain condi- tion in a stated population at a particular time or during a stated period of time, regardless of when that illness or condition began, divided by the population at risk of having the disease or condition at the point in time midway through the period in which they occurred. Procedural justice: The element of justice concerned with the application of laws, rather than with the content of the laws themselves. If an unjust law is applied, then procedural justice may obtain although the outcome is unjust. Similarly, an irregular procedure might be procedurally unjust, but give the right result on an occasion. Recombination: The formation of new combinations of genes as a result of crossing over (sharing of genes) between structurally similar chromosomes, resulting in progeny with different gene combinations than in the parents. Reservoir: Any person, animal, arthropod, plant, soil, or substance (or combina- tion of these) in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and in which it reproduces itself in such manner that it can be transmitted to a susceptible vector. Retrovirus: An RNA virus that is replicated in a host cell via the enzyme reverse transcriptase to produce DNA from its RNA genome. The DNA is then incorpo- rated into the host’s genome by an integrase enzyme. The virus thereafter replicates as part of the host cell’s DNA. Retroviruses are enveloped viruses that belong to the viral family Retroviridae. any of a large family of RNA virtuses that includes lentiviruses and oncoviruses, so called because they carry reverse transcriptase. Reverse transcription polymerase chain reaction: A variant of polymerase chain reaction (PCR), a laboratory technique commonly used in molecular biology to generate many copies of a DNA sequence, a process termed “amplification.” In

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395 APPENDIX D RT-PCR, however, the RNA strand is first reverse transcribed into its DNA com- plement (complementary DNA, or cDNA) using the enzyme reverse transcriptase, and the resulting cDNA is amplified using traditional or real-time PCR. Reverse transcription PCR is not to be confused with real-time polymerase chain reaction (Q-PCR/qRT-PCR), which is also sometimes (incorrectly) abbreviated as RT-PCR (http://en.wikipedia.org/wiki/Reverse_transcription_polymerase_chain_reaction, accessed November 6, 2009). RNA virus: A virus that contains ribonucleic acid (RNA) as its genetic material. Salvage therapy: A final treatment for people who are nonresponsive to or cannot tolerate other available therapies for a particular condition and whose prognosis is often poor (http://www.medterms.com/script/main/art.asp?articlekey=9380, accessed December 17, 2009). Serological: The use of immune serum in any of a number of tests (agglutina- tion, precipitation, enzyme-linked immunosorbent assay, etc.) to measure the response (antibody titer) to infectious disease; the use of serological reactions to detect antigen. Strain: A subgrouping of organisms within a species, characterized by some particular quality. Surveillance: The continuing scrutiny of all aspects of occurrence and spread of a disease that is pertinent to effective control. Vaccine: A biological preparation that improves immunity to a particular dis- ease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe. The agent stimulates the body’s immune system to recognize the agent as foreign, destroy it, and “remember” it, so that the immune system can more easily recog- nize and destroy any of these microorganisms that it later encounters. Virulence: The degree of pathogenicity of an organism as evidenced by the severity of resulting disease and the organism’s ability to invade the host tissues. Virulence factors: The properties (i.e., gene products) that enable a microorganism to establish itself on or within a host of a particular species and enhance its potential to cause disease. Virus: A small infectious agent that can only replicate inside the cells of another organism. Viruses are too small to be seen directly with a light microscope.

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396 IMPACTS OF THE 2009-H1N1 INFLUENZA A PANDEMIC Viruses infect all types of organisms, from animals and plants to bacteria and archaea. Zoonotic: Infection that causes disease in human populations but can be per- petuated solely in nonhuman host animals (e.g., influenza); may be enzootic or epizootic. Zoonotic pool: The population of animals infected with nonhuman microbes that present a potential threat of transmission to humans.