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. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.

Funding for this study was provided by the Centers for Disease Control, the Fogarty International Center, Lederle-Praxis Laboratories, the Lucille P. Markey Charitable Trust, the National Institute of Allergy and Infectious Diseases of the National Institutes of Health, the Rockefeller Foundation, and the U.S. Army Medical Research and Development Command.

Library of Congress Cataloging-in-Publication Data

Emerging infections: Microbial threats to health in the United States / Joshua Lederberg, Robert E. Shope, and Stanley C. Oaks, Jr., editors.

p. cm.

Includes bibliographical references and index.

1. Communicable diseases—United States. I. Lederberg, Joshua. II. Shope, Robert E. III. Oaks, S. C.

RA643.5.E43 1992

614.4'273—dc20 92-26480

CIP

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 image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

COVER: The background for the cover of this report is a photograph of 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.