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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.)
[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
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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.
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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
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
MICHAEL OSTERHOLM, Director,
Center for Infectious Disease Research and Policy and
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
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.
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
JONATHAN DAVIS, Senior Program Officer (until May 2001)
STACEY KNOBLER, Director,
Forum on Emerging Infections
MARJAN NAJAFI, Research Associate
LAURIE SPINELLI, Project Assistant
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
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
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.
A Perspective on Emerging Zoonoses,
Pathogenesis and Virulence of Zoonotic Infections in Humans,
The Potential “Bioweaponization” of Zoonotic Diseases,
Economic and Trade Implications of Zoonotic Diseases,
Variation and Interspecies Transmission of Influenza A Viruses,
Ecological Sources of Zoonotic Diseases,
Vectorborne Zoonotic Diseases,
The Role of Native Birds and Other Wildlife on the Emergence of Zoonotic Diseases,
Pathology and Early Recognition of Zoonotic Disease Outbreaks,
Molecular and Other Technologies for Rapid Diagnosis of Zoonotic Agents,
Methods and Models for Pathogen Discovery,
Vaccines for Emerging Zoonoses: Marburg Virus Paradigm,
Public Health Laboratory Surveillance,
SUMMARY AND ASSESSMENT
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.
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
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.
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;
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