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Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

THE INFECTIOUS ETIOLOGY OF CHRONIC DISEASES

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

Workshop Summary

Stacey L. Knobler, Siobhán O’Connor, Stanley M. Lemon, Marjan Najafi, Editors

Forum on Microbial Threats

Board on Global Health

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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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.

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. Agency for International Development; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Ellison Medical Foundation; Pfizer; GlaxoSmithKline; and The Merck Company Foundation. The views presented in this report are those of the editors and attributed authors 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 Microbial Threats. 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 Microbial Threats. The content of those sections is based on the presentations and the discussions that took place during the workshop.

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

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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“Knowing is not enough; we must apply.

Willing is not enough; we must do.”

—Goethe

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

Adviser to the Nation to improve Health

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

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.

The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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FORUM ON MICROBIAL THREATS

ADEL MAHMOUD (Chair), President,

Merck Vaccines, Whitehouse Station, New Jersey

STANLEY LEMON (Vice-Chair), Dean,

School of Medicine, University of Texas Medical Branch, Galveston

DAVID ACHESON, Chief Medical Officer,

Center for Food Safety and Applied Nutrition, Food and Drug Administration, Rockville, Maryland

STEVEN BRICKNER, Research Advisor,

Pfizer Global Research and Development, Pfizer Inc., Groton, Connecticut

DENNIS CARROLL,

U.S. Agency for International Development, Washington, DC

NANCY CARTER-FOSTER, Director,

Program for Emerging Infections and HIV/AIDS, U.S. Department of State, Washington, DC

GAIL CASSELL, Vice President,

Scientific Affairs, Eli Lilly & Company, Indianapolis, Indiana

JESSE GOODMAN, Deputy Director,

Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland

EDUARDO GOTUZZO, Director,

Instituto de Medicina Tropical–Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Peru

MARGARET HAMBURG, Vice President for Biological Programs,

Nuclear Threat Initiative, Washington, DC

CAROLE HEILMAN, Director,

Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

DAVID HEYMANN, Executive Director,

Communicable Diseases, World Health Organization, Geneva, Switzerland

JAMES HUGHES, Assistant Surgeon General and Director,

National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta

LONNIE KING, Dean,

College of Veterinary Medicine, Michigan State University, East Lansing

JOSHUA LEDERBERG,

Raymond and Beverly Sackler Foundation Scholar, Rockefeller University, New York

JOSEPH MALONE, Director,

Department of Defense Global Emerging Infections System, Walter Reed Army Institute of Research, Silver Spring, Maryland

LYNN MARKS, Senior Vice President of Infectious Diseases,

Medicine Development Center, GlaxoSmithKline, Collegeville, Pennsylvania

STEPHEN MORSE, Director,

Center for Public Health Preparedness, Columbia University, New York

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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MICHAEL OSTERHOLM, Director,

Center for Infectious Disease Research and Policy and

Professor,

School of Public Health, University of Minnesota, Minneapolis

GEORGE POSTE, Director,

Arizona BioDesign Institute, Arizona State University, Tempe

GARY ROSELLE, Program Director for Infectious Diseases,

VA Central Office, Veterans Health Administration, Department of Veterans Affairs, Washington, DC

JANET SHOEMAKER, Director,

Office of Public Affairs, American Society for Microbiology, Washington, DC

P. FREDRICK SPARLING,

J. Herbert Bate Professor Emeritus of Medicine, Microbiology, and Immunology, University of North Carolina, Chapel Hill

Liaisons

YVES BERGEVIN,

Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

ENRIQUETA BOND, President,

Burroughs Wellcome Fund, Research Triangle Park, North Carolina

EDWARD McSWEEGAN,

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Staff

STACEY KNOBLER, Director,

Forum on Microbial Threats

MARJAN NAJAFI, Research Associate

KATHERINE OBERHOLTZER, Research Assistant

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

BOARD ON GLOBAL HEALTH

DEAN T. JAMISON, (Chair),

Senior Fellow, Fogarty International Center, National Institutes of Health, Bethesda, Maryland

JAIME SEPÚLVEDA AMOR,

National Institute of Public Health, Mexico

YVES BERGEVIN,

Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland

JO IVEY BOUFFORD, Professor,

Robert F. Wagner School of Public Service, New York University, New York

RICHARD FEACHEM, Executive Director,

Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland

MARGARET HAMBURG, Vice President for Biological Programs,

Nuclear Threat Initiative, Washington, DC

GERALD T. KEUSCH,

Assistant Provost for Global Health, Medical Center, and Associate Dean for Global Health, Boston University School of Public Health, Boston

JEFFREY KOPLAN, Vice President for Academic Health Affairs,

Emory University, Atlanta

ADEL A.F. MAHMOUD, President,

Merck Vaccines, Whitehouse Station, New Jersey

MAMPHELA A. RAMPHELE, Managing Director,

The World Bank, Washington, DC

MARK L. ROSENBERG, Executive Director,

The Task Force for Child Survival and Development, Emory University, Atlanta

DONALD M. BERWICK, (IOM Council Liaison), Clinical Professor of Pediatrics and Health Care Policy,

Harvard Medical School; and

President and CEO,

Institute of Healthcare Improvement, Boston

DAVID R. CHALLONER, (IOM Foreign Secretary), Vice President for Health Affairs,

Emeritus, University of Florida, Gainesville

Staff

PATRICK KELLEY, Director

MONISHA ARYA, Policy Intern

HARRIET BANDA, Senior Project Assistant

ALLISON BERGER, Senior Project Assistant

STACEY KNOBLER, Senior Program Officer

MARJAN NAJAFI, Research Associate (through November 2003)

KATHERINE OBERHOLTZER, Research Assistant

LAURA SIVITZ, Research Associate

DIANNE STARE, Research Assistant/Administrative Assistant

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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Reviewers

All presenters at the workshop have reviewed and approved their respective sections of this report for accuracy. In addition, this workshop summary has been reviewed in draft form by independent reviewers 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 Institute of Medicine (IOM) in making the published workshop summary as sound as possible and to ensure that the workshop summary meets institutional standards. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

The Forum and IOM thank the following individuals for their participation in the review process:

Paul Eke, Centers for Disease Control and Prevention, Chamblee, Georgia

Charlotte Gaydos, Johns Hopkins University School of Medicine, Baltimore, Maryland

Julie Parsonnet, Stanford University School of Medicine, Palo Alto, California

David Relman, Veterans Administration Palo Alto Health Care System, Palo Alto, California

Donald Silberberg, University of Pennsylvania School of Medicine, Philadelphia

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

The review of this report was overseen by Melvin Worth, M.D., Scholar-in-Residence, National Academies, who 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 editors and individual authors.

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

Preface

The Forum on Microbial Threats 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

The belief that many long-recognized chronic diseases are infectious in origin goes back to the mid-nineteenth century, when cancer was studied as a possible infectious disease. In the 1950s and 1960s, much biomedical research was directed, unsuccessfully, at the identification of microorganisms purportedly causing a variety of chronic diseases. In recent years the picture has begun to change. One chronic disease after another has been linked, in some cases definitively, to

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

an infectious etiology (e.g., peptic ulcer disease with Helicobacter pylori, cervical cancer with several human papillomaviruses, Whipple’s disease with Tropheryma whippeli, Lyme arthritis and neuroborreliosis with Borrelia burgdorferi, AIDS with HIV). Evidence implicating microorganisms as etiologic agents of chronic diseases with substantial mortality and morbidity impact, including atherosclerosis and cardiovascular disease, diabetes mellitus, inflammatory bowel disease, and a variety of neurological and neuropsychiatric diseases, continues to mount.

Emerging infectious diseases are conceptualized as either newly identified or appreciated illnesses, conditions, or well-recognized diseases that are newly attributed to infection. Now, scientists are beginning to believe that a substantial portion of chronic diseases may actually be associated with infection.

In an effort to identify cross-disciplinary aspects of the challenge of infectious etiologies of chronic diseases, including inflammatory syndromes and cancer, the Institute of Medicine’s Forum on Microbial Threats hosted a two-day workshop on October 21–22, 2002. The workshop, Linking Infectious Agents and Chronic Diseases, explored the factors that drive infectious etiologies of chronic diseases to prominence, and sought to identify more broad-based strategies and research programs that need to be developed. The goals of the workshop were to:

  1. Review the range of pathogenic mechanisms and diversity of etiologic microbes and chronic diseases, including inflammatory syndromes and cancer;

  2. Explore trends, advances, and gaps in collaborative research on diagnostic technologies, and their integration into epidemiologic studies and surveillance;

  3. Identify chronic diseases and syndromes that warrant further investigation;

  4. Identify research needed to clarify the etiologic agents and pathogenic mechanisms involved in chronic diseases, screening for multiple potential agents of the same outcome, and considering that one microbe might induce multiple syndromes;

  5. Identify the principal bottlenecks and opportunities to detect, prevent, and mitigate the impact of chronic diseases on human health against the overall backdrop of emerging infections;

  6. Consider the benefits and risks of early detection and prevention of chronic diseases caused by infectious agents.

The issues pertaining to these goals were addressed through invited presentations and subsequent discussions, which highlighted ongoing programs and actions taken, and also identified the most vital needs in this important area.

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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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 a collection of individually authored papers. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Microbial Threats’ sponsors or the Institute of Medicine (IOM). 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. Chapters 1 through 4 begin with overviews provided by the editors, followed by authored papers that reflect the topics and findings of the authors’ workshop presentations. Chapter 1 presents case studies of infectious agents that have been shown to be associated with chronic diseases. Chapter 2 illustrates implications for developing countries where many infectious diseases remain endemic. Chapter 3 describes methodologies currently used in this area of research. Chapter 4 presents strategies to prevent and mitigate the impact of chronic diseases caused by infectious agents. Appendix A presents the workshop agenda. Appendix B is a list of information resources that review the relationship between infections and chronic diseases. Appendix C presents Forum member and speaker biographies.

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 IOM 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.

ACKNOWLEDGMENTS

The Forum on Microbial Threats and the 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 their participation in the workshop.

The Forum is indebted to the IOM staff who contributed their time and efforts in planning and executing the workshop and the production of this workshop

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

summary. On behalf of the Forum, we gratefully acknowledge the efforts led by Stacey Knobler, director of the Forum, and Marjan Najafi, research associate, coeditors of this report, 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. We would also like to thank the following Academies staff and consultants for their valuable contributions to this activity: Rob Coppock, Tom Burroughs, Carlos Orr, Jennifer Bitticks, Bronwyn Schrecker, Sally Stanfield, Rachel Marcus, Beth Gyorgy, Patricia Cuff, Katherine Oberholtzer, and Laura Sivitz.

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 Food and Drug Administration; U.S. Agency for International Development; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Ellison Medical Foundation; Pfizer; GlaxoSmithKline; and The Merck Company Foundation. The views presented in this workshop summary are those of the editors and workshop participants and are not necessarily those of the funding organizations.

Adel A.F. Mahmoud, Chair

Stanley M. Lemon, Vice-Chair

Forum on Microbial Threats

Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
×

2

 

ENDEMIC INFECTIOUS DISEASES LINKED TO CHRONIC DISEASES: IMPLICATIONS FOR DEVELOPING COUNTRIES

 

81

   

 Overview,

 

81

   

 Potential Long-Term Consequences of Early Childhood Enteric and Parasitic Infections,
Richard L. Guerrant, Aldo A.M. Lima, Sean R. Moore, Breyette Lorntz, and Peter Patrick

 

83

   

 Infectious Agents and Epilepsy,
Josemir W. Sander

 

93

   

 Control of Infectious Causes of Childhood Disability in Developing Countries,
Maureen Durkin

 

99

   

 HTLV-1: Clinical Impact of a Chronic Infection,
Eduardo Gotuzzo and Kristien Verdonck

 

110

   

 Progression of Hepatitis C Virus Infection with and Without Schistosomiasis,
Sanaa Kamal

 

120

   

 Interactions of Multiple Infectious Agents in Malaria-Endemic Areas: Concurrent HIV/AIDS and Malaria,
Altaf A. Lal

 

126

3

 

OBSTACLES AND OPPORTUNITIES FOR FRAMING FUTURE RESEARCH

 

135

   

 Overview,

 

135

   

 Pathogens and Disease: Issues in Determining Causality,
Patrick S. Moore

 

140

   

 Exploring the Genetic Background–Environment Interplay in an Animal Model of Neurodevelopmental Disorders: A Multidisciplinary Approach,
Mikhail V. Pletnikov

 

150

   

 Infection, Cancer, and the Immune Response,
David H. Persing and Franklyn G. Prendergast

 

154

4

 

OPPORTUNITIES TO PREVENT AND MITIGATE THE IMPACT OF CHRONIC DISEASES CAUSED BY INFECTIOUS AGENTS

 

174

   

 Overview,

 

174

   

 Developing Vaccines for Prevention of Chronic Disease,
P. Helena Mäkelä

 

175

   

 Toward a Strategic Approach: Integrating Epidemiology, Laboratory Research, and Surveillance; Setting Priorities,
Siobhán O’Connor

 

183

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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APPENDIXES

 

 

A

 

Workshop Agenda

 

187

B

 

Information Resources

 

192

C

 

Biosketches

 

194

   

 Members of the Forum on Microbial Threats,

 

194

   

 Speakers,

 

205

   

 Forum Staff,

 

215

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Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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Suggested Citation:"Front Matter." Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/11026.
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In recent years, a number of chronic diseases have been linked, in some cases definitively, to an infectious etiology: peptic ulcer disease with Helicobacter pylori, cervical cancer with several human papillomaviruses, Lyme arthritis and neuroborreliosis with Borrelia burgdorferi, AIDS with the human immunodeficiency virus, liver cancer and cirrhosis with hepatitis B and C viruses, to name a few. The proven and suspected roles of microbes does not stop with physical ailments; infections are increasingly being examined as associated causes of or possible contributors to a variety of serious, chronic neuropsychiatric disorders and to developmental problems, especially in children.

The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects, summarizes a two-day workshop held by the Institute of Medicine’s Forum on Microbial Threats to address this rapidly evolving field. Participants explored factors driving infectious etiologies of chronic diseases of prominence, identified difficulties in linking infectious agents with chronic outcomes, and discussed broad-based strategies and research programs to advance the field.

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