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Alexandra Beatty, Kimberly Scott, and Peggy Tsai, Rapporteurs Committee on Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin Board on Global Health Institute of Medicine Board on Agriculture and Natural Resources Division on Earth and Life Studies THE NATIONAL ACADEMIES PRESS Washington, DC www.nap.edu
THE NATIONAL ACADEMIES PRESS â500 Fifth Street, NW âWashington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Govern- ing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineer- ing, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropri- ate balance. This workshop was supported by the U.S. Agency for International Development Award No. GHN-G-00-07-00001-00. Any opinions, findings, conclusions, or rec- ommendations in this document are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project. Mention of trade names, commercial products, or organizations does not constitute their endorsement by the sponsoring agency. International Standard Book Number-13:â 978-0-309-12818-6 International Standard Book Number-10:â 0-309-12818-8 Additional copies of this report are available from The National Academies Press, 500 Fifth Street, NW, Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap. edu. For more information about the Institute of Medicine, visit the IOM homepage at: www.iom.edu. Copyright 2008 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Cover: Based on original artwork by Maggie Hofmann and used with permission. Suggested citation: IOM (Institute of Medicine) and National Research Council (NRC). 2008. Achieving sustainable global capacity for surveillance and response to emerging diseases of zoonotic origin: Workshop summary. Washington, DC: The National Academies Press.
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 Acad- emy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone 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 engineer- ing programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is presi- dent 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 Insti- tute 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 Sci- ences in 1916 to associate the broad community of science and technology with the Academyâs 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 C Â ouncil is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org
COMMITTEE ON ACHIEVING SUSTAINABLE GLOBAL CAPACITY FOR SURVEILLANCE AND RESPONSE TO EMERGING DISEASES OF ZOONOTIC ORIGIN GERALD T. KEUSCH (Co-Chair), Boston University MARGUERITE PAPPAIOANOU (Co-Chair), Association of American Veterinary Medical Colleges, Washington, DC CORRIE BROWN, University of Georgia, Atlanta JOHN S. BROWNSTEIN, Harvard Medical School, Cambridge, MA PETER DASZAK, Consortium for Conservation Medicine, New York CORNELIS DE HAAN, The World Bank, Washington, DC CHRISTL A. DONNELLY, Imperial College London, United Kingdom DAVID P. FIDLER, Indiana University, Bloomington KENNETH H. HILL, Harvard University, Cambridge, MA ANN MARIE KIMBALL, University of Washington, Seattle RAMANAN LAXMINARAYAN, Resources for the Future, Washington, DC TERRY F. McELWAIN, Washington State University, Pullman MARK NICHTER, University of Arizona, Tucson MO SALMAN, Colorado State University, Fort Collins OYEWALE TOMORI, Redeemerâs University, Ogun State, Nigeria KEVIN D. WALKER, Michigan State University, East Lansing MARK WOOLHOUSE, University of Edinburgh, United Kingdom Study Staff KIMBERLY SCOTT, Study Director (from May 2008) ALICIA GABLE, Study Director (February 2008âJune 2008) ALEXANDRA BEATTY, Lead Rapporteur and Senior Program Officer (June 2008âOctober 2008) PEGGY TSAI, Program Officer MILA GONZÃLEZ, Research Assistant (from May 2008) RACHEL PASSMAN, Research Associate (February 2008âJune 2008) SARAH JANE BROWN, Senior Program Assistant JULIE WILTSHIRE, Financial Officer PATRICK KELLEY, Director, Board on Global Health ROBIN A. SCHOEN, Director, Board on Agriculture and Natural Resources
BOARD ON GLOBAL HEALTH MARGARET HAMBURG (Chair), Senior Scientist, Nuclear Threat Initiative, Washington, DC JO IVEY BOUFFORD, Institute of Medicine Foreign Secretary, New York Academy of Medicine CLAIRE V. BROOME, Emory University, Atlanta, GA JACQUELYN C. CAMPBELL, Johns Hopkins University, Baltimore, MD THOMAS J. COATES, University of California, Los Angeles VALENTIN FUSTER, Mount Sinai Medical Center, New York SUE GOLDIE, Harvard University, Boston, MA RICHARD L. GUERRANT, University of Virginia, Charlottesville PETER J. HOTEZ, George Washington University, Washington, DC GERALD T. KEUSCH, Boston University, MA MICHAEL H. MERSON, Duke University, Durham, NC FITZHUGH MULLAN, George Washington University, Washington, DC PHILIP K. RUSSEL, Johns Hopkins University, Baltimore, MD BOARD ON AGRICULTURE AND NATURAL RESOURCES W. REG GOMES (Chair), University of California (Professor Emeritus), Oakland ROGER N. BEACHY, Donald Danforth Plant Science Center, St. Louis, MO H. H. CHENG, University of Minnesota (Emeritus), St. Paul DANIEL M. DOOLEY, University of California, Oakland JOAN H. EISEMANN, North Carolina State University, Raleigh KIRK C. KLASING, University of California, Davis VICTOR L. LECHTENBERG, Purdue University, West Lafayette, IN ROBERT PAARLBERG, Wellesley College, Watertown, MA BOBBY PHILLS, Florida A&M University, ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ï¿½ Tallahassee KEITH PITTS, Curragh Oaks Consulting, Fair Oaks, CA HAL SALWASSER, Oregon State University, Corvallis PEDRO A. SANCHEZ, The Earth Institute at Columbia University, Palisades, NY NORMAN R. SCOTT, Cornell University, Ithaca, NY vi
Acknowledgments T his document is a product of the cooperation and contributions of many people. The committee would like to thank all the speakers and participants who attended the workshop on June 25â26, 2008. Their presentations helped to set the stage for the fruitful discussions in the sessions that followed. This workshop summary has been reviewed in draft form by persons chosen for their diverse perspectives and technical expertise in accordance with procedures approved by the National Research Councilâs Report Review Committee. The purpose of the 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 of objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confiden- tial to protect the integrity of the deliberative process. We wish to thank the following for their review of this document: FranÃ§ois Elvinger, Department of Large Animal Clinical Sciences, Virginia Tech University Joel C. Gaydos, Armed Forces Health Surveillance Center B. Joseph Hinnebusch, Laboratory of Zoonotic Pathogens, The National Institute of Allergy and Infectious Diseases Lisa Jackson, Group Health Center for Health Studies Melinda Moore, RAND Corporation Katey Pelican, Department of Veterinary Population Medicine, University of Minnesota vii
viii ACKNOWLEDGMENTS Although the reviewers listed above have provided constructive com- ments and suggestions, they did not see the final draft of the report before its release. The review of this report was overseen by Dr. David Challoner, Vice President for Health Affairs, Emeritus, University of Florida. Appointed by the National Research Council, he was responsible for making certain that an independent examination of this document was carried out in accor- dance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authors and the institution.
Preface T he Institute of Medicine (IOM) and National Research Council (NRC) convened a 2-day workshop titled âWorkshop on Sustain- able Global Capacity for Surveillance and Response to Emerging Z Â oonosesâ in Washington, DC, on June 25 and 26, 2008. The goal of the workshopâas one of several planned data gathering sessions for the com- mittee to meet their overall chargeâwas more narrowly focused to review the current global capacity to carry out surveillance to detect, report, and monitor emerging infectious diseases in both humans and animals. This included brief discussions that began to examine how these systems might inform the necessary responses to emerging and reemerging infec- tious diseases of zoonotic origin that would be discussed more in-depth in the committeeâs forthcoming consensus report. The workshop did not address, however, the details of any specific global or regional responses to any particular disease outbreak. The workshop did provide an opportunity for participants to examine the effectiveness of communication pathways among multidisciplinary practitioners and researchers, between the human and animal health constituencies, and between these professionals and the public. This document is a summary of that workshop and is a companion to the full consensus report (anticipated for summer 2009) of the IOM/ NRC Committee on Achieving Sustainable Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin. For the complete study, the committee is charged with exploring how emerging zoonotic disease surveillance, prevention, detection, and response could be strengthened and ix
PREFACE sustained globally over time to reduce or eliminate outbreaks of zoonotic diseases in human populations. During the latter half of the 20th century, complacency toward infec- tious diseases as a global threat had set in due to the success of vaccines and antibiotics. The reality, however, was far different. First, although vaccines were developed for a number of important diseases, they were not consistently available in quantities needed by some countries, and it has been difficult to develop vaccines for many major infectious causes of morbidity and mortality. Second, antimicrobial resistance has occurred because antimicrobials were introduced into clinical practice and it now constitutes a real crisis. Third, new or newly discovered or known infec- tious agents have acquired new virulence attributes and have been emerging and reemerging during the past 30 years. The global spread of HIV/AIDS, multiple-drugâresistant tuberculosis, drug-resistant malaria, diarrheal dis- eases, and an increasing number of human outbreaks of emerging zoonotic infectious diseases (any disease or infection that is naturally transmissible from vertebrate animals to humans) discussed below are examples of the appearance of newly discovered or known agents over the last 30 years. According to a recent, comprehensive literature review of more than 1,400 species of human pathogensâincluding viruses, bacteria, rickettsia, fungi, protozoa, and helminthsâknown to be infectious to human beings, 868 (61 percent) are zoonotic (Cleaveland et al., 2001; Taylor et al., 2001). In the same review, of 175 agents found to be associated with emerging infections, 132 (75 percent) were zoonotic agents (Taylor et al., 2001). The same authors found that zoonotic diseases were twice as likely to be associated with emerging or newly discovered infections as nonzoonotic pathogens. These pathogens are transmitted through direct contact from animals to humans and through air, water, food, and insect vectors. The increase in infectious disease mortality from HIV/AIDS in persons 25 years of age and older, starting in the 1980s in the United States, was largely unforeseen (Armstrong et al., 1999). Even more catastrophic is the fact that AIDS has reversed the gains in life expectancy that had been achieved in Africa over the past 50 years (UNAIDS, 2004, 2006). Infectious diseases remain among the leading causes of death worldwide for children under 5 years of age (UNICEF, 2007). As we continue into the 21st cen- tury, infectious diseases are widely perceived as an unfinished agenda, and the ever-increasing potential of outbreaks or even pandemics caused by â The World Health Organization state in their definition of zoonoses: âAnimals thus play an essential role in maintaining zoonotic infections in nature. Zoonoses may be bacterial, viral, or parasitic, or may involve unconventional agents. As well as being a public health problem, many of the major zoonotic diseases prevent the efficient production of food of animal origin and create obstacles to international trade in animal productsâ (WHO, 2008c).
PREFACE xi zoonotic diseases make them an important public health problem in both the developed and the developing world, emphasizing the need to prepare for them. Since the 1980s, infectious diseases of zoonotic origin have become the focus of public health attention following several large and highly visible zoonotic infectious disease outbreaks around the globe. Some of the out- breaks of emerging zoonotic infections that have affected both human and animal populations and that have commanded attention worldwide include West Nile virus fever, human monkeypox, and Escherichia coli O157:H7 outbreaks in the United States; Hendra virus disease in Australia; Nipah virus encephalitis in Malaysia; Rift Valley fever in Africa; and HIV, Severe Acute Respiratory Syndrome (SARS), avian influenza, and dengue fever outbreaks globally. Of particular concern has been the relatively recent, unprecedented spread of a highly pathogenic avian influenza virus (H5N1) throughout Asia, Europe, and into Africa, with transmission from infected poultry to humans having occurred in 15 countries as of June 2008. This has placed the world in Stage 3 of a World Health Organization (WHO) pandemic influenza alert, with the threat of an influenza pandemic of t Â remendous concern around the world. In addition to mortality and mor- bidity in both human and animal populations, the costs of these outbreaks include severe impacts on national and international economies. The disease outbreaks mentioned above and others have underscored the importance of developing an even better understanding of the conditions that give rise to the emergence of these diseases in both human and animal populations, and their routes and mechanisms of transmission between species. As more has been learned about them, including the nationally and globally observed serious health and economic impacts they have had, many have come to understand that multiple disciplines and sectors must work together to carry out effective disease prevention programs, disease â Avian influenza is caused by Eurasian strain influenza A viruses, subtype H5N1. Serotyping is based on the hemagglutinin (HA) [with H5 standing for the fifth known type of this protein] and neuraminidase (NA), [with N1 standing for the first of several known types of this protein] on the surface of the influenza A virus. â WHO has developed a six-phase pandemic alert system to inform the world of the serious- ness of a threat and the need to launch more intense preparedness activities (with 1 = low risk of human cases, 6 = efficient and sustained human-to-human transmission). The designation and progression of phases are made by the Director-General. Each phase coincides with a series of recommended activities to be undertaken by WHO, the international community, governments, and industry. Changes in phases are triggered by several factors, including the epidemiological behavior of the disease and the characteristics of circulating viruses. In Phase 3, a new influenza virus subtype has been causing disease in humans, but there is no or very limited human-to-human transmission or it is not yet spreading efficiently and sustainably among humans (WHO, 2008b).
xii PREFACE surveillance for the early detection of outbreaks, and disease outbreak response and control in both human and animal populations. Several other IOM reports and workshop summaries have addressed many of the environmental, demographic, social, and other factors leading to the emergence or reemergence of infectious diseases, including ÂMicrobial Threats to Health: Emergence, Detection, and Response; The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities; The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health; and Global C Â limate Change and Extreme Weather Events: Understanding the Con- tributions to Infectious Disease Emergence (IOM, 2003, 2006, 2002, and 2008, respectively). During this 2-day workshop in June 2008, epidemiologists, laboratory scientists, researchers, policy makers, human and animal health clinicians, disease prevention and control experts, and others from around the world presented their personal views in 15-minute presentations about a set of topics. Those topics include the humanâanimalâecosystem interface and its associated drivers that promote the emergence of infectious diseases; the value and limitations of existing global and regional human and animal health active and passive surveillance networks and systems; reporting standards, data collection, and information sharing; early warning systems for epizootic and zoonotic diseases in animals and humans respectively; and global and regional laboratory and epidemiology capacity. Partici- pants were asked to discuss whether there is a need for sustainable global c Â apacity for surveillance that could inform response to zoonoses; to explore how that capacity might be conceptualized and operationalized on differ- ent levels; and to identify stakeholders who would be expected to assume leadership roles to help achieve this capacity. Participants were also asked to consider and explore other critical elements for such an endeavor, includ- ing human and animal health infrastructure needs; governance and funding challenges; workforce collaboration and training needs; multidisciplinary data collection and data-sharing challenges; and the complex interactions of economic and trade policies, regulations, and structures with human and animal health needs. This document is a summary of those presentations and discussions at the workshop; it is not intended to be a comprehensive examination of the subject matter. This summary is not a consensus report of the commit- tee, nor does it include recommendations or endorsements of any formally convened committee of the IOM or the NRC. The material contained in this report is directly derived from the remarks and presentations of the â These and other reports can be found at the website of the National Academies Press, www.nap.edu.
PREFACE xiii participants and the authors, and they do not necessarily represent the views of the convening committee, the IOM, or the NRC. We greatly appreciate the support of the U.S. Agency for International Development for the activities of the Committee on Achieving Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin. This committee has organized and convened this workshop in col- laboration with the IOM and the NRC staff. The committee co-chairs wish to express their deep appreciation to the workshop presenters and partici- pants (see Appendixes B and C), the committee members for their time and engagement in this study, and the following IOM staff: Patrick Kelley and Robin Schoen, board directors for Global Health and Agriculture and Nat- ural Resources; Kimberly Scott, study director; Peggy Tsai, program offi- cer; Mila GonzÃ¡lez, research assistant; Sarah Jane Brown, senior program assistant; and Julie Wiltshire, financial associate, for their able assistance in the organization of this meeting. We also recognize the contributions of Allison Brantley, Sarah Bronko, Reine Homawoo, and Karen Imhof of the IOM and the NRC for their logistic support during the meeting. Finally, special thanks go to our lead author Alexandra Beatty, as well as Kimberly Scott and Peggy Tsai for their revisions to the draft workshop summary and response to the comments of the external reviewers. Gerald T. Keusch, M.D. Committee Co-Chair Marguerite Pappaioanou, D.V.M., Ph.D. Committee Co-Chair
Contents ACRONYMS AND ABBREVIATIONS xix SUMMARY 1 1 INTRODUCTION 15 Charge to the Committee, 16 Organization of the Workshop Summary, 17 2 THE CONVERGENCE OF FORCES RESPONSIBLE FOR ZOONOSES 19 How Zoonoses Develop, 21 Human Factors, 23 Environmental Factors, 25 Animal Factors, 26 Challenges, 26 3 CURRENT SURVEILLANCE SYSTEMS FOR DETECTING ZOONOSES IN ANIMALS 33 The Global Early Warning System, 33 Standards of the World Organization for Animal Health, 35 Wildlife Disease Surveillance and Investigation, 36 Ebola Surveillance in Nonhuman Primates, 41 Global Surveillance of Bats, 43 Surveillance of Bushmeat and Exotic Animals, 46 Surveillance of Infectious Diseases in Companion Animals, 47 Discussion, 49 xv
xvi CONTENTS 4 DISEASES IN HUMANS: EARLY WARNING SYSTEMS 53 Global Public Health Intelligence Network, 54 Global Outbreak Alert and Response Network, 55 Program for Monitoring Emerging Diseases (ProMED-Mail), 57 Department of Defense Global Emerging Infections Surveillance and Response, 59 ArboNET, 62 Emerging Infections Network, 65 Discussion, 66 5 LABORATORY AND EPIDEMIOLOGICAL CAPACITY 69 Veterinary and Agricultural Laboratory Capacity in Resource- Constrained Countries, 69 The Reference Laboratory PerspectiveâThe Global H5N1 Crisis, 71 The Application of NAHLN Principles to International Animal Health Efforts, 73 Laboratories in Tanzania, 74 Building Epidemiological Capacity to Address Emerging Infections in Africa, 75 Laboratory and Field Training in Southeast Asia, 77 Discussion, 78 6 CONCLUDING PARTICIPANT DISCUSSIONS ON FACILITIATING COMMUNICATION AND DEVELOPING A GLOBALLY SUSTAINABLE SURVEILLANCE SYSTEM 81 REFERENCES 87 APPENDIXES A Committee Biographies 91 B Workshop Agenda 101 C List of Workshop Participants 107 D Speaker Biographies 111 E Overview of Disease Surveillance Systems Presented in the Workshop by Order of Presentation 123
List of Tables, Figures, and Boxes TABLES 2-1 Select Significant Outbreaks of Emerging Diseases (1993â2007), 22 2-2 U.S. Government Agencies Concerned with Zoonotic Disease Control, 29 3-1 Biothreat Agents in Dogs and Cats, 48 4-1 Disease Events Verified by the World Health Organization, January 2001 to April 2008, 55 E-1 Overview of Disease Surveillance Systems Presented in the Workshop by Order of Presentation, 124 FIGURES 2-1 Infectious diseases and pathogens newly identified from 1973â2004, 20 2-2 Infectious disease mortality rate in the United States, 1900â1996, 21 2-3 World meat consumption projections from 1983â2017, 23 2-4 Humanâanimalâecosystem domain interface, 27 2-5 Five stages through which pathogens of animals evolve to cause diseases confined to humans, 28 3-1 Complexity of disease investigation in wildlife populations, 37 3-2 All-cause mortality for white males in the United States, 1988â1992, 39 3-3 Wildlife mortality events, 1990â2008, 40 3-4 Proposed structure for a wildlife disease reporting system, 41 xvii
xviii LIST OF TABLES, FIGURES, AND BOXES 3-5 Emerging infectious disease hotspots, 45 3-6 Ideal data integration from multiple animal species, 49 4-1 Structure of the Global Outbreak Alert and Response Network, 56 4-2 Pathogens reported by global location via ProMED, 58 4-3 ProMED-mail disease report summary, 2007â2008, 59 4-4 Overview of Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS), 60 4-5 Incidence of West Nile Virus Human Neuroinvasive Disease in the United States, 2007, 64 BOXES 1-1 Statement of Task, 17 3-1 Zoonotic Viruses That Originated in Bats Since 1994, with Year of Outbreak or Discovery, 44 4-1 Examples of Arboviruses Tracked in ArboNET, 63
Acronyms and Abbreviations AIDS Acquired Immunodeficiency Syndrome AI-watch Avian Influenza-watch ALERTA Alerta Surveillance System in Peru ArboNET National surveillance system for arboviral diseases in the United States BSE Bovine spongiform encephalopathy BSE-vCJD Bovine Spongiform Encephalopathy and variant Creutzfeldt-Jakob disease BSL biosafety level CDC Centers for Disease Control and Prevention CSREES Cooperative State Research, Education, and Extension Service DNA Deoxyribonucleic acid DoD U.S. Department of Defense DoD-GEIS U.S. Department of Defense-Global Emerging Infections Surveillance and esponse System R ECE embryonated chicken eggs EIN Emerging Infections Network ESSENCE Electronic Surveillance System for Early Notification of Community-based Epidemics EWORS Early Warning Outbreak Recognition System xix
xx ACRONYMS AND ABBREVIATIONS FAO Food and Agriculture Organization of the United Nations FELTP Field Epidemiology and Laboratory Training Program FMD Foot-and-mouth disease GAINS Global Avian Influenza Network for Surveillance GLEWS Global Early Warning System GOARN Global Outbreak Alert and Response Network GPHIN Global Public Health Intelligence Network H5N1 influenza A virus subtype H5N1 HAZMAT hazardous materials HIV Human Immunodeficiency Virus HPAI highly pathogenic avian influenza IEIP International Emerging Infections Program IOM/NRC Institute of Medicine/National Research Council KEMRI Kenya Medical Research Institute NAHLN National Animal Health Laboratory Network NCASP National Companion Animal Surveillance Program NWHC National Wildlife Health Center OIE Office International des Epizooties (World Organization for Animal Health) PAHO Pan American Health Organization ProMED Program for Monitoring Emerging Diseases ProMED-ESP Program for Monitoring Emerging Diseases-Spanish ProMED-FRA Program for Monitoring Emerging Diseases-French ProMED-Port Program for Monitoring Emerging Diseases-Portuguese ProMED-RUS Program for Monitoring Emerging Diseases-Russian RFV Rift Valley fever SARS Severe Acute Respiratory Syndrome UNICEF United Nations Childrenâs Fund USAID U.S. Agency for International Development USDA U.S. Department of Agriculture USGS U.S. Geological Survey
ACRONYMS AND ABBREVIATIONS xxi WCS Wildlife Conservation Society WDIN Wildlife Disease Information Node WHO World Health Organization WISDOM Wildlife Information System for Disease Observation and Monitoring