THE CONVERGENCE OF
INFECTIOUS DISEASES AND
NONCOMMUNICABLE DISEASES
PROCEEDINGS OF A WORKSHOP
V. Ayano Ogawa, Cecilia Mundaca Shah, Yamrot Negussie,
and Anna Nicholson, Rapporteurs
Forum on Microbial Threats
Board on Global Health
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by contracts between the National Academy of Sciences and EcoHealth Alliance; Infectious Diseases Society of America; Johnson & Johnson (10003710); Merck & Co., Inc.; National Institute of Allergy and Infectious Diseases/National Institutes of Health (10003226); Sanofi Pasteur; The University of Hong Kong; Uniformed Services University of the Health Sciences (10003626); U.S. Agency for International Development; U.S. Army Medical Research and Materiel Command (10001249); U.S. Centers for Disease Control and Prevention (10002642); U.S. Department of Homeland Security (10003591); U.S. Department of Veterans Affairs (10003353); and U.S. Food and Drug Administration (10002125). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-49614-8
International Standard Book Number-10: 0-309-49614-4
Digital Object Identifier: https://doi.org/10.17226/25535
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. The convergence of infectious diseases and noncommunicable diseases: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/25535.
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PLANNING COMMITTEE ON BREAKING DOWN SILOS: THE CONVERGENCE OF INFECTIOUS DISEASES AND NONCOMMUNICABLE DISEASES1
PETER DASZAK (Chair), President, EcoHealth Alliance
DAVID BRETT-MAJOR, Sanford Chair in Tropical Medicine, Uniformed Services University of the Health Sciences
KEIJI FUKUDA, School Director and Clinical Professor, School of Public Health, The University of Hong Kong
JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases, Director, Center on Medical Access, Safety, and Stewardship, Georgetown University
KENT E. KESTER, Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
RIMA F. KHABBAZ, Director, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention
PETER R. LAMPTEY, Distinguished Scientist and President Emeritus, FHI360
MOSA MOSHABELA, Dean and Head, School of Nursing and Public Health, University of KwaZulu-Natal
RACHEL NUGENT, Vice President, Global Noncommunicable Diseases, RTI International
JULIE PARSONNET, George DeForest Barnett Professor in Medicine, Professor of Medicine and of Health Research and Policy, Stanford University
PADMA SHETTY, Senior Infectious Disease Advisor, Emerging Threats Division, U.S. Agency for International Development
Health and Medicine Division and Board on Global Health Staff
CECILIA MUNDACA SHAH, Project Director, Forum on Microbial Threats
V. AYANO OGAWA, Senior Program Officer, Forum on Microbial Threats
YAMROT NEGUSSIE, Program Officer, Forum on Microbial Threats (from August 2019)
EDITH AMPONSAH, Research Associate, Forum on Microbial Threats (from August 2019)
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the rapporteurs and the institution.
STEPHEN CHUKWURAH, Senior Program Assistant, Forum on Microbial Threats (from August 2019)
NATALIE LUBIN, Research Assistant, Forum on Microbial Threats (until May 2019)
JULIE PAVLIN, Director, Board on Global Health
National Academy of Medicine Staff
JARRETT NGUYEN, Program Specialist (from May 2019)
BHUMI SHAH, Intern (from June to August 2019)
FORUM ON MICROBIAL THREATS1
PETER DASZAK (Chair), President, EcoHealth Alliance
KENT E. KESTER (Vice Chair), Vice President and Head, Translational Science and Biomarkers, Sanofi Pasteur
MARY E. WILSON (Vice Chair), Clinical Professor of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco
KEVIN ANDERSON, Senior Program Manager, Science and Technology Directorate, U.S. Department of Homeland Security
TIMOTHY BURGESS, Director, Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
DENNIS CARROLL, Director, Global Health Security and Development Unit, U.S. Agency for International Development
EMILY ERBELDING, Director, Division of Microbiology and Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health
MARCOS A. ESPINAL, Director, Communicable Diseases and Health Analysis, Pan American Health Organization
KEIJI FUKUDA, School Director and Clinical Professor, The University of Hong Kong School of Public Health
JENNIFER GARDY, Senior Scientist, BC Centre for Disease Control; Associate Professor, School of Population and Public Health, University of British Columbia, Canada
JESSE L. GOODMAN, Professor of Medicine and Infectious Diseases; Director, Center on Medical Product Access, Safety, and Stewardship, Georgetown University
EVA HARRIS, Professor, Division of Infectious Diseases and Vaccinology, University of California, Berkeley
ELIZABETH D. HERMSEN, Head, Global Antimicrobial Stewardship, Merck & Co., Inc.
RIMA F. KHABBAZ, Director, National Center for Emerging and Zoonotic Infectious Diseases, U.S. Centers for Disease Control and Prevention
MICHAEL MAIR, Acting Director, Office of Counterterrorism and Emerging Threats, U.S. Food and Drug Administration
JONNA A. K. MAZET, Professor of Epidemiology and Disease Ecology; Executive Director, One Health Institute, School of Veterinary Medicine, University of California, Davis
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
SALLY A. MILLER, Professor of Plant Pathology and State Extension Specialist for Vegetable Pathology, Ohio Agricultural Research and Development Center, The Ohio State University
SUERIE MOON, Director of Research, Global Health Centre, Graduate Institute of International and Development Studies, Geneva
DAVID NABARRO, Advisor, Health and Sustainability, 4SD—Skills, Systems, and Synergies for Sustainable Development
RAFAEL OBREGON, Chief of Communications for Development, United Nations Children’s Fund
KUMANAN RASANATHAN, Board Member, Health Systems Global
GARY A. ROSELLE, Chief of Medical Service, Veterans Affairs Medical Center; Director, National Infectious Disease Services, Veterans Health Administration
PETER A. SANDS, Executive Director, The Global Fund to Fight AIDS, Tuberculosis and Malaria
THOMAS W. SCOTT, Distinguished Professor, Department of Entomology and Nematology, University of California, Davis
JAY P. SIEGEL, Retired Chief Biotechnology Officer, Head of Scientific Strategy and Policy, Johnson & Johnson
PAIGE E. WATERMAN, Assistant Director for Biological Threat Defense, White House Office of Science and Technology Policy
MATTHEW ZAHN, Medical Director, Division of Epidemiology and Assessment, Orange County Health Care Agency
Health and Medicine Division and Board on Global Health Staff
CECILIA MUNDACA SHAH, Project Director, Forum on Microbial Threats
V. AYANO OGAWA, Senior Program Officer, Forum on Microbial Threats
YAMROT NEGUSSIE, Program Officer, Forum on Microbial Threats (from August 2019)
EDITH AMPONSAH, Research Associate, Forum on Microbial Threats (from August 2019)
STEPHEN CHUKWURAH, Senior Program Assistant, Forum on Microbial Threats (from August 2019)
NATALIE LUBIN, Research Assistant, Forum on Microbial Threats (until May 2019)
JULIE PAVLIN, Director, Board on Global Health
National Academy of Medicine Staff
JARRETT NGUYEN, Program Specialist (from May 2019)
BHUMI SHAH, Intern (from June to August 2019)
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by DAVID R. CHALLONER, University of Florida. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
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Acknowledgments
The Forum on Microbial Threats staff and planning committee deeply appreciate the many valuable contributions from individuals who assisted us with this project. Thank you to Charlanne Burke, Bridgette Charles, and Naveen Rao for graciously hosting the workshop at The Rockefeller Foundation, and Tara Hoda and Anthony Ramos from the EcoHealth Alliance for their invaluable assistance organizing the logistics of the workshop. The workshop and this Proceedings of a Workshop would not be possible without the presenters and discussants at the workshop, who gave so generously of their time and expertise. A full list of the speakers and moderators and their biographical information may be found in Appendix C.
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Contents
Organization of the Proceedings of the Workshop
2 AN OVERVIEW OF COLLIDING EPIDEMICS AND SYNDEMICS
Convergent Action for Colliding Epidemics of Infectious and Noncommunicable Diseases
Syndemics of Infectious and Noncommunicable Diseases
3 EMERGING RESEARCH ON ASSOCIATIONS BETWEEN INFECTIOUS AND NONCOMMUNICABLE DISEASES
Alzheimer’s Disease and P. gingivalis
Epstein-Barr Virus in Autoimmune and Inflammatory Diseases
Role of the Microbiome in Food Allergies
4 RISKS POSED BY CHRONIC DISEASES TO THE DEVELOPMENT AND SEVERITY OF INFECTIOUS DISEASES
Converging Epidemics of Diabetes and Tuberculosis
5 MICROBIAL DIMENSION TO HUMAN DEVELOPMENT AND WELL-BEING
Global Microbial Biodiversity Crisis
Complexity of the Human Microbiome
Research Directions to Explore Microbiome Complexity
6 CONFRONTING “THE BLIND PEOPLE AND THE ELEPHANT” METAPHOR TO BRIDGE THE SILOS
Examining the Challenges and Opportunities of the Convergence
Language and Conceptual Barriers
7 INTEGRATING HEALTH CARE DELIVERY MODELS AND INTERVENTIONS
HIV and Noncommunicable Disease Integration Platforms
Addressing the Convergence with Integration Science
Mass Administration of Antibiotics to Reduce Child Mortality
8 POTENTIAL APPROACHES FOR RESEARCH, POLICY, AND PRACTICE IN THE IMMEDIATE TERM
Potential Priority Strategies and Actions from Table Group Discussions
9 VISIONARY STATEMENTS ON POTENTIAL PRIORITIES TO ADDRESS THE CONVERGENCE
Adapting Public Health Practice in Africa to a New Understanding of Microbes and Health
A Multifaceted Understanding of the Convergence
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Boxes, Figures, and Tables
BOXES
5-1 Future Tools for Personalized Microbiome Tracking
FIGURES
2-1 Crude death rate by country income status, 2015
2-2 Risk factors shared between infectious and noncommunicable diseases
3-1 Oral P. gingivalis infection induces Alzheimer’s disease pathology after 22 weeks
3-2 Some species of microbes keep humans healthy
5-1 Linkages among the microbiome, metabolites, and diseases
5-2 Map of the human microbiome
Acronyms and Abbreviations
| BMI | body mass index |
| CDR | crude death rate |
| CMA | cow’s milk allergy |
| COPD | chronic obstructive pulmonary disease |
| CVDRF | cardiovascular disease risk factor |
| DALY | disability-adjusted life year |
| EBV | Epstein-Barr virus |
| GLUT2 | glucose transporter 2 |
| GWAS | genomewide association study |
| HMP | Human Microbiome Project |
| HPV | human papillomavirus |
| NCD | noncommunicable disease |
| OTU | operational taxonomic unit |
| PEPFAR | The President’s Emergency Plan for AIDS Relief |
| TB | tuberculosis |
| USAID | U.S. Agency for International Development |
| WHO | World Health Organization |
