MICROBIAL THREATS TO HEALTH

NATIONAL ACADEMIES PRESS

Contents

LIST OF FIGURES, TABLES, AND BOXES.....................................................................xxiACRONYMS...............................................................................................xxvEXECUTIVE SUMMARY......................................................................................11 INTRODUCTION.........................................................................................192 SPECTRUM OF MICROBIAL THREATS........................................................................23The Global Burden of AIDS, Tuberculosis, and Malaria...................................................25Emerging Infectious Diseases...........................................................................32Antimicrobial-Resistant Infections.....................................................................32Chronic Diseases with Infectious Etiology..............................................................41Microbes Intentionally Used for Harm...................................................................463 FACTORS IN EMERGENCE.................................................................................53Microbial Adaptation and Change........................................................................53Human Susceptibility to Infection......................................................................60Climate and Weather....................................................................................64Changing Ecosystems....................................................................................67Economic Development and Land Use......................................................................75Human Demographics and Behavior........................................................................78Technology and Industry................................................................................88International Travel and Commerce......................................................................97Breakdown of Public Health Measures....................................................................107Poverty and Social Inequality..........................................................................121War and Famine.........................................................................................125Lack of Political Will.................................................................................127Intent to Harm.........................................................................................130A Case in Point: Influenza-We Are Unprepared...........................................................1364 ADDRESSING THE THREATS: CONCLUSIONS AND RECOMMENDATIONS..............................................149Enhancing Global Response Capacity.....................................................................149Improving Global Infectious Disease Surveillance.......................................................154Rebuilding Domestic Public Health Capacity.............................................................159Improving Domestic Surveillance Through Better Disease Reporting.......................................163Exploring Innovative Systems of Surveillance...........................................................170Developing and Using Diagnostics.......................................................................174Educating and Training the Microbial Threat Workforce..................................................181Vaccine Development and Production.....................................................................184Need for New Antimicrobial Drugs.......................................................................190Inappropriate Use of Antimicrobials....................................................................204Vector-borne and Zoonotic Disease Control..............................................................209Comprehensive Infectious Disease Research Agenda.......................................................220Interdisciplinary Infectious Disease Centers...........................................................222EPILOGUE...............................................................................................227GLOSSARY...............................................................................................231REFERENCES.............................................................................................241APPENDIXESA Microbial Threats to Health Public Committee Meeting Agendas.........................................277B Syndromic Surveillance...............................................................................281C Pathogen Discovery, Detection, and Diagnostics.......................................................313D Forum on Emerging Infections Membership and Publications, Board on Global Health.....................331E Computational Modeling and Simulation of Epidemic Infectious Diseases................................335F Committee and Staff Biographies......................................................................343INDEX..................................................................................................353

Chapter One

Microbes live in every conceivable ecological niche on the planet and have inhabited the earth for many hundreds of millions of years. Indeed, microbes may be the most abundant life form by mass, and they are highly adaptable to external forces. The vast majority of microbes are essential to human, animal, and plant life. Occasionally, however, a microbe is identified as a pathogen because it causes an acute infectious disease or triggers a pathway to chronic diseases, including some cancers. Certainly, humankind remains ignorant of the full scope of diseases caused by microbial threats, as only a small portion of all microbes have been identified by currently available technologies.

Microbial threats continue to emerge, reemerge, and persist. Some microbes cause newly recognized diseases in humans; others are previously known pathogens that are infecting new or larger population groups or spreading into new geographic areas. Within the last 10 years, newly discovered infectious diseases have emerged in the United States (e.g., hantavirus pulmonary syndrome from Sin Nombre virus) and abroad (e.g., viral encephalitis from Nipah virus). During the same time, the worldwide resurgence of long-recognized infectious diseases (e.g., tuberculosis, malaria, cholera, and dengue) has gained in force. The United States has seen the importation of infectious diseases, such as West Nile encephalitis, measles, multidrug-resistant tuberculosis, malaria, and cyclosporiasis, from immigrants, U.S. residents returning from foreign destinations, and products of international commerce.

The realization of just how quickly newly discovered infectious diseases can spread has generated a heightened appreciation of the inherent dangers of microbial pathogens. Acquired immunodeficiency syndrome (AIDS) has become the fourth-leading cause of death worldwide in a mere 20 years since its discovery. Today, more than 40 million people are living with infection from the human immunodeficiency virus (HIV), and 20 million people have died from AIDS. In just 3 years since West Nile virus was discovered in the Western Hemisphere, the virus has spread from its epicenter in New York to 39 states (including California), infecting...