Eileen R. Choffnes – författare

In recent public workshops and working group meetings, the Forum on Microbial Threats of the Institute of Medicine (IOM) has examined a variety of infectious disease outbreaks with pandemic potential, including those caused by influenza (IOM, 2005) and severe acute respiratory syndrome (SARS) (IOM, 2004). Particular attention has been paid to the potential pandemic threat posed by the H5N1 strain of avian influenza, which is now endemic in many Southeast Asian bird populations. Since 2003, the H5N1 subtype of avian influenza has caused 185 confirmed human deaths in 11 countries, including some cases of viral transmission from human to human (WHO, 2007). But as worrisome as these developments are, at least they are caused by known pathogens. The next pandemic could well be caused by the emergence of a microbe that is still unknown, much as happened in the 1980s with the emergence of the human immunodeficiency virus (HIV) and in 2003 with the appearance of the SARS coronavirus.

Vector-borne infectious diseases, such as malaria, dengue fever, yellow fever, and plague, cause a significant fraction of the global infectious disease burden; indeed, nearly half of the world''s population is infected with at least one type of vector-borne pathogen (CIESIN, 2007; WHO, 2004a). Vector-borne plant and animal diseases, including several newly recognized pathogens, reduce agricultural productivity and disrupt ecosystems throughout the world. These diseases profoundly restrict socioeconomic status and development in countries with the highest rates of infection, many of which are located in the tropics and subtropics.

Early detection is essential to the control of emerging, reemerging, and novel infectious diseases, whether naturally occurring or intentionally introduced. Containing the spread of such diseases in a profoundly interconnected world requires active vigilance for signs of an outbreak, rapid recognition of its presence, and diagnosis of its microbial cause, in addition to strategies and resources for an appropriate and efficient response. Although these actions are often viewed in terms of human public health, they also challenge the plant and animal health communities.

Surveillance, defined as "the continual scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control", involves the "systematic collection, analysis, interpretation, and dissemination of health data." Disease detection and diagnosis is the act of discovering a novel, emerging, or reemerging disease or disease event and identifying its cause. Diagnosis is "the cornerstone of effective disease control and prevention efforts, including surveillance."

Disease surveillance and detection relies heavily on the astute individual: the clinician, veterinarian, plant pathologist, farmer, livestock manager, or agricultural extension agent who notices something unusual, atypical, or suspicious and brings this discovery in a timely way to the attention of an appropriate representative of human public health, veterinary medicine, or agriculture. Most developed countries have the ability to detect and diagnose human, animal, and plant diseases.

Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions, Workshop Summary is part of a 10 book series and summarizes the recommendations and presentations of the workshop.

Long before the "germ theory" of disease was described, late in the nineteenth century, humans knew that climatic conditions influence the appearance and spread of epidemic diseases. Ancient notions about the effects of weather and climate on disease remain embedded in our collective consciousness-through expressions such as "cold" for rhinovirus infections; "malaria," derived from the Latin for "bad air;" and the common complaint of feeling "under the weather." Today, evidence is mounting that earth''s climate is changing at a faster rate than previously appreciated, leading researchers to view the longstanding relationships between climate and disease with new urgency and from a global perspective. On December 4 and 5, 2007, the Forum on Microbial Threats hosted a public workshop in Washington, DC to consider the possible infectious disease impacts of global climate change and extreme weather events on human, animal, and plant health, as well as their expected implications for global and national security.

Dr. Joshua Lederberg - scientist, Nobel laureate, visionary thinker, and friend of the Forum on Microbial Threats - died on February 2, 2008. It was in his honor that the Institute of Medicine''s Forum on Microbial Threats convened a public workshop on May 20-21, 2008, to examine Dr. Lederberg''s scientific and policy contributions to the marketplace of ideas in the life sciences, medicine, and public policy. The resulting workshop summary, Microbial Evolution and Co-Adaptation, demonstrates the extent to which conceptual and technological developments have, within a few short years, advanced our collective understanding of the microbiome, microbial genetics, microbial communities, and microbe-host-environment interactions.

As the human population grows—tripling in the past century while, simultaneously, quadrupling its demand for water—Earth''s finite freshwater supplies are increasingly strained, and also increasingly contaminated by domestic, agricultural, and industrial wastes. Today, approximately one-third of the world''s population lives in areas with scarce water resources. Nearly one billion people currently lack access to an adequate water supply, and more than twice as many lack access to basic sanitation services. It is projected that by 2025 water scarcity will affect nearly two-thirds of all people on the planet. Recognizing that water availability, water quality, and sanitation are fundamental issues underlying infectious disease emergence and spread, the Institute of Medicine held a two-day public workshop, summarized in this volume. Through invited presentations and discussions, participants explored global and local connections between water, sanitation, and health; the spectrum of water-related disease transmission processes as they inform intervention design; lessons learned from water-related disease outbreaks; vulnerabilities in water and sanitation infrastructure in both industrialized and developing countries; and opportunities to improve water and sanitation infrastructure so as to reduce the risk of water-related infectious disease.

Modern transportation allows people, animals, and plants—and the pathogens they carry—to travel more easily than ever before. The ease and speed of travel, tourism, and international trade connect once-remote areas with one another, eliminating many of the geographic and cultural barriers that once limited the spread of disease. Because of our global interconnectedness through transportation, tourism and trade, infectious diseases emerge more frequently; spread greater distances; pass more easily between humans and animals; and evolve into new and more virulent strains.

The IOM''s Forum on Microbial Threats hosted the workshop "Globalization, Movement of Pathogens (and Their Hosts) and the Revised International Health Regulations" December 16-17, 2008 in order to explore issues related to infectious disease spread in a "borderless" world. Participants discussed the global emergence, establishment, and surveillance of infectious diseases; the complex relationship between travel, trade, tourism, and the spread of infectious diseases; national and international policies for mitigating disease movement locally and globally; and obstacles and opportunities for detecting and containing these potentially wide-reaching and devastating diseases. This document summarizes the workshop.

As the human population grows—tripling in the past century while, simultaneously, quadrupling its demand for water—Earth''s finite freshwater supplies are increasingly strained, and also increasingly contaminated by domestic, agricultural, and industrial wastes. Today, approximately one-third of the world''s population lives in areas with scarce water resources. Nearly one billion people currently lack access to an adequate water supply, and more than twice as many lack access to basic sanitation services. It is projected that by 2025 water scarcity will affect nearly two-thirds of all people on the planet. Recognizing that water availability, water quality, and sanitation are fundamental issues underlying infectious disease emergence and spread, the Institute of Medicine held a two-day public workshop, summarized in this volume. Through invited presentations and discussions, participants explored global and local connections between water, sanitation, and health; the spectrum of water-related disease transmission processes as they inform intervention design; lessons learned from water-related disease outbreaks; vulnerabilities in water and sanitation infrastructure in both industrialized and developing countries; and opportunities to improve water and sanitation infrastructure so as to reduce the risk of water-related infectious disease.

In March and early April 2009, a new, swine-origin 2009-H1N1 influenza A virus emerged in Mexico and the United States. During the first few weeks of surveillance, the virus spread by human-to-human transmission worldwide to over 30 countries. On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. By October 30, 2009, the H1N1 influenza A had spread to 191 countries and resulted in 5,700 fatalities. A national emergency was declared in the United States and the swine flu joined SARS and the avian flu as pandemics of the 21st century. Vaccination is currently available, but in limited supply, and with a 60 percent effectiveness rate against the virus. The story of how this new influenza virus spread out of Mexico to other parts of North America and then on to Europe, the Far East, and now Australia and the Pacific Rim countries has its origins in the global interconnectedness of travel, trade, and tourism. Given the rapid spread of the virus, the international scientific, public health, security, and policy communities had to mobilize quickly to characterize this unique virus and address its potential effects. The World Health Organization and Centers for Disease Control have played critical roles in the surveillance, detection and responses to the H1N1 virus. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions aimed to examine the evolutionary origins of the H1N1 virus and evaluate its potential public health and socioeconomic consequences, while monitoring and mitigating the impact of a fast-moving pandemic. The rapporteurs for this workshop reported on the need for increased and geographically robust global influenza vaccine production capacities; enhanced and sustained interpandemic demand for seasonal influenza vaccines; clear "triggers" for pandemic alert levels; and accelerated research collaboration on new vaccine manufacturing techniques. This book will be an essential guide for healthcare professionals, policymakers, drug manufacturers and investigators.

Modern transportation allows people, animals, and plants—and the pathogens they carry—to travel more easily than ever before. The ease and speed of travel, tourism, and international trade connect once-remote areas with one another, eliminating many of the geographic and cultural barriers that once limited the spread of disease. Because of our global interconnectedness through transportation, tourism and trade, infectious diseases emerge more frequently; spread greater distances; pass more easily between humans and animals; and evolve into new and more virulent strains.

The IOM''s Forum on Microbial Threats hosted the workshop "Globalization, Movement of Pathogens (and Their Hosts) and the Revised International Health Regulations" December 16-17, 2008 in order to explore issues related to infectious disease spread in a "borderless" world. Participants discussed the global emergence, establishment, and surveillance of infectious diseases; the complex relationship between travel, trade, tourism, and the spread of infectious diseases; national and international policies for mitigating disease movement locally and globally; and obstacles and opportunities for detecting and containing these potentially wide-reaching and devastating diseases. This document summarizes the workshop.

Years of using, misusing, and overusing antibiotics and other antimicrobial drugs has led to the emergence of multidrug-resistant ''superbugs.'' The IOM''s Forum on Microbial Threats held a public workshop April 6-7 to discuss the nature and sources of drug-resistant pathogens, the implications for global health, and the strategies to lessen the current and future impact of these superbugs.

In March and early April 2009, a new, swine-origin 2009-H1N1 influenza A virus emerged in Mexico and the United States. During the first few weeks of surveillance, the virus spread by human-to-human transmission worldwide to over 30 countries. On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. By October 30, 2009, the H1N1 influenza A had spread to 191 countries and resulted in 5,700 fatalities. A national emergency was declared in the United States and the swine flu joined SARS and the avian flu as pandemics of the 21st century. Vaccination is currently available, but in limited supply, and with a 60 percent effectiveness rate against the virus. The story of how this new influenza virus spread out of Mexico to other parts of North America and then on to Europe, the Far East, and now Australia and the Pacific Rim countries has its origins in the global interconnectedness of travel, trade, and tourism. Given the rapid spread of the virus, the international scientific, public health, security, and policy communities had to mobilize quickly to characterize this unique virus and address its potential effects. The World Health Organization and Centers for Disease Control have played critical roles in the surveillance, detection and responses to the H1N1 virus. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions aimed to examine the evolutionary origins of the H1N1 virus and evaluate its potential public health and socioeconomic consequences, while monitoring and mitigating the impact of a fast-moving pandemic. The rapporteurs for this workshop reported on the need for increased and geographically robust global influenza vaccine production capacities; enhanced and sustained interpandemic demand for seasonal influenza vaccines; clear "triggers" for pandemic alert levels; and accelerated research collaboration on new vaccine manufacturing techniques. This book will be an essential guide for healthcare professionals, policymakers, drug manufacturers and investigators.

Dr. Joshua Lederberg - scientist, Nobel laureate, visionary thinker, and friend of the Forum on Microbial Threats - died on February 2, 2008. It was in his honor that the Institute of Medicine''s Forum on Microbial Threats convened a public workshop on May 20-21, 2008, to examine Dr. Lederberg''s scientific and policy contributions to the marketplace of ideas in the life sciences, medicine, and public policy. The resulting workshop summary, Microbial Evolution and Co-Adaptation, demonstrates the extent to which conceptual and technological developments have, within a few short years, advanced our collective understanding of the microbiome, microbial genetics, microbial communities, and microbe-host-environment interactions.

Vector-borne infectious diseases, such as malaria, dengue fever, yellow fever, and plague, cause a significant fraction of the global infectious disease burden; indeed, nearly half of the world''s population is infected with at least one type of vector-borne pathogen (CIESIN, 2007; WHO, 2004a). Vector-borne plant and animal diseases, including several newly recognized pathogens, reduce agricultural productivity and disrupt ecosystems throughout the world. These diseases profoundly restrict socioeconomic status and development in countries with the highest rates of infection, many of which are located in the tropics and subtropics.

Long before the "germ theory" of disease was described, late in the nineteenth century, humans knew that climatic conditions influence the appearance and spread of epidemic diseases. Ancient notions about the effects of weather and climate on disease remain embedded in our collective consciousness-through expressions such as "cold" for rhinovirus infections; "malaria," derived from the Latin for "bad air;" and the common complaint of feeling "under the weather." Today, evidence is mounting that earth''s climate is changing at a faster rate than previously appreciated, leading researchers to view the longstanding relationships between climate and disease with new urgency and from a global perspective. On December 4 and 5, 2007, the Forum on Microbial Threats hosted a public workshop in Washington, DC to consider the possible infectious disease impacts of global climate change and extreme weather events on human, animal, and plant health, as well as their expected implications for global and national security.

Early detection is essential to the control of emerging, reemerging, and novel infectious diseases, whether naturally occurring or intentionally introduced. Containing the spread of such diseases in a profoundly interconnected world requires active vigilance for signs of an outbreak, rapid recognition of its presence, and diagnosis of its microbial cause, in addition to strategies and resources for an appropriate and efficient response. Although these actions are often viewed in terms of human public health, they also challenge the plant and animal health communities.

Surveillance, defined as "the continual scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control", involves the "systematic collection, analysis, interpretation, and dissemination of health data." Disease detection and diagnosis is the act of discovering a novel, emerging, or reemerging disease or disease event and identifying its cause. Diagnosis is "the cornerstone of effective disease control and prevention efforts, including surveillance."

Disease surveillance and detection relies heavily on the astute individual: the clinician, veterinarian, plant pathologist, farmer, livestock manager, or agricultural extension agent who notices something unusual, atypical, or suspicious and brings this discovery in a timely way to the attention of an appropriate representative of human public health, veterinary medicine, or agriculture. Most developed countries have the ability to detect and diagnose human, animal, and plant diseases.

Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions, Workshop Summary is part of a 10 book series and summarizes the recommendations and presentations of the workshop.

In recent public workshops and working group meetings, the Forum on Microbial Threats of the Institute of Medicine (IOM) has examined a variety of infectious disease outbreaks with pandemic potential, including those caused by influenza (IOM, 2005) and severe acute respiratory syndrome (SARS) (IOM, 2004). Particular attention has been paid to the potential pandemic threat posed by the H5N1 strain of avian influenza, which is now endemic in many Southeast Asian bird populations. Since 2003, the H5N1 subtype of avian influenza has caused 185 confirmed human deaths in 11 countries, including some cases of viral transmission from human to human (WHO, 2007). But as worrisome as these developments are, at least they are caused by known pathogens. The next pandemic could well be caused by the emergence of a microbe that is still unknown, much as happened in the 1980s with the emergence of the human immunodeficiency virus (HIV) and in 2003 with the appearance of the SARS coronavirus.

Years of using, misusing, and overusing antibiotics and other antimicrobial drugs has led to the emergence of multidrug-resistant ''superbugs.'' The IOM''s Forum on Microbial Threats held a public workshop April 6-7 to discuss the nature and sources of drug-resistant pathogens, the implications for global health, and the strategies to lessen the current and future impact of these superbugs.

Neglected tropical diseases (NTDs) afflict more than 1.4 billion people, many of whom live on less than $1.25 a day. While there are effective ways to manage NTDs, policy-makers and funders have only recently begun to recognize the economic and public health importance of controlling NTDs. The IOM''s Forum on Microbial Threats held a workshop September 21-22, 2010, to discuss the science of and policy surrounding NTDs.

Fungal diseases have contributed to death and disability in humans, triggered global wildlife extinctions and population declines, devastated agricultural crops, and altered forest ecosystem dynamics. Despite the extensive influence of fungi on health and economic well-being, the threats posed by emerging fungal pathogens to life on Earth are often underappreciated and poorly understood. On December 14 and 15, 2010, the IOM''s Forum on Microbial Threats hosted a public workshop to explore the scientific and policy dimensions associated with the causes and consequences of emerging fungal diseases.

Fungal diseases have contributed to death and disability in humans, triggered global wildlife extinctions and population declines, devastated agricultural crops, and altered forest ecosystem dynamics. Despite the extensive influence of fungi on health and economic well-being, the threats posed by emerging fungal pathogens to life on Earth are often underappreciated and poorly understood. On December 14 and 15, 2010, the IOM''s Forum on Microbial Threats hosted a public workshop to explore the scientific and policy dimensions associated with the causes and consequences of emerging fungal diseases.

Neglected tropical diseases (NTDs) afflict more than 1.4 billion people, many of whom live on less than $1.25 a day. While there are effective ways to manage NTDs, policy-makers and funders have only recently begun to recognize the economic and public health importance of controlling NTDs. The IOM''s Forum on Microbial Threats held a workshop September 21-22, 2010, to discuss the science of and policy surrounding NTDs.

Many potential applications of synthetic and systems biology are relevant to the challenges associated with the detection, surveillance, and responses to emerging and re-emerging infectious diseases. On March 14 and 15, 2011, the Institute of Medicine''s (IOM''s) Forum on Microbial Threats convened a public workshop in Washington, DC, to explore the current state of the science of synthetic biology, including its dependency on systems biology; discussed the different approaches that scientists are taking to engineer, or reengineer, biological systems; and discussed how the tools and approaches of synthetic and systems biology were being applied to mitigate the risks associated with emerging infectious diseases.

The Science and Applications of Synthetic and Systems Biology is organized into sections as a topic-by-topic distillation of the presentations and discussions that took place at the workshop. Its purpose is to present information from relevant experience, to delineate a range of pivotal issues and their respective challenges, and to offer differing perspectives on the topic as discussed and described by the workshop participants. This report also includes a collection of individually authored papers and commentary.

Globalization of the food supply has created conditions favorable for the emergence, reemergence, and spread of food-borne pathogens-compounding the challenge of anticipating, detecting, and effectively responding to food-borne threats to health. In the United States, food-borne agents affect 1 out of 6 individuals and cause approximately 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year. This figure likely represents just the tip of the iceberg, because it fails to account for the broad array of food-borne illnesses or for their wide-ranging repercussions for consumers, government, and the food industry-both domestically and internationally. A One Health approach to food safety may hold the promise of harnessing and integrating the expertise and resources from across the spectrum of multiple health domains including the human and veterinary medical and plant pathology communities with those of the wildlife and aquatic health and ecology communities.The IOM''s Forum on Microbial Threats hosted a public workshop on December 13 and 14, 2011 that examined issues critical to the protection of the nation''s food supply. The workshop explored existing knowledge and unanswered questions on the nature and extent of food-borne threats to health. Participants discussed the globalization of the U.S. food supply and the burden of illness associated with foodborne threats to health; considered the spectrum of food-borne threats as well as illustrative case studies; reviewed existing research, policies, and practices to prevent and mitigate foodborne threats; and, identified opportunities to reduce future threats to the nation''s food supply through the use of a "One Health" approach to food safety. Improving Food Safety Through a One Health Approach: Workshop Summary covers the events of the workshop and explains the recommendations for future related workshops.

Beginning with the germ theory of disease in the 19th century and extending through most of the 20th century, microbes were believed to live their lives as solitary, unicellular, disease-causing organisms . This perception stemmed from the focus of most investigators on organisms that could be grown in the laboratory as cellular monocultures, often dispersed in liquid, and under ambient conditions of temperature, lighting, and humidity. Most such inquiries were designed to identify microbial pathogens by satisfying Koch''s postulates.3 This pathogen-centric approach to the study of microorganisms produced a metaphorical "war" against these microbial invaders waged with antibiotic therapies, while simultaneously obscuring the dynamic relationships that exist among and between host organisms and their associated microorganisms—only a tiny fraction of which act as pathogens.

Despite their obvious importance, very little is actually known about the processes and factors that influence the assembly, function, and stability of microbial communities. Gaining this knowledge will require a seismic shift away from the study of individual microbes in isolation to inquiries into the nature of diverse and often complex microbial communities, the forces that shape them, and their relationships with other communities and organisms, including their multicellular hosts.

On March 6 and 7, 2012, the Institute of Medicine''s (IOM''s) Forum on Microbial Threats hosted a public workshop to explore the emerging science of the "social biology" of microbial communities. Workshop presentations and discussions embraced a wide spectrum of topics, experimental systems, and theoretical perspectives representative of the current, multifaceted exploration of the microbial frontier. Participants discussed ecological, evolutionary, and genetic factors contributing to the assembly, function, and stability of microbial communities; how microbial communities adapt and respond to environmental stimuli; theoretical and experimental approaches to advance this nascent field; and potential applications of knowledge gained from the study of microbial communities for the improvement of human, animal, plant, and ecosystem health and toward a deeper understanding of microbial diversity and evolution. The Social Biology of Microbial Communities: Workshop Summary further explains the happenings of the workshop.

Individually and collectively, resident microbes play important roles in host health and survival. Shaping and shaped by their host environments, these microorganisms form intricate communities that are in a state of dynamic equilibrium. This ecologic and dynamic view of host-microbe interactions is rapidly redefining our view of health and disease. It is now accepted that the vast majority of microbes are, for the most part, not intrinsically harmful, but rather become established as persistent, co-adapted colonists in equilibrium with their environment, providing useful goods and services to their hosts while deriving benefits from these host associations. Disruption of such alliances may have consequences for host health, and investigations in a wide variety of organisms have begun to illuminate the complex and dynamic network of interaction - across the spectrum of hosts, microbes, and environmental niches - that influence the formation, function, and stability of host-associated microbial communities.

Microbial Ecology in States of Health and Disease is the summary of a workshop convened by the Institute of Medicine''s Forum on Microbial Threats in March 2013 to explore the scientific and therapeutic implications of microbial ecology in states of health and disease. Participants explored host-microbe interactions in humans, animals, and plants; emerging insights into how microbes may influence the development and maintenance of states of health and disease; the effects of environmental change(s) on the formation, function, and stability of microbial communities; and research challenges and opportunities for this emerging field of inquiry.