Stanley M. Lemon - Böcker

Infectious diseases continue to pose a substantial threat to the operational capacity of military forces. Protecting Our Forces reviews the process by which the U.S. military acquires vaccines to protect its warfighters from natural infectious disease threats. The committee found that poorly aligned acquisition processes and an inadequate commitment of financial resources within the Department of Defense vaccine acquisition process a " rather than uncleared scientific or technological hurdles a " contribute to the unavailability of some vaccines that could protect military personnel and, implicitly, the welfare and security of the nation. Protecting Our Forces outlines ways in which DoD might strengthen its acquisition process and improve vaccine availability. Recommendations, which include combining all DoD vaccine acquisition responsibilities under a single DoD authority, cover four broad aspects of the acquisition process: (1) organization, authority, and responsibility; (2) program and budget; (3)manufacturing; (4) and the regulatory status of special-use vaccines.

The resistance topic is timely given current events. The emergence of mysterious new diseases, such as SARS, and the looming threat of bioterrorist attacks remind us of how vulnerable we can be to infectious agents. With advances in medical technologies, we have tamed many former microbial foes, yet with few new antimicrobial agents and vaccines in the pipeline, and rapidly increasing drug resistance among infectious microbes, we teeter on the brink of loosing the upperhand in our ongoing struggle against these foes, old and new. The Resistance Phenomenon in Microbes and Infectious Disease Vectors examines our understanding of the relationships among microbes, disease vectors, and human hosts, and explores possible new strategies for meeting the challenge of resistance.

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 Medicinea (TM)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.

Public health officials and organizations around the world remain on high alert because of increasing concerns about the prospect of an influenza pandemic, which many experts believe to be inevitable. Moreover, recent problems with the availability and strain-specificity of vaccine for annual flu epidemics in some countries and the rise of pandemic strains of avian flu in disparate geographic regions have alarmed experts about the world's ability to prevent or contain a human pandemic. The workshop summary, The Threat of Pandemic Influenza: Are We Ready? addresses these urgent concerns. The report describes what steps the United States and other countries have taken thus far to prepare for the next outbreak of "killer flu." It also looks at gaps in readiness, including hospitals' inability to absorb a surge of patients and many nations' incapacity to monitor and detect flu outbreaks. The report points to the need for international agreements to share flu vaccine and antiviral stockpiles to ensure that the 88 percent of nations that cannot manufacture or stockpile these products have access to them.It chronicles the toll of the H5N1 strain of avian flu currently circulating among poultry in many parts of Asia, which now accounts for the culling of millions of birds and the death of at least 50 persons. And it compares the costs of preparations with the costs of illness and death that could arise during an outbreak.

The Forum on Microbial Threats (previously named the Forum on Emerging Infections) was created in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). 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. Recent increased attention to both United States and international public health systems as well as the medical research and treatment infrastructure has revealed significant deficiencies in their capacity to respond to infectious diseases. Medical and public health professionals may be poorly equipped to detect, diagnose, and treat common infectious diseases as well as those diseases that pose an unexpected threat. The need for the development of domestic and international training programs in the expanding field of emerging and reemerging infectious diseases is well recognized. Well-trained infectious disease professionals form the basis of a strong national healthcare system. The Forum on Emerging Infections (now renamed the Forum on Microbial Threats) convened a 2-day workshop discussion-the subject of this summary-to examine the education and training needs to ensure an adequate infectious diseases workforce.The workshop reviewed trends in research training programs and discussed the requirements for establishing successful educational initiatives and training programs to ensure a competent and prepared workforce for current and future challenges in infectious diseases. Some key disciplines explored as case-study examinations included infectious disease epidemiology, vaccinology, vector biology, and public health laboratorians.

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. Previous Forum meetings on pandemic disease have discussed the scientific and logistical challenges associated with pandemic disease recognition, identification, and response.Participants in these earlier meetings also recognized the difficulty of implementing disease control strategies effectively. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary as a factual summary of what occurred at the workshop.

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. 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 allows them to present their beliefs about which areas may merit further attention. These proceedings summarize only the statements of participants in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation.Vector-Borne Diseases : Understanding the Environmental, Human Health, and Ecological Connections, Workshop Summary (Forum on Microbial Threats) summarizes this workshop.

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.

This volume is composed of chapters that review important fundamental aspects of HCV biology and disease pathogenesis including, for example, the discovery and identification of the HCV genome, early virus-cell interactions including identification of various cellular receptors, HCV gene expression studied using the HCV replicon system, identification and characterization of HCV structural- and non-structural HCV proteins, HCV replication in cultured cells, and host factors involved in viral replication. This volume also contains chapters dealing with immunity to HCV infection and pathogenesis. This is particularly important in understanding hepatitis C because HCV infection alone is not cell lytic. Mechanisms underlying the persistent nature of HCV infection are also discussed in these chapters. Many of the authors published articles that were listed among the “top 10 papers” published in the 24 years since HCV was discovered in 1989. Their citations are above 1,000 (Web of Science). The authors describe the background and significance of their contributions to the field in the context of findings from other research groups.

This book helps scientists, clinicians and other interested individuals understand recent clinical advances and challenges for the future. It covers many basic aspects of the pathogenesis of chronic hepatitis C, HCV infections in particular populations, approaches to therapy, and prevention and control of HCV Infection. The book provides a succinct review of the large amount of data generated by multiple groups over the past two decades that has revealed the natural history of HCV infection. Similarly, it summarizes current understanding of the origins of HCV-associated hepatocellular carcinoma, cirrhosis and hepatic fibrosis. Extra-hepatic manifestation and metabolic disorders related to HCV infection are described. In this volume, these clinically important aspects of HCV infection are comprehensively described. Highlights are description of newly developed direct- acting antivirals. The authors represent a worldwide distribution of leaders in the field reflecting the global nature of HCV infection. Based on recent data concerning the genetic- and geographical diversity of HCV, and increased global disease burden of HCV infection, challenges for global control of HCV infections are described.

This volume is composed of chapters that review important fundamental aspects of HCV biology and disease pathogenesis including, for example, the discovery and identification of the HCV genome, early virus-cell interactions including identification of various cellular receptors, HCV gene expression studied using the HCV replicon system, identification and characterization of HCV structural- and non-structural HCV proteins, HCV replication in cultured cells, and host factors involved in viral replication. This volume also contains chapters dealing with immunity to HCV infection and pathogenesis. This is particularly important in understanding hepatitis C because HCV infection alone is not cell lytic. Mechanisms underlying the persistent nature of HCV infection are also discussed in these chapters. Many of the authors published articles that were listed among the “top 10 papers” published in the 24 years since HCV was discovered in 1989. Their citations are above 1,000 (Web of Science). The authors describe the background and significance of their contributions to the field in the context of findings from other research groups.