Forum on Microbial Threats

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Global pandemics often begin when a virus jumps from animals to humans, leading to initial cases of infection - sometimes referred to as "patient zero." As the world recovers from COVID-19, understanding how pathogens first spill over into human populations is critical to prevention efforts. The National Academies' Forum on Microbial Threats convened a workshop in January 2025 to examine how ecological, social, and technological factors shape the emergence of new infectious diseases in humans. Speakers addressed gaps in understanding of disease emergence with a focus on the human-animal interface and laboratory biosafety. This Proceedings of a Workshop summarizes the presentations and discussions that took place at the event.

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98 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-60176-2
ISBN Ebook: 0-309-60174-6
DOI: https://doi.org/10.17226/29313

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National Academies of Sciences, Engineering, and Medicine. 2025. Understanding the Introduction of Pathogens into Humans: Preventing Patient Zero: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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Advances in genome sequencing technologies, like next-generation sequencing, provide powerful tools that have vastly improved the detection and classification of pathogens and disease outbreaks and support data-driven public health responses. In July 2024, the National Academies Forum on Microbial Threats hosted a public workshop to explore opportunities to advance the use of pathogen genomics and metagenomics data in the U.S. public health system. Speakers considered the application of these technologies to monitoring disease, characterization of emerging pathogens, rapid public health response to outbreaks, and biomedical research.

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128 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-09984-6
ISBN Ebook: 0-309-09986-2
DOI: https://doi.org/10.17226/29103

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National Academies of Sciences, Engineering, and Medicine. 2025. Accelerating the Use of Pathogen Genomics and Metagenomics in Public Health: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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Arboviruses, or viruses carried by arthropods like mosquitoes or ticks, are responsible for hundreds of thousands of deaths worldwide each year. As the climate changes globally, the geographic distribution of these diseases, including Zika, dengue, chikungunya, West Nile, and yellow fever, are steadily expanding. The National Academies Forum on Microbial Threats hosted a public workshop in December 2023 to explore avenues of threat reduction from known and emerging arboviral diseases in the context of public health preparedness and capacity building. The workshop featured talks from experts in entomology, public health, ecology, virology, immunology, disease modeling, and urban planning.

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146 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-71927-5
ISBN Ebook: 0-309-71928-3
DOI: https://doi.org/10.17226/27774

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National Academies of Sciences, Engineering, and Medicine. 2024. Mitigating Arboviral Threat and Strengthening Public Health Preparedness: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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Antimicrobial resistance (AMR) is linked to millions of deaths globally each year. As an evolving public health threat, there is a need to further develop methods to quantify AMR's burden within medical practice and other sectors like food production. The National Academies Forum on Microbial Threats hosted a public workshop in March 2024 to explore the burden of AMR and discuss clinical, scientific, and policy strategies for addressing the growing AMR health threat across sectors.

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12 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-72924-6
DOI: https://doi.org/10.17226/28039

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National Academies of Sciences, Engineering, and Medicine. 2024. Assessing the Burden of and Potential Strategies to Address Antimicrobial Resistance: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.

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Since its establishment in 1996, the Forum on Microbial Threats has provided a platform for leaders from a wide range of disciplines and industries to debate and collaborate on the most effective ways to understand, anticipate, and manage emerging infectious diseases. The world still grapples with the effects of the COVID-19 pandemic at the same time as it addresses other infectious disease threats from highly pathogenic avian influenza to the spread of endemic zoonotic pathogens. In 2023, the forum held two workshops on infection-associated chronic illnesses and the mitigation of arboviral threats. The forum also continued to work closely with the One Health Action Collaborative and remained committed to both cross-disciplinary and community public health discourse.

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16 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-72451-1
DOI: https://doi.org/10.17226/27910

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National Academies of Sciences, Engineering, and Medicine. 2024. Forum on Microbial Threats: Annual Report 2023. Washington, DC: The National Academies Press.

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The National Academies Forum on Microbial Threats and Forum on Neuroscience and Nervous System Disorders hosted a hybrid public workshop in June 2023 to explore opportunities to advance research and treatment of infection-associated chronic illnesses. The illnesses discussed in this workshop, including COVID-19, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), persistent or posttreatment Lyme disease syndrome (PTLDS), and multiple sclerosis (MS), share overlapping mechanisms and symptoms and have been inadequately researched. Recognizing these commonalities, speakers identified the need to advance research more comprehensively, translating to improved diagnostic and treatment options for patients across multiple conditions.

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126 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-71524-5
ISBN Ebook: 0-309-71525-3
DOI: https://doi.org/10.17226/27462

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National Academies of Sciences, Engineering, and Medicine. 2024. Toward a Common Research Agenda in Infection-Associated Chronic Illnesses: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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The COVID-19 pandemic catalyzed unparalleled speed and cross-sector collaboration in the innovation of tools and technologies to address an emerging infectious disease outbreak. Continued innovation and collaboration in rapid development and implementation of new vaccines, therapeutics, and diagnostics is central to future outbreak preparedness. The National Academies Forum on Microbial Threats; Forum on Drug Discovery, Development, and Translation; and the Forum on Medical and Public Health Preparedness for Emergencies and Disasters held a workshop in December 2022 to explore how innovative approaches in research can enhance health systems preparedness and responses to emerging infectious diseases and dangerous pathogens. Workshop participants reflected on critical scientific infrastructure for stakeholder coordination and innovations that can facilitate rapid and effective preparedness and response to emerging infectious disease threats. This Proceedings of a Workshop summarizes the discussions held during the workshop.

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172 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-70784-6
ISBN Ebook: 0-309-70785-4
DOI: https://doi.org/10.17226/27194

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National Academies of Sciences, Engineering, and Medicine. 2023. Applying Lessons Learned from COVID-19 Research and Development to Future Epidemics: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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The use and misuse of antibiotics contributes to the rise in drug-resistant bacteria - a serious and worsening threat to human health. The development and use of rapid point-of-care diagnostics in the healthcare setting plays an important role in avoiding unnecessary use of antimicrobials by providing clinicians with the right information at the right time to help them make decisions about appropriate drug treatment for patients. Diagnostics also have the capacity to support early detection and diagnosis of drug-resistant bacterial infections, enable disease surveillance, and help prevent disease spread.

The National Academies Forum on Drug Discovery, Development, and Translation; Forum on Medical and Public Health Preparedness for Disasters and Emergencies; and Forum on Microbial Threats hosted an October 2022 workshop exploring the current landscape of rapid diagnostics to address antibiotic resistance, challenges and opportunities for spurring innovation, and practical next steps for accelerating the development of new diagnostic tools.

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Interactive Overview

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150 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-70240-2
ISBN Ebook: 0-309-70241-0
DOI: https://doi.org/10.17226/27008

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National Academies of Sciences, Engineering, and Medicine. 2023. Accelerating the Development and Uptake of Rapid Diagnostics to Address Antibiotic Resistance: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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Antifungal use in plant agriculture is a widespread practice necessary to safeguard food safety and security. While the impact of antimicrobial resistance (AMR) is a significant global health concern, knowledge gaps exist surrounding antifungal resistance, the connection to plant agriculture, and its implications for human health.

The National Academies Forum on Microbial Threats hosted a workshop series in June 2022 exploring the role of plant agricultural practices in AMR development and implications for human health, with a focus on plant crop production. Sessions explored the magnitude of environmentally induced/selected antifungal resistance connected to plant agriculture, agricultural practices that may contribute to AMR in human pathogens, and strategies for surveillance and mitigation.This Proceedings document summarizes workshop discussions.

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196 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-69767-0
ISBN Ebook: 0-309-69768-9
DOI: https://doi.org/10.17226/26833

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National Academies of Sciences, Engineering, and Medicine. 2023. The Role of Plant Agricultural Practices on Development of Antimicrobial Resistant Fungi Affecting Human Health: Proceedings of a Workshop Series. Washington, DC: The National Academies Press.

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The National Academies Forum on Medical and Public Health Preparedness for Disasters and Emergencies and Forum on Microbial Threats cohosted a two-day public workshop in March 2023 to explore U.S. laboratory and testing responses to past, present, and potential health emergencies (e.g., COVID-19, monkey pox, chemical, radiological or nuclear threats). Speakers addressed the future of laboratory capabilities, capacities, and coordination for national health emergencies response across public and private entities. The workshop culminated with a discussion envisioning the ideal structure, characteristics, components, capabilities, and functions of what could be considered a coordinated national laboratory system, a coordinated system of public and private laboratories, manufacturers, pharmacies, and other entities, that is prepared to respond to future public health threats and emergencies. This Proceedings of a Workshop-in Brief summarizes the discussions held during the workshop.

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14 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-70636-X
DOI: https://doi.org/10.17226/27147

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National Academies of Sciences, Engineering, and Medicine. 2023. Future of the Nation's Laboratory Systems for Health Emergency Response: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.

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Since its establishment in 1996, the Forum on Microbial Threat has provided a platform for leaders from a wide range of disciplines and industries to debate and collaborate on the most effective ways to understand, anticipate, and manage emerging infectious diseases. The world still grapples with the COVID-19 pandemic at the same time as it addresses other infectious disease threats from mpox to highly pathogenic avian influenza and the spread of drug-resistant bacterial and fungal pathogens. In 2022, the forum held two workshops on antimicrobial resistant fungal pathogens and lessons learned from biomedical research and development during the COVID-19 pandemic. The forum also continued to work closely with the One Health Action Collaborative and remained committed to both cross-disciplinary and community public health discourse.

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20 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-70652-1
DOI: https://doi.org/10.17226/27152

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National Academies of Sciences, Engineering, and Medicine. 2023. Forum on Microbial Threats: Annual Report 2022. Washington, DC: The National Academies Press.

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Despite being preventable and curable since the middle of the twentieth century, tuberculosis (TB) has long persisted as the world's deadliest infectious disease, with the communities most devastated by TB among the poorest and most vulnerable in the world. Only about half of people with TB receive successful treatment each year. As the global threat of antimicrobial resistance continues to escalate, so do cases of drug-resistant TB, or TB that is resistant to various antibiotics that constitute standard treatment regimens.

In response, the National Academies of Sciences, Engineering, and Medicine's Forum on Microbial Threats held a two-part virtual workshop on July 22 and September 14-16, 2021 titled Innovations for Tackling Tuberculosis in the Time of COVID-19. The aims of the workshop were to evaluate the current status of TB elimination, assess the effects of the COVID-19 pandemic on the global fight against TB, and examine technical and strategic innovations that could be leveraged to meet the United Nations High-Level Meeting on Tuberculosis targets in 2022 and The World Health Organization's END TB Strategy targets by 2030. This publication summarizes the presentations and discussions of the workshop.

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194 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-68642-3
ISBN Ebook: 0-309-68643-1
DOI: https://doi.org/10.17226/26530

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National Academies of Sciences, Engineering, and Medicine. 2022. Innovations for Tackling Tuberculosis in the Time of COVID-19: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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To take stock of lessons learned from COVID-19 around the world and in the United States, the Forum on Microbial Threats held two virtual workshops during 2021. The first workshop focused on what it means to frame the response to COVID-19 through a "syndemic" approach, and what the implications would be for global recovery. The second workshop focused more broadly on key lessons and emerging data from ongoing pandemic response efforts that can be incorporated into current health systems to improve resilience and preparedness for future outbreaks.

This workshop explored the long-term effects of COVID-19 on health equity, including considerations for mental health and social determinants of health. It also addressed uncertainties during a pandemic, such as trust, communication, and engagement and explored approaches to systematize recovery efforts to improve the ongoing responses and prepare for the next pandemic. Experts discussed possibilities for a post-pandemic world and a response strategy for stakeholders that ensures sustained community partnerships and prioritization of health equity. This Proceedings of a Workshop summarizes the presentations and discussions from the second workshop.

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Interactive Overview

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128 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-68840-X
ISBN Ebook: 0-309-68841-8
DOI: https://doi.org/10.17226/26556

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National Academies of Sciences, Engineering, and Medicine. 2022. Toward a Post-Pandemic World: Lessons from COVID-19 for Now and the Future: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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A planning committee convened by the Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine held a virtual workshop on February 23-25, 2021, titled Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks. The workshop gave particular consideration to research opportunities, multisectoral collaboration mechanisms, community-engagement strategies, educational opportunities, and policies that speakers have found effective in implementing the core capacities and interventions of One Health principles to strengthen national health systems and enhance global health security. This Proceedings of a Workshop summarizes the presentations and discussions of the workshop.

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180 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-09337-6
ISBN Ebook: 0-309-09338-4
DOI: https://doi.org/10.17226/26301

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National Academies of Sciences, Engineering, and Medicine. 2022. Systematizing the One Health Approach in Preparedness and Response Efforts for Infectious Disease Outbreaks: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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20 pages · 8 x 8 ·
ISBN Ebook: 0-309-68660-1
DOI: https://doi.org/10.17226/26534

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National Academies of Sciences, Engineering, and Medicine. 2022. Forum on Microbial Threats: 2021 Annual Report. Washington, DC: The National Academies Press.

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The Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine's Health and Medicine Division hosted a virtual workshop on July 22, 2021 to evaluate the current status in tuberculosis (TB) eradication and the impact that COVID-19 has had on the global fight against TB. With support from the U.S. Agency for International Development, the workshop examined technological and strategic innovations that can be leveraged to meet the targets set by the United Nations High-Level Meeting on Tuberculosis and the END TB Strategy from the World Health Organization. Workshop discussions comprised four main topics: gaps and challenges in diagnostic technologies, including point-of-care testing; promising potentials of vaccination approaches, including existing tools in the development pipeline and new vaccine platforms; possibilities and encouraging progress toward achieving a shorter, non-toxic treatment regimen; and opportunities for engaging increased and sustained commitments to achieve targets for ending TB in the face of challenges from COVID-19 and future disease threats. This Proceedings of a Workshop-in Brief summarizes the presentations and discussions that occurred during the workshop.

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12 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-27404-4
DOI: https://doi.org/10.17226/26404

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National Academies of Sciences, Engineering, and Medicine. 2021. Innovations for Tackling Tuberculosis in the Time of COVID-19: Current Tools and Challenges: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.

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Pathogens are the cause of infectious diseases, but the environment can play an important role in influencing the conditions under which pathogens spread and cause harm. Understanding the complex interplay among people, pathogens, and the environment - broadly encompassing the chemical, biological, physical, and social surroundings - can lead to a more complete picture of where and how infectious diseases emerge, how they spread, and how to respond to outbreaks.

The virtual workshop Pivotal Interfaces of Environmental Health and Infectious Disease Research to Inform Responses to Outbreaks, Epidemics, and Pandemics was held on June 8-9, 2021. This workshop provided a venue for experts in infectious diseases, environmental health, and data science from government, academia, and the private sector to examine current knowledge about the environment-infectious disease interface and to explore how this knowledge can be used to inform public health decisions. Key workshop topics included how advances in environmental exposure assessments can be applied to identify, predict, and monitor critical infectious disease exposure pathways, and how climate and environmental modeling techniques can be applied to better understand the biology and transmission dynamics of pathogens and provide early warning of emerging threats. In addition, workshop sessions explored critical data gaps at the environment-infectious disease interface and provided insight on how new and emerging techniques can be applied to address those data gaps, especially through the integration of tools used in environmental health and infectious disease research. This publication summarizes the presentation and discussion of the workshop.

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12 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-08750-3
DOI: https://doi.org/10.17226/26270

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National Academies of Sciences, Engineering, and Medicine. 2021. Pivotal Interfaces of Environmental Health and Infectious Disease Research to Inform Responses to Outbreaks, Epidemics, and Pandemics: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.

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Immunization against disease is among the most successful global health efforts of the modern era, and substantial gains in vaccination coverage rates have been achieved worldwide. However, that progress has stagnated in recent years, leaving an estimated 20 million children worldwide either undervaccinated or completely unvaccinated. The determinants of vaccination uptake are complex, mutable, and context specific. A primary driver is vaccine hesitancy - defined as a "delay in acceptance or refusal of vaccines despite availability of vaccination services". The majority of vaccine-hesitant people fall somewhere on a spectrum from vaccine acceptance to vaccine denial. Vaccine uptake is also hampered by socioeconomic or structural barriers to access.

On August 17-20, 2020, the Forum on Microbial Threats at the National Academies of Sciences, Engineering, and Medicine held a 4-day virtual workshop titled The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy. The workshop focused on two main areas (vaccine access and vaccine confidence) and gave particular consideration to health systems, research opportunities, communication strategies, and policies that could be considered to address access, perception, attitudes, and behaviors toward vaccination. This publication summarizes the presentations and discussion of the workshop.

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230 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-46156-1
ISBN Ebook: 0-309-46164-2
DOI: https://doi.org/10.17226/26134

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National Academies of Sciences, Engineering, and Medicine. 2021. The Critical Public Health Value of Vaccines: Tackling Issues of Access and Hesitancy: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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On March 17, 2021, the Forum on Microbial Threats of the National Academies of Sciences, Engineering, and Medicine's Health and Medicine Division hosted a virtual workshop on considering COVID-19 through a syndemic approach (analyzing the health consequences and interactions of multiple epidemics within a population in combination with underlying social, environmental, and economic drivers) and the implications that perspective might have for the ongoing response efforts in the United States and around the world. In addition, the meeting sought to raise prospective ideas for enhancing resilience and preparedness for future outbreaks.

This event kicked off the forum's initiative to evaluate lessons learned from the pandemic and served as a framing workshop for thinking about its long-term, cross-sectoral, and global impacts. Speakers and panelists addressed (1) the biological and social determinants of health that are involved in identifying and describing syndemics; (2) the reasons for and implications of using the syndemic framing for COVID-19, based on the influence of particular geographic and community contexts on localized disease impacts; and (3) why thinking about COVID-19 and other disease outbreaks through a syndemic lens is important for public health officials and the general public. This Proceedings of a Workshop-in Brief summarizes the presentations and discussions that occurred at the workshop. A broad range of perspectives were shared during the event.

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11 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-08586-1
DOI: https://doi.org/10.17226/26259

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National Academies of Sciences, Engineering, and Medicine. 2021. Using Syndemic Theory and the Societal Lens to Inform Resilient Recovery from COVID-19: Toward a Post-Pandemic World: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.

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This workshop, the first in a series on the topic of vaccine access and vaccine hesitancy, took place via Zoom on May 28, 2020. The remaining meetings are scheduled for August 17-20, 2020. The coronavirus pandemic made clear that people want scientific information, but many distrust it at the same time, making questions of vaccine hesitancy even more prominent. This publication summarizes the presentations and discussions from the workshop.

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5 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-68160-X
DOI: https://doi.org/10.17226/25895

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National Academies of Sciences, Engineering, and Medicine. 2020. Vaccine Access and Hesitancy: Part One of a Workshop Series: Proceedings of a Workshop—in Brief. Washington, DC: The National Academies Press.

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On December 4-5, 2019, the National Academies of Sciences, Engineering, and Medicine held a 1.5-day public workshop titled Exploring the Frontiers of Innovation to Tackle Microbial Threats. The workshop participants examined major advances in scientific, technological, and social innovations against microbial threats. Such innovations include diagnostics, vaccines (both development and production), and antimicrobials, as well as nonpharmaceutical interventions and changes in surveillance. This publication summarizes the presentations and discussions from the workshop.

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178 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-67533-2
ISBN Ebook: 0-309-67534-0
DOI: https://doi.org/10.17226/25746

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National Academies of Sciences, Engineering, and Medicine. 2020. Exploring the Frontiers of Innovation to Tackle Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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14 pages · 8.5 x 11 ·
ISBN Ebook: 0-309-08572-1
DOI: https://doi.org/10.17226/26245

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National Academies of Sciences, Engineering, and Medicine. 2020. Forum on Microbial Threats: 2019 Annual Report. Washington, DC: The National Academies Press.

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On June 11 and June 12, 2019, the National Academies convened a workshop to explore the growing understanding of how the interplay between humans and microbes affects host physiology and causes noncommunicable diseases. Discussions included an overview of colliding epidemics, emerging research on associations between infectious and noncommunicable diseases, risks posed by chronic diseases to the development and severity of infectious diseases, and the influence of the microbiome. Workshop participants also examined the challenges and opportunities of convergence, the integration of health care delivery models and interventions, potential approaches for research, policy, and practice in the immediate-term, and potential directions for the long-term. This publication summarizes the presentations and discussions from the workshop.

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184 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-49614-4
ISBN Ebook: 0-309-49615-2
DOI: https://doi.org/10.17226/25535

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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.

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Microbial threats, including endemic and emerging infectious diseases and antimicrobial resistance, can cause not only substantial health consequences but also enormous disruption to economic activity worldwide. While scientific advances have undoubtedly strengthened our ability to respond to and mitigate the mortality of infectious disease threats, events over the past two decades have illustrated our continued vulnerability to economic consequences from these threats.

To assess the current understanding of the interaction of infectious disease threats with economic activity and suggest potential new areas of research, the National Academies of Sciences, Engineering, and Medicine planned a 1.5-day public workshop on understanding the economics of microbial threats. This workshop built on prior work of the Forum on Microbial Threats and aimed to help transform current knowledge into immediate action. This publication summarizes the presentations and discussions from the workshop.

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168 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-48302-6
ISBN Ebook: 0-309-48303-4
DOI: https://doi.org/10.17226/25224

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National Academies of Sciences, Engineering, and Medicine. 2018. Understanding the Economics of Microbial Threats: Proceedings of a Workshop. Washington, DC: The National Academies Press.

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The urban built environment is a prime setting for microbial transmission, because just as cities serve as hubs for migration and international travel, components of the urban built environment serve as hubs that drive the transmission of infectious disease pathogens. The risk of infectious diseases for many people living in slums is further compounded by their poverty and their surrounding physical and social environment, which is often overcrowded, is prone to physical hazards, and lacks adequate or secure housing and basic infrastructure, including water, sanitation, or hygiene services.

To examine the role of the urban built environment in the emergence and reemergence of infectious diseases that affect human health, the National Academies of Sciences, Engineering, and Medicine planned a public workshop. This publication summarizes the presentations and discussions from the workshop.

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148 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-47439-6
ISBN Ebook: 0-309-47440-X
DOI: https://doi.org/10.17226/25070

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Over the past several decades, new scientific tools and approaches for detecting microbial species have dramatically enhanced our appreciation of the diversity and abundance of the microbiota and its dynamic interactions with the environments within which these microorganisms reside. The first bacterial genome was sequenced in 1995 and took more than 13 months of work to complete. Today, a microorganism's entire genome can be sequenced in a few days. Much as our view of the cosmos was forever altered in the 17th century with the invention of the telescope, these genomic technologies, and the observations derived from them, have fundamentally transformed our appreciation of the microbial world around us.

On June 12 and 13, 2012, the Institute of Medicine's (IOM's) Forum on Microbial Threats convened a public workshop in Washington, DC, to discuss the scientific tools and approaches being used for detecting and characterizing microbial species, and the roles of microbial genomics and metagenomics to better understand the culturable and unculturable microbial world around us. Through invited presentations and discussions, participants examined the use of microbial genomics to explore the diversity, evolution, and adaptation of microorganisms in a wide variety of environments; the molecular mechanisms of disease emergence and epidemiology; and the ways that genomic technologies are being applied to disease outbreak trace back and microbial surveillance. Points that were emphasized by many participants included the need to develop robust standardized sampling protocols, the importance of having the appropriate metadata, data analysis and data management challenges, and information sharing in real time. The Science and Applications of Microbial Genomics summarizes this workshop.

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428 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-26819-2
ISBN Ebook: 0-309-26820-6
DOI: https://doi.org/10.17226/18261

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Institute of Medicine. 2013. The Science and Applications of Microbial Genomics: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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632 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-26432-4
ISBN Ebook: 0-309-26433-2
DOI: https://doi.org/10.17226/13500

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Institute of Medicine. 2012. The Social Biology of Microbial Communities: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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418 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-25933-9
ISBN Ebook: 0-309-25934-7
DOI: https://doi.org/10.17226/13423

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Institute of Medicine. 2012. Improving Food Safety Through a One Health Approach: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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488 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-21226-X
ISBN Ebook: 0-309-21227-8
DOI: https://doi.org/10.17226/13147

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Institute of Medicine. 2011. Fungal Diseases: An Emerging Threat to Human, Animal, and Plant Health: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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604 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-18634-X
ISBN Ebook: 0-309-18635-8
DOI: https://doi.org/10.17226/13087

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Institute of Medicine. 2011. The Causes and Impacts of Neglected Tropical and Zoonotic Diseases: Opportunities for Integrated Intervention Strategies. Washington, DC: The National Academies Press.

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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.

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496 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-15611-4
ISBN Ebook: 0-309-15612-2
DOI: https://doi.org/10.17226/12925

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Institute of Medicine. 2010. Antibiotic Resistance: Implications for Global Health and Novel Intervention Strategies: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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440 pages · 6.25 x 9.25 · paperback
ISBN Paperback: 0-309-14677-1
ISBN Ebook: 0-309-14678-X
DOI: https://doi.org/10.17226/12799

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Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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350 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-10897-7
ISBN Ebook: 0-309-10898-5
DOI: https://doi.org/10.17226/11950

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Institute of Medicine. 2008. Vector-Borne Diseases: Understanding the Environmental, Human Health, and Ecological Connections: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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284 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-11114-5
ISBN Ebook: 0-309-11115-3
DOI: https://doi.org/10.17226/11996

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Institute of Medicine. 2007. Global Infectious Disease Surveillance and Detection: Assessing the Challenges—Finding Solutions: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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250 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-10769-5
ISBN Ebook: 0-309-10770-9
DOI: https://doi.org/10.17226/11917

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Institute of Medicine. 2007. Ethical and Legal Considerations in Mitigating Pandemic Disease: Workshop Summary. Washington, DC: The National Academies Press.

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In December 2004, at a press conference called to announce his departure as Secretary of the Department of Health and Human Services (HHS), Tommy Thompson raised both concern and controversy when he remarked that he could not understand why the terrorists had not yet attacked our food supply "because it is so easy to do." Although to date the United States has been spared such a disaster, the many documented examples of unintentional outbreaks of foodborne disease—some of which have sickened hundreds of thousands of people, and killed hundreds—provide a grim basis for estimating the impact of deliberate food adulteration. Due to the wide variety of potential chemical and biological agents that could be introduced at many vulnerable points along the food supply continuum, contaminating food is considered an especially simple, yet effective, means to threaten large populations.

To explore the nature and extent of such threats, possibilities for reducing their impact, and obstacles to this goal, the Forum on Microbial Threats of the Institute of Medicine (IOM) convened the workshop Foodborne Threats to Health: The Policies and Practice of Surveillance, Prevention, Outbreak Investigations, and International Coordination on October 25 and 26, 2005. Workshop participants discussed the threat spectrum and burden of disease associated with foodborne illness and the role that increasing globalization of food production and distribution plays in the transmission of foodborne disease. Participants also reviewed existing research, policies, and practices concerning foodborne threats in order to identify unmet needs, challenges, and opportunities for improving food safety systems, surveillance, and emergency response.

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 presents their beliefs on which areas may merit further attention. However, the reader should be aware that the material presented here expresses the views and opinions of the individuals participating in the workshop and not the deliberations of a formally constituted IOM study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation.

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304 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-10043-7
ISBN Ebook: 0-309-65457-2
DOI: https://doi.org/10.17226/11745

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Institute of Medicine. 2006. Addressing Foodborne Threats to Health: Policies, Practices, and Global Coordination: Workshop Summary. Washington, DC: The National Academies Press.

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Infectious diseases have existed longer than us, as long as us, or are relatively newer than us. It may be the case that a disease has existed for many, many years but has only recently begun affecting humans. At the turn of the century the number of deaths caused by infections in the United States had been falling steadily but since the '80s has seen an increase. In the past 30 years alone 37 new pathogens have been identified as human disease threats and 12% of known human pathogens have been classified as either emerging or remerging. Whatever the story, there is currently a "war" on infectious diseases. This war is simply the systematic search for the microbial "cause" of each disease, followed by the development of antimicrobial therapies.

The "war" on infectious diseases, however, must be revisited in order to develop a more realistic and detailed picture of the dynamic interactions among and between host organisms and their diverse populations of microbes. Only a fraction of these microbes are pathogens. Thus, in order to explore the crafting of a new metaphor for host-microbe relationships, and to consider how such a new perspective might inform and prioritize biomedical research, the Forum on Microbial Threats of the Institute of Medicine (IOM) convened the workshop, Ending the War Metaphor: The Changing Agenda for Unraveling the Host-Microbe Relationship on March 16-17, 2005.

Workshop participants examined knowledge and approaches to learning about the bacterial inhabitants of the human gut, the best known host-microbe system, as well as findings from studies of microbial communities associated with other mammals, fish, plants, soil, and insects. The perspective adopted by this workshop is one that recognizes the breadth and diversity of host-microbe relationships beyond those relative few that result in overt disease. Included in this summary are the reports and papers of individuals participating in the Forum as well as the views of the editors.

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306 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-09601-4
ISBN Ebook: 0-309-54904-3
DOI: https://doi.org/10.17226/11669

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Institute of Medicine. 2006. Ending the War Metaphor: The Changing Agenda for Unraveling the Host-Microbe Relationship: Workshop Summary. Washington, DC: The National Academies Press.

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Globalization is by no means a new phenomenon; transcontinental trade and the movement of people date back at least 2,000 years, to the era of the ancient Silk Road trade route. The global spread of infectious disease has followed a parallel course. Indeed, the emergence and spread of infectious disease are, in a sense, the epitome of globalization. Although some experts mark the fall of the Berlin Wall as the beginning of this new era of globalization, others argue that it is not so new. The future of globalization is still in the making. Despite the successful attempts of the developed world during the course of the last century to control many infectious diseases and even to eradicate some deadly afflictions, 13 million people worldwide still die from such diseases every year.

On April 16 and 17, 2002, the Forum on Emerging Infections held a working group discussion on the influence of globalization on the emergence and control of infectious diseases. The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop.

The Impact of Globalization on Infectious Disease Emergence and Control report summarizes the presentations and discussions related to the increasing cross-border and cross-continental movements of people and how this could exacerbate the emergence and global spread of infectious diseases. This report also summarizes the means by which sovereign states and nations must adopt a global public health mind-set and develop a new organizational framework to maximize the opportunities and overcome the challenges created by globalization and build the necessary capacity to respond effectively to emerging infectious disease threats.

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246 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-10098-4
ISBN Ebook: 0-309-65676-1
DOI: https://doi.org/10.17226/11588

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Institute of Medicine. 2006. The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the Consequences and Opportunities: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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238 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-10010-0
ISBN Ebook: 0-309-65334-7
DOI: https://doi.org/10.17226/11563

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Institute of Medicine. 2006. Ensuring an Infectious Disease Workforce: Education and Training Needs for the 21st Century: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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430 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-09504-2
ISBN Ebook: 0-309-54685-0
DOI: https://doi.org/10.17226/11150

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Institute of Medicine. 2005. The Threat of Pandemic Influenza: Are We Ready? Workshop Summary. Washington, DC: The National Academies Press.

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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 Medicine'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.

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234 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-08994-8
ISBN Ebook: 0-309-52672-8
DOI: https://doi.org/10.17226/11026

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Institute of Medicine. 2004. The Infectious Etiology of Chronic Diseases: Defining the Relationship, Enhancing the Research, and Mitigating the Effects: Workshop Summary. Washington, DC: The National Academies Press.

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The emergence of severe acute respiratory syndrome (SARS) in late 2002 and 2003 challenged the global public health community to confront a novel epidemic that spread rapidly from its origins in southern China until it had reached more than 25 other countries within a matter of months. In addition to the number of patients infected with the SARS virus, the disease had profound economic and political repercussions in many of the affected regions. Recent reports of isolated new SARS cases and a fear that the disease could reemerge and spread have put public health officials on high alert for any indications of possible new outbreaks. This report examines the response to SARS by public health systems in individual countries, the biology of the SARS coronavirus and related coronaviruses in animals, the economic and political fallout of the SARS epidemic, quarantine law and other public health measures that apply to combating infectious diseases, and the role of international organizations and scientific cooperation in halting the spread of SARS. The report provides an illuminating survey of findings from the epidemic, along with an assessment of what might be needed in order to contain any future outbreaks of SARS or other emerging infections.

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376 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-09154-3
ISBN Ebook: 0-309-59433-2
DOI: https://doi.org/10.17226/10915

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Institute of Medicine. 2004. Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington, DC: The National Academies Press.

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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.

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333 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-08854-2
ISBN Ebook: 0-309-50746-4
DOI: https://doi.org/10.17226/10651

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Institute of Medicine. 2003. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for Containment: Workshop Summary. Washington, DC: The National Academies Press.

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Since smallpox eradication, the science of eradication has changed and with it, our definitions of what diseases are possible to eradicate. However, eradication must not beget complacency. As has been learned from past control or eradication attempts with a variety of viral diseases, from yellow fever to influenza, accidental or intentional reintroduction is a real threat—one that could strike anywhere and for which we need to be fully prepared. The criteria for assessing eradicability of polio, measles, and other viral infections have been debated extensively. With the elimination and eradication of several viral diseases on the horizon, issues surrounding the cessation of immunization activities become exceedingly important. In an effort to better understand the dynamics of disease eradication and post-immunization policies, the Institute of Medicine Forum on Emerging Infections hosted a two-day workshop (February 1–2, 2001) on The Consequences of Viral Disease Eradication. This book explores the principles underlying the biological challenges, medical interventions, the continuing research agenda, and operational considerations for post-immunization strategies for vaccine-preventable viral diseases, and highlights important efforts that may facilitate wise decision making.

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232 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-08414-8
ISBN Ebook: 0-309-50089-3
DOI: https://doi.org/10.17226/10424

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Institute of Medicine. 2002. Considerations for Viral Disease Eradication: Lessons Learned and Future Strategies: Workshop Summary. Washington, DC: The National Academies Press.

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Zoonotic diseases represent one of the leading causes of illness and death from infectious disease. Defined by the World Health Organization, zoonoses are "those diseases and infections that are naturally transmitted between vertebrate animals and man with or without an arthropod intermediate." Worldwide, zoonotic diseases have a negative impact on commerce, travel, and economies. In most developing countries, zoonotic diseases are among those diseases that contribute significantly to an already overly burdened public health system. In industrialized nations, zoonotic diseases are of particular concern for at-risk groups such as the elderly, children, childbearing women, and immunocompromised individuals.

The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health, covers a range of topics, which include: an evaluation of the relative importance of zoonotic diseases against the overall backdrop of emerging infections; research findings related to the current state of our understanding of zoonotic diseases; surveillance and response strategies to detect, prevent, and mitigate the impact of zoonotic diseases on human health; and information about ongoing programs and actions being taken to identify the most important needs in this vital area.

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176 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-08327-3
ISBN Ebook: 0-309-50869-X
DOI: https://doi.org/10.17226/10338

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Institute of Medicine. 2002. The Emergence of Zoonotic Diseases: Understanding the Impact on Animal and Human Health: Workshop Summary. Washington, DC: The National Academies Press.

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In the wake of September 11th and recent anthrax events, our nation's bioterrorism response capability has become an imminent priority for policymakers, researchers, public health officials, academia, and the private sector. In a three-day workshop, convened by the Institute of Medicine's Forum on Emerging Infections, experts from each of these communities came together to identify, clarify, and prioritize the next steps that need to be taken in order to prepare and strengthen bioterrorism response capabilities. From the discussions, it became clear that of utmost urgency is the need to cast the issue of a response in an appropriate framework in order to attract the attention of Congress and the public in order to garner sufficient and sustainable support for such initiatives. No matter how the issue is cast, numerous workshop participants agreed that there are many gaps in the public health infrastructure and countermeasure capabilities that must be prioritized and addressed in order to assure a rapid and effective response to another bioterrorist attack.

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335 pages · 6 x 9 ·
ISBN Ebook: 0-309-51025-2
DOI: https://doi.org/10.17226/10290

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Institute of Medicine. 2002. Biological Threats and Terrorism: Assessing the Science and Response Capabilities: Workshop Summary. Washington, DC: The National Academies Press.

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In October 1999, the Forum on Emerging Infections of the Institute of Medicine convened a two-day workshop titled "International Aspects of Emerging Infections." Key representatives from the international community explored the forces that drive emerging infectious diseases to prominence.

Representatives from the Americas, Africa, Asia and the Pacific, and Europe made formal presentations and engaged in panel discussions. Emerging Infectious Diseases from the Global to the Local Perspective includes summaries of the formal presentations and suggests an agenda for future action.

The topics addressed cover a wide range of issues, including trends in the incidence of infectious diseases around the world, descriptions of the wide variety of factors that contribute to the emergence and reemergence of these diseases, efforts to coordinate surveillance activities and responses within and across borders, and the resource, research, and international needs that remain to be addressed.

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134 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-07184-4
ISBN Ebook: 0-309-56482-4
DOI: https://doi.org/10.17226/10084

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Institute of Medicine. 2001. Emerging Infectious Diseases from the Global to the Local Perspective: A Summary of a Workshop of the Forum on Emerging Infections. Washington, DC: The National Academies Press.

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The Forum on Emerging Infections was created in 1996 in response to a request from the Centers for Disease Control and Prevention and the National Institutes of Health. 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 relate to research, prevention, detection, and management of emerging infectious diseases. A critical part of this mission has been the convening of a series of workshops. Public Health Systems and Emerging Infections summarizes the fourth in a series of five workshops.

With a focus on our knowledge and understanding of the role of private and public health sectors in emerging infectious disease surveillance and response, the participants explored the effects of privatization of public health laboratories and the modernization of public health care. The issues discussed included epidemiological investigation, surveillance, communication, coordination, resource allocations, and economic support.

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128 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-06829-0
ISBN Ebook: 0-309-55817-4
DOI: https://doi.org/10.17226/9869

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Institute of Medicine. 2000. Public Health Systems and Emerging Infections: Assessing the Capabilities of the Public and Private Sectors: Workshop Summary. Washington, DC: The National Academies Press.

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This workshop summary report examines how the managed care revolution has created both problems and opportunities in the fight against infectious diseases. It highlights ways in which managed care systems can aid research, develop clinical guidelines, manage the use of antibiotics, support public education efforts, and monitor the spread of emerging infections and microbial resistance.

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127 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-06828-2
ISBN Ebook: 0-309-59388-3
DOI: https://doi.org/10.17226/9760

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Institute of Medicine. 2000. Managed Care Systems and Emerging Infections: Challenges and Opportunities for Strengthening Surveillance, Research, and Prevention: Workshop Summary. Washington, DC: The National Academies Press.

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Antibiotic resistance is neither a surprising nor a new phenomenon. It is an increasingly worrisome situation, however, because resistance is growing and accelerating while the world's tools for combating it decrease in power and number. In addition, the cost of the problem—especially of multidrug resistance—in terms of money, mortality, and disability are also rising. This book summarizes a workshop on antimicrobial resistance held by the Forum on Emerging Infections. The goal of the Forum on Emerging Infections is to provide an opportunity for representatives of academia, industry, government, and professional and interest groups to examine and discuss scientific and policy dilemmas of common interest that are specifically related to research on and the prevention, detection, and management of emerging infections. Organized as a topic-by-topic synthesis of presentations and exchanges during the workshop, the book highlights lessons learned, delineates a range of pivotal issues and the problems they raise, and proposes some simplified ideas about possible responses.

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128 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-06084-2
ISBN Ebook: 0-309-59183-X
DOI: https://doi.org/10.17226/6121

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Institute of Medicine. 1998. Antimicrobial Resistance: Issues and Options. Washington, DC: The National Academies Press.

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Infectious diseases remain a leading cause of prolonged illness, premature mortality, and soaring health costs. In the United States in 1995, infectious diseases were the third leading cause of death, right behind heart disease and cancer. Mortality is mounting over time, owing to HIV/AIDS, pneumonia, and septicemia, with drug resistance playing an ever-increasing role in each of these disease categories. This book, a report from a Forum on Emerging Infections workshop, focuses on product areas where returns from the market might be perceived as being too small or too complicated by other factors to compete in industrial portfolios with other demands for investment. Vaccines are quintessential examples of such products. The lessons learned fall into four areas, including what makes intersectoral collaboration a reality, the notion of a product life cycle, the implications of divergent sectoral mandates and concepts of risk, and the roles of advocacy and public education. The summary contains an examination of the Children's Vaccine Initiative and other models, an industry perspective on the emerging infections agenda, and legal and regulatory issues.

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112 pages · 6 x 9 · paperback
ISBN Paperback: 0-309-05941-0
ISBN Ebook: 0-309-59133-3
DOI: https://doi.org/10.17226/5948

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Institute of Medicine. 1997. Orphans and Incentives: Developing Technology to Address Emerging Infections. Washington, DC: The National Academies Press.

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