Infectious diseases are a global hazard that puts every nation and every person at risk. The recent SARS outbreak is a prime example. Knowing neither geographic nor political borders, often arriving silently and lethally, microbial pathogens constitute a grave threat to the health of humans. Indeed, a majority of countries recently identified the spread of infectious disease as the greatest global problem they confront. Throughout history, humans have struggled to control both the causes and consequences of infectious diseases and we will continue to do so into the foreseeable future.

Following up on a high-profile 1992 report from the Institute of Medicine, Microbial Threats to Health examines the current state of knowledge and policy pertaining to emerging and re-emerging infectious diseases from around the globe. It examines the spectrum of microbial threats, factors in disease emergence, and the ultimate capacity of the United States to meet the challenges posed by microbial threats to human health. From the impact of war or technology on disease emergence to the development of enhanced disease surveillance and vaccine strategies, Microbial Threats to Health contains valuable information for researchers, students, health care providers, policymakers, public health officials. and the interested public.

Contents

• THE NATIONAL ACADEMIES
• COMMITTEE ON MICROBIAL THREATS TO HEALTH IN THE 21ST CENTURY
• Reviewers
• Cover Artwork
• Preface
• Acknowledgments
• Synopsis
• Acronyms
• Executive Summary
• 1. Introduction
• 2. Spectrum of Microbial Threats
  • THE GLOBAL BURDEN OF AIDS, TUBERCULOSIS, AND MALARIA
  • EMERGING INFECTIOUS DISEASES
  • ANTIMICROBIAL-RESISTANT INFECTIONS
  • CHRONIC DISEASES WITH INFECTIOUS ETIOLOGY
  • MICROBES INTENTIONALLY USED FOR HARM
• 3. Factors in Emergence
  • MICROBIAL ADAPTATION AND CHANGE
  • HUMAN SUSCEPTIBILITY TO INFECTION
  • CLIMATE AND WEATHER
  • CHANGING ECOSYSTEMS
  • ECONOMIC DEVELOPMENT AND LAND USE
  • HUMAN DEMOGRAPHICS AND BEHAVIOR
  • TECHNOLOGY AND INDUSTRY
  • INTERNATIONAL TRAVEL AND COMMERCE
  • BREAKDOWN OF PUBLIC HEALTH MEASURES
  • POVERTY AND SOCIAL INEQUALITY
  • WAR AND FAMINE
  • LACK OF POLITICAL WILL
  • INTENT TO HARM
  • A CASE IN POINT: INFLUENZA—WE ARE UNPREPARED
• 4. Addressing the Threats: Conclusions and Recommendations
  • ENHANCING GLOBAL RESPONSE CAPACITY
  • IMPROVING GLOBAL INFECTIOUS DISEASE SURVEILLANCE
  • REBUILDING DOMESTIC PUBLIC HEALTH CAPACITY
  • IMPROVING DOMESTIC SURVEILLANCE THROUGH BETTER DISEASE REPORTING
  • EXPLORING INNOVATIVE SYSTEMS OF SURVEILLANCE
  • DEVELOPING AND USING DIAGNOSTICS
  • EDUCATING AND TRAINING THE MICROBIAL THREAT WORKFORCE
  • VACCINE DEVELOPMENT AND PRODUCTION
  • NEED FOR NEW ANTIMICROBIAL DRUGS
  • INAPPROPRIATE USE OF ANTIMICROBIALS
  • VECTOR-BORNE AND ZOONOTIC DISEASE CONTROL
  • COMPREHENSIVE INFECTIOUS DISEASE RESEARCH AGENDA
  • INTERDISCIPLINARY INFECTIOUS DISEASE CENTERS
• Epilogue
• Glossary
• References
• Appendix A Microbial Threats to Health Public Committee Meeting Agendas
• Appendix B Syndromic Surveillance
• Appendix C Pathogen Discovery, Detection, and Diagnostics
• Appendix D Forum on Emerging Infections Membership and Publications Board on Global Health
• Appendix E Computational Modeling and Simulation of Epidemic Infectious Diseases
• Appendix F Committee and Staff Biographies

Support for this project was provided by the Centers for Disease Control and Prevention's National Center for Infectious Diseases (Contract No. H75/CCH311468, TO#8), the U.S. Department of Defense (Contract No. DAMD17-01-2-0040), the U.S. Agency for International Development (Contract No. HRN-A-00-00-00012-00), the U.S. Department of Agriculture's Food Safety and Inspection Service (Contract No. 590-0790-1-188), the National Institutes of Health's National Institute of Allergy and Infectious Diseases, the National Institutes of Health's Fogarty International Center, the Ellison Medical Foundation, the U.S. Food and Drug Administration, and the U.S. Joint Institute for Food Safety Research. The views presented in this report are those of the Institute of Medicine Committee on Emerging Microbial Threats to Health in the 21st Century and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.