Excerpt

In an effort to identify cross-disciplinary aspects of the challenge of infectious etiologies of chronic diseases, including inflammatory syndromes and cancer, the Institute of Medicine's Forum on Microbial Threats hosted a two-day workshop on October 21–22, 2002. The workshop, Linking Infectious Agents and Chronic Diseases, explored the factors that drive infectious etiologies of chronic diseases to prominence, and sought to identify more broad-based strategies and research programs that need to be developed. The goals of the workshop were to:

1. Review the range of pathogenic mechanisms and diversity of etiologic microbes and chronic diseases, including inflammatory syndromes and cancer;
2. Explore trends, advances, and gaps in collaborative research on diagnostic technologies, and their integration into epidemiologic studies and surveillance;
3. Identify chronic diseases and syndromes that warrant further investigation;
4. Identify research needed to clarify the etiologic agents and pathogenic mechanisms involved in chronic diseases, screening for multiple potential agents of the same outcome, and considering that one microbe might induce multiple syndromes;
5. Identify the principal bottlenecks and opportunities to detect, prevent, and mitigate the impact of chronic diseases on human health against the overall backdrop of emerging infections;
6. Consider the benefits and risks of early detection and prevention of chronic diseases caused by infectious agents.

The issues pertaining to these goals were addressed through invited presentations and subsequent discussions, which highlighted ongoing programs and actions taken, and also identified the most vital needs in this important area.

Contents

• THE NATIONAL ACADEMIES
• FORUM ON MICROBIAL THREATS
• BOARD ON GLOBAL HEALTH
• Reviewers
• Preface
• ACKNOWLEDGMENTS
• Summary and Assessment
  • DEFINING THE RELATIONSHIP
  • IMPLICATIONS FOR DEVELOPING COUNTRIES
  • OBSTACLES AND OPPORTUNITIES FOR FRAMING THE RESEARCH: PRIORITIES FOR THE FUTURE
  • OPPORTUNITIES TO PREVENT AND MITIGATE THE IMPACT OF CHRONIC DISEASES CAUSED BY INFECTIOUS AGENTS
  • CONCLUSION
• 1. Defining the Relationship: An Examination of Infectious Agents Associated with Chronic Diseases
  • OVERVIEW
  • THE ROLE OF VIRUSES IN ONCOGENESIS: HUMAN PAPILLOMAVIRUSES AND CERVICAL CANCER AS A PARADIGM
  • CHRONIC HEPATITIS B VIRUS INFECTIONS
  • INFECTIOUS AGENTS AND CARDIOVASCULAR DISEASE
  • DEMYELINATING DISEASES
  • COMMON INFECTIONS AND UNCOMMON DISEASE: ELUSIVE ASSOCIATIONS OF ENTEROVIRUSES AND TYPE I DIABETES MELLITUS
  • INFECTIOUS AGENTS AND SCHIZOPHRENIA
  • OVINE PULMONARY ADENOCARCINOMA: IDENTIFYING THE CAUSATIVE AGENT FOR A NEOPLASTIC DISEASE AND IMPLICATIONS FOR HUMAN LUNG CANCER
  • PROPIONIBACTERIUM ACNES AND CHRONIC DISEASES
• 2. Endemic Infectious Diseases Linked to Chronic Diseases: Implications for Developing Countries
  • OVERVIEW
  • POTENTIAL LONG-TERM CONSEQUENCES OF EARLY CHILDHOOD ENTERIC AND PARASITIC INFECTIONS
  • INFECTIOUS AGENTS AND EPILEPSY
  • CONTROL OF INFECTIOUS CAUSES OF CHILDHOOD DISABILITY IN DEVELOPING COUNTRIES
  • HTLV-1: CLINICAL IMPACT OF A CHRONIC INFECTION
  • PROGRESSION OF HEPATITIS C VIRUS INFECTION WITH AND WITHOUT SCHISTOSOMIASIS
  • INTERACTIONS OF MULTIPLE INFECTIOUS AGENTS IN MALARIA-ENDEMIC AREAS: CONCURRENT HIV/AIDS AND MALARIA
• 3. Obstacles and Opportunities for Framing Future Research
  • OVERVIEW
  • PATHOGENS AND DISEASE: ISSUES IN DETERMINING CAUSALITY
  • EXPLORING THE GENETIC BACKGROUND–ENVIRONMENT INTERPLAY IN AN ANIMAL MODEL OF NEURODEVELOPMENTAL DISORDERS: A MULTIDISCIPLINARY APPROACH
  • INFECTION, CANCER, AND THE IMMUNE RESPONSE
• 4. Opportunities to Prevent and Mitigate the Impact of Chronic Diseases Caused by Infectious Agents
  • OVERVIEW
  • DEVELOPING VACCINES FOR PREVENTION OF CHRONIC DISEASE
  • TOWARD A STRATEGIC APPROACH: INTEGRATING EPIDEMIOLOGY, LABORATORY RESEARCH, AND SURVEILLANCE; SETTING PRIORITIES
• APPENDIXES
  • Appendix A Workshop Agenda
  • Appendix B Information Resources
  • Appendix C Biosketches

Support for this project was provided by the U.S. Department of Health and Human Services' National Institutes of Health, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Agency for International Development; U.S. Department of Defense; U.S. Department of State; U.S. Department of Veterans Affairs; U.S. Department of Agriculture; American Society for Microbiology; Burroughs Wellcome Fund; Ellison Medical Foundation; Pfizer; GlaxoSmithKline; and The Merck Company Foundation.

The views presented in this report are those of the editors and attributed authors 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.

This report is based on the proceedings of a workshop that was sponsored by the Forum on Microbial Threats. It is prepared in the form of a workshop summary by and in the name of the editors, with the assistance of staff and consultants, as an individually authored document. Sections of the workshop summary not specifically attributed to an individual reflect the views of the editors and not those of the Forum on Microbial Threats. The content of those sections is based on the presentations and the discussions that took place during the workshop.