The Forum on Microbial Threats 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 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.


The belief that many long-recognized chronic diseases are infectious in origin goes back to the mid-nineteenth century, when cancer was studied as a possible infectious disease. In the 1950s and 1960s, much biomedical research was directed, unsuccessfully, at the identification of microorganisms purportedly causing a variety of chronic diseases. In recent years the picture has begun to change. One chronic disease after another has been linked, in some cases definitively, to an infectious etiology (e.g., peptic ulcer disease with Helicobacter pylori, cervical cancer with several human papillomaviruses, Whipple's disease with Tropheryma whippeli, Lyme arthritis and neuroborreliosis with Borrelia burgdorferi, AIDS with HIV). Evidence implicating microorganisms as etiologic agents of chronic diseases with substantial mortality and morbidity impact, including atherosclerosis and cardiovascular disease, diabetes mellitus, inflammatory bowel disease, and a variety of neurological and neuropsychiatric diseases, continues to mount.

Emerging infectious diseases are conceptualized as either newly identified or appreciated illnesses, conditions, or well-recognized diseases that are newly attributed to infection. Now, scientists are beginning to believe that a substantial portion of chronic diseases may actually be associated with infection.

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.


This workshop summary report is prepared for the Forum membership in the name of the editors, with the assistance of staff and consultants, as a collection of individually authored papers. 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' sponsors or the Institute of Medicine (IOM). The contents of the unattributed sections are based on the presentations and discussions that took place during the workshop.

The workshop summary is organized within chapters as a topic-by-topic description of the presentations and discussions. Its purpose is to present lessons from relevant experience, delineate a range of pivotal issues and their respective problems, and put forth some potential responses as described by the workshop participants. The Summary and Assessment chapter discusses the core messages that emerged from the speakers' presentations and the ensuing discussions. Chapters 1 through 4 begin with overviews provided by the editors, followed by authored papers that reflect the topics and findings of the authors' workshop presentations. Chapter 1 presents case studies of infectious agents that have been shown to be associated with chronic diseases. Chapter 2 illustrates implications for developing countries where many infectious diseases remain endemic. Chapter 3 describes methodologies currently used in this area of research. Chapter 4 presents strategies to prevent and mitigate the impact of chronic diseases caused by infectious agents. Appendix A presents the workshop agenda. Appendix B is a list of information resources that review the relationship between infections and chronic diseases. Appendix C presents Forum member and speaker biographies.

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 those 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.