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Institute of Medicine (US) Forum on Emerging Infections; Knobler S, Lederberg J, Pray LA, editors. Considerations for Viral Disease Eradication: Lessons Learned and Future Strategies: Workshop Summary. Washington (DC): National Academies Press (US); 2002.

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Considerations for Viral Disease Eradication: Lessons Learned and Future Strategies: Workshop Summary.

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Appendix BWorkshop Agenda

The Consequences of Viral Disease Eradication: Addressing Post-Immunization Challenges

February 1–2, 2001

Lecture Room

National Academy of Sciences

2101 Constitution Avenue, N.W., Washington, DC

Thursday, February 1, 2001

8:30Continental Breakfast
9:00Welcome and workshop introduction
Joshua Lederberg, Ph.D.
Chair, Forum on Emerging Infections
Sackler Foundation Scholar and Nobel Laureate
The Rockefeller University, New York, NY
9:15Keynote address
History and Prospects for Disease Eradication
Ciro de Quadros, M.D., M.P.H.
Director, Division of Vaccines and Immunization
Pan American Health Organization, Washington, DC

Session I. Case Studies of Major Eradication or Elimination Efforts

This session will address the standards and strategies, technical feasibility, political will, and financial commitment for several diseases targeted for eradication or elimination. Discussions will identify the successes and failures of these efforts, and the challenges for post-eradication/elimination strategies.

10:00Smallpox
Donald A. Henderson, M.D., M.P.H.
Director, Center for Civilian Biodefense Studies
The Johns Hopkins University, Baltimore, MD
10:30Break
10:45The next target after polio: Global eradication of measles
Stephen Cochi, M.D., M.P.H.
Director, Vaccine-Preventable Disease Eradication Division
National Immunization Program, Centers for Disease Control and Prevention, Atlanta GA
11:15Eradication of congenital rubella syndrome
Stanley A. Plotkin, M.D.
Aventis Pasteur, Swiftwater, PA
11:45Post-polio eradication: Issues and challenges
Walter R. Dowdle, M.D.
Public Health Consultant
Task Force for Child Survival and Development, Atlanta, GA
12:15Lunch

Session II. Biologic Challenges to Post-Eradication

This session will address the science-based underpinnings of how and when to stop immunization, and the protective actions that remain to be established. We will examine the current state-of-the-science of several diseases poised for elimination/eradication and identify gaps in our knowledge, primarily focusing on the risk of pathogen transmission to and maintenance in susceptible individuals. Through the issues discussed we will identify the effect they have on the duration of disease elimination/eradication programs, as well as the likelihood for their success.

1:30Duration of infection, recrudescence, and environmental stability of pathogens targeted for elimination
Professor Roy Anderson
Chair, Department of Infectious Disease Epidemiology
Imperial College School of Medicine, London, UK
2:15Laboratory specimens, genetic research, bio-engineering, and the danger of malice
C.J. Peters, M.D.
Professor, Departments of Pathology, and Microbiology and Immunology
Center for Tropical Diseases, University of Texas Medical Branch, Galveston, TX
2.45Break
3:00Natural SIV reservoirs and human zoonotic risk
Beatrice H. Hahn, M.D.
Professor, Departments of Medicine and Microbiology
University of Alabama, Birmingham, AL
3:30Vaccine-associated cases
Jeffrey I. Cohen, M.D
Head, Medical Virology Section, Laboratory of Clinical Investigation
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD
4:00Adjourn public session

Friday, February 2, 2001

7:30Continental Breakfast
8:00Opening remarks
Joshua Lederberg, Ph.D.
Chair, Forum on Emerging Infections

Session III. Challenges to Post-Eradication Operational and Institutional Remediation

The need for resources will likely increase for countries with multiple eradication campaigns, particularly as disease prevalence decreases and surveillance intensifies. This session will address the thoroughness with which public health systems and laboratories are able to define their limitations and manage their resources.

8:15International health regulations and quarantine
Marlo Libel, M.D.
Division of Disease Prevention and Control
Pan American Health Organization, Washington, DC
9:00Disease surveillance, program management, and sustainability of immunization programs
Donald S. Burke, M.D.
Professor and Director, Center for Immunization Research, Department of International Health
School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD
9:30The capacity of public health services to respond to an outbreak in the post-eradication era
Carl E. Taylor, M.D., M.P.H.
Professor Emeritus, Department of International Health
School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD
10:00Laboratory security and regulations governing viral pathogenesis in a post-immunization era
Raymond H. Cypess, D.V.M., Ph.D.
President and CEO
American Type Culture Collection (ATCC), Manassas, VA
Frank Simione, M.S.
American Type Culture Collection (ATCC), Manassas, VA
10:30Break

Session IV. Medical Intervention and Technological Solutions

Many of the vaccines and drugs available today are the same ones that have been used for decades. This session will review the present vaccine and drug armamentaria with a view toward improving their safety, efficacy and potential value against diseases targeted for eradication.

10:45The polio eradication effort: should vaccine eradication be next?
Vincent R. Racaniello, Ph.D.
Higgins Professor, Department of Microbiology, and Editor, Journal of Virology
Columbia University College of Physicians & Surgeons, New York, NY
11:15Antiviral therapy in the management of post-eradication outbreaks
Richard J. Whitley, M.D.
Professor, Department of Pediatrics
Ambulatory Care Center, School of Medicine, University of Alabama, South Birmingham, AL
11:45Passive antibody and immune-enhancement strategies
Diane E. Griffin, M.D., Ph.D.
Professor and Chair, Department of Molecular Microbiology and Immunology
School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD
12:15The potential role of probiotics and microbial ecology in host defense
Susanna Cunningham-Rundles, Ph.D.
Professor of Immunology
Weill Medical College of Cornell University, New York, NY
12:45Lunch

Session V. The Response to Post-Eradication Outbreaks

Protecting populations that are no longer immune presents formidable challenges to public health agencies, pharmaceutical manufacturers, security analysts, and the public. Resolution of these issues in advance affects when and how prevention activities can be stopped in conjunction with disease eradication.

1:30Preparedness of the U.S. health care system to respond to disease outbreaks
Ken Bloem, M.D.
Senior Fellow, The Johns Hopkins Center for Civilian Biodefense Studies
Former CEO, Georgetown Medical Center
2:00Vaccines for post-elimination (eradication) contingencies
Thomas Monath, M.D.
Vice President, Research and Medical Affairs
Acambis Inc. (formerly Ora Vax, Inc.), Cambridge, MA
2:30Strategic priorities for addressing post-eradication outbreaks
Robert Kadlec, M.D., M.T.M.H.
Colonel, US Air Force, and Professor, Military Strategy and Operations
National War College, National Defense University, Washington, D.C.
3:00Understanding the public and media response to an outbreak
Ann E. Norwood, M.D.
Colonel, US Army, Associate Professor and Associate Chair
Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD
3:30The post-eradication research agenda
Joshua Lederberg, Ph.D.
Chair, Forum on Emerging Infections
Sackler Foundation Scholar, and Nobel Laureate
The Rockefeller University, New York, NY
4:00Break

Session VI. Panel Session: Identifying the Threats and Mitigating the Impact

The challenges and opportunities facing disease eradication and how they will affect public policy will be identified through an open discussion among invited panelists, Forum members, speakers, and the workshop audience. Issues to address will include the identification of possible requirements that need to be met prior to eradication, such as collections of diverse isolates and strains, an organism's complete genomic sequence, full understanding of the life history of the organism and its mechanism(s) of pathogenesis, legal issues and authorities surrounding the response to an epidemic; and the ethical considerations pertaining to cessation of immunization, as well as preserving biodiversity versus species extinction.

Co-Moderators:
Joshua Lederberg, Ph.D. Chair, Forum on Emerging Infections
Margaret Hamburg, M.D., Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
Invited Panelists:
Gail Cassell, Vice President, Infectious Diseases, Drug Discovery Research and Clinical Investigation, Eli Lilly & Company, Indianapolis, IN
Michael Osterholm, Chairman and CEO, Infection Control Advisory Network, Inc., Eden Prairie, MN
Stephen Teret J.D, Professor, Program on Law and Public Health, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD
Samuel L. Katz, M.D., D.Sc., Chairman of the Board, Burroughs Wellcome Fund, and; Wilburt C. Davison Professor & Chairman Emeritus, Department of Pediatrics, Duke University Medical Center, Durham, NC
Ellyn W. Ogden, MPH, Worldwide Polio Eradication Coordinator and Senior Technical Advisor in Health and Child Survival, Bureau for Global Programs, U.S. Agency for International Development, Washington, D.C.
4:15Panel discussion, perspectives from different communities, and synthesis
5:30Closing remarks
Joshua Lederberg, Ph.D.
Chair, Forum on Emerging Infections
Sackler Foundation Scholar, and Nobel Laureate
The Rockefeller University, New York, NY
5:45Adjournment
Copyright © 2002, National Academy of Sciences.
Bookshelf ID: NBK98123

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