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Appendix A Glossary and Acronyms GLOSSARY This glossary is intended to define terms commonly encountered throughout this report as well as some terms that are commonly used in the public health arena. This glossary is not all inclusive. New terms and new usages of existing terms will emerge with time and with advances in tech- nology. The definitions for the terms presented here were compiled from a multitude of sources. . . . Adenovirus: A group of viruses responsible for a spectrum of respira- tory disease as well as infection of the stomach and intestine, eyes, and bladder. Patients with compromised immune systems are especially suscep- tible to severe complications of adenovirus infection. Adenoviruses are transmitted by direct contact, fecal-oral transmission, and occasionally waterborne transmission. Shedding of the virus can occur for months or years after the initial infection. Anthropogenic: Of, relating to, or resulting from the influence of hu- man beings on nature. Antibiotic: Class of substances or chemicals that can kill or inhibit the growth of bacteria. Originally antibiotics were derived from natural sources (e.g., penicillin was derived from molds), but many currently used antibiot- ics are semisynthetic and are modified by the addition of artificial chemical components. Antibiotic resistance: Property of bacteria that confers the capacity to 173

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174 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION inactivate or exclude antibiotics or a mechanism that blocks the inhibitory or killing effects of antibiotics. Antimicrobial agents: Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi. Apoptosis: A genetically cletermined process of intracellular cell de- struction postulated to exist and to be activated by a stimulus or by the removal of a suppressing agent or stimulus in order to explain the orderly breakdown and elimination of superfluous or unwanted cells (as immune cells targeted against the self in the development of self-tolerance or larval cells in amphibians undergoing metamorphosis) also called programmed cell death. Arenaviruses: Any of a group of viruses containing a single strand of RNA, having a grainy appearance due to the presence of ribosomes in the virion, and including the Machupo virus and the causative agents of lym- phocytic choriomeningitis and Lassa fever. Attenuate: To reduce the severity of (a disease) or virulence or vitality of (a pathogenic agent). ~ ~ v ~ , Bacteremia: The presence of bacteria in the bloodstream. Bacteria: Microscopic, single-celled organisms that have some bio- chemical and structural features different from those of animal and plant cells. Bacteriophage: A virus that infects bacteriacalled also phage. Basic research: Fundamental, theoretical, or experimental investigation to advance scientific knowledge, with immediate practical application not being a direct objective. Benchmark: For a particular indicator or performance goal, the indus- try measure of best performance. The benchmarking process identifies the best performance in the industry (health care or non-health care) for a particular process or outcome, determines how that performance is achieved, and applies the lessons learned to improve performance. Broad-spectrum antibiotic: An antibiotic effective against a large num- ber of bacterial species. It generally describes antibiotics effective against both gram-positive and gram-negative classes of bacteria. BSL (biosafety level): Specific combinations of work practices, safety equipment, and. facilities, designed to minimize the exposure of workers ancl the environment to infectious agents. Biosafety level 1 applies to agents that do not ordinarily cause human disease. Biosafety level 2 is appropriate for agents that can cause human clisease, but whose potential for transmis- sion is limited. Biosafety level 3 applies to agents that may be transmitted by the respiratory route which can cause serious infection. Biosafety level 4 is user! for the diagnosis of exotic agents that pose a high risk of life-

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APPENDIX A 175 threatening disease, which may be transmitted by the aerosol route and for which there is no vaccine or therapy. BT (bioterrorism): Terrorism using biologic agents. Biological diseases and the agents that might be used for terrorism have been listed by the CDC and comprise viruses, bacteria, rickettsiae, fungi and biological toxins. These agents have been classified according to the degree of danger each agent is felt to pose into one of three categories: A, B. and C. CDC (Centers for Disease Control and Prevention): A public health agency of the U.S. Department of Health and Human Services whose mis- sion is to promote health and quality of life by preventing and controlling disease, injury, and disability. Clinical practice guidelines: Systematically developed statements that assist practitioners and patients with decision making about appropriate health care for specific clinical circumstances. Clinical research: Investigations aimed at translating basic, fundamen- . . . . tat science into met lea practice. Clinical trials: As used in this report, research with human volunteers to establish the safety and efficacy of a drug, such as an antibiotic or a vaccine. Clinician: One qualified or engaged in the clinical practice of medicine, psychiatry, or psychology, as distinguished from one specializing in labora- tory or research techniques in the same fields. Coxsackievirus: Any of several enteroviruses associated with human diseases (as meningitis or herpangina). CRS (congenital rubella syndrome): The constellation of abnormalities caused by infection with the rubella (German measles) virus before birth. The syndrome is characterized by multiple congenital malformations (birth defects) and mental retardation. Cytokine: A small protein released by cells that has a specific effect on the interactions between cells, on communications between cells or on the behavior of cells. The cytokines include the interieukins, tymphokines and cell signal molecules, such as tumor necrosis factor and the interferons, which trigger inflammation and respond to infections. DHHS (U.S. Department of Health and Human Services): The U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves (www.os.dhhs.gov). DoD (U.S. Department of Defense): DoD trains and equips the armed forces through three military departments- the Army, Navy, and Air Force whose primary job is to train and equip their personnel to perform warfighting, peacekeeping and humanitarian/disaster assistance tasks.

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176 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION Echovirus: One of a group of viruses found in the gastrointestinal tract. The "echo" part of the name stands for enteric cytopathic human orphan viruses. "Orphan" implied that they were viruses not associated with any disease. Now, however, it is known that echoviruses can cause meningitis, intestinal infection, pericarditis (inflammation of the membrane around the heart) and upper respiratory infections. ELISA (enzyme-linked immunosorbent assay): A rapid immunochemi- cal test utilized to detect substances that have antigenic properties, prima- rily proteins. ELISA tests are generally highly sensitive and specific. Emerging infections: Any infectious disease that has come to medical attention within the last two decades or for which there is a threat that its prevalence will increase in the near future. Many times, such diseases exist in nature as zoonoses and emerge as human pathogens only when humans come into contact with a formerly isolated animal population, such as monkeys in a rain forest that are no longer isolated because of deforesta- tion. Drug-resistant organisms could also be included as the cause of emerg- ing infections since they exist because of human influence. Some recent examples of agents responsible for emerging infections include human im- munocleficiency virus, Ebola virus, and multidrug-resistant Mycobacterium tuberculosis. Encephalitis: An acute inflammatory disease of the brain due to direct . ~ . . .. . . .. . . . . viral Invasion or to nypersens~t~v~ty ~n~t~atec , by a virus or other foreign protein. Endemic: Disease that is present in a community or common among a group of people; said of a disease continually prevailing in a region. Enterovirus: A virus that comes into the body through the gastrointes- tinal tract and thrives there, often moving on to attack the nervous system. Enteroviruses include the polioviruses, rhinoviruses, and echoviruses. Enzootic: A disease of low morbidity that is constantly present in an . . anlma. . community. Epizootic: A disease of high morbidity that is only occasionally present . . . in an amma . commumty. Etiology: Science and study of the causes of diseases and their mode of operation. FDA (U.S. Food and Drug Administration): A public health agency of the U.S. Department of Health and Human Services charged with protect- ing American consumers by enforcing the Federal Food, Drug, and Cos- metic Act and several related health laws. Flavivirus: Any of a group of arboviruses that contain a single strand of RNA, are transmitted by ticks and mosquitoes, and include the causative agents of dengue, Japanese B encephalitis, and yellow fever.

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APPENDIX A 177 Hantavirus: A group of viruses that cause hemorrhagic fever and pneumonia. Hantaviruses are transmitted to humans by contact direct or indirectly with the saliva and excrete of rodents such as deer mice, field mice, and ground voles. Hepatosplenomegaly: Coincident enlargement of the liver and spleen. Herd immunity: A reduction in the probability of infection that is held to apply to susceptible members of a population in which a significant proportion of the individuals are immune because the chance of coming in contact with an infected individual is less. IFN (interferon): A naturally occurring substance that interferes with the ability of viruses to reproduce. Interferon also boosts the immune sys- tem. There are a number of different interferons and they fall into three main classes: alpha, beta, and gamma. All are proteins (lymphokines) nor- mally produced by the body in response to infection. The interferons have been synthesized using recombinant DNA technology. IgG: A class of antibodies including those most commonly circulating in the blood and active especially against bacteria, viruses, and proteins foreign to the bodyalso called imm?~noglobulin G. IgM: A class of antibodies of high molecular weight including those that appear early in the immune response to be replaced later by IgG of lower molecular weight, are capable of binding complement, and do not cross the placenta also called immunogiab?~lin M. Immunogenicity: The property that endows a substance with the capac- ity to provoke an immune response or the degree to which a substance possesses this property. Incidence: The frequency of new occurrences of disease within a cle- fined time interval. Incidence rate is the number of new cases of a specified disease divided by the number of people in a population over a specified period of time, usually 1 year. Infection: The invasion of the body or a part of the body by a patho- genic agent, such as a microoganism or virus. Under favorable conditions the agent develops or multiplies, the results of which may produce injurious effects. Infection should not be confused with disease. IPV (inactivated polio vaccine): A vaccine for polio given as a shot in the arm or leg. The polio virus in IPV has been inactivated (killed). Also called the Salk vaccine. Lentivirus: Any of a group of retroviruses that cause slowly progressive often fatal animal diseases (as AIDS).

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178 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION Macrophages: A type of white blood cell that ingests foreign material. Macrophages are key players in the immune response to foreign invaders . i. . . . sue n as Infectious microorganisms. Men~ngoencephalitis: Inflammation of the brain and meninges also called er~cephalomeningitis. MHC (major histocompatibility complex): A cluster of genes on chro- mosome 6 concerned with antigen production and critical to transplanta- tion. Microcephaly: A condition of abnormal smallness of the head usually associated with mental retardation. Monoclonal antibodies: Identical antibodies that are made in large amounts in the laboratory. Doctors are studying ways of using monoclonal antibodies to treat leukemia. NCID (National Center for Infectious Diseases): Its mission is to pre- vent illness, disability, and death caused by infectious diseases in the US and around the world. NCID conducts surveillance, epidemic investigations, epidemiological and laboratory research, training, and public eclucation programs to develop, evaluate, and promote prevention and control strate- gies for infectious diseases. Neurovirulence: The tendency or capacity of a microorganism to cause disease of the nervous system. NIAID (National Institute of Allergy and Infectious Diseases): A divi- sion of NIH that provides the major support for scientists conducting re- search aimed at developing better ways to diagnose, treat, and prevent the many infectious, immunological, and allergenic diseases that afflict people worldwide. N1H (National Institutes of Health): A public health agency of the U.S. Department of Health and Human Services whose goat is to acquire new knowledge to help prevent, detect, diagnose, and treat disease and disabil- ity, from the rarest genetic disorder to the common cold. NK (natural killer) cell: A large granular lymphocyte capable of killing a tumor or microbial cell without prior exposure to the target cell and without having it presented with or marked by a histocompatibility anti- gen. OPV (oral polio vaccine): A vaccine for polio, given by mouth, and preferred for most children. PAHO (Pan American Health Organization): An international public health agency with almost 100 years of experience working to improve health and living standards of the people of the Americas. It enjoys interna- tional recognition as part of the United Nations system, serving as the

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APPENDIX A 179 Regional Office for the Americas of the World Health Organization, and as the health organization of the Inter-American System. Pandemic: Occurring over a wide geographic area and affecting an exceptionally high proportion of the population. Parvoviruses: A group of extremely small, morphologically similar, ether-resistant, DNA viruses; the group includes the osteolytic hamster viruses and adeno-associatect viruses. PDA (patent ductus arteriosus): An abnormal condition in which the ductus arteriosus fails to close after birth. Prions: A newly discovered type of disease-causing agent, neither bacte- rial nor fungal nor viral, and containing no genetic material. A prion is a protein that occurs normally in a harmless form. By folding into an aber- rant shape, the normal prion turns into a rogue agent. It then coopts other normal prions to become rogue prions.They have been held responsible for a number of degenerative brain diseases, including mad cow disease, CreutzfelUt-Tacob disease, and possibly some cases of Alzheimer's disease. Prophylactic antibiotics: Antibiotics that are administered before evi- dence of infection with the intention of warding off disease. Purpura: Any of several hemorrhagic states characterized by patches of purplish discoloration resulting from extravasation of blood into the skin and mucous membranes. Radiolucent: Partly or wholly permeable to radiation and especially X rays. RSV (respiratory syncytial virus): A virus that causes mild respiratory infections in adults but in young children can produce severe respiratory problems. Effective immunity against RSV requires a continuous solid level of antibodies against the virus. Seroconversion: The production of antibodies in response to an anti gen. Seronegative: Having or being a negative serum reaction especially in a test for the presence of an antibody. Seroposiiive: Having or being a positive serum reaction especially in a test for the presence of an antibody. Seroprevalence: The frequency of individuals in a population that have a particular element (as antibodies to HIV) in their blood serum. Serotype: The kind of microorganism as characterized by serologic typing (testing for recognizable antigens on the surface of the microorgan- ism). Surveillance systems: Used in this report to refer to data collection and recor~keeping to track the emergence and spread of disease-causing organ- . ... . . . . tams suc ~ as ant~b~ot~c-res~stant bacteria.

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180 CONSIDERATIONS FOR VIRAL DISEASE ERADICATION TOPOFF: An exercise conducted by the Department of Justice which engaged key personnel in the management of mock chemical, biological, or cyberterrorist attacks. So named because it involved the participation of top officials of the U.S. government. USAID (U.S. Agency for International Development): An independent fecleral government agency that receives overall foreign policy guidance from the Secretary of State. The agency works to support long-term, equi- table economic growth and to advance U.S. foreign policy objectives by supporting global health, democracy, conflict prevention, and humanitar- . . . . . . Ian assistance 1mtlatlves. USAMRIID (U.S. Army Medical Research Institute of Infectious Dis- eases): It is the lead medical research laboratory for the U.S. Biological Defense Research Program which conducts research to develop strategies, products, information, procedures, and training programs for medical de- fense against biological warfare threats and naturally occurring infectious diseases that require special containment. It is an organization of the U.S. Army Medical Research and Materiel Command (USAMRMC). USDA (U.S. Department of Agriculture): Founded in 1862, its mission is to enhance the quality of life for the American people by supporting production of agriculture and ensuring a safe, affordable, nutritious, and accessible food supply. VA (Department of Veterans Affairs): A cabinet-level department that has the care of veterans as its primary mission and is composed of 3 admin- istrations: Veterans Health Administration, Veterans Benefit Administra- tion, and National Cemetery Administration. Vaccine: A preparation of living, attenuated, or killed bacteria or vi- ruses, *actions thereof, or synthesized or recombinant antigens identical or similar to those found in the disease-causing organisms that is administered . . . . . . to raise immunity to a part1cu ar microorganism. VHF (viral hemorrhagic fevers): A group of illnesses that are caused by viruses of four distinct families: arenaviruses, filoviruses, bunyaviruses, and flaviviruses. Viremia: The presence of virus in the blood of a host. Virulence: The ability of any infectious agent to produce disease. The virulence of a microoganism (such as a bacterium or virus) is a measure of the severity of the disease it is capable of causing. WHO (Wor1d Health Organization): Its objective is the attainment by all peoples of the highest possible level of health, a state of complete physi- cal, mental, and social well-being and not merely the absence of disease or infirmity. WHO also proposes conventions, agreements, regulations, and

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.$ APPENDIX A 181 makes recommendations about international nomenclature of diseases, causes of death and public health practices. It develops, establishes, and promotes international standards concerning foods and biological, phar- maceutical, and similar substances. Xenogeneic: Derived from, originating in, or being a member of an- other species. Zoonotic disease or infection: An infection or infectious disease that may be transmitted from vertebrate animals (e.g., a rodent) to humans. ACRONYMS AFP acute flaccid paralysis BRC Biological Resource Centers BW 1 C Biological Weapons and Toxins Convention DMORT Disaster Mortuary Operational Response Team DPT diptheria-pertussis-tetanus EMTALA Emergency Medical Treatment and Labor Act EPI Expancled Programme on Immunization GAVI Global Alliance for Vaccines and Immunization GIDs global immunization days IHR International Health Regulations TCAHO Joint Commission on the Accreditation of Health Care Organi- zations Joint Information Center loins Operations Center JIC JOC MMR NIDs PCR SIV TNF measles- mumps-rubella I. . . natlona Immunization nays polymerase chain reaction . . . . .. . . slmlan 1mmunouerlclency virus tumor necrosis factor

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~2 VAPP OVER MA COO FOR ~~[ D~ [~4D1~ON vaccine-associated paralytic poliovirus ~~ Epide~io/~' Record World Health Assembly