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Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Appendix D

Glossary

Abiotic: Nonliving chemical and physical factors in an environment.

Aerosolize: To disperse (as a medicine, bactericide, or insecticide) as an aerosol.

African swine fever: A highly contagious tick-borne hemorrhagic disease of pigs, warthogs, European wild boar, and American wild pigs. With high virulence forms of the virus, it is characterized by high fever, loss of appetite, hemorrhages in the skin and internal organs, and death in 2–10 days on average. Mortality rates may be as high as 100%. It is caused by a DNA virus of the Asfarviridae family.

Agent (of disease): Factor such as a microorganism whose presence is essential for the occurrence of a disease.

Alveolitis: An inflammation of the alveoli of the lungs caused by the inhalation of an allergen.

Anophelines: A genus of mosquitoes that includes all mosquitoes that transmit malaria to humans.

Anthropogenic: Caused or produced by humans.

Anthroponotic: Transmission from human to human and potentially from human to animal.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Antibiotic: Class of substances that can kill or inhibit the growth of some groups of microorganisms. Used in this report to refer to chemicals active against bacteria. Originally antibiotics were derived from natural sources (e.g., penicillin from molds), but many currently used antibiotics are semisynthetic and modified with additions of man-made chemical components. See antimicrobials.

Antibiotic resistance: Property of bacteria that confers the capacity to inactivate or exclude antibiotics or a mechanism that blocks the inhibitory or killing effects of antibiotics.

Antibody: A protein produced by the immune system in response to the introduction of a substance (an antigen) recognized as foreign by the body’s immune system. Antibody interacts with the other components of the immune system and can render the antigen harmless, although for various reasons this may not always occur.

Antimicrobials: Class of substances that can destroy or inhibit the growth of pathogenic groups of microorganisms, including bacteria, viruses, parasites, and fungi.

Antiretroviral: A substance that stops or suppresses the activity of a retrovirus such as HIV.

Arboviral diseases: Shortened form of arthropod-borne virus. Any of a group of viruses that are transmitted to man and animals by mosquitoes, ticks, and sand flies; they include such agents as yellow fever and eastern, western, and Venezuelan equine encephalitis viruses.

Arthropod: As used in this report, refers to insects and ticks, many of which are medically important as vectors of infectious diseases.

Arthropod-borne: Capable of being transmitted by insect and tick (arthropod) vectors.

Asymptomatic: Presenting no symptoms of disease.

Avian influenza: Any of several highly variable diseases of domestic and wild birds that are caused by orthomyxoviruses and characterized usually by respiratory symptoms but sometimes by gastrointestinal, integumentary, and urogenital symptoms.

Bacteria: Microscopic, single-celled organisms that have some biochemical and structural features different from those of animal and plant cells.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Biosafety: Safety with respect to the effects of biological research on humans and the environment.

Biosafety Level 3 (BSL-3): Is applicable to clinical, diagnostic, teaching, research, or production facilities where work is performed with indigenous or exotic agents that may cause serious or potentially lethal disease through the inhalation route of exposure. Laboratory personnel must receive specific training in handling pathogenic and potentially lethal agents, and must be supervised by scientists competent in handling infectious agents and associated procedures. All procedures involving the manipulation of infectious materials must be conducted within biological safety cabinets or other physical containment devices. A BSL-3 laboratory has special engineering and design features.

Biosafety Level 4 (BSL-4): Is required for work with dangerous and exotic agents that pose a high individual risk of aerosol-transmitted laboratory infections and life-threatening disease that is frequently fatal, for which there are no vaccines or treatments, or a related agent with unknown risk of transmission. Agents with a close or identical antigenic relationship to agents requiring BSL-4 containment must be handled at this level until sufficient data are obtained either to confirm continued work at this level, or redesignate the level. Laboratory staff must have specific and thorough training in handling extremely hazardous infectious agents. Laboratory staff must understand the primary and secondary containment functions of standard and special practices, containment equipment, and laboratory design characteristics. All laboratory staff and supervisors must be competent in handling agents and procedures requiring BSL-4 containment. The laboratory supervisor in accordance with institutional policies controls access to the laboratory.

Biota: The animal and plant life of a given region.

Bluetongue disease: Bluetongue disease or catarrhal fever is a noncontagious, insect-borne, viral disease of ruminants, mainly sheep and less frequently cattle, goats, buffalo, deer, dromedaries, and antelope. It is caused by the Bluetongue virus.

Bronchiolitis: An acute viral infection of the small air passages of the lungs called the bronchioles.

Bushmeat: Wildlife species that are hunted in the “bush” or forests.

Canine distemper virus: A highly contagious, systemic, viral disease of dogs seen worldwide. Clinically, it is characterized by a diphasic fever, leukopenia, gastrointestinal and respiratory catarrh, and frequently pneumonic and neurologic

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

complications. Its epidemiology is complicated by the large number of species susceptible to infection. The disease is seen in Canidae (dog, fox, wolf, raccoon dog), Mustelidae (ferret, mink, skunk, wolverine, marten, badger, otter), most Procyonidae (raccoon, coatimundi), some Viveridae (binturong, palm civet), Ailuridae (red panda), Ursidae (bear), Elephantidae (Asian elephant), primates (Japanese monkey), and large Felidae. Domestic dogs (including feral populations) are considered to be the reservoir species in most, if not all, locations.

Chemoprophylaxis: The use of drugs or biologics taken by asymptomatic persons to reduce the risk of developing a disease.

Chikungunya: A febrile disease that resembles dengue, occurs especially in parts of Africa, India, and southeastern Asia, and is caused by a togavirus of the genus Alphavirus (species Chikungunya virus) transmitted by mosquitoes especially of the genus Aedes— also called chikungunya fever.

Cholera: Any of several diseases of humans and domestic animals usually marked by severe gastrointestinal symptoms; an acute diarrheal disease caused by an enterotoxin produced by a comma-shaped Gram-negative bacillus of the genus Vibrio (V. cholerae syn. V. comma) when it is present in large numbers in the proximal part of the human small intestine.

Climate: Average meteorological conditions over a specified time period, usually at least a month, resulting from interactions among the atmosphere, oceans, and land surface. Climate variations occur over a wide range of spatial and temporal scales.

Climate change: A change of climate that is attributed directly or indirectly to human activity that alters the composition of the global atmosphere and which is in addition to natural climate variability observed over comparable time periods.

Cloaca: The common chamber into which the intestinal, urinary, and generative canals discharge especially in monotreme mammals, birds, reptiles, amphibians, and elasmobranch fishes; the terminal part of the embryonic hindgut of a mammal before it divides into rectum, bladder, and genital precursors; a passage in a bone leading to a cavity containing a sequestrum.

Colony collapse disorder: A pathological condition affecting a large number of honeybee colonies, in which various stresses may lead to the abrupt disappearance of worker bees from the hive, leaving only the queen and newly hatched bees behind and thus causing the colony to stop functioning.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Communicable disease: An infectious disease transmissible (as from person to person) by direct contact with an infected individual or the individual’s discharges or by indirect means (as by a vector).

Coronavirus: Any of a family (Coronaviridae) of single-stranded RNA viruses that have a lipid envelope with club-shaped projections and include some causing respiratory symptoms in humans.

Cytokine: Any of a class of immunoregulatory proteins (as interleukin, tumor necrosis factor, and interferon) that are secreted by cells, especially of the immune system.

Dengue fever: An acute infectious disease that is characterized by headache, severe joint pain, and a rash and that is caused by a single-stranded RNA virus of the genus Flavivirus (species Dengue virus) transmitted by mosquitoes of the genus Aedes— also called breakbone fever, dandy fever, dengue fever.

Disease: As used in this report, refers to a situation in which infection has elicited signs and symptoms in the infected individual; the infection has become clinically apparent.

Dual-use research of concern: In the life sciences, research that, based on current understanding, can be reasonably anticipated to provide knowledge, information, products, or technologies that could be directly misapplied to pose a significant threat with broad potential consequences to public health and safety, agricultural crops and other plants, animals, the environment, materiel, or national security.

E. coli: A straight rod-shaped Gram-negative bacterium (Escherichia coli of the family Enterobacteriaceae) that is used in public health as an indicator of fecal pollution (as of water or food) and in medicine and genetics as a research organism and that occurs in various strains that may live as harmless inhabitants of the human lower intestine or may produce a toxin causing intestinal illness.

Ebola: A hemorrhagic fever caused by the Ebola virus.

Ecosystem: Mutually interrelated communities of species and abiotic components, existing as a system with specific interactions and exchange of matter, energy, and information.

El Niño: A warming of the surface waters of the tropical Pacific that occurs every 3 to 5 years, temporarily affecting weather worldwide.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Emerging infection: Either a newly recognized, clinically distinct infectious disease or a known infectious disease whose reported incidence is increasing in a given place or among a specific population.

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 deforestation. Drug-resistant organisms could also be included as the cause of emerging infections since they exist because of human influence. Some recent examples of agents responsible for emerging infections include human immunodeficiency virus, Ebola virus, multi-drug resistant Mycobacterium tuberculosis, and influenza A (H1N1).

Emerging infectious diseases: Infections that are rapidly increasing in incidence or geographic range.

Endemic: Present in a community or common among a group of people; said of a disease prevailing continually in a region.

Enteric: Of, relating to, or affecting the intestines.

Enterovirus: Any of a genus (Enterovirus) of picornaviruses (as the causative agent of poliomyelitis) that typically occur in the gastrointestinal tract but may be involved in respiratory ailments, meningitis, and neurological disorders.

Enzootic: A disease of low morbidity that is constantly present in an animal community.

Epidemic: The condition in which a disease spreads rapidly through a community in which that disease is normally not present or is present at a low level.

Epidemiology: Study of the distribution and determinants of health-related states or events in specified populations. Epidemiology is the basic quantitative science of public health.

Epizootic: A disease of high morbidity that is only occasionally present in an animal community.

Eradication: Reduction of the worldwide incidence of a disease to zero as a result of deliberate efforts.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Etiologic agent: The organism that causes a disease.

Etiological: Of or pertaining to causes or origins.

Etiology: Science and study of the causes of diseases and their mode of operation.

Extrinsic incubation period: Time required for the development of a disease agent in a vector from the time of uptake of the agent to the time the vector is infective.

Gallinaceous birds: Also called galliforms, belong to an order (Galliformes) of heavy-bodied ground-feeding birds that includes the turkey, grouse, chicken, New and Old World quail, ptarmigan, partridge, and pheasant.

Genomics: The study of all the genes in a person, as well as interactions of those genes with each other and with that person’s environment. (http://www.cdc.gov/genomics/faq.htm)

Global warming: The gradual increase, observed or projected, in global surface temperature, as one of the consequences of radiative forcing caused by anthropogenic emissions.

Globalization: The increased interconnectedness and interdependence of peoples and countries, is generally understood to include two interrelated elements: the opening of borders to increasingly fast flows of goods, services, finance, people, and ideas across international borders; and the changes in institutional and policy regimes at the international and national levels that facilitate or promote such flows. (http://www.who.int/trade/glossary/story043/en/index.html)

Hantavirus: Any of a genus (Hantavirus) of bunyaviruses (as the Hantaan virus) that are transmitted by rodent feces and urine and cause hantavirus pulmonary syndrome and hemorrhagic fevers marked by renal necrosis.

Hemagglutinin protein: Species-specific binding protein that allows for the virus to bind to the cell membrane of host respiratory cells and propagate through cellular processes.

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.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Host (disease): Person or other living animal that affords subsistence or lodgment to an infectious agent under natural conditions.

Immune competence: The ability of the immune system to respond appropriately to an antigenic stimulation.

Immunoassay: A technique or test (as the enzyme-linked immunosorbent assay) used to detect the presence or quantity of a substance (as a protein) based on its capacity to act as an antigen or antibody.

Immunocompromised: A condition (caused, for example, by the administration of immunosuppressive drugs or irradiation, malnutrition, aging, or a condition such as cancer or HIV disease) in which an individual’s immune system is unable to respond adequately to a foreign substance.

Incidence: Number of cases of a disease commencing, or of persons falling ill, during a given period of time in a specified population. Incidence rate is the number of new cases of a specific disease diagnosed or reported during a defined interval of time divided by the number of all persons in a defined population during the same time.

Index case: An instance of a disease or a genetically determined condition that is discovered first and leads to the discovery of others in a family or population.

Infection: The invasion of the body or a part of the body by a pathogenic agent, such as a microorganism 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.

Influenza: An acute highly contagious virus disease that is caused by various strains of orthomyxoviruses belonging to three major types now considered as three separate genera and that is characterized by sudden onset, fever, prostration, severe aches and pains, and progressive inflammation of the respiratory mucous membrane—often used with the letter A, B, or C to denote disease caused by a virus of a specific one of the three genera; any human respiratory infection of undetermined cause—not used technically; any of numerous febrile usually virus diseases of domestic animals (as shipping fever of horses and swine influenza) marked by respiratory symptoms, inflammation of mucous membranes, and often systemic involvement.

Intermediate host: A host that is normally used by a parasite in the course of its life cycle and in which it may multiply asexually but not sexually.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

International Health Regulations (IHR): An international legal instrument that is binding on 194 countries across the globe, including all the member states of WHO. Their aim is to help the international community prevent and respond to acute public health risks that have the potential to cross borders and threaten people worldwide. The IHR, which entered into force on June 15, 2007, requires countries to report certain disease outbreaks and public health events to WHO. Building on the unique experience of WHO in global disease surveillance, alert, and response, the IHR defines the rights and obligations of countries to report public health events, and establishes a number of procedures that WHO must follow in its work to uphold global public health security.

Interstitial pneumonia: Any of several chronic lung diseases of unknown etiology that affect interstitial tissues of the lung without filling of the alveolae and that may follow damage to the alveolar walls or involve interstitial histological changes.

Lassa: A disease especially of Africa that is caused by the Lassa virus and is characterized by a high fever, headaches, mouth ulcers, muscle aches, small hemorrhages under the skin, heart and kidney failure, and a high mortality rate.

Microbe: A microorganism or biologic agent that can replicate in humans (including bacteria, viruses, protozoa, fungi, and prions).

Microbial threat: Microbes that lead to disease in humans.

Microbiology: A branch of biology dealing especially with microscopic forms of life.

Migration: The regular, usually seasonal, movement of all or part of an animal population to and from a given area.

Millennium Development Goals: Eight international development goals that were established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration. These goals—which range from halving extreme poverty rates to halting the spread of HIV/AIDS and providing universal primary education, all by the target date of 2015—form a blueprint agreed to by all the world’s countries and all the world’s leading development institutions. They have galvanized unprecedented efforts to meet the needs of the world’s poorest.

Mitigation: Initiatives that reduce the risk from natural and man-made hazards. With respect to climate change, mitigation usually refers to actions taken to reduce the emissions or enhance the sinks of greenhouse gases.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Morbidity: Diseased condition or state.

Mortality: The number of deaths in a given time or place; the proportion of deaths to population.

Mutation: Genetic change that can occur either randomly or at an accelerated rate through exposure to radiation or certain chemicals (mutagens) and may lead to change in structure of the protein coded by the mutated gene.

Neuraminidase: A substance used (as in detecting or measuring a component, in preparing a product, or in developing photographs) because of its chemical or biological activity.

Nucleoprotein: Any of a group of substances found in the nuclei of all living cells and in viruses and composed of a protein and a nucleic acid.

One Health: The collaborative effort of multiple disciplines working locally, nationally, and globally to attain optimal health for people, animals, and our environment.

Outbreak: Localized occurrence as opposed to a generalized epidemic.

Pandemic: Epidemic occurring over a wide geographic area and affecting an exceptionally high proportion of the population.

Parainfluenza: Any of several paramyxoviruses (genus Paramyxovirus) that are associated with or responsible for some respiratory infections especially in children— also called parainfluenza.

Pathogen: Organism capable of causing disease.

Pathogenic: Capable of causing disease.

Pathology: The branch of medicine concerned with disease, especially its structure and its functional effects on the body.

Phylogeny: The connections between all groups of organisms as understood by ancestor/descendant relationships.

Physiochemical: Of or relating to physiological chemistry.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

Prevalence: Proportion of persons in a population currently affected by a particular disease. Prevalence rate is the number of cases of a specific disease at a particular time divided by the population at that time living in the same region.

ProMED: The Program for Monitoring Emerging Diseases. An Internet-based reporting system dedicated to rapid global dissemination of information on outbreaks of infectious diseases and acute exposures to toxins that affect human health, including those in animals and in plants grown for food or animal feed.

Prophylaxis: Measures designed to preserve health (as of an individual or of society) and prevent the spread of disease.

Public health: The art and science of dealing with the protection and improvement of community health by organized community effort and including preventive medicine and sanitary and social health.

Public health emergency of international concern: An extraordinary event that is determined (1) to constitute a public health risk to other states through the international spread of disease; and (2) to potentially require a coordinated international response. This definition implies a situation that is serious, unusual, or unexpected; carries implications for public health beyond the affected state’s national border; and may require immediate international action.

Quarantine: The enforced isolation or restriction of free movement imposed to prevent the spread of a contagious disease.

Ranavirus: A genus in the family Iridoviridae that causes disease in amphibians

Resistance: See antibiotic resistance.

Retrovirus: Any of large family of RNA viruses that includes lentiviruses and oncoviruses, so called because they carry reverse transcriptase.

Risk: Probability that an event will occur; a measure of the degree of loss expected by the occurrence of a loss.

Schmallenberg virus: A virus first identified in Schmallenberg, Germany, in 2011, which causes brain and limb malformations in cattle and lambs. It is thought to be a negative-sense, single-stranded RNA virus of the Bunyaviridae family, genus Orthobunyavirus.

Shoe-leather epidemiology: Often synonymous with field epidemiology or intervention epidemiology. All three terms imply investigations initiated in response

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

to urgent public health problems and for which the investigative team does much of its work in the field (i.e., outside the office or laboratory).

Species barrier: Difficulty or impossibility for an infectious agent to pass from one species to another (due to differences between species).

Surveillance: Used in this workshop summary to refer to data collection and record keeping to track the emergence and spread of disease-causing organisms such as antibiotic-resistant bacteria.

Syndrome: A group or recognizable pattern of symptoms or abnormalities that indicate a particular trait or disease. (http://www.genome.gov/glossary.cfm?key=syndrome)

Transmission: Process by which a pathogen passes from a source of infection to a new host.

Vaccine: A preparation of living, attenuated, or killed bacteria or viruses, fractions thereof, or synthesized or recombinant antigens identical or similar to those found in the disease-causing organism that is administered to raise immunity to a particular microorganism.

Vector: An organism, such as an insect, that transmits a pathogen from one host to another.

Vector-borne: Transmitted from one host to another by a vector.

Vector-borne disease: (1) Mechanical: This includes simple mechanical carriage by a crawling or flying insect through soiling of its feet or proboscis or by passage of organisms through its gastrointestinal tract. This does not require multiplication or development of the organism. (2) Biological: Propagation (multiplication), cyclic development, or a combination of these (cyclopropagative) is required before the arthropod can transmit the infective form of the agent to humans. An incubation period (extrinsic) is required following infection before the arthropod becomes infective. The infectious agent may be passed vertically to succeeding generations (transovarian transmission); transstadial transmission indicates its passage from one stage of the life cycle to another, as nymph to adult. Transmission may be by injection of salivary gland fluid during biting, or by regurgitation or deposition on the skin of feces or other material capable of penetrating the bite wound or an area of trauma from scratching or rubbing. This transmission is by an infected nonvertebrate host and not simple mechanical carriage by a vector or vehicle. However, an arthropod in either role is termed a vector.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

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 microorganism (such as a bacterium or virus) is a measure of the severity of the disease it is capable of causing.

West Nile virus: A flavivirus (genus Flavivirus) that causes an illness marked by fever, headache, muscle ache, skin rash, and sometimes encephalitis or meningitis, that is spread chiefly by mosquitoes and that is closely related to the viruses causing Japanese B encephalitis and Saint Louis encephalitis.

White-nose syndrome: An emergent disease caused by the fungus Geomyces destructans. The fungus invades bats’ skin where it is not covered by fur, such as the muzzle, wings, and ears, forming white patches on these areas, giving rise to the name. The fungus attacks bats while they are hibernating, disrupting their hibernation and potentially causing starvation or dehydration.

Zoonotic infection: Infection that causes disease in human populations but can be perpetuated solely in nonhuman host animals (e.g., bubonic plague); may be enzootic.

Suggested Citation:"Appendix D: Glossary." Institute of Medicine. 2015. Emerging Viral Diseases: The One Health Connection: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/18975.
×

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In the past half century, deadly disease outbreaks caused by novel viruses of animal origin - Nipah virus in Malaysia, Hendra virus in Australia, Hantavirus in the United States, Ebola virus in Africa, along with HIV (human immunodeficiency virus), several influenza subtypes, and the SARS (sudden acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronaviruses - have underscored the urgency of understanding factors influencing viral disease emergence and spread.

Emerging Viral Diseases is the summary of a public workshop hosted in March 2014 to examine factors driving the appearance, establishment, and spread of emerging, re-emerging and novel viral diseases; the global health and economic impacts of recently emerging and novel viral diseases in humans; and the scientific and policy approaches to improving domestic and international capacity to detect and respond to global outbreaks of infectious disease. This report is a record of the presentations and discussion of the event.

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