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Microbial Ecology in States of Health and Disease: Workshop Summary Eileen R. Choffnes, LeighAnne Olsen, and Alison Mack, Rapporteurs Forum on Microbial Threats Board on Global Health Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 NOTICE: The workshop that is the subject of this workshop summary 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. Financial support for this activity was provided by the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infec- tious Diseases, Centers for Disease Control and Prevention, Food and Drug Administra- tion, and the Fogarty International Center; U.S. Department of Defense: Armed Forces Health Surveillance Center, Defense Threat Reduction Agency, and Medical Research and Materiel Command; U.S. Department of Justice: Federal Bureau of Investigation; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; U.S. Agency for International Development; Uniformed Services University of the Health Sciences; Alfred P. Sloan Foundation; American Society for Microbiology; Burroughs Wellcome Fund; GlaxoSmithKline; Infectious Diseases Society of America; Johnson & Johnson; Merck Company Foundation; and sanofi pasteur. The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for this activity. International Standard Book Number-13: 978-0-309-29062-3 International Standard Book Number-10: 0-309-29062-7 Additional copies of this workshop summary are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2014 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover images: (Front, upper) Medical illustration of methicillin-resistant Staphylococcus aureus (MRSA); (Front, lower) Medical Illustration of Clostridium difficile ; (Back) Medi- cal illustration of Streptococcus pneumoniae. Photo Credits: All photos courtesy of the Centers for Disease Control and Prevention, www.cdc.gov. Suggested citation: IOM (Institute of Medicine). 2014. Microbial ecology in states of health and disease: Workshop summary. Washington, DC: The National Academies Press. Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe Advising the Nation. Improving Health. Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examina- tion of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council. www.national-academies.org Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary PLANNING COMMITTEE FOR A WORKSHOP ON MICROBIAL ECOLOGY IN STATES OF HEALTH AND DISEASE1 ARTURO CASADEVALL, Albert Einstein College of Medicine, Bronx, New York EDUARDO GOTUZZO, Instituto de Medicina Tropical–Alexander von Humboldt, Universidad Peruaña Cayetano Heredia, Lima, Peru JO HANDELSMAN, Yale University, New Haven, Connecticut JAMES M. HUGHES, Emory University, Atlanta, Georgia DAVID A. RELMAN, Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California P. FREDERICK SPARLING, University of North Carolina, Chapel Hill, North Carolina 1 Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests solely with the workshop rapporteurs and the institution. v Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary FORUM ON MICROBIAL THREATS1 DAVID A. RELMAN (Chair), Stanford University, and Veterans Affairs Palo Alto Health Care System, Palo Alto, California JAMES M. HUGHES (Vice-Chair), Global Infectious Diseases Program, Emory University, Atlanta, Georgia LONNIE J. KING (Vice-Chair), Ohio State University, Columbus, Ohio KEVIN ANDERSON, Biological and Chemical Defense Division, Science and Technology Directorate, Department of Homeland Security, Washington, DC ENRIQUETA C. BOND, Burroughs Wellcome Fund (Emeritus), QE Philanthropic Advisors, Marshall, Virginia ROGER G. BREEZE, Lawrence Livermore National Laboratory, Livermore, California JOHN E. BURRIS,2 Burroughs Wellcome Fund, Research Triangle Park, North Carolina ARTURO CASADEVALL, Albert Einstein College of Medicine, Yeshiva University, Bronx, New York ANDREW CLEMENTS, U.S. Agency for International Development, Washington, DC PETER DASZAK, EcoHealth Alliance, New York, New York JEFFREY S. DUCHIN, Public Health–Seattle and King County, Seattle, Washington JONATHAN EISEN, Genome Center, University of California, Davis, California RALPH L. ERICKSON,3 Walter Reed Army Institute of Research, Silver Spring, Maryland MARK B. FEINBERG, Merck Vaccine Division, Merck & Co., Inc., West Point, Pennsylvania JACQUELINE FLETCHER, Oklahoma State University, Stillwater, Oklahoma CLAIRE FRASER, Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland JESSE L. GOODMAN, Food and Drug Administration, Rockville, Maryland EDUARDO GOTUZZO, Instituto de Medicina Tropical–Alexander von Humboldt, Universidad Peruaña Cayetano Heredia, Lima, Peru CAROLE A. HEILMAN, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland DAVID L. HEYMANN, Public Health England, London, United Kingdom 1 Institute of Medicine forums and roundtables do not issue, review, or approve individual docu- ments. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution. 2 Forum member until October 18, 2013. 3 Forum member until June 30, 2013. vi Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary ZHI HONG,4 GlaxoSmithKline, Research Triangle Park, North Carolina PHILIP HOSBACH, sanofi pasteur, Swiftwater, Pennsylvania STEPHEN ALBERT JOHNSTON, Arizona BioDesign Institute, Arizona State University, Tempe, Arizona KENT KESTER,5 Uniformed Services University of the Health Sciences, Bethesda, Maryland GERALD T. KEUSCH, Boston University School of Medicine and Boston University School of Public Health, Boston, Massachusetts RIMA F. KHABBAZ, Centers for Disease Control and Prevention, Atlanta, Georgia MARK KORTEPETER,6 Uniformed Services University of the Health Sciences, Bethesda, Maryland STANLEY M. LEMON, University of North Carolina, Chapel Hill, North Carolina MARGARET J. McFALL-NGAI, University of Wisconsin, Madison, Wisconsin EDWARD McSWEEGAN, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland PAULA J. OLSIEWSKI, Alfred P. Sloan Foundation, New York, New York JULIE PAVLIN, Armed Forces Health Surveillance Center, Silver Spring, Maryland GEORGE POSTE, Complex Adaptive Systems Initiative, Arizona State University, SkySong, Scottsdale, Arizona DAVID RIZZO, University of California, Davis, California GARY A. ROSELLE, Veterans Health Administration, Department of Veterans Affairs, Cincinnati, Ohio KEVIN RUSSELL, Armed Forces Health Surveillance Center, Silver Spring, Maryland JANET SHOEMAKER, American Society for Microbiology, Washington, DC JAY P. SIEGEL,7 Johnson & Johnson, Radnor, Pennsylvania P. FREDERICK SPARLING, University of North Carolina, Chapel Hill, North Carolina MARY E. WILSON, Harvard School of Public Health, Harvard University, Boston, Massachusetts EDWARD H. YOU,8 Federal Bureau of Investigation, Washington, DC 4 Forum member until October 18, 2013. 5 Retired as of December 31, 2013. 6 Forum member since January 15, 2014. 7 Forum member since January 15, 2014. 8 Forum member since July 1, 2013. vii Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary IOM Staff EILEEN CHOFFNES, Scholar and Director LEIGHANNE OLSEN,9 Program Officer KATHERINE McCLURE, Associate Program Officer REBEKAH HUTTON, Research Associate CHARLEE ALEXANDER,10 Senior Program Assistant JOANNA ROBERTS,11 Senior Program Assistant (Temp) 9 Staff member until August 15, 2013. 10 Staff member from April 1 to November 15, 2013. 11 Staff member since November 1, 2013. viii Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary BOARD ON GLOBAL HEALTH1 THOMAS C. QUINN (Chair), Associate Director for International Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Professor of Medicine, International Health, Epidemiology, and Molecular Biology and Immunology, Johns Hopkins University School of Medicine, Baltimore, Maryland JO IVEY BOUFFORD (IOM Foreign Secretary), President, New York Academy of Medicine, New York CLAIRE V. BROOME, Adjunct Professor, Division of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia JACQUELYN C. CAMPBELL, Anna D. Wolf Chair, and Professor, Johns Hopkins University School of Nursing, Baltimore, Maryland THOMAS J. COATES, Michael and Sue Steinberg Professor of Global AIDS, Research Co-Director, UC Global Health Institute, David Geffen School of Medicine, University of California, Los Angeles, California GARY DARMSTADT, Director, Family Health Division, Global Health Program, Bill & Melinda Gates Foundation, Seattle, Washington VALENTIN FUSTER, Director, Wiener Cardiovascular Institute, Kravis Cardiovascular Health Center, Professor of Cardiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York JACOB A. GAYLE, Vice President, Community Affairs, Executive Director, Medtronic Foundation, Minneapolis, Minnesota GLENDA E. GRAY, Executive Director, Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Diepkloof, South Africa STEPHEN W. HARGARTEN, Associate Dean, Global Health Program, Medical College of Wisconsin, Milwaukee, Wisconsin PETER J. HOTEZ, Professor of Pediatrics and Molecular Virology and Microbiology, Texas Children’s Hospital Endowed Chair of Tropical Pediatrics, President, Sabin Vaccine Institute and Texas Children’s Center for Vaccine Development, Dean, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas CLARION JOHNSON, Consultant, Exxon Mobil, Fairfax, Virginia FITZHUGH MULLAN, Professor, Department of Health Policy, The George Washington University, Washington, DC OLUFUNMILAYO F. OLOPADE, Walter L. Palmer Distinguished Service Professor of Medicine, The University of Chicago, Chicago, Illinois 1 Institute of Medicine boards do not review or approve individual workshop summaries. The responsibility for the content of the workshop summary rests with the workshop rapporteurs and the institution. ix Copyright © National Academy of Sciences. All rights reserved. Microbial Ecology in States of Health and Disease: Workshop Summary GUY PALMER, Regents Professor of Pathology and Infectious Diseases, Director of the School for Global Animal Health, Washington State University, Pullman, Washington IOM Staff PATRICK KELLEY, Director ANGELA CHRISTIAN, Program Associate x Copyright © National Academy of Sciences. All rights reserved.

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Daniel Garrido, David C. Dallas, and David A. Mills. A15 Bacteriophage Neil R. Gottel, Hector F. Castro, Marilyn Kerley, Zamin Yang,. Dale A. Pelletier, Mircea . A12-3 Schematic illustration of our light sheet microscope setup, 330.
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