THE RELATIONSHIP OF THE "MICROBIOME" AND INFECTIOUS DISEASE OUTBREAKS

FROM:  THE NATIONAL SCIENCE FOUNDATION 

"Microbiome" of Sierra Nevada yellow-legged frogs shifts during infectious disease outbreaks

Interaction between microbiome and infectious pathogens may drive disease
The adult human body is made up of some 37 trillion cells. But microbes, mainly bacteria, outnumber our body's cells by a ratio of 10-to-1.

Scientists now recognize that this huge community of benign microbes--called the microbiome--affects the health, development and evolution of all multicellular organisms, including humans.

Studies show that interactions between such microbiomes and pathogens, or disease-causing microorganisms, can have profound effects on infectious diseases.

In results of a new study, scientists from the University of California, Santa Barbara (UCSB) demonstrate that a fungal pathogen of amphibians does just that. The findings appear this week in the journal Proceedings of the National Academy of Sciences.

Infectious pathogens may disrupt the microbiome

Experiments with model organisms such as mice have shown that infectious pathogens can disrupt the microbiome, but the extent to which this process shapes disease outbreaks is largely unknown.

The work, conducted by scientists Cherie Briggs and Andrea Jani of UCSB, addresses a gap in disease ecology and microbiome research.

"This study shows the importance of knowing how the many benign microbes living on and in our bodies interact with those that cause disease," says Sam Scheiner, National Science Foundation program director for the joint NSF-NIH-USDA Ecology and Evolution of Infectious Disease Program, which funded the research.

"The results are important for developing responses to a disease that's causing amphibians to go extinct worldwide," says Scheiner, "and have implications for future studies of human health."

Jani and Briggs found that the fungus Batrachochytrium dendrobatidis (Bd) drives changes in the frogs' skin microbiomes during disease outbreaks in four populations of the Sierra Nevada yellow-legged frog (Rana sierrae).

Chytridiomycosis, an infectious disease of amphibian skin caused by the Bd pathogen, is a leading cause of amphibian losses worldwide.

"Since amphibian skin is the organ infected by Bd, there has been a lot of interest in how anti-fungal properties of some skin bacteria may protect the frogs," says Briggs.

"We focused on the flip side of this interaction: how infection with Bd can disrupt the skin microbial community."

Next-generation DNA sequencing documents changes

"We used next-generation DNA sequencing to document shifts in skin bacteria communities of the frogs during Bd outbreaks," Jani says.

"We paired field surveys with laboratory infection experiments, demonstrating a causal relationship in which Bd altered the frog's microbiome."

The researchers found that the severity of infection with Bd is strongly correlated with the composition of bacteria communities on the frogs' skin.

"It was surprising that across the different frog populations, there was a striking consistency in the correlation with Bd," says Jani.

One of the populations crashed due to Bd infection, but the other three populations tolerated Bd infections.

"There are different disease dynamics going on," says Jani, "yet there's a similar relationship between the microbiome and Bd."

Answers still elusive

The researchers were unable to conclusively determine whether the Bd-induced disturbance of the frog skin microbiome contributed to the disease symptoms.

The pathogens may interact with the microbiome directly or by manipulating the frogs' immune systems.

It's possible, the biologists say, that the pathogens directly compete with certain bacteria for space or resources or release compounds that affect some bacteria species.

Or the pathogens may control frog immune responses to favor their own growth and disrupt the normal microbiome.

The researchers say that promise exists for probiotic treatments as a way of fighting the decline of frogs due to Bd, but they're careful to qualify the statement.

There is a lot they still don't understand about the environmental effects of such treatments or the interactions between the frogs' microbiomes and the Bd pathogen.

-- Cheryl Dybas, NSF
-- Julie Cohen, UCSB (
Related Programs
Ecology of infectious disease

U.S. TUBERCULOSIS TRENDS

FROM CENTERS FOR DISEASE CONTROL AND PREVENTION

1. Trends in Tuberculosis — United States, 2013

Data indicate that cases and rates of TB disease continue to fall in the U.S.; however, a higher burden in some populations – such as foreign-born individuals and racial/ethnic minorities – keeps TB elimination out of reach. Preliminary data from the CDC National TB Surveillance System show a total of 9,588 cases were reported in the U.S. in 2013, marking a 4.2 percent decline in the 2012 rate (from 3.2 to 3.0 cases per 100,000 population). Despite overall progress, the TB rate for foreign-born individuals is 13 times higher than among individuals born in the U.S., and the proportion of TB cases in the foreign-born group continues to increase. Racial disparities persist. Hispanics, blacks and Asians face higher TB rates—7, 7 and 26 times higher, respectively—than whites. Persons infected with HIV and people who are homeless are also especially vulnerable to TB. Although the proportion of drug-resistant cases remains relatively small, drug resistant TB is a concern because it is difficult and costly to treat and more often fatal. In 2012, multidrug-resistant TB accounted for 1.2 percent of cases (86 cases). Two cases of extensively-drug-resistant TB were reported in 2013. The authors note that eliminating TB in the U.S. requires continuing to address TB in affected populations and improvements in awareness, testing and treatment of TB disease.

2. Implementation of New TB Screening Requirements for U.S.-Bound Immigrants and Refugees — 2007–2014

Updated CDC recommendations for overseas tuberculosis screening of immigrants and refugees has resulted in better diagnosis of TB before individuals arrive in the United States. CDC reports the completion of implementation of new tuberculosis screening and treatment requirements for US-bound immigrants and refugees. Implementation of these requirements has resulted in twice as many cases of tuberculosis being diagnosed and treated before immigrants and refugees arrive in the U.S. compared with the previous screening program. Since the new requirements were implemented, reports of cases of foreign-born tuberculosis have declined. In addition, the increase in persons diagnosed and treated overseas is projected to result in a savings of more than $15 million in US health care costs.

U.S. AND 26 OTHER NATIONS COMMIT TO GLOBAL HEALTH SECURITY AGENDA GOALS

FROM:  U.S. HEALTH AND HUMAN SERVICES DEPARTMENT 
Nations Commit to Accelerating Progress against Infectious Disease Threats

The United States joins 26 countries, the World Health Organization (WHO), the Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE), to accelerate progress toward a world safe and secure from the threat of infectious disease, and committing to the goals of the Global Health Security Agenda.

“Global health security is a shared responsibility; no one country can achieve it alone,” Health and Human Services Secretary Kathleen Sebelius said. “In the coming months, we will welcome other nations to join the United States and the 26 other countries gathered here in Washington and in Geneva, as we work to close the gaps in our ability to prevent, detect, and respond to infectious disease threats.”

Over the next five years the United States plans to work with at least 30 partner countries (containing at least 4 billion people) to prevent, detect and effectively respond to infectious disease threats, whether naturally occurring or caused by accidental or intentional releases of dangerous pathogens.

“While we have made great progress in fighting and treating diseases, biological threats can emerge anywhere, travel quickly, and take lives,” said Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism.  “The recent outbreaks of H7N9 influenza and Middle East Respiratory Syndrome are reminders of the need to step up our efforts as a global community.  The Global Health Security Agenda is about accelerating progress toward a world safe and secure from infectious disease threats.”

Later this year, the White House will host an event bringing together nations who are committed to protecting the world from infectious disease threats to review progress and chart the way forward on building a global system for preventing, detecting, and responding to such threats.

“The United States and the world can and must do more to prevent, detect, and respond to outbreaks as early and as effectively as possible,” CDC Director Dr. Tom Frieden said.  “CDC conducted two global health security demonstration projects last year in partnership with Vietnam and Uganda to strengthen laboratory systems, develop strong public health emergency operations centers, and create real-time data sharing in health emergencies.  CDC is committed to replicate the successes in these two projects in ten additional countries this year.”

In FY 2014, CDC and the Defense Threat Reduction Agency have jointly committed to accelerate progress on global health security by co-developing a strategy and devoting $40 million toward activities focusing on advancing the U.S. government's GHS objectives in ten nations.

The FY 2015 President’s Budget will include an increase of $45 million within CDC to prevent avoidable catastrophes, detect threats early, and mobilize effective responses to contain outbreaks.  The increase also would allow CDC to partner with up to ten countries in 2015 to begin implementation and accelerate successful CDC efforts including training of field epidemiologists, developing new diagnostic tests, building capacities to detect new pathogens, building public health emergency management capacity, and supporting outbreak responses.

Secretary Sebelius, Ms. Monaco and Dr. Frieden were joined at the launch meeting by representatives in Washington and Geneva from 26 other countries, three international organizations, and by other U.S. government officials, including Deputy Secretary of State Heather Higginbottom, Acting Deputy Secretary of Defense Christine Fox, and Department of Agriculture Chief Veterinary Officer John Clifford, whose agencies will lead efforts to fulfill the U.S. government commitment to global health security.

“Efforts to prevent deadly outbreaks strengthen geopolitical stability and security, Agriculture Secretary Tom Vilsack said. “None of us, not the public health, security or agriculture sectors can accomplish global health security on our own—it is obvious that an interdisciplinary approach is the best way to make progress.”

HHS, DoS, USDA, and DoD will work closely with global partners to build countries’ global health security capacities in areas such as surveillance, detection and response in order to slow the spread of antimicrobial resistance, establish national biosecurity systems, reduce zoonotic disease transmission, increase routine immunization, establish and strengthen national infectious disease surveillance and laboratory systems, and develop public health electronic reporting systems and emergency operations centers.

“The Global Health Security Agenda set forth today establishes a roadmap for progress that ultimately depends on collaboration between the health and security communities,” said Acting Deputy Defense Secretary Fox. “The Department of Defense is committed to continuing our work, together with our national and international partners, to strengthen global health security.”

Countries joining the United States to meet the Global Health Security goals at today’s launch were Argentina, Australia, Canada, Chile, China, Ethiopia, Finland, France, Georgia, Germany, India, Indonesia, Italy, Japan, Kazakhstan, Mexico, Netherlands, Norway, Republic of Korea, Russian Federation, Saudi Arabia, South Africa, Turkey, Uganda, United Kingdom, and, Vietnam.

REDWOODS IN DANGER

Fire consumes a once-healthy California redwood tree.  Credit: USFS

FROM:  NATIONAL SCIENCE FOUNDATION

California's iconic redwoods in danger from fire and infectious disease
Pathogen that causes sudden oak death leaves redwoods vulnerable to fire
First it was sudden oak death, the oak disease caused by the plant pathogen Phytophthora ramorum, that threatened California's extensive coastal forests.

Now these forests' stately trees are facing a new menace: the combined effects of sudden oak death and fire. And this time, the iconic redwoods are at risk.

Usually resistant to the effects of wildfires, California's coast redwoods are now burning as fast as other trees. Why?

Into the redwood forest

To find answers, plant pathologist David Rizzo of the University of California at Davis (UC Davis) and colleagues monitored more than 80,000 hectares of forests near Big Sur, Calif. In their plots, tanoaks, California bay laurels and coast redwoods grow.

The study began in 2006. "In 2008, almost half our plots were burned by wildfires that lasted the better part of a month," says Rizzo.

That was the beginning of the end for many coast redwoods, surprising researchers who expected the trees to be fire-proof.

The key to the redwood deaths, discovered Rizzo, Margaret Metz and Kerri Frangioso of UC Davis, along with Morgan Varner of Mississippi State University and Ross Meentemeyer of North Carolina State University, lies in the sudden oak death pathogen.

"If redwoods didn't live in forests affected by the disease," says Metz, "they could withstand fires just fine."

The biologists recently reported their results online in the journal Ecology, published by the Ecological Society of America.

After the fires were under control, the scientists returned to their study plots. Half had long been infested with the sudden oak death pathogen; half had been spared. The redwoods' mortality risk, it turned out, was four times higher in the sudden oak death plots as in healthy plots.

"The disease likely created more fuel for wildfires as dead tanoak branches fell," says Rizzo. "The loss of the oaks also would have decreased the amount of shade, drying out the forest and turning it into a tinder box, one not even redwoods could survive."

Pathogens + fires = dead redwoods

The forest ecosystem disturbance that happens when a pathogen like sudden oak death becomes established and starts killing trees, says Rizzo, "clearly isn't the only one that may be important to that forest."

Sudden oak death has killed millions of trees in the coastal forests of California and Oregon. It was first linked with the mortality of tanoaks and coast live oaks in the San Francisco Bay area in the mid-1990s. In 2000, Phytophthora ramorum was confirmed as the causal agent.

Analyses of the pathogen's genetic structure indicate that a single introduction sparked the wave of disease. It likely originated at a nursery in Santa Cruz, Calif.

Since then, scientists have found that the pathogen has infected plants in 45 genera, including ferns. "These host species are important parts of the forests along the California coast and at the wildland-urban interface," says Rizzo.

The pathogen's current range extends more than 435 miles from the Big Sur area in central California north to Mendocino County, with smaller affected areas in Humboldt County, Calif., and Curry County, Ore. Forests along Big Sur are among the most affected, with 100 percent of tanoaks infected in some stands.

Many of those forests are also prone to wildfires. "There's a growing concern that dead trees from the disease may make wildfires worse," Metz says.

The 2008 wildfires were the first in forests affected by sudden oak death. The largest fire, called the Basin Complex, was ignited by a lightning storm in June. It burned more than 95,000 hectares in the Big Sur region.

In September, the Chalk Fire started south of the Basin Complex perimeter; it burned an additional 16,000 acres. "More than 40 percent of our 280 plots went up in flames, 98 in the Basin Fire, and 23 in the Chalk Fire," says Rizzo.

A month after containment of the Basin Complex fire, the researchers surveyed 61 plots to measure burn severity before the forest could change with the onset of California's winter rains. "These measurements serve as our baseline data on ecosystem responses to interactions between fire and infectious disease," says Rizzo.

Key hidden high in the forest canopy

When sudden oak death kills tanoaks, it alters the trees in ways that leave neighboring redwoods vulnerable, the researchers found.

Flames are carried high into the tree canopy by the dead tanoaks; they then scorch the crowns of surrounding redwoods. Injury to the redwoods' crowns is what likely caused the trees to die in the 2008 fires, the scientists believe.

"Humans are causing widespread changes throughout our world, including greater wildfires related to changing climate and from increasing infectious diseases due to more modes of transportation," says Sam Scheiner, program director at the National Science Foundation (NSF) for the joint NSF-NIH Ecology and Evolution of Infectious Diseases Program, which funded the research.

"This study shows that these changes can combine in unexpected ways that can be very destructive. More such research is needed if we are to prepare for what's to come."

Rizzo agrees. "We're moving species around the globe at high rates, and global warming has increased fire severity. There may be all sorts of consequences, among them, dead and dying coast redwoods."

-- Cheryl Dybas, NSF

ANIMAL-TO-HUMAN INFECTIOUS DISEASE AT ANNUAL CONFERENCE

FROM:  CDC.  This is a male Ixodes ricinus tick (smaller) shown copulating with a female tick (larger). I. ricinus, the "castor bean" tick, so called because of its resemblance to the castor bean, is a vector for the B. burgdorferi spirochete, the cause of Lyme disease, and is commonly found on farm animals, and deer who are the natural host. Credit: Centers For Disease Control and Prevention/Wikimedia

FROM: THE NATONAL SCIENCE FOUNDATION

Interplay of Ecology, Infectious Disease, Wildlife and Human Health Featured at Annual Conference
West Nile virus, Lyme disease and hantavirus. All are infectious diseases spreading in animals and in people. Is human interaction with the environment somehow responsible for the increase in these diseases?

The ecology and evolution of infectious diseases will be highlighted at two symposia at the Ecological Society of America's annual meeting, held from Aug. 5-9 in Minneapolis, Minn.

One symposium will address human influences on viral and bacterial diseases through alteration of landscapes and ecological processes.

Another will focus on the emerging field of eco-epidemiology, which seeks to integrate biomedical and ecological research approaches to addressing human health threats.

Much of the research presented is funded by the joint National Science Foundation- (NSF) National Institutes of Health Ecology and Evolution of Infectious Diseases (EEID) Program.

"These sessions show that basic research is critical for managing disease threats," said Sam Scheiner, NSF EEID program director. "They also showcase the need to link scientists with public health professionals."

The first symposium, on Monday, Aug. 5, will take a deeper look at the connections between human activities and infectious diseases.

Though we often think of diseases as simply being "out there" in the environment, human actions--such as feeding birds--can influence the abundance, diversity and distribution of wildlife species and thus, infectious diseases.

"New human settlements, the spread of agriculture and the increasing proximity of people, their pets and livestock to wild animals increase the probability of disease outbreaks," said session organizer Courtney Coon of the University of South Florida.

"We're interested in learning more about how urban and other environments that humans dramatically change affect the susceptibility and transmission potential of animals that are hosts or vectors of disease."

What are the key determinants of spillover of wildlife diseases to domestic animals and humans?

Why is the prevalence of pathogens in wildlife in urban areas often altered by counterparts in less developed environments?

Speakers will address these and other questions.

The second symposium, on Tuesday, Aug. 6, will continue the theme of infectious diseases, but with an eye toward integrating biomedical and ecological approaches into the investigation and control of emerging diseases.

"Environmental processes and human health are linked, and we'd like to chart a future in which ecologists and epidemiologists more routinely work in tandem to address health problems," said symposium organizer Jory Brinkerhoff of the University of Richmond.

Scientists studying human diseases may overlook possible ecological factors.

For example, most Lyme disease cases in the eastern United States happen in the North even though the black-legged tick, which transmits the bacterium, is found throughout the Eastern states.

Human life histories and interactions with the environment, researchers say, are critically important to the success of managing a mosquito-borne virus called dengue fever.

"Disease ecologists and epidemiologists address some of the same kinds of questions, yet operate largely in isolation of one another," said Brinkerhoff.

"We're bringing them together to share their approaches and study designs, and to strengthen our ability to address public health issues."

Disease Ecology in Human-Altered Landscapes: Monday, Aug. 5, 2013, 1:30 p.m.-5 p.m., 205AB, Minneapolis Convention Center.
Organizer/Moderator: Courtney Coon, University of South Florida
Co-Organizer: James Adelman, Virginia Tech

Speakers:
Parviez Hosseini, EcoHealth Alliance
Matthew Ferrari, Penn State University
Marm Kilpatrick, University of California, Santa Cruz
Raina Plowright, Penn State University
Sonia Altizer, University of Georgia
Becki Lawson, Zoological Society of London
Eco-Epidemiology: A Multi-Disciplinary Approach to Addressing Public Health Problems: Tuesday, Aug. 6, 2013, 1:30 p.m.-5 p.m., 205AB Minneapolis Convention Center.
Organizer/Moderator: Jory Brinkerhoff, University of Richmond
Co-Organizer: Maria Diuk-Wasser, Yale School of Public Health

Speakers:
Maria Diuk-Wasser, Yale School of Public Health
Daniel Salkeld, Colorado State University
Mark Wilson, University of Michigan
James Holland Jones, Stanford University
Harish Padmanabha, National Center for Socio-Environmental Synthesis
Jean Tsao, Michigan State University
-NSF-

NATIONAL CENTER FOR MEDICAL INTELLIGENCE LOOKS FOR THREATS

Photo Credit:  U.S. Army

FROM: U.S. DEPARTMENT OF DEFENSE
Medical Intelligence Center Monitors Health Threats
By Cheryl Pellerin
American Forces Press Service

FORT DETRICK, Md., Oct. 10, 2012 – From a windowless building behind barriers and fences here, scientists, physicians and other experts monitor a range of intelligence and open-source channels for threats to the health of U.S. forces and the homeland.

But the Defense Intelligence Agency’s National Center for Medical Intelligence, known as NCMI, is an intelligence organization, not a public health organization.

The job, NCMI Director Air Force Col. (Dr.) Anthony M. Rizzo told American Forces Press Service, is not to tell the public what is happening. "It is our responsibility to tell policymakers and planners … what we believe is going to happen," he explained.

The center’s intelligence targets are medical and scientific issues. Its products, like those of the rest of the intelligence community, are predictive analysis and products for warning, produced in four divisions whose experts follow developments in infectious disease, environmental health, global health systems and medical science and technology.

NCMI is the primary source of medical intelligence in the federal government, Rizzo said, "so as a consequence, we have to write for all levels, all customers, … from the president down to the most tactical intelligence officer or surgeon in the field."

In the hallways and offices of the nondescript NCMI building are a broad range of scientists, many with multiple advanced academic degrees, many of them leaders in their fields.

"We take these very smart people," Rizzo said, "and turn them into intelligence officers."

Downstairs is a typical operations center -- multiple desks and computer monitors face large, wall-mounted screens that carry news reports from around the world.

Also at work in the building are scientists from many partner organizations.

"We are an all-source organization, and thus we have to use every means available to get our data. And the intelligence community partners who provide national technical means are physically located here," the director said.

"But we also have responsibility for intelligence for homeland health protection," he added, "[and] we could not do that job without a large number of non-intelligence-community partners who are also resident here -- fully cleared and full-up members of the organization."

Resident partners include organizations like the National Geospatial Intelligence Agency and the Agriculture Department. And Rizzo said he has NCMI experts embedded at other intelligence agencies.

Each NCMI division needs a certain amount of baseline data to do its job, the director explained.

"In the Infectious Disease Division, the baseline requirement is to understand the risk of every type of [endemic] infectious disease in every country. You can imagine why," Rizzo said.

"If an outbreak of mystery disease occurs in a country, we need to be able to say that we know in that country that Ebola, malaria and dengue are very common, so my people can look at the symptoms of mystery disease and know" the most likely suspects, Rizzo said.

"If mystery disease doesn’t fit the things that are most likely," he added, "then we have to start looking really differently."

At NCMI, every division also has a baseline product in addition to alerts and threat forecasts. In the Infectious Disease Division, it’s the Infectious Disease Risk Assessment, a predictive product, Rizzo noted, "that says if you go to a place unprotected, we predict these are the diseases your people will get, and … these are the numbers of cases."

Every federal organization that sends Americans overseas uses this product, along with baseline products from the other divisions.

Also at NCMI is a cross-divisional pandemic warning team that spends all its time monitoring highly pathogenic H5N1 avian influenza and other potential pandemic diseases.

In April 2009, two months before the World Health Organization and the U.S. Centers for Disease Control and Prevention officially declared the global outbreak of H1N1 influenza a pandemic, NCMI published an intelligence product for senior U.S. policymakers that predicted H1N1 would be a pandemic.

"That does not make us better than [CDC]," Rizzo said, "What it does do is make us different, because [CDC] has to be right. We in the intelligence community love to be right, but we also know that in order to provide timely warning, warning in time for the customer to take action to mitigate what we’ve predicted, we have to be early. And the earlier we predict, … the less certainty we have."

At NCMI, the Environmental Health Division monitors toxic industrial chemicals, materials and facilities worldwide. Its baseline product is the Environmental Health Risk Assessment, which addresses the quality of air, food, soil, water and risk from chemical exposure worldwide. The division also does what Rizzo calls predictive hazard area modeling.

"We can tell you with 99 percent accuracy," the director said, "if this thing that’s full of chemicals leaks next Thursday, here’s where the hazard area is, here’s where you should not be standing, and here’s where it’s OK to stand."

The division monitors several facilities around the clock and can forecast dispersion events at those places immediately, but it also can do similar forecasts for any chemical or nuclear facility on the planet, Rizzo said.

Every day of the year, the director said, "there is a biological or chemical event somewhere in the world, sometimes many of them. And we own the responsibility of assessing whether or not those events … are manmade or naturally occurring, and then making predictions about them."

The Global Health Systems Division is responsible for understanding the medical capabilities of every country in the world, and it monitors the quality of every nation’s blood supply. The division’s baseline product is the Medical Capabilities Assessment for each country, and it is responsible for maintaining Defense Department databases that characterize overseas medical facilities, including hospitals, clinics, labs, blood banks and pharmaceutical production facilities.

"If you’re a planner," the director said, "and I don’t care who you’re a planner for, you’re using that Infectious Disease Risk Assessment, you’re using that Medical Capabilities Assessment, you’re using the Environmental Health Assessment to decide, ‘What do I use to protect my people? What do I have to bring? What can I leave home?’"

The NCMI Science and Technology Division is responsible for understanding every nation’s medical defense capabilities against chemical, biological, radiological and nuclear weapons.

"If you understand a country’s medical defense capabilities, that can very much help you understand what their other capabilities might be and what their intent is," Rizzo said. "People plan medical defense based on what they think is going to happen to them or what they think they can do."

Along with the baseline products that come out of each NCMI division, all produce warnings, alerts and special products during crises.

"When it comes to a crisis such as the earthquake in Haiti or an invasion of a country or a NATO bombing campaign against a country, … we have to tailor products to support the U.S. government and the governments of our allies," Rizzo said. "So while we are writing all the time, we’re also very responsive to world events. When the earthquake in Haiti occurred, we put out close to 100 products."

Most products start out in a classified version, but the director said his people are very good at writing products to be shared with NCMI’s non-intelligence community partners.

"We don’t get credit," Rizzo added, "but that doesn’t matter."

NCMI itself is an important partner in the multiagency effort to implement the nation’s first U.S. National Strategy for Biosurveillance, released this summer by the White House to make sure that agencies can quickly detect a range of global health and security hazards.

"When we think of the word biosurveillance, we think of the kinds of things that the public health community does -- collecting cases, taking cultures, deciding which disease is which," Rizzo said. "But we in the intelligence community are looking way before that to determine [if there are] threats on the horizon."

When the experts at NCMI communicate a threat to the public health community, the director added, "they can focus … their public health efforts, and so we are very much involved in biosurveillance, but … at the front end of the process."

The whole world deals with limited resources, Rizzo added, and CDC, the World Health Organization and other public health organizations can’t look at everything all the time.

"But if we in the intelligence community, especially we in medical intelligence, are able to say, ‘Here’s a threat on the horizon that we perceive,’ … then it’s up to our customer to decide whether or not they will think about it," the director added.

"We have very good, nonadversarial, very supportive relationships with our partners," Rizzo said, "and typically if we say we’re concerned, they respond."