NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

The Committee recommends an appropriation of $1,359,688,000 for the National Institute of Allergy and Infectious Diseases [NIAID]. This is $47,186,000 more than the budget request and $103,029,000 more than the fiscal year 1997 appropriation. The comparable numbers for the budget estimate include funds to be transferred from the Office of AIDS Research.

Mission- The NIAID supports and conducts basic and clinical research and research training programs in infectious diseases, including AIDS, and diseases caused by, or associated with, disorders of the immune system. The NIAID is the lead NIH Institute charged with developing new and improved vaccines and supporting research on acquired immunodeficiency syndrome, tuberculosis, sexually transmitted diseases, and tropical diseases. The NIAID's research goal is to improve the health and quality of life of people by improving diagnosis, treatment, and prevention of diseases.

Tuberculosis- NIAID's support for tuberculosis research is critical in developing improved diagnostic tests, and treatments in response to the reemergence of TB in the United States. The Committee understands that NIAID-supported researchers have begun to understand multidrug resistant tuberculosis and hope to develop methods to quickly determine which drug therapy is appropriate for MDRTB strains, so a patient can begin an appropriate treatment therapy immediately, thus reducing the risk of transmitting the disease to others.

Primary immune deficiency diseases.--The Committee recognizes that more than 70 primary immune deficiency diseases have been identified to date, with 500,000 cases diagnosed and estimates of another 500,000 undiagnosed. These diseases, in which the body is unable to fight off infections, strike most severely at children, many of whom do not survive beyond their teens or early twenties. The Committee encourages NIAID to maintain its research focus on these devastating disorders as well its support of primary immune deficiency disease registries. The Committee also encourages the Institute to continue the important collaborations with the Jeffrey Modell Foundation on both research and public education endeavors.

Sarcoidosis.--The Committee supports the role NIAID has played in the establishment of the sarcoidosis national network [SNN], a national network of sarcoidosis patients, their family members, and the public health community. We encourage their continued support of this effort. The Committee also urges NIAID to continue its examination of the environmental and genetic agents associated with sarcoidosis, since approximately one-fourth of the chronic sarcoidosis cases are dying due to respiratory failure, or other pulmonary dysfunctions.

Food safety- In May 1997 the DOA, the Department of Health and Human Services, and the Environmental Protection Agency submitted a report to the President detailing a national food safety initiative. The report notes that many of the new foodborne pathogens that have emerged over the past decade are not easily detected and are increasingly resistant to time-tested controls. This clarifies the need for biomedical research to enhance our ability to prevent, detect, and treat foodborne illness in humans. The report noted that relevant agencies `need to better coordinate their research efforts on the highest priority issues and work together more effectively to leverage each other's resources.' Toward that end, the NIAID is encouraged to work with the NIDDK, the Centers for Disease Control and Prevention, and the Agricultural Research Service to develop a research agenda on food safety to be collaboratively funded by the three agencies.

Hepatitis C [HCV]- The Committee is aware that significant new NIAID research recommendations were made by the Hepatitis C Consensus Conference in March 1997 to develop a HCV vaccine and to conduct clinical trials to better determine optimum treatment regimens, including better treatment for those coinfected with HIV. The Committee urges that this research be initiated in fiscal year 1998 in a manner responsive to the conference recommendations.

Blood safety/hemophilia.--The Committee is pleased with NIAID's continuing commitment to maximize clinical funding support, to assure access to newly available HIV/AIDS drugs for people with hemophilia. The Committee urges NIAID to work with the national hemophilia leadership to determine what further research steps should be taken to address the complications associated with hemophilia including treatment for viral hepatitis.

Chronic fatigue and immune dysfunction syndrome- The Committee encourages the Institute to provide additional support for extramural grants focused on promising areas of CFIDS biomedical research, particularly those investigations which will define the pathophysiology of the illness and identify diagnostic markers.

Organ transplantation research.--The Committee urges the Director to support research efforts to increase organ donation, including projects: (1) aimed at increasing organ donations in underserved and rural areas and among minority populations, and (2) evaluating community-based initiatives.

Postpolio syndrome.--The Committee is aware of the progress being made on the postpolio syndrome and encourages the Institute to support research in this area, including providing rehabilitation alternatives for postpolio patients.

E. coli- The Committee is aware that 10,000 to 20,000 infections of Escherichia coli (E. coli) occur in the United States annually and that such infections can lead to serious complications, including death. The Committee encourages the NIAID to expand its work in E. coli infections.

Alternative research resources- The Committee supports the expansion of existing alternative resources to the use of animals, particularly through ensuring increased access by researchers to human tissues and organs for research purposes. The Committee encourages the Director to give consideration to participating in a multi-Institute initiative geared to increase support in this area and respond to the research community's growing need for human tissues and organs.

Malaria.--The Committee is encouraged by NIH's interest and effort to bring renewed attention to research opportunities for malaria prevention and control. U.S. leadership at this time is critical. The Committee supports the National Institute of Allergy and Infectious Diseases [NIAID] intention to launch a new malaria research initiative to better understand human immunity to several forms of malaria, and to accelerate the development of a malaria vaccine. In addition, the Committee urges NIAID to coordinate its efforts with the CDC, the Agency for International Development, and the Department of Defense to maximize Federal research efforts.

Allergic diseases.--As many as 50 million Americans suffer from allergic diseases. Allergic reactions can be debilitating or even fatal, and they can often lead to such chronic conditions as sinusitis and asthma. Researchers do not fully understand how the immune system recognizes an allergen or why reactions are more severe in certain individuals. The Committee urges that additional research be supported in this area to help determine risk factors for developing allergic disorders and sinusitis, and to determine the role of infectious agents including viruses, bacteria, and fungi in the pathogenesis of such disorders.

The Committee is concerned about the effects of untreated allergies, as well as the impact of sedating antihistamines on worker safety and children's learning. Further, the Committee is concerned about allergic rhinitis as a factor contributing to the morbidity and mortality related to asthma. The Committee looks to the Institute to develop guidelines with regard to the management of allergic rhinitis and related conditions. These guidelines should build support for the proper diagnosis and treatment of allergic rhinitis.

Emerging infectious diseases.--The Committee supports the continued focus on research into the antibiotic resistance of life-threatening bacterial organisms and the development of a new generation of antibiotics, and the Committee recommends support for this continued area of research. The Committee is aware of the research into infectious diseases being conducted at the Public Health Research Institute and encourages the NIAID to give appropriate consideration to research proposals received from this institution.