Michael H Merson
Michael Howard Merson
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Interim Chair and Clinical Professor of the Department of Global and Environmental Health
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Professional overview
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Michael Merson is Interim Chair of the Department of Global and Environmental Health and Clinical Professor of Global and Environmental Health. He is the William Joklik Emeritus Professor of Medicine and Global Health at Duke University, where he served as the founding director of the Duke Global Health Institute and as Vice President and Vice Provost for Global Affairs. His current research is focused on policy issues related to the response to pandemics, evaluating the rollout of Paxlovid in low-income countries and on ways to regain trust in public health.
Prior to NYU, he joined the faculty at Yale University as its first Dean of Public Health. Before entering academia, between 1980 and 1995, Dr. Merson served as director of the World Health Organization (WHO) programs on Diarrheal Diseases and Acute Respiratory Infections, and subsequently the WHO Global Program on AIDS. He has authored over 150 articles, is the senior editor of a leading global health textbook “Global Health: Disease, Programs, Systems, and Policies” and lead author of The AIDS Pandemic: Searching for a Global Response on the history of the global response to AIDS. He has served in advisory capacities for UNAIDS, WHO, the Global Fund to Fight AIDS, TB and Malaria, World Bank, World Economic Forum, Bill & Melinda Gates Foundation, and was an advisor to various private sector entities on the COVID-19 pandemic. He has two honorary degrees and is a member of the National Academy of Medicine.
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Education
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B.A., 1966, cum laude, Amherst College, Amherst, MassachusettsM.D., 1970, summa cum laude, SUNY, Health Sciences Center at Brooklyn, New York
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Honors and awards
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Consortium of Universities for Global Health (CUGH) Distinguished Leadership Award (2018)Duke Medical Alumni Association Distinguished Faculty Award (2017)Master Teacher Award in Preventive Medicine, Downstate Medical Center (2010)Outstanding Contribution to the Campaign Against HIV/AIDS, Russian Association Against AIDS (2000)Connecticut Health Commissioner’s AIDS Leadership Award (1998)Connecticut Health Commissioner’s AIDS Leadership Award (1997)Frank Babbott Alumni Award (1995)Surgeon General's Exemplary Service Medal (1993)Commendation Medal, US Public Health Service; (1986)Arthur S. Flemming Award for Outstanding Federal Service (1983)Commendation Medal, US Public Health Service (1975)
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Publications
Publications
Ciguatera in Puerto Rico and the Virgin Islands
AbstractPayne, C. A., Payne, S. N., Hughes, J. M., & Merson, M. H. (n.d.). In New England Journal of Medicine (1–).Publication year
1977Volume
296Issue
16Page(s)
949-950AbstractTo the Editor: The report of Hughes and Merson1 presented a concise résumé of the general problem of ciguatera (fish poisoning) and once again brought the topic to the clinical literature, where it is seldom seen. The major neurology and gastroenterology textbooks contain no reference to this entity, which was apparently known to the ancient Egyptians. The authors state, “Ninety per cent of outbreaks reported to the Center for Disease Control occurred in Hawaii and Florida.” This figure apparently represents deficiency in case reporting rather than the actual incidence of the problem. We became interested in ciguatera in mid-1975.Coproexamination for Botulinal Toxin and Clostridium botulinum: A New Procedure for Laboratory Diagnosis of Botulism
AbstractDowell, V. R., Hatheway, C. L., Lombard, G. L., McCroskey, L. M., Hughes, J. M., & Merson, M. H. (n.d.).Publication year
1977Journal title
JAMA: The Journal of the American Medical AssociationVolume
238Issue
17Page(s)
1829-1832AbstractStool or serum specimens or both from 318 persons pertaining to 165 botulism investigations over a three-year period were examined. Botulinal toxin was detected in stools of 19 of 56 patients and in sera of 20 of 60 patients with clinical botulism; it was not detected in specimens from 246 persons with an illness other than botulism or well contacts of patients. Clostridium botulinum was identified in stools of 36 of 60 clinical botulism patients and in four of 27 asymptomatic contacts of patients with botulism victims, but not in stools of 65 persons not associated with confirmed botulism. When stool and serum samples were examined, confirmatory evidence was obtained for 72.9% of the botulism cases. Detection of botulinal toxin or C botulinum in the stool of a person should be considered evidence supporting the clinical diagnosis of botulism.Enzyme-linked immunosorbent assay for detection of Escherichia coli heat-labile enterotoxin
AbstractYolken, R. H., Greenberg, H. B., Merson, M. H., Sack, R. B., & Kapikian, A. Z. (n.d.).Publication year
1977Journal title
Journal of Clinical MicrobiologyVolume
6Issue
5Page(s)
439-444AbstractThe development of an enzyme-linked immunosorbent assay (ELISA) for the detection of heat-labile Escherichia coli enterotoxin is described. The assay, which is based on the immunological similarity between Vibrio cholerae toxin and heat-labile E. coli enterotoxin, is similar in design to a radioimmunoassay but utilizes enzyme-labeled rather than radioactive isotope-labeled reagents. The ELISA system is as sensitive as both radioimmunoassay and the y-1 adrenal cell assay for the detection of heat-labile E. coli enterotoxin but requires neither radioactive reagents nor tissue culture techniques. The ELISA is easy to perform and is adaptable for use in small laboratories.Epidemiologic Assessment of the Relevance of the So-Called Enteropathogenic Serogroups of Escherichia coli in Diarrhea
AbstractGangarosa, E. J., & Merson, M. H. (n.d.).Publication year
1977Journal title
New England Journal of MedicineVolume
296Issue
21Page(s)
1210-1213AbstractSince the early 1950's the concept has evolved that certain serogroups of Escherichia coli, commonly designated enteropathogenic, are like shigellae and salmonellae, inherent enteric pathogens. This view is so widely held that many clinicians regard diarrhea associated with these serogroups as a distinct clinical entity, and many large hospitals include, as diagnostic laboratory routine, a search for these serogroups in stools from patients, particularly infants, with diarrhea. In the light of knowledge obtained in the last 10 years about virulence plasmids and about mechanisms by which Esch. coli causes diarrhea, we attempt to evaluate this concept through a historical.Escherichia coli Serotypes and Diarrhea
AbstractGurwith, M., Hinde, D., Gangarosa, E. J., & Merson, M. H. (n.d.). In New England Journal of Medicine (1–).Publication year
1977Volume
297Issue
9Page(s)
510-511AbstractTo the Editor: Gangarosa and Merson (N Engl J Med 296:1210, 1977) conclude that “routine serogrouping of Esch. coli in sporadic cases of diarrhea using commercial antiserums#x2026;is#x2026;useless.” They review studies relating Esch. coli of the traditional enteropathogenic serotypes (EPEC) to diarrhea. Seven of these reports, published from 1950 to 1961, form the entire epidemiologic evidence “refuting” the virulence of EPEC.1 2 3 4 5 6 7 We wonder whether the results of these studies, especially when their methods are scrutinized, support the conclusions drawn, and we question their relevance to serogrouping in 1977. In one study, transient and sometimes asymptomatic infection with EPEC was found in.Food borne botulism in the United States, 1970 to 1975
Horwitz, M. A., Hughes, J. M., Merson, M. H., & Gangarosa, E. J. (n.d.).Publication year
1977Journal title
Journal of Infectious DiseasesVolume
136Issue
1Page(s)
153-159Foodborne disease outbreaks of chemical etiology in the United States, 1970-1974
AbstractHughes, J. M., Horwitz, M. A., Merson, M. H., Barker, W. H., & Gangarosa, E. J. (n.d.).Publication year
1977Journal title
American Journal of EpidemiologyVolume
105Issue
3Page(s)
233-244AbstractIn the United States between 1970 and 1974 there was an increase each year both in the absolute number of foodborne disease outbreaks of chemical etiology reported to the Center for Disease Control and in the proportion of these outbreaks in the total reported foodborne disease outbreaks. Nearly half (48.9%) of these foodborne disease outbreaks of chemical origin were caused by toxic fish or shellfish. Of the rest, 16.5% were caused by poisonous mushrooms, 10.9% by heavy metal poisoning, 7.2% by excessive use in food of monosodium. glutamate (the etiologic agent of Chinese Restaurant Syndrome) and 16.5% by miscellaneous chemicals. Practices that contributed to the occurrence of these outbreaks included the inadvertent selection for consumption of toxic fish, shellfish, or mushrooms, storage of fish at improper temperatures, storage of acidic liquids in metal containers, and addition of excessive amounts of monosodium glutamate to foods. Commercially-processed foods were responsible for outbreaks of scombroid fish poisoning, shellfish poisoning, and heavy metal poisoning. Because outbreaks of chemical etiology due to contaminated commercial products do occur, prompt recognition and reporting of outbreaks to public health personnel are essential so that epidemiologic investigations can be conducted and effective control measures promptly initiated.The characteristics and mortality of outpatient acquired pneumonia
AbstractMoore, M. A., Merson, M. H., Charache, P., & Shepard, R. H. (n.d.).Publication year
1977Journal title
Johns Hopkins Medical JournalVolume
140Issue
1Page(s)
9-14AbstractOne hundred fifty four cases of pneumonia occurring over a 6 month period were analyzed. Population characteristics admission diagnoses, causative pathogens, frequency of associated illnesses, antibiotic usage and mortality were evaluated. Despite population characteristics known to predispose to a poor clinical outcome, the mortlity was low, probably because of rapid institution of a single, appropriate antibiotic.The Safety of Eating Shellfish
Hughes, J. M., Merson, M. H., & Gangarosa, E. J. (n.d.).Publication year
1977Journal title
JAMA: The Journal of the American Medical AssociationVolume
237Issue
18Page(s)
1980-1981Type a botulism from commercially canned beef stew
AbstractBlake, P. A., Horwitz, M. A., Hopkins, L., Lombard, G. L., McCroan, J. E., Prucha, J. C., & Merson, M. H. (n.d.).Publication year
1977Journal title
Southern Medical JournalVolume
70Issue
1Page(s)
5-7AbstractTwo of three persons who ate lunch together became ill with symptoms characteristic of botulism. One died before botulism was suspected and before specimens could be collected for laboratory testing, but a serum specimen from the other patient, who survived, yielded botulinal toxin, type A. The third person remained asymptomatic, but Clostridium botulinum type A was cultured from his stool. The three persons had shared two canned foods: home-canned green beans and commercially canned beef stew. The green beans were initially assumed to be the cause of the outbreak. However, the empty stew can was recovered from the garbage, and washings from the can yielded C botulinum, type A, and its toxin.Diagnostic value of indirect hemagglutination in the seroepidemiology of Shigella infections
AbstractPatton, C. M., Gangarosa, E. J., Weissman, J. B., Merson, M. H., & Morris, G. K. (n.d.).Publication year
1976Journal title
Journal of Clinical MicrobiologyVolume
3Issue
2Page(s)
143-148AbstractTo evaluate the usefulness of the indirect hemagglutination (HA) test in the epidemiological investigation of shigellosis, single serum specimens were tested from 50 patients with Shigella dysenteriae 1 (Shiga bacillus) infections, 103 asymptomatic contacts of these cases, 267 adult and 100 student control, and serum specimens collected during two outbreaks caused by S. sonnei and one outbreak due to S. flexneri 6. In patients with S. dysenteriae 1, 74% demonstrated titers of ≥ 1:40, with 50% showing titers of ≥ 1:60, whereas in the controls 10.4% had titers of ≥ 1:40 and only 0.3% had titers of ≥ 1:60. IHA titers in serum specimens collected from patients with S. sonnei and S. flexneri 6 were too low to be considered diagnostic for individual patients, but were useful in analysis of group results. Groups of ill individuals yielded titers significantly higher than non ill groups; however, titers from ill groups were usually less than 1:40. The IHA test for S. dysenteriae 1 antibodies serves as a valuable adjunct to the diagnosis of Shiga bacillus dysentery. In the laboratory, an IHA titer of 1:40 or 1:80 is a 'borderline positive.' Shiga bacillus dysentery is strongly indicated when IHA titers are ≥ 1:60.ENTEROTOXIGENIC ESCHERICHIA COLI AND REOVIRUS-LIKE AGENT IN RURAL BANGLADESH
AbstractRyder, R. W., Sack, D. A., Kapikian, A. Z., Mclaughlin, J. C., Chakraborty, J., Mizanur Rahman, A. S., Merson, M. H., & Wells, J. G. (n.d.).Publication year
1976Journal title
The LancetVolume
307Issue
7961Page(s)
659-663Abstract48 patients admitted to a rural Bangladesh hospital with dehydration secondary to diarrhœa were examined for infection caused by reovirus-like agent (R.L.A.) or enterotoxigenic Escherichia coli (E.T.E.C.). The diagnosis of R.L.A. infection was established by electron microscopy of stool filtrates and by a fourfold or greater rise in serum complement-fixing antibodies to the Nebraska calf diarrhœa virus. Evidence of infection by heat-labile-toxin (L.T.)-producing E.T.E.C. was sought by stool culture and serological testing using the adrenal-cell tissue-culture system. Infection by heat-stable-toxin (S.T.)-producing E.T.E.C. was sought by stool culture using the infant mouse test. 12 patients, all less than two years old, had evidence of R.L.A. infection, accounting for illness in 55% of the 22 patients who were less than two years old. None of these 22 children had evidence of E.T.E.C. infection. R.L.A. diarrhœa lasted five to six days, often led to serious dehydration, and was associated with vomiting and fever. 11 cases of E.T.E.C. diarrhœa were detected, accounting for 56% of the cases of diarrhœa in the 18 patients who were more than ten years old. Diarrhœa caused by E.T.E.C. was sudden in onset, shorter in duration, and caused pronounced dehydration. In a community survey E.T.E.C. was isolated with equal frequency in the stools of control and case family members. The data suggest that E.T.E.C. is a common cause of adult diarrhœa in Bangladesh, while R.L.A. is a common cause of diarrhœa in children.Fish and Shellfish Poisoning
AbstractHughes, J. M., & Merson, M. H. (n.d.).Publication year
1976Journal title
New England Journal of MedicineVolume
295Issue
20Page(s)
1117-1120AbstractVertebrate fish containing toxins capable of causing human illness are divided into three categories based on the location of the toxin.1 Ichthyosarcotoxic fish contain toxin in their musculature, viscera, skin or mucus and are responsible for most cases of fish poisoning. Ichthyo-otoxic fish have toxin in their gonads, and ichthyohemotoxic fish contain toxin in their blood; poisoning due to these fish is relatively rare. Of the nine types of ichthyosarcotoxism, ciguatera, scombroid and puffer-fish poisoning (tetrodotoxism) are the most common worldwide. Shellfish may cause paralysis (paralytic shellfish poisoning) if they contain toxin derived from the dinoflagellates Gonyaulax catenella or Go.Laboratory investigation of diarrhea in travelers to Mexico: Evaluation of methods for detecting enterotoxigenic Echerichia coli
AbstractMorris, G. K., Merson, M. H., Sack, D. A., Wells, J. G., Martin, W. T., Dewitt, W. E., Feeley, J. C., Sack, R. B., & Bessudo, D. M. (n.d.).Publication year
1976Journal title
Journal of Clinical MicrobiologyVolume
3Issue
5Page(s)
486-495AbstractA laboratory investigation was conducted on cultures collected from travelers before, during, and after a trip to Mexico to characterize the etiology of traveler's diarrhea. Four laboratory methods for detecting enterotoxigenicity of Escherichia coli were evaluated: the infant mouse assay, the Chinese hamster ovary (CHO) cell assay, the Y1 adrenal cell assay, and the rabbit ileal loop. Although a number of common enteric pathogens were identified as a cause of traveler's diarrhea, including six serotypes of Salmonella, two serotypes of Shigella, Vibrio parahaemolyticus, Giardia lamblia, and Entamoeba histolytica, enterotoxigenic Escherichia coli was most commonly isolated. Strains were identified that produced only heat labile enterotoxin (LT), only heat stable enterotoxin (ST), or both LT and ST. The infant mouse assay yielded results falling into two distinct groups, providing a clear separation of positive and negative cultures. The CHO assay also formed two groups, with positive cultures producing 11% or more of the elongated cells. There was good agreement between the CHO and the Y1 adrenal cell assays for detection of LT. The adrenal cell system for detection of LT was more suitable than the CHO assay for processing large numbers of specimens because of the miniculture modification of this method utilized in this study. The infant mouse method was a simple and reliable method for detecting ST.Salmonellosis in the united states, 1968-1974
Ryder, R. W., Merson, M. H., Pollard, R. A., & Gangarosa, E. J. (n.d.).Publication year
1976Journal title
Journal of Infectious DiseasesVolume
133Issue
4Page(s)
483-486Travelers' Diarrhea in Mexico: A Prospective Study of Physicians and Family Members Attending a Congress
AbstractMerson, M. H., Morris, G. K., Sack, D. A., Wells, J. G., Feeley, J. C., Sack, R. B., Creech, W. B., Kapikian, A. Z., & Gangarosa, E. J. (n.d.).Publication year
1976Journal title
New England Journal of MedicineVolume
294Issue
24Page(s)
1299-1305AbstractWe conducted a prospective study of travelers' diarrhea on 73 physicians and 48 family members attending a medical congress in Mexico City, in October, 1974. Fecal and blood specimens were collected before, during and after their visit and examined for enteric bacterial pathogens, viruses and parasites. In 59 (49 per cent) participants travelers' diarrhea developed. Median duration of illness was five days. Onset occurred a median of six days after arrival. An etiologic agent was found in 63 per cent of ill participants. Enterotoxigenic Escherichia coli of different, non-“enteropathogenic” serotypes was the most common cause; other responsible pathogens included salmonellae, invasive Esch. coli., shigellae, Vibrio parahaemolyticus, Giardia lamblia and the human reovirus-like agent. Consumption of salads containing raw vegetables was associated with enterotoxigenic Esch. coli infection (P = 0.014). Travelers' diarrhea in Mexico is a syndrome caused by a variety of pathogens, the most common of which is enterotoxigenic Esch. coli. (N Engl J Med 294:1299–1305, 1976) AMERICANS traveling in foreign countries often experience “travelers' diarrhea” shortly after arrival. This illness can be mild and short-lived but is sometimes prolonged and incapacitating. In travelers to Mexico the illness which is frequently called “turista” or ”Montezuma's revenge,” has an attack rate of 24 to 50 per cent.123The cause of “turista” was unknown until a recent study demonstrated that strains of Escherichia coli that produce heat-labile enterotoxin play an important part.3The vehicles responsible for this illness have not been identified, and thus preventive measures have been difficult to define. To characterize more clearly the clinical, epidemiologic and.A CONTINUING COMMON-SOURCE OUTBREAK OF BOTULISM IN A FAMILY
AbstractHorwitz, M. A., Marr, J. S., Merson, M. H., Dowell, V. R., & Ellis, J. M. (n.d.).Publication year
1975Journal title
The LancetVolume
306Issue
7940Page(s)
861-863AbstractIn December, 1974, three cases of botulism occurred in a family; two were fatal. The first patient died after a 10-day illness without botulism being suspected. 4 days later, after a 2-day illness, the second patient was diagnosed as having botulism after a cardiorespiratory arrest; she died 3 days later. In the third patient, the only symptom was dysphagia. Clostridium botulinum type B was found in stool specimens from all three patients. Home-canned (bottled) mushrooms, which were found to contain C. botulinumtype B and its toxin, were believed to be responsible for the outbreak; mushrooms were found at necropsy in the gastrointestinal tracts of both patients who died. Heat treatment of the mushrooms during canning had been inadequate.A new criterion for implicating Clostridium perfringens as the cause of food poisoning
AbstractDowell, V. R., Torres-Anjel, M. J., Riemann, H. P., Merson, M., Whaley, D., & Darland, G. (n.d.).Publication year
1975Journal title
Revista Latinoamericana de MicrobiologiaVolume
17Issue
3Page(s)
137-142AbstractFor the first time the enterotoxin of Clostridium perfringens type A (CPE) was demonstrated in stools from patients suffering from the specific type of 'food poisoning'. Sensitivity was 100% and specificity 94% vs. diarrhea reporting. The only person in which the CPE was demonstrated without his reporting diarrhea, had consumed implicated food; and the suspect strain, Hobb's type 1, was isolated from him. The samples were studied in a 'blind' fashion, during an outbreak epidemiologically and bacteriologically assigned to C. perfringens. The methodology was based on reversed, passive, hemagglutination. Glutaraldehyde was both the fixative as well as Y globulin sensitizer (from anti CPE rabbit serum), upon sheep red blood cells. The simplicity of the test will allow for detection of CPE in stools from patients at local public health laboratories of any capacity. Protocols to be followed in further outbreaks are recommendedDIARRHŒA ASSOCIATED WITH HEAT-STABLE ENTEROTOXIN-PRODUCING STRAINS OF ESCHERICHIA COLI
AbstractSack, D. A., Wells, J. G., Merson, M. H., Sack, R. B., & Morris, G. K. (n.d.).Publication year
1975Journal title
The LancetVolume
306Issue
7928Page(s)
239-241AbstractFive patients who developed acute watery diarrhœa while travelling in Mexico in October, 1974, were found to have enterotoxigenic Escherichia coli in their stool which produced heat-stable enterotoxin (S.T.) without producing heat-labile enterotoxin (L.T.). These S.T.-only E. coli,which have previously been described as causing diseases in animals, must now be regarded as pathogenic for humans as well.Food borne disease outbreaks in the United States, 1973
Hughes, J. M., Merson, M. H., & Pollard, R. A. (n.d.).Publication year
1975Journal title
Journal of Infectious DiseasesVolume
132Issue
2Page(s)
224-228From the Center for Disease Control: outbreaks of waterborne for disease control: outbreaks of Waterborne disease in the United States, 1973
Hughes, J. M., Merson, M. H., Craun, G. F., & McCabe, L. J. (n.d.).Publication year
1975Journal title
Journal of Infectious DiseasesVolume
132Issue
3Page(s)
336-339Gastrointestinal Illness on Passenger Cruise Ships
AbstractMerson, M. H., Hughes, J. M., Wood, B. T., Yashuk, J. C., & Wells, J. G. (n.d.).Publication year
1975Journal title
JAMA: The Journal of the American Medical AssociationVolume
231Issue
7Page(s)
723-727AbstractMedical logs of 2,445 cruises taken by 38 vessels over a 20-month period beginning Jan 1, 1972, were reviewed. On 92% of the cruises, the recorded incidence of gastrointestinal illness was 1% or less; on 2% of cruises, it was 5% or greater. The actual incidence of gastrointestinal illness determined by a questionnaire survey of passengers sailing on nine cruises was found to be at least four times as high as that recorded in the medical logs. Although the cause of the illnesses was not known, there was evidence that transmission took place aboard ship. A survey of food-handling practices and water systems aboard selected ships demonstrated a significant potential for transmission of foodborne and waterborne disease.Shigellosis at sea: An outbreak aboard a passenger cruise ship
AbstractMerson, M. H., Tenney, J. H., Meyers, J. D., Wood, B. T., Wells, J. G., Rymzo, W., Cline, B., Dewitt, W. E., Skaliy, P., & Mallison, G. F. (n.d.).Publication year
1975Journal title
American Journal of EpidemiologyVolume
101Issue
2Page(s)
165-175AbstractBetween June 23 and June 30. 1973, 90% of 650 passengers and at least 35% of 299 crew members experienced a diarrheal illness during a 7-day Caribbean cruise aboard a passenger cruise liner. Symptoms were consistent with shigellosis, and Shigella flexneri 6. Boyd 88 biotype, was isolated from rectal swabs taken from 8 of 35 ill passengers and 33 of 294 crew members. Epidemiologic evidence incriminated the ship's water, including ice, as the probable vehicle of transmission, and elevated coliform counts were found in potable water samples obtained aboard the vessel at the peak of the outbreak. Potential sources of contamination of the vessel's potable water supply were investigated, and improvements in the loading and chlorination of potable water were recommended.Toxigenic Turista
AbstractMerson, M. H. (n.d.).Publication year
1975Journal title
New England Journal of MedicineVolume
292Issue
18Page(s)
969-970AbstractBefore departing on their long awaited vacation, visit, or business trip to a foreign land, many Americans pack an ample supply of various pharmaceuticals for treatment of an anticipated diarrheal illness. The medications that they carry are as varied as the names given this affliction. Not to be taken lightly, this illness, most commonly referred to as travelers' diarrhea, has compromised the activity of American troops stationed in Europe and Vietnam, limited the performance of Olympic athletes, and altered the best laid plans of scientific visitors to international congresses. The clinical syndrome of travelers' diarrhea generally follows a typical pattern….Travelers’ Diarrhea
Merson, M. H., & Gangarosa, E. J. (n.d.).Publication year
1975Journal title
JAMA: The Journal of the American Medical AssociationVolume
234Issue
2Page(s)
200-201