Emerging Infectious Diseases from the Global to the Local Perspective A Summary of a Workshop of the Forum on Emerging Infections (2001) / Chapter Skim
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Summary and Assessment
Summary and Assessment
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EMERGING INFECTIONS: THE GLOBAL PICTURE In his keynote address, David Heymann, Executive Director of Communicable Diseases for the World Health Organization (WHO) , described the global proportions of infectious diseases.
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Therefore, it is in the best interest of all countries to support global initiatives to control infectious diseases. In addition, the growing rise and spread of antimicrobial resistance is of increasing concern in developed countries as the inappropriate use of antibiotics goes unchecked.
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. FIGURE 2 Emerging/reemerging infectious diseases, 1996 and 1997.
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1990 to 1998 United Kingdom Bovine Spongiform >5,740 Encephalopathy 1991 Peru Cholera 770 1991 India Plague 1,800 1994 India Tuberculosis > 1,000 1997 Tanzania Cholera 36 1997 to 1998 Thailand HIV/AIDS 2,500 SOURCE: Workshop presentation by David Heymann, World Health Organization, 1999. · In 1996 the European Union banned the worldwide export of British beef in response to fears about bovine spongiform encephalopathy (so-called mad cow disease)
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SUMMARYAND ASSESSMENT 800000 700000 600000 500000 400000 300000 200000 1 00000 o 250000 200000 150000 1 00000 50000 o 300000 250000 200000 150000 1 00000 50000 o Americas Region 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 South-East Asia Region 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 Western Pacific Region 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 FIGURE 4 Resurgence of dengue fever and dengue hemorrhagic fever; number of cases.
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Considering that total spending for health care in some of the poorest countries in the world is less than $7 per person per year, the increased costs associated with a delayed response to disease control are beyond the reach of the poorest countries. Not only does treatment become impossible as economic and societal costs increase, but infectious disease control is often neglected, as are disease prevention efforts.
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Many of these factors lie outside the purview of the health sector, making it difficult to mitigate their impact on the transmission of infectious diseases and requiring coordinated approaches among various sectors of society for successful control. For example, economic and environmental policies can have direct and negative effects on the emergence and spread of infectious diseases.
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Mitigation of these events requires greater investment in the public health infrastructure, disease investigation, sanitary infrastructure, strengthening of health ministries and other health agencies within governments, and coordinated action among the various sectors of society that deal with these issues. Global travel also affects the transmission of infectious diseases.
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Examples of emerging and reemerging zoonotic disease agents include equine morbillivirus, Japanese encephalitis virus, and Australian bat lyssavirus in Australia, equine encephalitis virus in Colombia and Venezuela, enterohemorrhagic Escherichia cold in Japan, the bovine spongiform encephalopathy agent in the United Kingdom, and dengue virus in South America. A dramatic example of a recent zoonotic disease outbreak was the occurrence of H5N1 influenza A virus the so-called avian or bird flu in Hong Kong in 1997 (Figure 6)
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Studies of Hendra virus led to the discovery of Australian bat lyssavirus, a rabies-like virus, in both fruit and insectivorous bats. Australian bat lyssavirus is in the same group to which classical rabies belongs, antigenic group 1 of the lyssaviruses, but Australian bat lyssavirus can be differentiated from rabies virus on genetic grounds (see Chapter 4~.
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Apart from human and animal health and welfare, due consideration must be given to the economic and political effects of zoonotic disease outbreaks. Food Safety Ensuring a safe food supply can have a large impact on the reduction of many common infectious diseases, such as diarrhea!
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Hospitals worldwide are facing unprecedented crises from the rapid emergence of antibiotic-resistant microorganisms. Infectious diseases such as cholera, malaria, and tuberculosis once thought to be nearly eradicated, particularly in developed countries are making a comeback (Figure 7~.
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Just as an expanded research effort led to the discovery of protease inhibitors as treatments for HIV/AIDS, a renewed commitment to research is needed to ensure that similar successes are achieved for the numerous other infectious diseases currently threatening the earth's human population. Although vaccines against acute respiratory infections, diarrhea!
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1994 Sabia virus Hendra virus Hantavirus pulmonary syndrome (Sin Nombre virus) Vibrio cholerae 0139 Guanarito virus Hepatitis C Hepatitis E Human herpesvirus 6 1 983 HIV 1982 Escherichia cold 0157:H7 Lyme borreliosis Human T-lymphotropic virus type 2 1980 Human T-lymphotropic virus 1993 1992 1991 1989 1988 SOURCE: Workshop presentation by David Heymann, World Health Organization, 1999.
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However, standard immunizations for children are not as widespread as expected in many less developed regions of the world, where the risk of infectious diseases remains high. High vaccine costs, difficulties with administration (e.g., the logistics of refrigerating vaccines in tropical climates)
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Mexico has instituted special surveillance programs in response to natural disasters. After such events, for example Hurricane Mitch, new infectious disease events are exacerbated by the migration of individuals from Central America into Mexico, as well as the hygienic problems caused by the heavy rainfall and flooding.
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The project implements integrated infectious disease surveillance and improved epidemic preparedness and response (see Chapter 3~. Correspondingly, in June 1995 the Pan American Health Organization (PAHO)
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For example, the CDC Division of Quarantine is collaborating with Mexico on a pilot sentinel surveillance project along the U.S.-Mexico border for febrile exanthemas and hepatitis. This effort aims to strengthen the sensitivity of infectious disease surveillance through the observation of clinical syndromes and to enhance the public health capacity along the border through surveillance efforts at the provider level.
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Emerging infectious diseases have also been discussed under the Asian-Pacific Economic Cooperation (APEC) , as well through the U.S.-European Union New Transatlantic Agenda.
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will inevitably occur. The potential for disagreement must be recognized and dealt with early in the course of an infectious disease outbreak.
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Efforts are under way to establish networks for the surveillance of emerging infectious diseases in nine countries of the Amazon Region and the Southern Cone Region. A plan of action was developed for each region in collaboration with international reference centers, including CDC, the University of Texas Medical Branch at Galveston, and the U.S.
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In addition, inventories of capacity and capabilities across Europe have been generated, including a directory of vaccination policies. Despite these multiple national and international efforts, existing and planned networks focus on known infectious diseases, which means that new agents may go undetected.
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The Internet is increasingly being used as a source of outbreakrelated information through media newswires, electronic discussion groups, and websites. Quality assurance, however, is an important requirement for officials using worldwide web-based information as a source of infectious disease information.
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For example, there is an enormous need and opportunity to introduce new infectious disease control infrastructures into the Central Asia republics and Russia because their relatively new state of independence has left them with no experience in international procurement and self-governance. For example, they lack the logistical wherewithal to purchase reagents or vaccines or implement directly observed therapy.
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Similarly, the medical research laboratories of overseas military assets can help local civilian medical communities find ways to adapt the many new and emerging detection technologies to infectious disease surveillance. Training and education activities sponsored by the military could also be coordinated with those programs administered by the public health infrastructures of governments and NGOs.
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All nations should promote the participation of the health sector in international trade agreements that may affect human, animal, or plant health. This requires a commitment at the highest levels of government to improve the components of the global surveillance system, upgrading the infrastructure and the qualifications of the human resources needed to control emerging infections, and supporting and encouraging rapid intra- and intercountry communications on health issues, including infectious disease outbreaks.
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