emerging and re-emerging infectious diseases samantha rosenthal, mph, phd candidate
TRANSCRIPT
Emerging and Re-emerging Infectious Diseases
Samantha Rosenthal, MPH, PhD Candidate
WNV
Monkeypox from Prairie Dogs
Are infectious diseases emerging more than before?
Institute of Medicine 1992 Report on Emerging Infections
Defined emerging infections as: “New, reemerging or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.”
Major Factors Contributing to Emerging Infections: 1992
1. Human demographics and behavior
2. Technology and Industry
3. Economic development and land use
4. International travel and commerce
5. Microbial adaptation and change
6. Breakdown of public health measures
Institute of Medicine Report, 1992
More Factors Contributing to Emerging Infections: 2003
7. Human vulnerability
8. Climate and weather
9. Changing ecosystems
10.Poverty and social inequality
11.War and famine
12.Lack of political will
13. Intent to harm
Institute of Medicine Report, 2003
Emerging Infections:Human Demographics, Behavior, Vulnerability
• More populations with weakened immune system: elderly, HIV/AIDS, cancer patients and survivors, persons taking antibiotics and other drugs
•More people, more crowding•Changing sexual mores (HIV, STDs)•Injection drug use (HIV, Hepatitis C)•Changing eating habits (foodborne infections)
Emerging Infections:Technology and Industry
• Mass food production (Campylobacter, E.coli
O157:H7, etc…)• Use of antibiotics in
food animals (antibiotic-resistant bacteria)
•New drugs for humans (prolonging vulnerability)
Emerging Infections:Economic Development, Land Use, Changing
Ecosystems
• Changing ecology influencing waterborne, vectorborne transmission (e.g. dams, deforestation)
•Contamination of watershed areas by cattle (Cryptosporidium)•More exposure to wild animals and vectors (Lyme disease)
Emerging Infections:International Travel and Commerce
• Persons infected with an exotic disease anywhere in the world can be into major US city within hours (SARS, VHF,…)
• Foods from other countries imported routinely into US (Cyclospora,….)
• Vectors hitchhiking on imported products (Asian tiger mosquitoes on lucky bamboos,….)
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Speed of Global Travel in Relation toWorld Population Growth
From: Murphy and Nathanson. Semin. Virol. 5, 87, 1994CDC
Emerging Infections:Microbial Adaptation and Change
• Increased antibiotic resistance with increased use of antibiotics in humans and food animals (VRE, VRSA, penicillin- and macrolide-resistant Strep pneumonia, multidrug-resistant Salmonella, TB,….)
• Jumping species from animals to humans (avian influenza, HIV, SARS?)
Emerging Infections:Poverty, Social Inequality, Breakdown of Public
Health Measures
• Lack of basic hygienic infrastructure (safe water, foods)• Inadequate vaccinations (measles, diphtheria)
• Discontinued mosquito control efforts (dengue, malaria)• Lack of monitoring and reporting (SARS
Emerging Infections:Intent to Harm
• Bioterrorism: Anthrax in US 2001
• Bio-Crimes: Salmonella in OR, Shigella in TX.
• Potential agents: Smallpox, Botulism toxin, Plague, Tularemia, ….
CDC
Prevention of Emerging Infectious Diseases Will Require Action in
Each of These Areas
Surveillance and Response
Applied Research
Infrastructure and Training
Prevention and ControlCDC
Enhance communication: locally, regionally,
nationally, globally
Increase global collaboration
Share technical expertise and resources
Provide training and infrastructure support globally
Ensure political support
Ensure judicious use of antibiotics
Vaccines for all
Preventing EmergingInfectious Diseases: More to Do
Rosenthal SR, Ostfeld RS, McGarvey ST, Lurie MN, and Smith KF. The Overlooked Pathways to Infectious Disease Emergence. Emerging Infectious Diseases; under review.
Rosenthal SR, Ostfeld RS, McGarvey ST, Lurie MN, and Smith KF. The Overlooked Pathways to Infectious Disease Emergence. Emerging Infectious Diseases; under review.
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Questions?
Preventing EmergingInfectious Diseases
Surveillance and Response
Detect, investigate, and monitor emerging
pathogens, the diseases they cause, and
the factors influencing their emergence,
and respond to problems as they are
identified.
CDC
Applied Research
Integrate laboratory science and
epidemiology to increase the
effectiveness of public health
practice.
Preventing EmergingInfectious Diseases
CDC
Infrastructure and Training
Strengthen public health infrastructures to support surveillance, response, and research and to implement prevention and control programs.
Provide the public health work force with the knowledge and tools it needs.
Preventing EmergingInfectious Diseases
CDC
Prevention and Control
Ensure prompt implementation of
prevention strategies and enhance
communication of public health
information about emerging diseases.
Preventing EmergingInfectious Diseases
CDC