Joel G. Breman, MD, DTPH Fogarty International Center

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Presentation transcript:

Scourges Old and New: The Burden of Infectious Diseases in the 21st Century Joel G. Breman, MD, DTPH Fogarty International Center National Institutes of Health University of Pennsylvania November 1, 2002

Global Infectious Diseases Objectives Problem Determinants Diseases Control and eradication Triumphs Tribulations

Global Infectious Diseases Objectives Problem Determinants Diseases Control and eradication Triumphs Tribulations

Infectious Disease Mortality in the United States, 1980-1996 70 60 Deaths per 100,000 population 50 Crude ID Mortality Rate 40 30 20 10 1980 1982 1984 1986 1988 1990 1992 1994 1996 Year Source: JAMA 1996;275:189-193 and unpublished CDC data

Global Infectious Diseases Objectives Problem Determinants Diseases Control and eradication Triumphs Tribulations

Determinants of Emergence of Infectious Diseases Population growth and density (measles, chickenpox, influenza) Migration and transhumance (cholera, sexually transmitted infections) Urbanization (plague, water-borne diseases, respiratory diseases) Human behavior and lifestyles (STIs, HIV/AIDS) Contact with animal populations (salmonella, anthrax, monkeypox, Ebola/Marburg) International travel and commerce (malaria, cholera, food-borne diseases) Modified from U.S. Institute of Medicine, 1997

Determinants of Emergence of Infectious Diseases (2) Technology and industry (toxic shock syndrome, nosocomial infections) Microbial adaptation and change (Staphylococcus aureus, influenza, HIV/AIDS, malaria) Breakdown of public health measures (tuberculosis, diphtheria, pertussis, meningitis) Global warming (malaria, dengue, yellow fever, cholera) Bioterrorism (smallpox, anthrax, plague, tularemia, botulinum toxin, hemorrhagic fevers) Modified from U.S. Institute of Medicine, 1997

Antimicrobial Resistance Worldwide problem Dramatic increase in antimicrobial-resistant community-acquired and nosocomial pathogens Major risk factors: Antimicrobial use (misuse) Infection control practices (noncompliance)

Evolution of Antimicrobial Resistance Penicillin  [1950s] Methicillin  [1980s] Penicillin-resistant S. aureus Methicillin-resistant S. aureus (MRSA) S. aureus Vancomycin [1997] [1990s] Vancomycin (glycopeptide) - intermediate resistant S. aureus Vancomycin-resistant enterococcus (VRE) Vancomycin- Resistant S. aureus [ ? ]

Global Infectious Diseases Objectives Problem Determinants Diseases Control and eradication Triumphs Tribulations

Label, 2002

Blood Safety Units donated in the U.S. are routinely tested for evidence of seven infectious agents: HTLV I and II HIV 1 and 2 Treponema pallidum Hepatitis B and C viruses