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: 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: 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,….)

Speed of Global Travel in Relation to World Population Growth From: Murphy and Nathanson. Semin. Virol. 5, 87, 1994 CDC

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 Control CDC

 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 Emerging Infectious 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.

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Questions?

Preventing Emerging Infectious 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 Emerging Infectious 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 Emerging Infectious Diseases CDC

Prevention and Control Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases. Preventing Emerging Infectious Diseases CDC