1. 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

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

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

10. Infectious Disease Mortality in the United States, 1980-199670 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Source: JAMA 1996;275: and unpublished CDC data

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

12. 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

13. 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

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

16. 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
[ ? ]

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

35. Label, 2002

36. 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