Supplementary notes for module 31

 

Module title

Emerging infectious diseases: spotlight on influenza

Lead author

George W. Rutherford, M.D.

Rebecca Grossman-Kahn

University of California, San Francisco

Institute for Global Health

San Francisco, CA  2006

Date

Version 1 / Aug 2006

Table of contents

Supplementary notes for module 31. 1

Table of contents. 1

Notes A.. 2

Preventing disease emergence and re-emergence. 2

General references – notes B.. 4

Papers. 4

Web links. 4

 

Notes A

Preventing disease emergence and re-emergence

How to prevent disease emergence has become an important topic nationally.  CDC published its updated plan, Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, in 1998.  The plan outlined four goals: surveillance and response, applied research, infrastructure and training, and prevention and control.  These goals are to focus on nine specific problems

 

  1. Antimicrobial resistance in bacteria, parasites, viruses, fungi and arthropod vectors is caused by antibiotic overuse and misuse, leading to fewer treatment choices and infections that are more difficult, if not impossible, to treat.

 

  1. Foodborne and waterborne diseases are facilitated by new methods of food procurement (globalization of the food supply), multistate food distribution systems and emergence of waterborne pathogens resistant to routine disinfection.

 

  1. Vectorborne and zoonotic diseases will increase as habitats of animals and arthropod vectors change and increase the risk of exposure for humans.  For instance, if sea levels rise as a result of climate change, vast new stretches of the Central Valley will become wetlands again with a resultant increase in vector density.

 

4.   Diseases transmitted through blood transfusions and blood products have  been problematic since the introduction of blood transfusion in World War I.  Several parenterally transmissible pathogens have been recognized since the 1980s, including HIV, hepatitis C and Trypanasoma cruzi, the causative agent of Chaga’s disease.  As the population ages and blood transfusions increase, there is a distinct possibility that new pathogens may emerge; this happened very recently with West Nile virus.

 

  1. Chronic diseases caused by infectious agents, as exemplified by Helicobacter pylori as a cause of peptic ulcer disease and speculation around Chlamydia pneumoniae as a cause of coronary heart disease, have been recently recognized.  Older examples include the recognition of syphilis as the cause of the psychiatric disorder generalized paresis of the insane in the 19th century and the recognition of Lyme disease as the cause of a peculiar cluster of juvenile rheumatoid arthritis in the 1970s.  As research matures, new microbial prevention and treatment targets may emerge for diseases previously through to be mediated by environmental factors.

 

  1. Vaccine development and use are needed to keep certain infectious diseases under control, to bring new immunizations into public health program (e.g., human papilloma virus vaccine) and to create new immunizations for huge public health problems (e.g., HIV and malaria).  Note that the re-emergence of diphtheria was the direct consequence of the collapse of childhood immunization programs at the end of the Soviet Union.

 

  1. Diseases of persons with impaired immunity due to medical treatment, age or infection (e.g., HIV) are of particular concern both in the U.S. and worldwide as the number of immunosuppressed persons has exploded worldwide (primarily as the result of HIV).

 

  1. Diseases of pregnant women and neonates of concern include asymptomatic diseases in pregnant women that can increase fetus’s risk of premature birth (e.g., Group B Streptococcus) or can be transmitted from mother to child during pregnancy, delivery or breastfeeding.  Worldwide, mother-to-child transmission of HIV and congenital syphilis are two daunting public health problems.

 

  1. Diseases of travelers, immigrants and refugees will only increase.  Persons who travel into new areas are at risk of acquiring locally endemic disease (for example, retirees who move to southern Arizona and are exposed to coccidioidomycosis) and can also disseminate diseases to relatively susceptible populations.  Transmission of tuberculosis from the persons born in endemic regions to non-immune Californians is a major public health problem.

 

Go back to Table of contents.

Ungchusak K, Aueqarakul P, Dowell SF, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med.  2005; 352:333-40.

Go back to Table of contents.

 

1. CDC. Protecting the Nation’s Health in an Era of Globalization: CDC’s Global Infectious Disease Strategy. Atlanta: CDC, 2002: 11-23.

http://www.cdc.gov/globalidplan/4-introduction.htm

2. CDC Emerging Infectious Diseases: http://www.cdc.gov/ncidod/diseases/eid/index.htm

3. WHO Emerging and Re-emerging Infectious Diseases: http://www.who.int/inf-fs/en/fact097.html

4. US Pandemic Plan: www.pandemicflu.gov

 

Go back to Table of contents.