Английская Википедия:Emerging infectious disease

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Файл:Global Examples of Emerging and Re-Emerging Infectious Diseases.jpg

When Anthony Fauci became director of the NIAID, he drew a map of the world for presentation at a congressional hearing that showed a single notable emerging infectious disease threat: HIV. Since then, he has continually updated the map, now showing the emergence of numerous infectious disease threats to illustrate the experiences of his years in office as well as highlighting certain infections that had emerged before HIV.

An emerging infectious disease (EID) is an infectious disease whose incidence has increased recently (in the past 20 years), and could increase in the near future. The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics. Their many impacts can be economic and societal, as well as clinical. EIDs have been increasing steadily since at least 1940.

For every decade since 1940, there has been a consistent increase in the number of EID events from wildlife-related zoonosis. Human activity is the primary driver of this increase, with loss of biodiversity a leading mechanism.

Emerging infections account for at least 12% of all human pathogens. EIDs can be caused by newly identified microbes, including novel species or strains of virus (e.g. novel coronaviruses, ebolaviruses, HIV). Some EIDs evolve from a known pathogen, as occurs with new strains of influenza. EIDs may also result from spread of an existing disease to a new population in a different geographic region, as occurs with West Nile fever outbreaks. Some known diseases can also emerge in areas undergoing ecologic transformation (as in the case of Lyme disease). Others can experience a resurgence as a re-emerging infectious disease, like tuberculosis (following drug resistance) or measles. Nosocomial (hospital-acquired) infections, such as methicillin-resistant Staphylococcus aureus are emerging in hospitals, and are extremely problematic in that they are resistant to many antibiotics. Of growing concern are adverse synergistic interactions between emerging diseases and other infectious and non-infectious conditions leading to the development of novel syndemics.

Many EID are zoonotic, deriving from pathogens present in animals, with only occasional cross-species transmission into human populations. For instance, most emergent viruses are zoonotic (whereas other novel viruses may have been circulating in the species without being recognized, as occurred with hepatitis C).

History of the concept of emerging infectious diseases

The French doctor Charles Anglada (1809–1878) wrote a book in 1869 on extinct and new diseases. He did not distinguish infectious diseases from others (he uses the terms reactive and affective diseases, to mean diseases with an external or internal cause, more or less meaning diseases with or without an observable external cause). He writes in the introduction:Шаблон:BlockquoteCharles Nicolle, laureate of the Nobel Prize in Physiology or Medicine elaborated the concept of emergence of diseases in his 1930 book Naissance, vie et mort des maladies infectieuses (Birth, Life and Death of Infectious Diseases), and later in Destin des maladies infectieuses (Fate of Infectious Diseases) published in 1933 which served as lecture notes for his teaching of a second year course at the Collège de France. In the introduction of the book he sets out the program of the lectures:Шаблон:BlockquoteThe term emerging disease has been in use in scientific publications since the beginning of the 1960s at least and is used in the modern sense by David Sencer in his 1971 article "Emerging Diseases of Man and Animals" where in the first sentence of the introduction he implicitly defines emerging diseases as "infectious diseases of man and animals currently emerging as public health problems" and as a consequence also includes re-emerging diseases:Шаблон:BlockquoteHe also notes that some infectious agents are newly considered as diseases because of changing medical technologies:Шаблон:BlockquoteHe concludes the introduction with a word of caution:Шаблон:BlockquoteHowever, to many people in the 1960s and 1970s the emergence of new diseases appeared as a marginal problem, as illustrated by the introduction to the 1962 edition of Natural History of Infectious Disease by Macfarlane Burnet:Шаблон:Blockquoteas well as the epilogue of the 1972 edition:Шаблон:Blockquote

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Throughout the 20th century until 1980, with the exception of the 1918 Spanish flu pandemic, the death rate from infectious diseases in the United States was steadily decreasing. However, because of the AIDS epidemic, the death rate from infectious diseases increased by 58% between 1980 and 1992.

The concept gained more interest at the end of the 1980s as a reaction to the AIDS epidemic. On the side of epistemology, Mirko Grmek worked on the concept of emerging diseases while writing his book on the history of AIDS and later in 1993 published an article about the concept of emerging disease as a more precise notion than the term "new disease" that was mostly used in France at that time to qualify AIDS among others.

Also under the shock of the emergence of AIDS, epidemiologists wanted to take a more active approach to anticipate and prevent the emergence of new diseases. Stephen S. Morse from The Rockefeller University in New York was chair and principal organizer of the NIAID/NIH Conference "Emerging Viruses: The Evolution of Viruses and Viral Diseases" held 1–3 May 1989 in Washington, DC. In the article summarizing the conference the authors write:Шаблон:BlockquoteThey further note:Шаблон:BlockquoteIn a 1991 paper Morse underlines how the emergence of new infectious diseases (of which the public became aware through the AIDS epidemic) is the opposite of the then generally expected retreat of these diseases:Шаблон:BlockquoteAs a direct consequence of the 1989 conference on emerging viruses, the Institute Of Medicine convened in February 1991 the 19-member multidisciplinary Committee on Emerging Microbial Threats to Health, co-chaired by Joshua Lederberg and Robert Shope, to conduct an 18-month study. According to the report produced by the committee in 1992, its charge "was to identify significant emerging infectious diseases, determine what might be done to deal with them, and recommend how similar future threats might be confronted to lessen their impact on public health." The report recommended setting up a surveillance program to recognize emerging diseases and proposed methods of intervention in case an emergent disease was discovered.Шаблон:BlockquoteThe proposed interventions were based on the following: the U.S. public health system, research and training, vaccine and drug development, vector control, public education and behavioral change. A few years after the 1989 Emerging Viruses conference and the 1992 IOM report, the Program for Monitoring Emerging Diseases (ProMED) was formed by a group of scientists as a follow-up in 1994 and the Centres for Disease Control (CDC) launched the Emerging Infectious Diseases journal in 1995.

A decade later the IOM convened the Committee on Emerging Microbial Threats to Health in the 21st Century which published its conclusions in 2003.

In April 2000 the WHO organized a meeting on Global Outbreak Alert and Response, which was the founding act of the Global Outbreak Alert and Response Network.

In 2014, the Western African Ebola virus epidemic demonstrated how ill-prepared the world was to handle such an epidemic. In response, the Coalition for Epidemic Preparedness Innovation was launched at the World Economic Forum in 2017 with the objective of accelerating the development of vaccines against emerging infectious diseases to be able to offer them to affected populations during outbreaks. CEPI promotes the idea that a proactive approach is required to "create a world in which epidemics are no longer a threat to humanity".

Classification

One way to classify emerging infections diseases is by time and how humans were involved in the emergence:

• Newly emerging infectious diseases – diseases that were not previously described in humans, such as HIV/AIDS
• Re-emerging infectious diseases – diseases that have spread to new places or which previous treatments no longer control, such as methicillin-resistant Staphylococcus aureus
• Deliberately emerging infectious diseases – diseases created by humans for bioterrorism
• Accidentally emerging infectious diseases – diseases created or spread unintentionally by humans, such as vaccine-derived poliovirus

Contributing factors

The 1992 IOM report distinguished 6 factors contributing to emergence of new diseases (Microbial adaptation and change; Economic development and land use; Human demographics and behavior; International travel and commerce; Technology and industry; Breakdown of public health measures) which were extended to 13 factors in the 2003 report (Chapter 3 of the report detailing each of them)

• Microbial adaptation and change
• Human susceptibility to infection
• Climate and weather
• Changing ecosystems
• Human demographics and behavior
• Economic development and land use
• International travel and commerce
• Technology and industry
• Breakdown of public health measures
• Poverty and social inequality
• War and famine
• Lack of political will
• Intent to harm

Their classification serves as a basis for many others. The following table gives examples for different factors:

Factor of emergence	Example
Microbial adaption	genetic drift and genetic shift in Influenza A
Changing human susceptibility	mass immunocompromisation with HIV/AIDS
Climate change	diseases transmitted by animal vectors such as mosquitoes (e.g. West Nile fever) are moving further from the tropics as the climate warms
Changes in human demographics and travel facilitating rapid global spread	SARS-related coronaviruses
Economic development	use of antibiotics to increase meat yield of farmed cows leads to antibiotic resistance
War and famine	Clearing of animal habitats that increase the range of diseases such as ebola
Inadequate public health services
Poverty and social inequality	tuberculosis is primarily a problem in low-income areas
Bioterrorism	2001 Anthrax attacks
Land use	Dam construction and irrigation systems can encourage malaria and other mosquito-borne diseases Use of indiscriminate pesticides in industrial farming reduces/eliminates biological controls (e.g. dragonflies, amphibians, insectivorous birds, spiders) of known disease vectors (e.g. mosquito, tick, biting midge)
Anti-vaccination or Vaccine hesitancy	Re-emergence of measles
Wildlife trade	Has been linked to zoonotic emergence and spread of new infectious diseases in humans, including Nipah virus and COVID-19. Crowded and unhygienic wet markets and wildlife farms have been implicated in animal-human transmission of emergent viruses, including novel coronaviruses and influenza viruses Complex issues surrounding the commerce and consumption of bushmeat are also of particular concern.

Emerging Infectious Diseases between Humans and Animals

Emerging infectious diseases between human, animal have become a significant concern in recent years, playing a crucial role in the occurrence and spread of diseases. Human population growth, increased proximity to wildlife, and climate change have created favorable conditions for the transmission of zoonotic diseases, leading to outbreaks such as Zika, Ebola, and COVID-19. The One Health approach, which integrates animal, human, and environmental health, has emerged as a crucial tool for monitoring and mitigating the spread of infectious diseases.

Zoonotic diseases, originating from animal sources, pose a significant threat to human health. Up to 75% of emerging infectious diseases are zoonotic, originating from viruses and other pathogens that are transmitted from animals to humans. Understanding the mechanisms of transmission, the role of wildlife trade, and the importance of surveillance and early detection is crucial for mitigating the impact of zoonotic diseases on human health. Surveillance efforts involving wastewater have been identified as valuable tools for detecting early warning signs of disease emergence and providing timely interventions.

List

NIAID list of Biodefense and Emerging Infectious Diseases

The U.S. National Institute of Allergy and Infectious Diseases (NIAID) maintains a list of Biodefense and Emerging Infectious Diseases. The list is categorized by biodefense risk, which is mostly based on biological warfare and bioterrorism considerations. As of 2004, it recognized the following emerging and re-emerging diseases.

WHO list of most important emerging infectious diseases

In December 2015, the World Health Organization held a workshop on prioritization of pathogens "for accelerated R&D for severe emerging diseases with potential to generate a public health emergency, and for which no, or insufficient, preventive and curative solutions exist." The result was a list containing the following six diseases:

• Crimean–Congo hemorrhagic fever
• Filovirus diseases (Ebola virus disease and Marburg virus disease)
• Highly pathogenic emerging Coronaviruses relevant to humans (MERS and SARS)
• Lassa fever
• Nipah virus infection
• Rift Valley fever

These were selected based on the following measures:

1. Human transmissibility (including population immunity, behavioural factors, etc.)
2. Severity or case fatality rate
3. Spillover potential
4. Evolutionary potential
5. Available countermeasures
6. Difficulty of detection or control
7. Public health context of the affected area(s)
8. Potential scope of outbreak (risk of international spread)
9. Potential societal impacts

Newly reported infectious diseases

In 2007 Mark Woolhouse and Eleanor Gaunt established a list of 87 human pathogens first reported in the period between 1980 and 2005. These were classified according to their types.

Numbers of pathogen species by taxonomic category

	Number of species known in 2005	Number of species reported from 1980 to 2005
TOTAL	1399	87
Bacteria	541	11
Fungi	325	13
Helminths	285	1
Prions	2	1
Protozoa	57	3
Viruses	189	58
DNA viruses	36	9
RNA viruses	153	49

Major outbreaks

The following table summarizes the major outbreaks since 1998 caused by emerging or re-emerging infectious diseases.

Disease	Country or region	Year of start of outbreak
Ngari virus	Kenya, Tanzania, Somalia	1998
Nipah virus	Malaysia	1998
West Nile virus	US	1999
Itaya virus	Peru	1999
Rift Valley fever	Saudi Arabia and Yemen	2000
EBLV-2	Scotland	2002
SARS-CoV		2002
Influenza A virus subtype H7N2		2002
Monkeypox	US	2003
Chapare virus	Bolivia	2003
Plague	Algeria	2003
HTLV-3, HTLV-4	Cameroon	2005
Melaka virus	Malaysia	2006
LuJo virus	southern Africa	2008
Multi-drug resistant P. falciparum	South-East Asia	2008
Candida auris		2009
Heartland virus	US	2009
Bas-Congo virus	DRC	2009
Lassa fever	Mali	2009
Pandemic H1N1/09 virus	Global pandemic	2009
Huaiyangshan banyangvirus		2009
Plague	Libya	2009
Cholera	Haiti	2010
Lassa fever	Ghana	2011
Plasmodium cynomolgi	Malaysia	2011
H3N2v		2011
MERS -CoV		2012
Mojiang paramyxovirus		2012
H7N9		2013
Sosuga pararubulavirus		2013
H10N8		2013
Chikungunya	Caribbean	2013
Шаблон:Ill		2013
Colpodella sp. Heilongjiang	China	2013
Ebola virus disease	West Africa	2014
H5N6		2014
Lassa fever	Benin	2014
Bourbon virus	US	2014
Zika virus	Americas	2015
Crimean–Congo hemorrhagic fever	Spain	2016
Chikungunya	Pakistan	2016
Lassa fever	Togo	2016
Ntwetwe virus	Uganda	2016
Monkeypox	Nigeria	2017
Yellow fever	Brazil	2017
Rat hepatitis E virus		2017
Guinea worm	Chad	2018
Lyme disease		2018
H7N4		2018
Monkeypox	Liberia, UK	2018
Nipah virus	India	2018
COVID-19	Global pandemic	2019

Methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) evolved from methicillin-susceptible Staphylococcus aureus (MSSA), otherwise known as common S. aureus. Many people are natural carriers of S. aureus, without being affected in any way. MSSA was treatable with the antibiotic methicillin until it acquired the gene for antibiotic resistance. Through genetic mapping of various strains of MRSA, scientists have found that MSSA acquired the mecA gene in the 1960s, which accounts for its pathogenicity, before this it had a predominantly commensal relationship with humans. It is theorized that when this S. aureus strain that had acquired the mecA gene was introduced into hospitals, it came into contact with other hospital bacteria that had already been exposed to high levels of antibiotics. When exposed to such high levels of antibiotics, the hospital bacteria suddenly found themselves in an environment that had a high level of selection for antibiotic resistance, and thus resistance to multiple antibiotics formed within these hospital populations. When S. aureus came into contact with these populations, the multiple genes that code for antibiotic resistance to different drugs were then acquired by MRSA, making it nearly impossible to control. It is thought that MSSA acquired the resistance gene through the horizontal gene transfer, a method in which genetic information can be passed within a generation, and spread rapidly through its own population as was illustrated in multiple studies. Horizontal gene transfer speeds the process of genetic transfer since there is no need to wait an entire generation time for gene to be passed on. Since most antibiotics do not work on MRSA, physicians have to turn to alternative methods based in Darwinian medicine. However, prevention is the most preferred method of avoiding antibiotic resistance. By reducing unnecessary antibiotic use in human and animal populations, antibiotics resistance can be slowed.

Scientific Advisory Group for Origins of Novel Pathogens

On 16 July 2021, the Director-General of WHO announced the formation of the Scientific Advisory Group for Origins of Novel Pathogens (SAGO), which is to be a permanent advisory body of the organisation. The Group was formed with a broad objective to examine emerging infectious diseases, including COVID-19. According to the WHO Director-General, "SAGO will play a vital role in the next phase of studies into the origins of SARS-CoV-2, as well as the origins of future new pathogens."

See also

• Disease X
• Epidemiological transition
• Globalization and disease
• Pandemic prevention

References

Further reading

• Шаблон:Cite book

External links

• Website of Emerging Infectious Diseases, an open-access, peer-review journal published by the Centers for Disease Control and Prevention (CDC)