Significant funding gaps persist for the prevention and control of arboviral infections Other challenges include knowledge gaps on the risk factors for transmission of emerging infections, weak and variable surveillance systems for early detection and response, limited laboratory diagnostic capacities, insufficient investment in disease surveillance and response activities, and absence comprehensive preparedness and response plans World Health Organization will continue to support countries in the areas of surveillance, early detection, and response to emerging infectious disease outbreaks.
Accelerated efforts are needed by countries to build and maintain a resilient public health system for detection and response to all acute public health events. Countries need to roll out the strategic framework for prevention and control of emerging diseases and develop a framework for integrating the early warning system for disease outbreaks in countries affected by humanitarian crises within the routine disease surveillance system.
The IHR remains the key driver in national and international efforts to strengthen national and global health security. Information in this mini review was obtained from information sources that are publicly available.
This information presents the point of view of all contributing authors and not the point of view of the organization WHO. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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Ramsey, Nancy Rawding, William C. Reeves, Russell Regnery, Arthur L. Reingold, I. Paul Reiter, Roselyn J. For example, dengue came to the Americas in association with the slave trade of earlier centuries. In this regard, slaves infected by mosquitoes in Africa presumably brought the infection to the Americas by seeding the mosquito population upon arrival [15]. Similarly, WNV came to the United States in when an infected human, bird, or mosquito came by air travel from the Middle East to the Western Hemisphere, providing a source for introduction of infection to New World mosquitoes and birds.
Pathogenic strains of dengue have also spread back from Southeast Asia to the Western Hemisphere, as has a major mosquito vector, Aedes albopictus. Unlike most arboviruses, which are partly or completely host-restricted, WNV has become adapted to multiple mosquito and avian species, a major factor in increasing its opportunity to infect humans.
The lack of additional hosts undoubtedly drove the mosquitoes that are the vectors of dengue and the dengue virus itself to favor adapting to humans and to their behaviors and environments. The association of dengue with Aedes mosquitoes that live in and around human habitations mean that crowding, poor sanitation, and poverty provide ideal environments for transmission to humans [15].
Other non-arboviral examples of emerging infections abound. For example, cholera has repeatedly reemerged over more than two centuries in association with global travel, changing seasons, war, natural disasters, and conditions that lead to inadequate sanitation, poverty, and social disruption.
Drug resistance mutations have also caused the reemergences of certain pathogens such as multidrug-resistant and extensively drug-resistant tuberculosis, drug-resistant malaria, and numerous bacterial diseases such as vancomycin-resistant enterococci.
Fungi have made significant contributions to disease emergence as well. In Africa, cryptococcal disease has already surpassed tuberculosis as a leading cause of death [17]. Other examples of fungal emergence include comorbidities in HIV-infected individuals 17 , Cryptococcus gattii epidemics in predominantly healthy persons in the U.
While it has become possible to eradicate certain infectious diseases smallpox and the veterinary disease rinderpest , and to significantly control many others dracunculiasis, measles, and polio, among others , it seems unlikely that we will eliminate most emerging infectious diseases in the foreseeable future.
Pathogenic microorganisms can undergo rapid genetic changes, leading to new phenotypic properties that take advantage of changing host and environmental opportunities. Influenza viruses serve as a good example of emerging and reemerging infectious agents in their ability to rapidly evolve in response to changing host and environmental circumstances via multiple genetic mechanisms. The influenza pandemic virus is one example: over the past 95 years, its descendants have evolved continually by antigenic drift, intra-subtypic reassortment, and antigenic shift, the latter producing new pandemics in and [14].
Even the genetically complex pandemic H1N1 influenza virus is a descendant of the virus [14]. Such continuous genetic hyper-evolution forces us to develop new influenza vaccines containing new antigens on an annual basis. In the meantime, new human diseases keep emerging.
As noted, in late the novel MERS coronavirus emerged in Saudi Arabia [13] , and in early a new H7N9 avian influenza virus became epizootic in Eastern China, causing spillover infections of humans as of June 7, , with 28 percent case fatality [10] , [22].
Its pandemic potential, if any, remains to be determined. Whether or not such outbreaks become more widespread, they nonetheless attract global attention and require significant international effort to monitor and contain.
Microbial advantages can be met and overcome only by aggressive vigilance, ongoing dedicated research, and rapid development and deployment of such countermeasures as surveillance tools, diagnostics, drugs, and vaccines. We appear to be entering a new era in which several important emerging, reemerging, and stable infectious diseases are becoming better controlled e. However, our success in stopping the many new emerging diseases that will inevitably appear is not assured.
We have many tools in our armamentarium, including preparedness plans and stockpiles of drugs and vaccines. But each new disease brings unique challenges, forcing us to continually adapt to ever-shifting threats [1] — [10] , [23].
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