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The outstanding issue regarding recent trends in the epidemiology of infectious diseases is the epidemic occurrence of severe acute respiratory syndrome (SARS) in 2003. SARS is caused by a novel coronavirus, presumably originating from wild cats. This new agent was rapidly identified and characterized, the outbreak was terminated in early summer 2003 after implementation of strict infectious control measures. Especially the high rate of complications and nosocomial infections has caused severe public health problems in China and Canada. The number of persons infected with HIV is still rising rapidly globally. New regions with rapid spread include the countries of the former Soviet Union in East Europe and Central Asia. The introduction of modern antiretroviral therapy in countries with high prevalence is making slow progress, with no visible impact on transmission dynamics so far. The WHO has implemented a number of programs to eradicate or eliminate targeted infectious diseases. Polio eradication and elimination of neonatal tetanus are making slow progress, obstacles to the control of these diseases are ongoing armed conflicts in regions with high prevalence and under financing of programs. Lack of funding is especially obvious regarding programs for the control and therapy of malarial infections. The numbers of patients newly identified with new variant Creutzfeldt-Jakob disease are not rising, but rather constant or even declining, making a large epidemic of vCJD unlikely.
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PMID:[Infectious diseases-part I: epidemiology]. 1471 83

Over the last decade, there was noted a large advancement of knowledge on living organisms and their products posing a potential occupational risk. Novel risk factors, often new to science, were identified, the role and significance of already known factors better comprehended, and occupational groups endangered by biological hazards more thoroughly recognized. Novel viruses and prions, emerging in different parts of the world, may pose a particular threat to health and life of health care workers, agriculture workers and veterinarians. A new coronavirus (SCoV) that evoked a rapid outbreak of disease described as severe acute respiratory syndrome (SARS) in the first half of 2003 may serve as an example. The disease was particularly common among health care workers. Previously discovered zoonotic viruses, Nipah virus in pigs and Hendra virus in horses, may be a cause of fatal encephalitis in animal farmers. Hantaviruses (Puumala, Hantaan, Sin Nombre and others) infecting field rodents may be a cause of hemorrhagic fever with renal syndrome (HFRS) or pulmonary syndrome (HPS) in farmers and laboratory workers. Prions responsible for inducing a zoonotic variant of Creutzfeldt-Jakob disease (vCJD) are considered to be a potential cause of work-related infections in agricultural and health care workers, however, this assumption has not as yet been supported by any conclusive evidence. In many countries, blood-borne occupational infections with hepatitis C virus (HCV) is the major epidemiological problem among health care workers, mostly because no vaccine against this virus has been produced to date. Vaccinations effectively restricted the number of occupational infections with hepatitis B virus (HBV), and work-related infections with human immunodeficiency virus (HIV) causing acquired immunodeficiency syndrome (AIDS) are very rare. Hazardous bioserosols, occurring in many work environments, pose an occupational health hazard of particular importance. Many new biological factors present in organic dusts that may induce work-related allergic and immunotoxic diseases among farmers and workers of the agricultural and wood industries have been identified. Droplet aerosols, which are generated from water, oils, oil-water emulsions and other liquids in various work environments, may contain infectious agents (Legionella spp.) as well as allergic and/or toxic agents. It has been shown that allergens and endotoxins produced by Gram-negative bacteria occurring in oil mist from metalworking fluids may cause occupational respiratory diseases in workers of the metallurgic industry.
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PMID:[Occupational bio hazards: current issues]. 1515 65

Fifty years ago, the age-old scourge of infectious disease was receding in the developed world in response to improved public health measures, while the advent of antibiotics, better vaccines, insecticides and improved surveillance held the promise of eradicating residual problems. By the late twentieth century, however, an increase in the emergence and re-emergence of infectious diseases was evident in many parts of the world. This upturn looms as the fourth major transition in human-microbe relationships since the advent of agriculture around 10,000 years ago. About 30 new diseases have been identified, including Legionnaires' disease, human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), hepatitis C, bovine spongiform encephalopathy (BSE)/variant Creutzfeldt-Jakob disease (vCJD), Nipah virus, several viral hemorrhagic fevers and, most recently, severe acute respiratory syndrome (SARS) and avian influenza. The emergence of these diseases, and resurgence of old ones like tuberculosis and cholera, reflects various changes in human ecology: rural-to-urban migration resulting in high-density peri-urban slums; increasing long-distance mobility and trade; the social disruption of war and conflict; changes in personal behavior; and, increasingly, human-induced global changes, including widespread forest clearance and climate change. Political ignorance, denial and obduracy (as with HIV/AIDS) further compound the risks. The use and misuse of medical technology also pose risks, such as drug-resistant microbes and contaminated equipment or biological medicines. A better understanding of the evolving social dynamics of emerging infectious diseases ought to help us to anticipate and hopefully ameliorate current and future risks.
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PMID:Social and environmental risk factors in the emergence of infectious diseases. 1557 34

Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis annually cause 3 million and 2 million deaths, respectively. Last year, 600,000 individuals, doubly infected with HIV and M. tuberculosis, died. Since World War I, approximately 150 million people have succumbed to these two infections--more total deaths than in all wars in the last 2,000 years. Although the perceived threats of new infections such as SARS, new variant Creutzfeldt-Jakob disease and anthrax are real, these outbreaks have caused less than 1,000 deaths globally, a death toll AIDS and tuberculosis exact every 2 h. In 2003, 40 million people were infected with HIV, 2 billion with M. tuberculosis, and 15 million with both. Last year, 5 million and 50 million were newly infected with HIV or M. tuberculosis, respectively, with 2 million new double infections. Better control measures are urgently needed.
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PMID:Annulling a dangerous liaison: vaccination strategies against AIDS and tuberculosis. 1581 88

Much can be learnt about the mechanisms by which micro-organisms cause disease from the ways that they interact with cells and tissues. This issue of The Journal of Pathology contains articles that address the roles that cell and tissue biology and pathology are playing in the elucidation of these mechanisms. A review of variant Creutzfeldt-Jakob disease is followed by a discussion of severe acute respiratory syndrome (SARS). Two articles on human papillomavirus (HPV) infection address the association between viral infection and neoplasia, as do reviews on viruses and lymphoma/leukaemia, and Kaposi's sarcoma-associated herpesvirus (human herpesvirus 8, HHV8). The section on viral disease concludes with an article on morbilliviruses. The intracellular effects of bacteria are addressed in a review of Listeria infection and a further review outlines recent advances in our knowledge of syphilis. Reviews on Helicobacter and gastric neoplasia, innate defences against methicillin-resistant Staphylococcus aureus (MRSA) infection, and the function of granulomas in tuberculosis also address aspects of tissue responses to bacterial infection. Following a review of the function of immunoglobulin A in defence against infection, a group of articles considers vaccination and gene therapy approaches, the latter involving consideration of both viral and bacterial strategies. The reviews assembled here bridge several gaps: between microbiology and cellular pathology; between host and infecting organism; and between disease and therapy. It is clear that cell and tissue pathology approaches are of value in all of these spheres, providing cell and tissue relevance to microbiological and immunological observations.
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PMID:Infection and disease: cause and cure. 1636 91

Two main types of safety procedures must be applied to biological products, including plasma derivatives: (i) preventive procedures and (ii) elimination procedures. Prevention includes epidemiological control of donor populations; checks on each donor's health condition; analysis of each donation for the main pathogens using serological methods; additional analysis of all plasma for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis A virus (HAV) and the B19 virus, using nucleic acid amplification techniques (NAT). A 60 days or longer inventory hold of all plasma donations is applied, to allow additional time to discard previous donations from potential seroconverting or otherwise rejectable donors. Elimination procedures minimize the low residual risk of transmitting pathogens, including unknown or previously undetected ones. Since the introduction 20 years ago of solvent-detergent treatment, very effective against enveloped viruses (HIV, HBV, HCV, West Nile virus, SARS, avian influenza virus etc), there have been no known cases of transmission of this type of pathogens by products manufactured according to this procedure. Other inactivation procedures such as pasteurization, dry-heat or nanofiltration may prove equally effective. In addition, dry-heat treatment and nanofiltration are capable of effectively eliminating non-enveloped viruses (HAV, B19 virus). Recent studies show that the B19 virus is much more sensitive to heat (in lyophilized state or by pasteurization) and acid pH than previously thought. Although there is no evidence for the transmission of classic transmissible spongiform encephalopathies (TSEs) through blood or blood-products transfusion, four possible cases have been reported in the United Kingdom involving transmission by non-leukoreduced blood components of the agent that causes variant Creutzfeldt-Jakob Disease (vCJD), a disease linked to the outbreak of bovine spongiform encephalopathy (BSE) which took place in that country. However, there are no cases of human TSE (classic or variant) transmission by plasma-derived products. Analytical methods capable of detecting the vCJD agent in patients' brains (where high titres are found) and other tissues (such as the spleen, appendix and lymph nodes, where much lower concentrations are found) are unable to detect the agent in blood or plasma from patients with vCJD, even in the clinical phase of the disease. Experiments by Grifols and other groups show that the capacity of the production processes to eliminate vCJD agent models is many orders of magnitude greater than the maximum expected load of the agent. In this regard, the efficacy of precipitation, affinity chromatography, depth filtration and nanofiltration are particularly notable.
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PMID:Safety procedures of coagulation factors. 1807 96

The concept of new and emerging diseases has captured the public interest and has revitalized the public health infectious disease research community. This interest has also resulted in competition for funding and turf wars between animal health and public health scientists and public officials and, in some cases, has delayed and hindered progress toward effective prevention, control and biodefense. There is a dynamic list of outbreaks causing substantial morbidity and mortality in humans and often in the reservoir animal species. Some agents have the potential to grow into major epidemics. There are many determinants that influence the emergence of diseases of concern that require the use of current understanding of the nature of agent persistence and spread. Additional factors that are global must be added to plans for prevention and control. To this complex mix has been added the potential for accidental or malicious release of agents. The nature of emerging infectious agents and their impact is largely unpredictable. Models that strive to predict the dynamics of agents may be useful but can also blind us to increasing disease risks if it does not match a specific model. Field investigations of early events will be critical and should drive prevention and control actions. Many disease agents have developed strategies to overcome extremes of reservoir qualities like population size and density. Every infectious agent spreads easier when its hosts are closer together. Zoonoses must be dealt with at the interface of human and animal health by all available information. Lessons learned from the emergence of and response to agents like West Nile virus, H5N1 avian influenza, SARS and bovine spongiform encephalopathy, the cause of new-variant Creutzfeldt-Jakob disease in humans, must be used to create better plans for response and meet the challenge for public health and biodefense.
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PMID:Emerging zoonoses: the challenge for public health and biodefense. 1837 40

Following the detection of bovine spongiform encephalopathy (BSE) in Canada, and subsequently in the United States, confidence in the safety of beef products remained high. Consumers actually increased their consumption of beef slightly after the news of an increased risk from mad cow disease, which has been interpreted as public support for beef farmers and confidence in government regulators. The Canadian public showed a markedly different reaction to the news of domestic BSE than the furious and panicked responses observed in the United Kingdom, Germany, and Japan. Using the social amplification of risk framework, we show that, while other countries displayed social amplification of risk, Canada experienced a social attenuation of risk. The attenuated reaction in Canada toward mad cow disease and increased human health risks from variant Creutzfeldt-Jakob disease (vCJD) was due to the social context at the time when BSE was discovered domestically. Mortality, morbidity, and psychosocial impacts resulting from other major events such as severe acute respiratory syndrome (SARS), West Nile virus (WNV), and the U.S.-Iraq war made the theoretical risks of BSE and vCJD a lower priority, reducing its concern as a risk issue.
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PMID:The impact of social amplification and attenuation of risk and the public reaction to mad cow disease in Canada. 1919 34

Emerging and re-emerging zoonoses have raised great concerns in both human and animal health worldwide in the past 20 years. Rudolph Virchow proposed a "one medicine" discipline and emphasized the importance of cooperation 150 years ago. In the face of emerging threats from unpredictable zoonoses, human medicine and veterinary medicine should not be separate and independent sciences. Anatomic pathologists who are capable of analyzing and interpreting anatomical manifestations of diseases to obtain a definite diagnosis or exclude a wide variety of diseases play an important role in the diagnostic team. Although disease-associated microbes are numerous, morphologic patterns of tissue reaction caused by microbes are limited. Therefore, the interactions between microbes and host determine the histological changes in the target tissues. The contributions of anatomic pathology, with its use of morphologic similarities and special techniques, are important in zoonosis diagnosis. This can be seen in retrospective case studies of recent zoonoses such as multinucleated syncytial giant cells in severe acute respiratory syndrome and mouse hepatitis virus infection, syncytial cells in Henipahvirus infection and paramyxovirus, neuronal vacuolation in bovine spongiform encephalopathy and variant Creutzfeldt-Jakob disease, and Streptococcus suis type 2 meningitis. In Taiwan, the Chinese Society for Comparative Pathology, which was established in 1994, provides for this interaction. Interlaboratory cooperation plays an important role in the diagnosis, surveillance, and control of emerging and re-emerging zoonoses.
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PMID:The Role of Comparative Pathology in the Investigation of Zoonoses. 3228 24

It is now increasingly common for infectious disease epidemics to be analysed with mathematical models. Modelling is possible because epidemics involve relatively simple processes occurring within large populations of individuals. Modelling aims to explain and predict trends in disease incidence, prevalence, morbidity or mortality. Models give important insight into the development of epidemics. Following disease establishment, epidemic growth is approximately exponential. The rate of growth in this phase is primarily determined by the basic reproduction number (R0), the number of secondary cases per primary case when the population is susceptible. R0 also determines the ease with which control policies can control epidemics. Once a significant proportion of the population has been infected, not all contacts of an infected individual will be with susceptible people. Infection can now continue only because new births replenish the susceptible population. Eventually, an endemic equilibrium is reached whereby every infected person infects one other individual on average. Heterogeneity in host susceptibility, infectiousness, human contact patterns and the genetic composition of pathogen populations introduces substantial additional complexity into the models required to model real diseases realistically. The contribution concludes with a brief review of the recent application of mathematical models to emerging human and animal epidemics, notably the spread of HIV in Africa, the variant Creutzfeldt-Jakob disease epidemic in the UK and its relationship to bovine spongiform encephalitis in cattle, the 2001 foot and mouth epidemic in UK livestock, bioterrorism threats such as smallpox, and the SARS epidemics in 2003.
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PMID:Mathematical prediction in infection. 3228 61


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