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Changing Viral Epidemiology: Strategies & lessons learnt
• 19,21Firstly, Identifying the emergence and associated clinical phenotypes of a new outbreak rapidly and accurately is of utmost importance, underlining the critical need for effective registries and surveillance systems, and the need to compile detailed clinical and biological assessment of infected cases as early as possible as an emergence unfolds. Strengthening health systems in low‐ and middle‐ income countries, where a lot of emerging infections originate.
• Secondly, the modes of pathogen transmission need to be rapidly identified to understand the magnitude and ramifications of the threat, which requires rapid implementation of descriptive epidemiological and case‐control studies.
• Thirdly, researchers need to identify basic scientific questions to be addressed, which include deciphering the basic microbiology of the emerging microorganism, and the development of diagnostic and research tools to characterize the pathogen, the delineation of the biological phenotypes associated with the infection and their underlying mechanisms, which may help develop countermeasures aimed at stopping the emerging microorganism and/or its impact on human health.
• This requires the development of experimental systems that allow faithful reproduction of the infection characteristics, including cell, tissue and animal models. Their relevance will need to be assessed by comparison to human data.
• Rapid progress in these areas requires close collaboration between clinicians and scientists, as well as mutual understanding of each other’s needs and priorities. Working with local communities and empowering them to better respond to future threats is also essential to foster a collaborative environment and bring about true impact where outbreaks emerge. Indeed, some of the infrastructure put in place for diagnosis and surveillance during the Brazil ZIKV outbreak were subsequently used to respond more effectively to the recent yellow fever outbreak.
• Media coverage is useful in creating the necessary social and political awareness that precedes the release of funds to tackle an emerging outbreak, but should be measured and accurate to avoid causing unnecessary panic and distress in the population. Incorporation of preparedness exercises to identify the ways in which the response system needs to improve.
• Development of preprint publishing services (such as bioRxiv) should allow a better conciliation of the apparent contradictory need to rapidly release research results of high relevance to public health, and allow publication in peer‐reviewed journals to fully ensure their scientific rigor, consistency and relevance
Changing Viral Epidemiology: Factors influencing
• 13,23,24SARS could potentially spread through modern ventilation systems
• Human immunodeficiency virus and hepatitis C virus have been spread through transfusions of unscreened
• Genomic epidemiology approaches have revealed significant food‐related disease for noroviruses and hepatitis A viruses associated with food‐handler transmission and sewage‐contaminated foods.
• Airplanes have replaced ships as major vehicles of international disease spread.
• More people are traveling to tropical rain forests and other wilderness habitats that are reservoirs for insects and animals that harbour unknown infectious agents. This incursion is due to economic development (e.g., mining, forestry and agriculture) and an expanded tourist trade that caters to persons who wish to visit undeveloped areas.
• increasing suburbanization and the reversion of agricultural land to secondary growth forest has brought people into contact with deer that carry ticks infected with Borrelia burgdorferi, the causative agent of Lyme disease, and has brought household pets into contact with rabies‐infected raccoons.
• The increased development and use of antimicrobial agents has hastened the development of drug resistance.
• People whose immunologic and other host defences have been impaired by modern medical treatments (e.g., bone marrow or solid organ transplants, chemotherapy, chronic corticosteroid therapy, renal dialysis, or indwelling medical devices) are more likely to acquire opportunistic infections.
blood & IDU.
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