NEHA's position on emerging infectious diseases.
Adopted July 3, 1996
Background and General Discussion
Emerging infectious diseases, which are defined as infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range, are currently the leading cause of death worldwide (1-3). Complacency about infectious diseases infectious diseases: see communicable diseases. in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. has been misplaced mis·place
tr.v. mis·placed, mis·plac·ing, mis·plac·es
a. To put into a wrong place: misplace punctuation in a sentence.
b. . According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Margaret Hamburg, Commissioner of the New York City New York City: see New York, city.
New York City
City (pop., 2000: 8,008,278), southeastern New York, at the mouth of the Hudson River. The largest city in the U.S. Department of Health, considering domestic and international diseases as separate entities is an outmoded concept since many conditions that contribute to disease emergence or reemergence in the developing world are also present in the United States (4). For example, in 1993, contamination of the municipal water supply in Milwaukee, Wisconsin For other places with the same name, see Milwaukee (disambiguation).
Milwaukee is the largest city within the state of Wisconsin and 25th largest (by population) in the United States. , resulted in an outbreak of cryptosporidiosis Cryptosporidiosis Definition
Cryptosporidiosis refers to infection by the sporeforming protozoan known as Cryptosporidia. Protozoa are a group of parasites that infect the human intestine, and include the better known Giardia. that affected an estimated 400,000 people; approximately 4,400 persons required hospitalization (5). It should be noted that similar problems with water purification systems have been found in other U.S. cities (6). One of the six main re-emerging diseases, as identified by the World Health Organization, tuberculosis, has reemerged in the United States after decades of decline (7,8).
The purpose of this position paper is to review current information on the status of emerging infectious diseases with particular emphasis on the implications for environmental and public health. This document should serve as a basis for initiating proactive discussions on the topic among environmental and public health practitioners and colleagues in related fields with policy makers at all levels - local, state, national, and world-wide. In addition, it is intended to be used for the purpose of educating both the public and policy makers about the serious issue of emerging pathogens.
According to Morse (3,9), most emerging infectious diseases (Table 1) appear to be caused by pathogens already present in the environment that have been given a selective advantage by changing conditions. For example, there are many infections originating as zoonoses Zoonoses
Infections of humans caused by the transmission of disease agents that naturally live in animals. People become infected when they unwittingly intrude into the life cycle of the disease agent and become unnatural hosts. (10,11) suggesting that the "zoonotic Zoonotic
A disease which can be spread from animals to humans.
Mentioned in: Zoonosis pool" - introductions of infections from other species - is an important and potentially rich source of emerging diseases. Therefore, certain basic concepts in disease emergence, as put forth by Wilson (12,13), must be considered. These concepts are:
* emergence of infectious diseases is complex
* infectious diseases are dynamic
* most new infections are not caused by genuinely new pathogens
* agents involved in new and reemergent infections cross taxonomic lines to include viruses, bacteria, fungi, protozoa, and helminths helminths (hel´minths),
n.pl the parasitic worms that cause disease and illness in humans such as tapeworm, pinworm, and trichinosis. They are usually transmitted via contaminated food, water, soil, or other objects.
* the concept of the microbe microbe /mi·crobe/ (mi´krob) a microorganism, especially a pathogenic one such as a bacterium, protozoan, or fungus.micro´bialmicro´bic
n. as the cause of disease is inadequate and incomplete
* human activities are the most potent factors driving disease emergence
* social, economic, political, climatic, technologic, and environmental factors shape disease patterns and influence emergence
* understanding and responding to disease emergence require a global perspective, conceptually and geographically
* the current global situation favors disease emergence
Specific factors, such as ecological, environmental, or demographic factors, precipitating disease emergence can be identified in virtually all cases and are increasing in prevalence (1,14-17). Recently the World Health Organization listed several of these factors for new and re-emerging diseases, including:
* changes in lifestyle, including over-crowded cities where population growth has out-paced supplies of clean water and adequate housing
* dramatic increases in national and international travel, whereby an individual traveler may be infected in one country and spread the disease to others before falling ill
* deterioration of traditional public health activities such as surveillance and diagnostic laboratories needed to quickly recognize emerging problems
* complacency, despite numerous warnings in recent years
Interestingly, the National Academy of Science's Institute of Medicine has also identified erosion of the public health infrastructure among the factors contributing to new and reemerging infectious diseases (18). Classical environmental and public health measures have long served to minimize dissemination and human exposure to many pathogens spread by traditional routes such as water or preventable by vector control (1). It should be noted, however, that upon breakdown in preventive measures the pathogens, which, as previously noted, often remain in the environment, are sometimes able to take advantage of the opportunity to reemerge. Limited financial and human resources and competing priorities have resulted in a "crisis mentality" with emphasis on implementing so-called emergency control methods in response to epidemics rather than on developing programs to prevent epidemic transmission (19).
In 1995, the National Environmental Health Association (NEHA NEHA National Environmental Health Association
NEHA National Executive Housekeepers Association
NEHA Northern Estates Homeowners Association (Indianapolis, Indiana) ) released a position statement on health care reform which stated, "Highly publicized epidemics of waterborne and food-borne illness Food-borne illness
A disease that is transmitted by eating or handling contaminated food.
Mentioned in: Campylobacteriosis, Shigellosis have occurred recently, with substantial morbidity and associated cost. Such epidemics were due in part to inadequate systems of early detection and insufficient environmental protection, which in turn were caused by the divestiture of public health programs to nonpublic health agencies and by years of financial neglect.... Regardless of federal reform, state and local governments should emphasize prevention first.... Public and environmental health programs are established by law to protect the health of the entire community [and] should be seen as the crucial population-based practice in which the scientific base for defining problems, developing interventions, and measuring results is epidemiology. Thus, then [other health services health services Managed care The benefits covered under a health contract ] become active after the failure of the public health system. Thus the stronger the public and environmental health system, the less need for [these other, more costly, services]" (20).
With the recent demise of many environmental and public health programs, the existing capacity of the public and environmental health infrastructure at the local, state, national, and international level to respond to these challenges is limited. Human resource, equipment, and facility needs must be identified and addressed. Training needs of environmental and public health professionals, as well as medical students, clinicians, epidemiologists, microbiologists, entomologists The following is a list of entomologists, people who have studied insects.
Name Born Died Country Speciality
John Abbot 1751 1840 United States , mammalogists This is a list of notable mammalogists, in alphabetical order by surname. A-D
1. Morse, S.S. (1995), "Factors in the Emergence of Infectious Diseases," Emerging Infectious Diseases, 1:7-15.
2. Morse, S.S., and A. Schluederberg (1990), "Emerging Viruses: the Evolution of Viruses and Viral Diseases," J. Infect. Dis., 162:1-7.
3. Morse, S.S. (1993), "Examining the Origins of Emerging Viruses," Emerging viruses, ed. S.S. Morse, Oxford University Press, NY, pp. 10-28.
4. Hamburg, M. (June 1995), Remarks at the Conference on Emerging Infectious Diseases: Meeting the Challenge, NY.
5. MacKenzie, W.R., N.J. Hoxie, M.E. Proctor, et al. (1994), "A Massive Outbreak in Milwaukee of Cryptosporidium cryptosporidium (krĭp'tōspərĭd`ēəm), genus of protozoans having at least four species; they are waterborne parasites that cause the disease cryptosporidiosis. Infection Transmitted Through the Public Water Supply," N. Engl. J. Med, 331:161-7.
6. Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. (December 1993). "Assessment of Inadequately Filtered Public Drinking Water drinking water
supply of water available to animals for drinking supplied via nipples, in troughs, dams, ponds and larger natural water sources; an insufficient supply leads to dehydration; it can be the source of infection, e.g. leptospirosis, salmonellosis, or of poisoning, e.g. - Washington, D.C.," MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, , 43:661-3.
7. Centers for Disease Control and Prevention (1993), "Expanded Tuberculosis Surveillance and TuBerculosis Morbidity - United States, 1993," MMWR, 43:361-6.
8. Centers for Disease Control and Prevention (1994), "Multi-drug-resistant Tuberculosis in a Hospital - Jersey City, New Jersey, 1990-1992," MMWR, 43:417-9.
9. Morse, S.S. (1991), "Emerging Viruses: Defining the Rules for Vital Traffic," Perspect. Biol. Med., 34:387-409.
10. Fiennes, R.W. (1978), Zoonoses and the Origins and Ecology of Human Disease, Academic Press, London.
11. McNeill, W.H. (1976), Plagues and Peoples, Anchor Press/Doubleday, NY.
12. Wilson, M.E. (1995), "Travel and the Emergence of Injections Diseases," Emerging Infectious Diseases, 2:39-46.
13. Wilson, M.E. (1994), "Disease in Evolution: Introduction," Disease in Evolution: Global Changes and Emergence of Infectious Diseases, ed. M.E. Wilson, R. Levins, and A. Spielman, New York Academy of Sciences The New York Academy of Sciences is the third oldest scientific society in the United States. An independent, non-profit organization with more than 25,000 members in 140 countries, the Academy’s mission is to advance understanding of science and technology. , NY, 740:1-12.
14. Mahon, B.E., D.D. Rohn, S.R. Pack, and R.V. Tauxe (1995), "Electronic Communication Facilitates Investigation of a Highly Dispersed Foodborne Outbreak: Salmonella on the Superhighway," Emerging Infectious Diseases, 1:94-5
15. Tauxe, R.V. (1991), "Salmonella: a Postmodern Pathogen," J. Food Protection, 54:563-8.
16. Hedberg, C.W., K.L. MacDonald, and M.T. Osterholm (1994), "Changing Epidemiology of Food-borne Disease: A Minnesota Perspective," Clin. Infect. Dis., 18:671-82.
17. Hedberg, C.W., W.C. Levine, K.E. White, R.H. Carlson, D.K. Winsor, D.N. Cameron, et al. (1992), "An International Food-borne Outbreak of Shigellosis Shigellosis Definition
Shigellosis is an infection of the intestinal tract by a group of bacteria called Shigella. The bacteria is named in honor of Shiga, a Japanese researcher, who discovered the organism in 1897. Associated with a Commercial Airline," JAMA JAMA
Journal of the American Medical Association , 268:3208-12.
18. Institute of Medicine (1988), The Future of Public Health, National Academy Press, Washington, D.C.
19. Gubler, D.J., and G.G. Clark (1995), "Dengue/Dengue Hemorrhagic Fever hemorrhagic fever (hĕm'ərăj`ĭk), any of a group of viral diseases characterized by sudden onset, muscle and joint pain, fever, bleeding, and shock from loss of blood. : The Emergence of a Global Health Problem, Emerging Infectious Diseases, 1:55-7.
20. National Environmental Health Association (June 1995), Position on Health Care Reform, Denver, Co.
21. Braukus, M., and R. Khanna (1966), "NASA NASA: see National Aeronautics and Space Administration.
in full National Aeronautics and Space Administration
Independent U.S. Sponsors Symposium on Remote Sensing and Control of Insect-transmitted Diseases, Emerging Infectious Diseases, 2:74.
22. Satcher, D. (1995), "Emerging Infections: Getting Ahead of the Curve," Emerging Infectious Diseases, 1:1-6.
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