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The challenge of emerging and re-emerging infectious diseases

An Erratum to this article was published on 07 January 2010

Abstract

Infectious diseases have for centuries ranked with wars and famine as major challenges to human progress and survival. They remain among the leading causes of death and disability worldwide. Against a constant background of established infections, epidemics of new and old infectious diseases periodically emerge, greatly magnifying the global burden of infections. Studies of these emerging infections reveal the evolutionary properties of pathogenic microorganisms and the dynamic relationships between microorganisms, their hosts and the environment.

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Figure 1: Global examples of emerging and re-emerging infectious diseases, some of which are discussed in the main text.
Figure 2: Leading causes of death worldwide.
Figure 3: Probable cases of severe acute respiratory syndrome (SARS) with onset of illness from 1 November 2002 to 31 July 2003.
Figure 4: Documented human infections with avian influenza viruses, 1997–2004.

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References

  1. Morse, S. S. Factors in the emergence of infectious diseases. Emerg. Infect. Dis. 1, 7–15 (1995).

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Kohn, G. C. in The Wordsworth Encyclopedia of Plague and Pestilence (ed. Kohn, G. C.) 25–26 (Facts on File, New York, 1995).

    Google Scholar 

  3. Johnson, N. P. A. S. & Mueller, J. Updating the accounts: global mortality of the 1918–1920 “Spanish” influenza pandemic. Bull. Hist. Med. 76, 105–115 (2002).

    PubMed  Google Scholar 

  4. Centers for Disease Control and Prevention. Multistate outbreak of monkeypox — Illinois, Indiana, and Wisconsin, 2003. MMWR 52, 537–540 (2003).

  5. Peiris, J. S. M. et al. The severe acute respiratory syndrome. N. Engl. J. Med. 349, 2431–2441 (2003).

    CAS  PubMed  Google Scholar 

  6. Jernigan, D. B. et al. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Emerg. Infect. Dis. 8, 1019–1028 (2002).

    PubMed  PubMed Central  Google Scholar 

  7. World Health Organization. The World Health Report 2004 (World Health Organization, Genève, 2004).

  8. Guerrant, R. L. & Blackwood, B. L. Threats to global health and survival: the growing crises of tropical infectious diseases — an “unfinished” agenda. Clin. Infect. Dis. 28, 966–986 (1999).

    CAS  PubMed  Google Scholar 

  9. Butler, J. C. et al. Emerging infectious diseases among indigenous peoples. Emerg. Infect. Dis. 7 (suppl.), 554–555 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Hodges, N. Λoιµoλoγια — sive, Pestis Nuperæ apud Populum Londinensem Grassantis Narratio Historica (Josephi Nevill, London, 1672).

    Google Scholar 

  11. Morens, D. M. & Littman, R. J. Epidemiology of the Plague of Athens. Trans. Am. Philol. Assoc. 122, 271–304 (1992).

    Google Scholar 

  12. Crosby, A. W. in The Columbian Exchange: Biological and Cultural Consequences of 1492 (Greenwood, Westport, Connecticut, 1972).

    Google Scholar 

  13. Hopkins, D. in Princes and Peasants. Smallpox in History Ch. 6, 204–233 (Univ. Chicago Press, Chicago, 1983).

    Google Scholar 

  14. MacArthur, N. Island Populations of the Pacific (Australian National Univ. Press, Canberra, 1968).

    Google Scholar 

  15. Bushnell, O. A. The Gifts of Civilization. Germs and Genocide in Hawai'i (Univ. Hawaii Press, Honolulu, 1993).

    Google Scholar 

  16. De Bevoise, K. Agents of Apocalypse: Epidemic Disease in the Colonial Philippines (Princeton Univ. Press, Princeton, New Jersey, 1995).

    Google Scholar 

  17. Morens, D. M. Measles in Fiji, 1875: thoughts on the history of emerging infectious diseases. Pac. Health Dialog 5, 119–128 (1998).

    Google Scholar 

  18. Koch, R. Untersuchungen über Bacterien. V. Die Aetiologie der Milzbrand-Krankheit, begründet auf die Entwicklungsgeschichte des Bacillus Anthracis. Beiträge zur Biologie der Pflanzen 2, 277–310 (1876).

    Google Scholar 

  19. Worboys, M. Spreading Germs: Diseases, Theories, and Medical Practice in Britain, 1865–1900 (Cambridge Univ. Press, Cambridge, 2000).

    Google Scholar 

  20. Porter, R. The Greatest Benefit to Mankind: A Medical History of Humanity from Antiquity to the Present (W. W. Norton and Co., London, 1997).

    Google Scholar 

  21. Deming, W. C. The extermination of infectious diseases. NY Med. J. 59, 710–715 (1894).

    Google Scholar 

  22. Cockburn, A. The Evolution and Eradication of Infectious Diseases (Johns Hopkins Univ. Press, Baltimore, 1963).

    Google Scholar 

  23. Fauci, A. S. Infectious diseases: considerations for the 21st century. Clin. Infect. Dis. 32, 675–685 (2001).

    CAS  PubMed  Google Scholar 

  24. Krause, R. M. The Restless Tide: The Persistent Challenge of the Microbial World (National Foundation for Infectious Diseases, Washington DC, 1981).

    Google Scholar 

  25. Committee on Emerging Microbial Threats to Health. Emerging Infections. Microbial Threats to Health in the United States (eds Lederberg, J., Shope, R. E. & Oaks, S. C.) (National Academy Press, Washington DC, 1992).

  26. Committee on Emerging Microbial Threats to Health in the 21st Century. Microbial Threats to Health in the United States: Emergence, Detection and Response (eds Smolinski, M. S., Hamburg, M. A. & Lederberg, J.) (National Academy Press, Washington DC, 2003).

  27. Stephens, D. S. et al. Emerging and re-emerging infectious diseases: a multidisciplinary perspective. Am. J. Med. Sci. 315, 64–75 (1998).

    CAS  PubMed  Google Scholar 

  28. Desselberger, U. Emerging and re-emerging infectious diseases. J. Infect. 40, 3–15 (2000).

    CAS  PubMed  Google Scholar 

  29. Lederberg, J. Infectious history. Science 288, 287–293 (2000).

    CAS  PubMed  Google Scholar 

  30. Pollard, A. J. & Dobson, A. R. Emerging infectious diseases in the 21st century. Curr. Opin. Infect. Dis. 13, 265–275 (2000).

    PubMed  Google Scholar 

  31. Feldman, H. et al. Emerging and re-emerging infectious diseases. Med. Microbiol. Immunol. 191, 63–74 (2002).

    Google Scholar 

  32. McMichael, T. Human Frontiers, Environments and Disease. Past Patterns, Uncertain Futures (Cambridge Univ. Press, Cambridge, 2001).

  33. Joint United Nations Programme on HIV/AIDS. AIDS Epidemic Update: December 2003 (UNAIDS, Genéve, 2003).

  34. Sharp, P. M. et al. The origins of acquired immune deficiency viruses: where and when? Phil. Trans. R. Soc. Lond. B 356, 867–876 (2001).

    CAS  Google Scholar 

  35. Quinn, T. C. Population migration and the spread of types 1 and 2 human immunodeficiency viruses. Proc. Natl Acad. Sci. USA 91, 2407–2014 (1994).

    ADS  CAS  PubMed  PubMed Central  Google Scholar 

  36. Daley, C. L. et al. in The AIDS Knowledge Base 3rd edn (eds Cohen, P. T., Sande, M. A. & Volberding, P. A.) Ch. 3, 23–52 (Lippincott, Williams and Wilkins, Philadelphia, 1999).

    Google Scholar 

  37. Ronald, A. R. Slowing heterosexual HIV transmission. Infect. Dis. Clin. North Am. 9, 287–296 (1995).

    CAS  PubMed  Google Scholar 

  38. Hjelle, B. et al. A novel hantavirus associated with an outbreak of fatal respiratory disease in the southwestern United States: evolutionary relationships to known hantaviruses. J. Virol. 168, 592–596 (1994).

    Google Scholar 

  39. Chua, K. B. et al. Nipah virus: a recently emergent deadly paramyxovirus. Science 288, 1432–1435 (2000).

    ADS  CAS  PubMed  Google Scholar 

  40. Beisel, C. D. & Morens, D. M. Variant Creutzfeldt–Jakob disease and the acquired and transmissible spongiform encephalopathies. Clin. Infect. Dis. 38, 697–704 (2004).

    PubMed  Google Scholar 

  41. Leopoldt, J. G. Nützliche und auf die Erfahrung gegründete Einleitung zu der Landwirthschaft, fünf Theile 348 (Christian Friedrich Güvnthern, Berlin, 1759).

    Google Scholar 

  42. Casalone, C. et al. Identification of a second bovine amyloidotic spongiform encephalopathy: molecular similarities with sporadic Creutzfeldt–Jakob disease. Proc. Natl Acad. Sci. USA 101, 3065–3070 (2004).

    ADS  CAS  PubMed  PubMed Central  Google Scholar 

  43. Williams, E. S. Scrapie and chronic wasting disease. Clin. Lab. Med. 23, 139–159 (2003).

    PubMed  Google Scholar 

  44. Katz, A. R. & Morens, D. M. Severe streptococcal infections in historical perspective. Clin. Infect. Dis. 14, 298–307 (1992).

    CAS  PubMed  Google Scholar 

  45. Musser, J. M. & Krause, R. M. in Emerging Infections. Biomedical Research Reports (ed. Krause, R. M.) 185–218 (Academic Press, San Diego, 1998).

    Google Scholar 

  46. Musser, J. M. & Selander, R. K. Brazilian purpuric fever: evolutionary genetic relationships of the case clone of Haemophilus influenzae biogroup aegyptius to encapsulated strains of Haemophilus influenzae. J. Infect. Dis. 161, 130–133 (1990).

    CAS  PubMed  Google Scholar 

  47. Li, M. -S., Farrant, J. L., Langford, P. R. & Kroll, J. S. Identification and characterization of genomic loci unique to the Brazilian purpuric fever clonal group of H. influenzae biogroup aegyptius: functionality explored using meningococcal homology. Mol. Microbiol. 47, 1101–1111 (2003).

    CAS  PubMed  Google Scholar 

  48. Reid, S. D., Hoe, N. P., Smoot, L. M. & Musser, J. M. Group A streptococcus: allelic variation, population genetics, and host–pathogen interactions. J. Clin. Invest. 107, 393–399 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Beres, S. B. et al. Genome sequence of a serotype M3 strain of group A Streptococcus: phage-encoded toxins, the high-virulence phenotype, and clone emergence. Proc. Natl Acad. Sci. USA 99, 10078–10083 (2003).

    ADS  Google Scholar 

  50. Chang, Y. et al. Identification of herpesvirus-like DNA sequences in AIDS-associated Kaposi's sarcoma. Science 266, 1865–1869 (1994).

    ADS  CAS  PubMed  Google Scholar 

  51. Parsonnet, J. (ed.) Microbes and Malignancy: Infection as a Cause of Human Cancers (Oxford Univ. Press, New York, 1999).

  52. Sanders, M. K. & Peura, D. A. Helicobacter pylori-associated diseases. Curr. Gastroenterol. Rep. 4, 448–454 (2002).

    PubMed  Google Scholar 

  53. Fredricks, D. N. & Relman, D. A. in Current Clinical Topics in Infectious Diseases Vol. 18 (eds Remington, J. S. & Swartz, M. N.) 180–200 (Blackwell Science, Malden, Massachusetts, 1998).

    Google Scholar 

  54. Kovats, R. S., Bouma, M. J., Hajat, S., Worrall, E. & Haines, A. El Niño and health. Lancet 362, 1481–1489 (2003).

    PubMed  Google Scholar 

  55. Cliff, A., Haggett, P. & Smallman-Raynor, M. in Island Epidemics Ch. 6, 165–236 (Oxford Univ. Press, Oxford, 2000).

    Google Scholar 

  56. Massey, A. Epidemiology in Relation to Air Travel (H. K. Lewis and Co., London, 1933).

    Google Scholar 

  57. Morens, D. M. Acute haemorrhagic conjunctivitis: dealing with a newly emerging disease. Pac. Health Dialog 5, 147–153 (1998).

    Google Scholar 

  58. Wellems, T. E. & Miller, L. H. Two worlds of malaria. N. Engl. J. Med. 349, 1496–1498 (2003).

    CAS  PubMed  Google Scholar 

  59. Miller, L. H. & Hoffman, S. L. Research toward vaccines against malaria. Nature Med. 4 (suppl.), 520–524 (1998).

    CAS  PubMed  Google Scholar 

  60. Espinal, M. A. The global situation of MDR-TB. Tuberculosis 83, 44–51 (2003).

    PubMed  Google Scholar 

  61. Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin — United States, 2002. MMWR 51, 565–567 (2002).

  62. Lee, J. H. Methicillin (oxacillin)-resistant Staphylococcus aureus strains isolated from major food animals and their potential transmission to humans. Appl. Environ. Microbiol. 69, 6489–6494 (2003).

    CAS  PubMed  PubMed Central  Google Scholar 

  63. Neu, H. C. The crisis in antibiotic resistance. Science 257, 1064–1072 (1992).

    ADS  CAS  PubMed  Google Scholar 

  64. Jones, J. L. et al. Surveillance for AIDS-defining opportunistic illnesses, 1992–1997. MMWR 48 (CDC Surveillance Summary no. SS-2), 1–22 (1999).

    PubMed  Google Scholar 

  65. Vento, S. & Cainelli, F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment. Lancet Oncol. 4, 595–604 (2003).

    PubMed  Google Scholar 

  66. Singh, N. Impact of current transplantation practices on the changing epidemiology of infections in transplant recipients. Lancet Infect. Dis. 3, 156–161 (2003).

    PubMed  Google Scholar 

  67. Chapman, L. E. Xenotransplantation: public health risks — patient vs. society in an emerging field. Curr. Top. Microbiol. Immunol. 278, 23–45 (2003).

    CAS  PubMed  Google Scholar 

  68. Nash, D. et al. The outbreak of West Nile virus infection in the New York City area in 1999. N. Engl. J. Med. 344, 1807–1814 (2001).

    CAS  PubMed  Google Scholar 

  69. Platonov, A. E. et al. Outbreak of West Nile infection, Volgograd Region, Russia, 1999. Emerg. Infect. Dis. 7, 128–132 (2001).

    CAS  PubMed  PubMed Central  Google Scholar 

  70. Komar, N. West Nile virus: epidemiology and ecology in North America. Adv. Virus Res. 61, 185–234 (2003).

    PubMed  Google Scholar 

  71. Gubler, D. J. Dengue and dengue haemorrhagic fever. Clin. Microbiol. Rev. 11, 480–497 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Morens, D. M. Antibody-dependent enhancement of infection and the pathogenesis of viral disease. Clin. Infect. Dis. 19, 500–512 (1994).

    CAS  PubMed  Google Scholar 

  73. Faruque, S. M. & Nair, G. B. Molecular ecology of toxigenic Vibrio cholerae. Microbiol. Immunol. 46, 59–66 (2002).

    CAS  PubMed  Google Scholar 

  74. Shortridge, K. F., Peiris, J. S. & Guan, Y. The next influenza pandemic: lessons from Hong Kong. J. Appl. Microbiol. 94 (suppl.), 70S–79S (2003).

    PubMed  Google Scholar 

  75. Webster, R. G. A molecular whodunit. Science 293, 1773–1775 (2001).

    CAS  PubMed  Google Scholar 

  76. Subbarao, K. & Katz, J. Avian influenza viruses infecting humans. Cell Mol. Life Sci. 571, 1770–1784 (2000).

    Google Scholar 

  77. Stevens, J. et al. Structure of the uncleaved human H1 haemagglutinin from the extinct 1918 influenza virus. Science 303, 1866–1870 (2004).

    ADS  CAS  PubMed  Google Scholar 

  78. Reid, A. H. & Taubenberger, J. K. The origin of the 1918 pandemic influenza virus: a continuing enigma. J. Gen. Virol. 84, 2285–2292 (2003).

    CAS  PubMed  Google Scholar 

  79. Anderson, R. M., Swinton, J. & Garnett, G. P. Potential impact of low-efficacy HIV-1 vaccines in populations with high rates of infection. Proc. R. Soc. Lond. B 261, 147–161 (1995).

    ADS  CAS  Google Scholar 

  80. Ghani, A. C., Ferguson, N. M., Donnelly, C. A. & Anderdson, R. M. Short-term projections for variant Creutzfeldt–Jakob disease onsets. Stat. Methods Med. Res. 12, 191–201 (2003).

    MathSciNet  PubMed  MATH  Google Scholar 

  81. Thompson, W. W. et al. Mortality associated with influenza and respiratory syncytial virus in the United States. J. Am. Med. Assoc. 289, 179–186 (2003).

    Google Scholar 

  82. Alibek, K. & Handelman, S. Biohazard: The Chilling True Story of the Largest Covert Biological Weapons Program in the World — Told From the Inside by the Man Who Ran It (Random House, New York, 1999).

    Google Scholar 

  83. Henschel, A. W. Document zur Geschichte des schwarzen Todes. Mitgetheilt und eingeleitet. Archiv für die gesammte Medicin 2, 26–59 (1842).

    Google Scholar 

  84. Duffy, J. Smallpox and the Indians in the American colonies. Bull. Hist. Med. 25, 324–341 (1951).

    CAS  PubMed  Google Scholar 

  85. Török, T. et al. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. J. Am. Med. Assoc. 278, 389–395 (1997).

    Google Scholar 

  86. Fauci, A. S. Biodefence on the research agenda: the world needs new and creative ways to counter bioterrorism. Nature 421, 787 (2003).

    ADS  CAS  PubMed  Google Scholar 

  87. Darling, R. G., Catlett, C. L., Huebner, K. D. & Jarrett, D. G. Threats in bioterrorism: I. CDC category A agents. Emerg. Med. Clin. North Am. 20, 273–309 (2002).

    PubMed  Google Scholar 

  88. World Health Organization. Consensus Document on the Epidemiology of Severe Acute Respiratory Syndrome (SARS)http://www.who.int/entity/csr/sars/en/WHOconsensus.pdf〉 (2003).

  89. Centers for Disease Control and Prevention. Preventing Emerging Infectious Diseases: A Strategy for the 21st Century (Department of Health and Human Services, Atlanta, 1998).

  90. NIH Bioengineering Consortium. Nanoscience and Nanotechnology: Shaping Biomedical Research. Symposium Report 〈http://grants.nih.gov/grants/becon/becon_symposia.htm〉 (2002).

  91. Baker, D. & Sali, A. Protein structure prediction and structural genomics. Science 294, 93–96 (2001).

    ADS  CAS  PubMed  Google Scholar 

  92. Dybul, M. et al. Guidelines for using antiretroviral agents among HIV-infected adults and adolescents. Ann. Intern. Med. 137, 381–433 (2002).

    PubMed  Google Scholar 

  93. Zhu, H., Bilgin, M. & Snyder, M. Annu. Rev. Biochem. 72, 783–812 (2003).

    CAS  PubMed  Google Scholar 

  94. Gluck, R. & Metcalfe, I. C. New technology platforms in the development of vaccines for the future. Vaccine 20, B10–B16 (2002).

    CAS  PubMed  Google Scholar 

  95. National Institute of Allergy and Infectious Diseases. The Jordan Report: 20th Anniversary. Accelerated Development of Vaccineshttp://www.niaid.nih.gov/dmid/vaccines/jordan20/jordan20_2002.pdf〉 (2002).

  96. Bendelac, A. & Medzhitov, R. Adjuvants of immunity: harnessing innate immunity to promote adaptive immunity. J. Exp. Med. 195, F19–F23 (2002).

    CAS  PubMed  PubMed Central  Google Scholar 

  97. O'Hagan, D. T. & Valiante, N. M. Recent advances in the discovery and delivery of vaccine adjuvants. Nature Rev. Drug Discov. 2, 727–735 (2003).

    CAS  Google Scholar 

  98. Fraser, C. M., Eisen, J. A., Nelson, K. E., Paulsen, I. T. & Salzberg, S. L. The value of complete microbial genome sequencing (you get what you pay for). J. Bacteriol. 184, 6403–6405 (2002).

    CAS  PubMed  PubMed Central  Google Scholar 

  99. Cromley, E. K. GIS and disease. Annu. Rev. Public Health 24, 7–24 (2003).

    PubMed  Google Scholar 

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Acknowledgements

The authors thank R. M. Krause for helpful discussions, and J. Weddle for graphic design.

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Morens, D., Folkers, G. & Fauci, A. The challenge of emerging and re-emerging infectious diseases. Nature 430, 242–249 (2004). https://doi.org/10.1038/nature02759

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