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Emerging and Re-emerging Infectious Diseases 2003. Duc J. Vugia, M.D., M.P.H. Chief, Infectious Diseases Branch Division of Communicable Disease Control California Department of Health Services. WNV . Monkeypox from Prairie Dogs . Are infectious diseases emerging more recently than before? .

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emerging and re emerging infectious diseases 2003

Emerging and Re-emerging Infectious Diseases 2003

Duc J. Vugia, M.D., M.P.H.

Chief, Infectious Diseases Branch

Division of Communicable Disease Control

California Department of Health Services

infectious disease mortality in the united states 1980 1996










Infectious Disease Mortality in the United States, 1980-1996






Crude ID Mortality Rate

Deaths per 100,000 population







Source: JAMA 1996;275:189-193 and unpublished CDC data

emerging infections in the world and us since 1973
Emerging Infections in the World and US since 1973

1973 Rotavirus Enteritis/Diarrhea

1976 Cryptosporidium Enteritis/Diarrhea

1977 Ebola virus VHF

1977 Legionella Legionnaire’s dz

1977 Hantaan virus VHF w/ renal flr

1977 Campylobacter Enteritis/Diarrhea

1980 HTLV-1 Lymphoma

1981 Toxin prod. S.aureus Toxic Shock Synd.

1982 E.coli 0157:H7 HUS

1982 HTLV-II Leukemia

1982 Borrelia burgdorferi Lyme disease

emerging infections in the world and us since 19739
Emerging Infections in the World and US since 1973


1983 Helicobacter pylori Peptic ulcer dz

1988 Hepatitis E Hepatitis

1989 Hepatitis C Hepatitis

1990 Guanarito virus VHF

1991 Encephalitozoon Disseminated dz

1992 Vibrio cholerae O139 Cholera

1992 Bartonella henselae Cat scratch dz

emerging infections in the world and us since 197310
Emerging Infections in the World and US since 1973

1993 Sin Nombre virus Hanta Pulm. Synd.

1994 Sabia virus VHF

1994 Hendra virus Respiratory dz

1995 Hepatitis G Hepatitis

1995 H Herpesvirus-8 Kaposi sarcoma

1996 vCJD prion Variant CJD

1997 Avian influenza (H5N1) Influenza

1999 Nipah virus Encephalitis

1999 West Nile virus Encephalitis

2001 BT Bacillus anthracis Anthrax

2003 Monkeypox Pox


institute of medicine 1992 report on emerging infections
Institute of Medicine 1992 Report on Emerging Infections

Defined emerging infections as: “New, reemerging or drug-resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future.”

major factors contributing to emerging infections 1992
Major Factors Contributing to Emerging Infections: 1992

1. Human demographics and behavior

2. Technology and Industry

  • Economic development and land use

4. International travel and commerce

5. Microbial adaptation and change

6. Breakdown of public health measures

Institute of Medicine Report, 1992

more factors contributing to emerging infections 2003
More Factors Contributing to Emerging Infections: 2003

7. Human vulnerability

  • Climate and weather
  • Changing ecosystems
  • Poverty and social inequality
  • War and famine
  • Lack of political will
  • Intent to harm

Institute of Medicine Report, 2003

emerging infections human demographics behavior vulnerability
Emerging Infections:Human Demographics, Behavior, Vulnerability
  • More people, more crowding
  • Changing sexual mores (HIV, STDs)
  • Injection drug use (HIV, Hepatitis C)
  • Changing eating habits: out more, more produce (foodborne infections)
  • More populations with weakened immune system: elderly, HIV/AIDS, cancer patients and survivors, persons taking antibiotics and other drugs
emerging infections technology and industry
Emerging Infections:Technology and Industry
  • Mass food production (Campylobacter, E.coli O157:H7, etc…)
  • Use of antibiotics in food animals (antibiotic-resistant bacteria)
  • More organ transplants and blood transfusions (Hepatitis C, WNV,…)
  • New drugs for humans (prolonging immunosuppression)
organ transplantation year end waiting lists vs transplanted kidney liver pancreas heart lung
Organ TransplantationYear-end Waiting Lists vs. Transplanted(kidney, liver, pancreas, heart, lung)









Source: UNOS


emerging infections economic development land use changing ecosystems
Emerging Infections:Economic Development, Land Use, Changing Ecosystems
  • Changing ecology influencing waterborne, vectorborne disease transmission (e.g. dams, deforestation)
  • Contamination of watershed areas by cattle (Cryptosporidium)
  • More exposure to wild animals and vectors (Lyme disease, erhlichiosis, babesiosis, HPS,…)
emerging infections international travel and commerce
Emerging Infections:International Travel and Commerce
  • Persons infected with an exotic disease anywhere in the world can be into major US city within hours (SARS, VHF,…)
  • Foods from other countries imported routinely into US (Cyclospora,….)
  • Vectors hitchhiking on imported products (Asian tiger mosquitoes on lucky bamboos,….)

Speed of Global Travel in Relation to

World Population Growth

From: Murphy and Nathanson. Semin. Virol. 5, 87, 1994




10 µm

Immature oocysts

Contaminated raspberries


emerging infections microbial adaptation and change
Emerging Infections:Microbial Adaptation and Change
  • Increased antibiotic resistance with increased use of antibiotics in humans and food animals (VRE, VRSA, penicillin- and macrolide-resistant Strep pneumonia, multidrug-resistant Salmonella,….)
  • Increase virulence (Group A Strep?)
  • Jumping species from animals to humans (avian influenza, HIV?, SARS?)

Emerging Vancomycin-resistant Enterococcal Infections*

% Resistant

* in U.S. NNIS Hospitals


emerging infections poverty social inequality breakdown of public health measures
Emerging Infections:Poverty, Social Inequality, Breakdown of Public Health Measures
  • Lack of basic hygienic infrastructure (safe water, safe foods, etc..)
  • Inadequate vaccinations (measles, diphtheria)
  • Discontinued mosquito control efforts (dengue, malaria)
  • Lack of monitoring and reporting (SARS)
emerging infections intent to harm
Emerging Infections:Intent to Harm
  • Bioterrorism: Anthrax in US 2001
  • Bio-Crimes: Salmonella in OR, Shigella in TX.
  • Potential agents: Smallpox, Botulism toxin, Plague, Tularemia, ….
prevention of emerging infectious diseases will require action in each of these areas

Prevention of Emerging Infectious Diseases Will Require Action in Each of These Areas

Surveillance and Response

Applied Research

Infrastructure and Training

Prevention and Control


preventing emerging infectious diseases

Preventing EmergingInfectious Diseases

Surveillance and Response

Detect, investigate, and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified.


preventing emerging infectious diseases30

Preventing EmergingInfectious Diseases

Applied Research

Integrate laboratory science and epidemiology to increase the effectiveness of public health practice.


preventing emerging infectious diseases31

Preventing EmergingInfectious Diseases

Infrastructure and Training

Strengthen public health infrastructures to support surveillance, response, and research and to implement prevention and control programs.

Provide the public health work force with the knowledge and tools it needs.


preventing emerging infectious diseases32

Preventing EmergingInfectious Diseases

Prevention and Control

Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases.


preventing emerging infectious diseases more to do

Preventing EmergingInfectious Diseases: More to Do

Enhance communication: locally, regionally, nationally, globally

Increase global collaboration

Share technical expertise and resources

Provide training and infrastructure support globally

Ensure political support

Ensure judicious use of antibiotics

Vaccines for all