Desenclos J-C, De Valk H
Département des maladies infectieuses, institut de veille sanitaire, 12, rue du Val-d'Osne, 94415 Saint-Maurice, France.
Med Mal Infect. 2005 Feb;35(2):49-61. doi: 10.1016/j.medmal.2004.09.005.
At the end of the 70s, it was said that eradicating infectious diseases was possible. With the occurrence of AIDS and the discovery of new pathogens the come-back of infectious diseases was noted, 15 to 20 years later, and the concept of emerging infections was defined. An emerging infection is the appearance of a new infection or the increase of its incidence if not new. It also includes infections for which the incidence could increase because of favorable conditions. Several scenarios can be proposed: 1) the appearance of a new infection (AIDS or SARS); 2) the appearance of a known infection where it did not exist previously (West Nile virus infection in the USA); 3) an infection that existed but that was not diagnosed or could not be linked precisely to a particular infectious agent (hepatitis C before the discovery of the hepatitis C virus; 4) a known infection that increases its usual incidence (outbreaks...); 5) infectious diseases for which current conditions may facilitate transmission (decrease of immunization coverage...). The deliberate release of a biological agent is one of the possible scenarios of emergence. Qualitative changes of infectious agents such as the resistance to anti-infectious agents may also contribute, through a selection mechanism, to the emergence of new infectious threat. Emerging infections result from the interaction between the agent, the host, and environment evolving according to human activity. Surveillance, research, laboratory capacity, and an effective public health system are key factors for their control.
20世纪70年代末,有人认为根除传染病是有可能的。随着艾滋病的出现以及新病原体的发现,15到20年后,人们注意到传染病卷土重来,于是出现了新发感染的概念。新发感染是指出现一种新的感染,或者如果不是新感染则是其发病率增加。它还包括那些由于有利条件其发病率可能增加的感染。可以提出几种情况:1)出现一种新感染(艾滋病或非典);2)在以前不存在的地方出现一种已知感染(美国的西尼罗河病毒感染);3)一种存在但未被诊断或无法精确关联到特定传染源的感染(丙型肝炎病毒发现之前的丙型肝炎);4)一种已知感染其通常发病率增加(暴发……);5)当前状况可能促进传播的传染病(免疫接种覆盖率下降……)。故意释放生物制剂是可能的新发情况之一。病原体的定性变化,如对抗感染药物的耐药性,也可能通过选择机制促成新的感染威胁的出现。新发感染是病原体、宿主和随人类活动而演变的环境之间相互作用的结果。监测、研究、实验室能力和有效的公共卫生系统是控制它们的关键因素。