Emerging and re-emerging Infectious diseases: a global health threat.

The HIV/AIDS pandemic can truly be described as an infectious disease that has recently emerged and judging from its rapid global spread, it leaves no doubt that it is one of the greatest health threats mankind has to contend with. This pandemic has alerted and stimulated the international scientific community to seriously reflect oa other recent episodes of emerging and re-emerging infections. The examples that have recently been observed and addressed include new emerging infectious diseases, unusual manifestations of previously known diseases and unusual eruption of known diseases in unusual geographic foci or unusual altitudes. The scientific community has considered the following as plausible explanations for the epidemics: 1. It is known that micro-organisms mutate and selection pressures for appearance of resistant strains are encouraged by the widespread misuse of drugs; 2. Human population pressures, particularly ih the developing world, is leading migration to urban slums. Other populations are venturing into virgin jungles to open up new agricultural land. In the same category are economic pursuits in the forest or alteration of the environment by economic activities such as new dams and roads. All these activities put new susceptible populations at risk of interacting with new disease ecological systems. It is also tempting to include in this category civil disruptions which have led to acute displacement of large populations within a country or across international borders as refugees; 3. The re-emergence of some of the old familiar diseases, hitherto considered well controlled, can be attributed directly to the deterioration of health services as a result of global economic depression which has affected some countries more severely than others; 4. There is sound and growing scientific evidence implicating global warming as contributing to some of the new disease manifestations. The threat to health by emerging and re-emerging infectious diseases is a reality and the scientific basis for this occurrence, though complex, is slowly being understood. The response of the international scientific community to this situation has been acknowledged as appropriate. It is gratifying to recognise the leading role that CDC/US A in collaboration with WHO are playing in globalising the responses to these threats. WHO has rightly assumed its leadership role in matters of this nature in coordinating global efforts to address this subject. A new division of Emerging Infectious Diseases (EMC) became operational in WHO headquarters in October 1995. The scientific world looks to it for timely, accurate global information, coordination and resource mobilisation. Some of the activities that are deemed central in globalising the surveillance for emerging and re-emerging diseases are: 1. Setting up of a global network for laboratories capable of rapidly identifying emerging and re-emerging organisms; 2. Setting up of a global network for surveillance and monitoring the development of antibiotic resistant organisms. The WHONET computer programme is already operational in some countries and extension of its use to other countries will lead to a very powerful and comprehensive global monitoring system for antibiotic resistant organisms. The participation of Kenya Medical Research Institute in this programme has been elicited as one of the pilots for Africa; 3. Setting up rapid reaction forces to respond to specific outbreak situations in order to control the spread of an emerging infectious disease. In this area of rapid trans not continental travel, the world is viewed as a "global village" and the relevance of the current International Sanitary Regulations requires a re-appraisal. Global sensitisation of the international community to the importance of this programme will ease and facilitate efforts at mobilisation resources needed and the training of the manpower required to make the above activities operational on a global scale.