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新发人畜共患病的溢出前预防:目标是什么,工具又有哪些?

Pre-spillover prevention of emerging zoonotic diseases: what are the targets and what are the tools?

作者信息

Childs J E

机构信息

Department of Epidemiology and Public Health and Center for Eco-Epidemiology, Yale University School of Medicine, 60 College Street, P.O. Box 208034 New Haven, CT 06520-8034, USA.

出版信息

Curr Top Microbiol Immunol. 2007;315:389-443. doi: 10.1007/978-3-540-70962-6_16.

Abstract

The uneven standards of surveillance, human- or animal-based, for zoonotic diseases or pathogens maintained and transmitted by wildlife H(R)s, or even domestic species, is a global problem, readily apparent even within the United States, where investment in public health, including surveillance systems, has a long and enviable history. As of 2006, there appears to be little scientific, social, or political consensus that animal-based surveillance for zoonoses merits investment in international infrastructure, other than the fledgling efforts with avian influenza, or targeted nontraditional avenues of surveillance and research. National institutions charged with strategic planning for emerging diseases or intentional releases of zoonotic agents have emphasized improving diagnostic capabilities for detecting human infections, modifying the immune status of human or domestic animals through vaccines, producing better antiviral or antibacterial drugs, and enhancing human-based surveillance as an early warning system. With the possible exception of extensive human vaccination, each of these approaches target post-spillover events and none of these avenues of research will have the slightest impact on reducing the risk of additional emergence of viruses or other pathogens from wildlife. Novel schemes of preventing spillover of human pathogens from animal H(R)s can only spring from improving our understanding of the ecological context and biological interactions of pathogen maintenance among H(R)s. Although the benefit derived from investments to improve surveillance and knowledge of zoonotic pathogens circulating among wildlife H(R) populations is uncertain, our experience with HIV and the looming threat of pandemic avian influenza A inform us of the outcomes we can expect by relying on detection of post-spillover events among sentinel humans.

摘要

对于由野生动物宿主(或家养动物)维持和传播的人畜共患病或病原体,基于人类或动物的监测标准参差不齐,这是一个全球性问题,即使在美国也很明显,美国在包括监测系统在内的公共卫生方面的投资有着悠久且令人羡慕的历史。截至2006年,除了在禽流感方面刚刚起步的努力,或有针对性的非传统监测和研究途径外,对于基于动物的人畜共患病监测是否值得在国际基础设施方面进行投资,似乎几乎没有科学、社会或政治共识。负责新兴疾病战略规划或人畜共患病原体故意释放的国家机构强调提高检测人类感染的诊断能力,通过疫苗改变人类或家养动物的免疫状态,生产更好的抗病毒或抗菌药物,以及加强基于人类的监测作为早期预警系统。除了广泛的人类疫苗接种可能是个例外,这些方法都针对溢出后事件,而且这些研究途径都不会对降低野生动物中病毒或其他病原体再次出现的风险产生丝毫影响。预防人类病原体从动物宿主溢出的新方案只能源于我们对宿主中病原体维持的生态背景和生物相互作用的更好理解。尽管投资改善对野生动物宿主种群中传播的人畜共患病原体的监测和了解所带来的好处尚不确定,但我们在艾滋病毒方面的经验以及甲型禽流感大流行迫在眉睫的威胁让我们明白,依靠对哨点人群中溢出后事件的检测我们可能会得到什么样的结果。

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