Mailman School of Public Health, Columbia University, New York, NY, USA.
Lancet. 2012 Dec 1;380(9857):1956-65. doi: 10.1016/S0140-6736(12)61684-5.
Most pandemics--eg, HIV/AIDS, severe acute respiratory syndrome, pandemic influenza--originate in animals, are caused by viruses, and are driven to emerge by ecological, behavioural, or socioeconomic changes. Despite their substantial effects on global public health and growing understanding of the process by which they emerge, no pandemic has been predicted before infecting human beings. We review what is known about the pathogens that emerge, the hosts that they originate in, and the factors that drive their emergence. We discuss challenges to their control and new efforts to predict pandemics, target surveillance to the most crucial interfaces, and identify prevention strategies. New mathematical modelling, diagnostic, communications, and informatics technologies can identify and report hitherto unknown microbes in other species, and thus new risk assessment approaches are needed to identify microbes most likely to cause human disease. We lay out a series of research and surveillance opportunities and goals that could help to overcome these challenges and move the global pandemic strategy from response to pre-emption.
大多数大流行病——例如艾滋病病毒/艾滋病、严重急性呼吸系统综合征、大流行性流感——源自动物，由病毒引起，并且由于生态、行为或社会经济变化而促使其出现。尽管它们对全球公共卫生产生了重大影响，并且人们对其出现的过程有了更多的了解，但在感染人类之前，从未预测过大流行病。我们回顾了已知的出现病原体、起源宿主以及驱动其出现的因素。我们讨论了对其控制的挑战以及预测大流行病、将监测重点放在最关键界面以及确定预防策略的新努力。新的数学模型、诊断、通信和信息学技术可以识别和报告其他物种中以前未知的微生物，因此需要新的风险评估方法来识别最有可能导致人类疾病的微生物。我们提出了一系列研究和监测机会和目标，这有助于克服这些挑战，并将全球大流行病战略从应对转变为先发制人。
