Stoto Michael A
Biosecur Bioterror. 2014 Sep-Oct;12(5):225-30. doi: 10.1089/bsp.2014.0030.
The biosurveillance capabilities needed to rapidly detect and characterize emerging biological threats are an essential part of the Global Health Security Agenda (GHSA). The analyses of the global public health system's functioning during the 2009 H1N1 pandemic suggest that while capacities such as those identified in the GHSA are essential building blocks, the global biosurveillance system must possess 3 critical capabilities: (1) the ability to detect outbreaks and determine whether they are of significant global concern, (2) the ability to describe the epidemiologic characteristics of the pathogen responsible, and (3) the ability to track the pathogen's spread through national populations and around the world and to measure the impact of control strategies. The GHSA capacities-laboratory and diagnostic capacity, reporting networks, and so on-were essential in 2009 and surely will be in future events. But the 2009 H1N1 experience reminds us that it is not just detection but epidemiologic characterization that is necessary. Similarly, real-time biosurveillance systems are important, but as the 2009 H1N1 experience shows, they may contain inaccurate information about epidemiologic risks. Rather, the ability of scientists in Mexico, the United States, and other countries to make sense of the emerging laboratory and epidemiologic information that was critical-an example of global social capital-enabled an effective global response. Thus, to ensure that it is meeting its goals, the GHSA must track capabilities as well as capacities.
快速检测和鉴定新出现的生物威胁所需的生物监测能力是全球卫生安全议程(GHSA)的重要组成部分。对2009年甲型H1N1流感大流行期间全球公共卫生系统运作情况的分析表明,虽然GHSA所确定的能力是必不可少的基石,但全球生物监测系统必须具备3项关键能力:(1)检测疫情并确定其是否引起全球重大关注的能力;(2)描述致病病原体流行病学特征的能力;(3)追踪病原体在各国人群及全球范围内传播并衡量控制策略影响的能力。GHSA的各项能力——实验室和诊断能力、报告网络等——在2009年至关重要,在未来事件中肯定也会如此。但2009年甲型H1N1流感的经历提醒我们,不仅需要检测,还需要进行流行病学特征描述。同样,实时生物监测系统很重要,但正如2009年甲型H1N1流感的经历所示,它们可能包含有关流行病学风险的不准确信息。相反,墨西哥、美国和其他国家的科学家解读新出现的实验室和流行病学信息的能力至关重要——这是全球社会资本发挥作用的一个例子——促成了有效的全球应对。因此,为确保实现其目标,GHSA必须跟踪能力以及容量。