Rosenthal Samantha R, Ostfeld Richard S, McGarvey Stephen T, Lurie Mark N, Smith Katherine F
Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street Box G-S121-2, Providence, RI 02912, United States.
Cary Institute of Ecosystem Studies, Box AB, Millbrook, NY 12545, United States.
One Health. 2015 Aug 11;1:17-23. doi: 10.1016/j.onehlt.2015.08.001. eCollection 2015 Dec.
Microbial infections are as old as the hosts they sicken, but interest in the emergence of pathogens and the diseases they cause has been accelerating rapidly. The term 'emerging infectious disease' was coined in the mid-1900s to describe changes in disease dynamics in the modern era. Both the term and the phenomena it is meant to characterize have evolved and diversified over time, leading to inconsistencies and confusion. Here, we review the evolution of the term 'emerging infectious disease' (EID) in the literature as applied to human hosts. We examine the pathways (e.g., speciation or strain differentiation in the causative agent vs. rapid geographic expansion of an existing pathogen) by which diseases emerge. We propose a new framework for disease and pathogen emergence to improve prioritization. And we illustrate how the operational definition of an EID affects conclusions concerning the pathways by which diseases emerge and the ecological and socioeconomic drivers that elicit emergence. As EIDs appear to be increasing globally, and resources for science level off or decline, the research community is pushed to prioritize its focus on the most threatening diseases, riskiest potential pathogens, and the places they occur. The working definition of emerging infectious diseases and pathogens plays a crucial role in prioritization, but we argue that the current definitions may be impeding these efforts. We propose a new framework for classifying pathogens and diseases as "emerging" that distinguishes EIDs from emerging pathogens and novel potential pathogens. We suggest prioritization of: 1) EIDs for adaptation and mitigation, 2) emerging pathogens for preventive measures, and 3) novel potential pathogens for intensive surveillance.
微生物感染与它们所侵害的宿主一样古老，但对病原体的出现及其所引发疾病的关注一直在迅速加速。“新发传染病”这一术语于20世纪中叶被创造出来，用以描述现代时期疾病动态的变化。随着时间的推移，这个术语及其所描述的现象都在不断演变和多样化，导致了不一致和混乱。在此，我们回顾文献中“新发传染病”（EID）这一术语在应用于人类宿主时的演变。我们研究疾病出现的途径（例如，病原体的物种形成或菌株分化与现有病原体的快速地理扩张）。我们提出一个新的疾病和病原体出现框架，以改进优先级划分。并且我们说明新发传染病的操作定义如何影响有关疾病出现途径以及引发出现的生态和社会经济驱动因素的结论。由于新发传染病在全球范围内似乎正在增加，而科学研究资源趋于平稳或减少，研究界被迫将重点优先放在最具威胁的疾病、最具风险的潜在病原体以及它们出现的地点上。新发传染病和病原体的现行定义在优先级划分中起着关键作用，但我们认为当前的定义可能正在阻碍这些努力。我们提出一个将病原体和疾病分类为“新发”的新框架，以区分新发传染病与新兴病原体和新型潜在病原体。我们建议优先考虑：1）针对适应和缓解的新发传染病，2）针对预防措施的新兴病原体，以及3）针对强化监测的新型潜在病原体。
