Aarestrup Frank M, Bonten Marc, Koopmans Marion
Technical University of Denmark, Copenhagen, Denmark.
Utrecht University Medical Centre, Utrecht, The Netherlands.
Lancet Reg Health Eur. 2021 Oct;9:100210. doi: 10.1016/j.lanepe.2021.100210. Epub 2021 Oct 7.
The majority of emerging infectious diseases originate in animals. Current routine surveillance is focused on known diseases and clinical syndromes, but the increasing likelihood of emerging disease outbreaks shows the critical importance of early detection of unusual illness or circulation of pathogens - prior to human disease manifestation. In this Viewpoint, we focus on one key pillar of preparedness-the need for early warning surveillance at the human, animal, environmental interface. The COVID-19 pandemic has revolutionized the scale of sequencing of pathogen genomes, and the current investments in global genomic surveillance offer great potential for a novel, truly integrated Disease X (with epidemic or pandemic potential) surveillance arm provided we do not make the mistake of developing them solely for the case at hand. Generic tools include metagenomic sequencing as a catch-all technique, rather than detection and sequencing protocols focusing on what we know. Developing agnostic or more targeted metagenomic sequencing to assess unusual disease in humans and animals, combined with random sampling of environmental samples capturing pathogen circulation is technically challenging, but could provide a true early warning system. Rather than rebuilding and reinforcing the pre-existing silo's, a real step forward would be to take the lessons learned and bring in novel essential partnerships in a One Health approach to preparedness.
大多数新发传染病源自动物。当前的常规监测聚焦于已知疾病和临床综合征，但新发疾病暴发可能性的增加表明，在人类疾病显现之前早期发现异常疾病或病原体传播至关重要。在本观点文章中，我们聚焦于防范的一个关键支柱——在人类、动物、环境界面进行早期预警监测的必要性。新冠疫情彻底改变了病原体基因组测序的规模，目前对全球基因组监测的投入为建立一个新型、真正综合的具有大流行或潜在大流行可能的X疾病监测部门提供了巨大潜力，前提是我们不犯仅为当前情况而开发这些监测手段的错误。通用工具包括宏基因组测序这种全面的技术，而不是专注于我们已知内容的检测和测序方案。开发不可知论或更具针对性的宏基因组测序以评估人类和动物中的异常疾病，同时对捕获病原体传播的环境样本进行随机采样，在技术上具有挑战性，但可以提供一个真正的早期预警系统。与其重建和强化现有的孤立体系，真正向前迈出的一步是吸取经验教训，并在“同一健康”防范方法中引入新的重要伙伴关系。
