Cabello F, Springer A D
Departamento de Microbiología, New York Medical College, Valhalla 10595, USA.
Rev Med Chil. 1997 Jan;125(1):74-84.
During recent years the world has experienced the reemergence of old communicable diseases and the emergence of new ones caused by novel pathogens such as the HIV virus and Borrelia burgdorferi. The problem consists mostly in the reemergence of old diseases but specially in industrialized countries new pathogens have also been described. Although the emergence of these infections in rare instances is due to genetic changes of pathogens to more virulent forms, most commonly they are due to changes in the environment and the host. Rapidly deteriorating living standards, disintegration of sanitation and public health infrastructure, cultural changes, migration and variations in behavior are some of the factors involved in the worldwide increase of infectious diseases. The degradation of natural habitats including forests and marine niches accompanied by climatic changes, are also playing an increasing role in the detrimental evolution of these diseases. The global emergence of these diseases calls into question the doctrine of epidemiological transition and directs us to scrutinize the paradigm that bases the prevention of these diseases solely on vaccination. The current situation also highlights the limitations of classical epidemiology in dealing with unexpected problems, and strongly suggests that this discipline should incorporate into its analysis findings from other fields, including ecological, climatological, and economical information. As most of the negative social and economical developments that impinge on the detrimental evolution of these diseases are increasing world-wide, it can be predicted that the problems posed by these infections will continue and perhaps worsen in the near future.
近年来，世界经历了一些古老传染病的再度出现，以及由新型病原体如艾滋病毒和伯氏疏螺旋体引起的新疾病的出现。问题主要在于古老疾病的再度出现，但特别是在工业化国家，也有新病原体被发现。虽然这些感染在极少数情况下是由于病原体基因变化为更具毒性的形式，但最常见的原因是环境和宿主的变化。生活水平迅速下降、卫生和公共卫生基础设施瓦解、文化变迁、移民以及行为变化是全球传染病增加所涉及的一些因素。包括森林和海洋生态位在内的自然栖息地退化，以及气候变化，在这些疾病的有害演变中也发挥着越来越大的作用。这些疾病在全球范围内的出现，对流行病学转变理论提出了质疑，并促使我们审视仅将这些疾病的预防基于疫苗接种的范式。当前的形势也凸显了经典流行病学在应对意外问题方面的局限性，并强烈表明该学科应将其他领域的分析结果纳入其中，包括生态、气候和经济信息。由于影响这些疾病有害演变的大多数负面社会和经济发展在全球范围内都在增加，可以预测这些感染所带来的问题将持续存在，并且在不久的将来可能会恶化。
