434 - Infection Disease Threats

FEBRUARY 2020 | The Surgical Technologist | 63 Bloom and Cadarette Responding to Infectious Disease Threats TABLE 1 | Prominent outbreaks, epidemics, and pandemics of the last century. Year(s) Pathogen Geographic location Cases/mortality Other notes References 1918–1920 Influenza (Spanish flu) Worldwide 500 million cases and 30 to 100 million deaths The Spanish flu claimed the lives of 2–5% of world’s population, far exceeding the death toll of WWI. ( 1 , 2 , 6 ) 1957–1958 Influenza (Asian flu) Worldwide 1 to 2 million deaths Accelerated development of a vaccine limited the spread of the responsible influenza strain. ( 7 ) 1968–1969 Influenza (Hong Kong flu) Worldwide 500,000 to 2 million deaths The Hong Kong flu was the first virus to spread extensively due to air travel. ( 7 ) 1960-present HIV/AIDS Worldwide, primarily Africa 70 million cases and 35 million deaths HIV was first identified in 1983. The earliest known case came from a blood sample collected in 1959. ( 8 – 10 ) 1961-present Cholera Worldwide 1.4 to 4 million annual cases and 21,000 to 143,000 annual deaths The seventh cholera pandemic began in South Asia in 1961. Recent notable outbreaks include those in Zimbabwe from 2008 to 2009, Haiti from 2010-present, and Yemen from 2016-present. ( 11 , 12 ) 1974 Smallpox India 130,000 cases and 26,000 deaths One of the worst smallpox epidemics of the twentieth century occurred just 3 years before the disease was eradicated. ( 13 ) 1994 Plague India 693 suspected cases and 56 deaths The outbreak originated in Surat, India. Within days, hundreds of thousands of the city’s 1.6 million residents fled, spreading the disease across five states. ( 14 , 15 ) 2002–2003 SARS Originated in China, spread to 37 countries 8,098 cases and 774 deaths International business travel allowed the SARS virus to spread quickly across continents. ( 16 , 17 ) 2009 Influenza (Swine flu) Worldwide 284,000 deaths Many public and private facilities in Mexico closed in an attempt to prevent the spread of “swine flu” during the early days of the epidemic. The pork industry also suffered losses, even though eating pork products posed no risk. ( 18 – 20 ) 2014–2016 Ebola West Africa, primarily Guinea, Liberia, and Sierra Leone 28,600 cases and 11,325 deaths reported (likely underestimates) 300,000 doses of an experimental Ebola vaccine were subsequently stockpiled. ( 21 , 22 ) 2015-present Zika The Americas, primarily Brazil Unknown number of cases and 0 deaths reported The Zika epidemic has resulted in few, if any, deaths. However, birth defects resulting from infection in pregnant women occurred frequently, which prompted some governments to encourage delaying pregnancy for as long as 2 years. ( 23 ) 2016 Dengue Worldwide 100 million cases and 38,000 deaths Dengue outbreaks occur periodically in affected regions. 2016 was notable for the unusual scale of outbreaks across the globe. ( 24 ) 2017 Plague Madagascar 2,417 cases and 209 deaths Plague is endemic in Madagascar, but an increase in pneumonic plague, which can be transmitted from human to human, was associated with the recent spike in cases. ( 25 ) widespread pan-resistant “superbugs” could pose yet another threat if we fail to act ( 43 ). While rapid transmission of resistant pathogens is unlikely to occur in the same way it may with pandemic threats, the proliferation of superbugs is making the world an increasingly risky place. AMR threats also differ from epidemic threats in a number of other respects: Most of the top AMR threats are bacterial, and many are typically contracted as nosocomial infections; pathogens of epidemic potential tend to be viral and often emerge from zoonotic reservoirs to cause outbreaks in human populations. Table 3 documents the WHO’s list of priority pathogens for R&D of new antibiotics ( 44 ). The list was selected through a multi-criteria decision analysis incorporating both quantifiable evidence and the input of 70 experts with different backgrounds and from a variety of geographies. Notably, the list was not developed to prioritize the top public health threats with respect to AMR, but rather to identify the pathogens for which R&D needs are greatest, considering both health burden and availability of treatment. The WHO explicitly excluded TB from the list and included only bacterial pathogens. Beyond the pathogens on this list, mounting resistance against the drugs used to treat TB, HIV, and malaria is especially concerning. Resistant TB, for instance, is already responsible for 240,000 deaths globally per year (out of 700,000 total AMR- related deaths, which is likely an underestimate) ( 43 , 45 ). Frontiers in Immunology | www.frontiersin.org 3 March 2019 | Volume 10 | Article 549