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Inslght revlew arllcles The challenge of emerging andre-emerging infectious diseases Dmiil.Imml.filInalfllmr[8.E_il mmmflqflmmnfiumoimmmqnm oapmmayrrrmsimdmmmmm mm: mam Lisa vie—marl Winks”) lnhetluus m have [or immune ranksrl vlttl Ivar: ad tombs as mahr ehalannas to turn massand ML The: remsir Inna] th lsalllnu caress at death III disdain mine. In“ a can“ Melanin“ it established splitsflenlnwaml lllll mm nuhdluitymnw, nraattjlugnll’fhutbanlrlflhldan uflntaeflnu. Slrdlesnfflrssaernm itseflunsmflthmh’flnurv omits: Int palngmii: liemrganlsms nil lira Emmi: relatiunslllus bellman “Hungarians, llair heels at the Irvin-nan. merging infections fills) can be defined as1‘1’n.fecl:i.|:n’isIlla!havenewlyappalledinapopu—lationorhaveeidfiedpreviouslybmare rapidlyinueasing in incidence or geographic range”.Elsl’raveshapeil rlseoourseofhumanhistoryandhavecaused inmlaculable miseryanddeat’h. ln “Shane“disease—acqmred immune defidencysyndrome {AIDS}—vrasfirst iaed.Asa5lobalkillec.A]D5nnwll1reat—ens to surpass Hie Black Death of the fourteenlh cmtlu’yand the IBIS—1920 influenm andecnicq each o‘thichkilledatleastSDmfllinnpeo .Dflhe ‘newlfecnerging’and ‘re-emergingfcesurging’diseasesthalhaiefollowedrlieappmanceoffllDS[Fig.1}.somehavebeenminorcuriosi— tinssuchaslhemicasesofioonlaevpoximportedintoflieUnitedSIates‘,whereasothers. suohassevereacute reEpiIa— tocysyndrome {EARS}. wtuch emerged in un- same years.havehad awrldwide impact. TheZIIKll an‘fllraxbioterrm—is! altaclc in the United Sinai falls into a. third category:deliberately emerginga diseases. Els can be npected toremain a considerable challenge Eortl’ie foresemlile fishue.Here’we examinethenal’ureand soopeofemergingand re-emergingmicrobiallhreatsmndconsidermeflludsfortlleilcomtmL’Weemphasieetl’ul emergenoeresullsfromdynamicinteracfinnsbemeen rapidlyevolyinginfieclinusagenlsaudchanges in the em’ironment and in host behaviour thatprovide suchagentswithfavourableneweeologicalnidles. Elml linden Ill mm lllfiflflsAbout [5 million [325%] of 5’1″ million annual clutter“mldvrideareestimatedtoberelateddirectlyto infectiousdiseaseutlusfigruedoesnothldudemeaddiuonalmillionsofdcadistlu‘ro-ocurasaconsequmee ofpastinfectiocoflficrecampleatreptoooocalrhemnaticheartdisflselmrbecauseofeoropliuflnnsassodamdwiflr clmonicinfiedionhsuchasliverfailureaiflhepato-cellularmrcirmmain peopleinliactedwimhcparitisfiurcvirm’fiiga).Theburdmofmorbidityfillhealth}andmorlalityasso—cia‘ledvritll infectious dis-mm falls mostheavily on peoplein developing countries’, and particularly on infants andchildren (about three million children die each year frommalaria and diamhoeal diseases aloe-rel). In devflopednations. inflections disease mortality disproportionatelyafieckindipousaoddifldvanlagednnnnritiesn. Ema“ mill“ ll1 lllllllfl filmEls havebeen fimiliar Ilu’ea‘ls since ancient times.were once identified by terms such as luaqui: [loimosll . and Ia‘lnei’as‘pestilenees’.‘pestos’= ‘pesls’and’plsgucsilvlanyexamplescan beciled bladditicm to the Black Death andthe 19m influenu pandemic. such as certain biblicalpharaonicplagues and the unidentified Plague ofAtbens,which heralded I‘l’ieend of’Greece’s GoldenAge“.TheJi.geofDisooveryastartingin Illefifleenthcenturyawas spa-clic-ularly disastrous period vri’flr regard to tbespread ofiniec-fiousdiseaseslmpomlionofanallpmrinlolvmcaused[El—[5 milllnndcl‘llliiJIISZD—IEZI, cfl—Dcflvnl‘ymdiugmciviliaatiou’z’u.0therilmerindian and Pacific civilizationswere destroyed by imported smallpox and measles’L”.Histoflanshaierefienedtoflieseevmtsasapoealypsfi’iandevenasgmocide’s. For centuries. mankind seemed helpless against thinesuddenepflemics. lluflheei.‘t’.1l:ilisl‘|n|eutol’tlleger‘mtl:|.eo1′}Iand the idenlification ofspecific microbes as the causativeagentsocFa widemHyoFmfiecfiomdheaws’udeenor—mous progress. notably the development ofvacdnm andultunatelyofantinuu’obiialsndnfachtheeraofflieidmtifi—auunocl’micmhm had barelyhgunflwhenoplnnistsaflheendofthe nineteenth century predicted the eradication ofinfixfinmdismag’nythrlesnswhidmimmdthmidg—mead useofpenicillioq Ihedeveloproent ofpolin vaccinesmdflrediseoseryofdrugsfiirtrdaerculosismnmplanencyhadsetinnmnd i11196?,Tl’leU§§urgeonGenn:aldaledfltat“thewaginstmfectiousdiseaseshasbemwon”n. Some experts remained snepficaL aware of recurrentlessonsfromhistortheywueleapersuadedbysuomesflunalumedbyfiflwfisudaslhelackofprogress againstird’ectionsinmedevelnpingwddandflleglobalspzeadofantimicrobial resislance. RicbaIdKrause.tlrmdre-directoroftlanSl‘htioclallnsfimteothflergysodlufiecoousDimmers, warned in 1931(ref. 2.4} tl’ert microbial diversityand evolutionary vigour were slill dynamic forces thrul-ening mankind. As Krause was completing his book TheRestless Tide“, AIDS—one ofhistory’s most devaslatingpandemics — was already insidiously emerging. TheemergenceofiUDS ledto renewed appreciation oflheinevitability and consequeneesofthe emergence of infiec—tious diseaseifi’ai. In tllepast 2.5 years, some oftl’re FactmsIliatresulled in AIDS havealsolod hire-mgenoesocfhistoricallyimportautdise-ases suchascbdera.d.iphtheria.trench Fever and plague. Many re-emergences have beencatalysed by wars. loss ofsocial cohesion. and naturaldisasters such as eardrqualces and floods. indicating theimpocrlaneenolonlyofmicrobialandviraliacmrsbutalsoofsocialandenvironmenlaldelerminan‘lsb’“. mmlvmmlsmmlmmmmm ml Iii-Immanuel“: