Comings and Goings in the Infectious Diseases World

Abstract

Dr Tolan has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.About 30 years ago, as I was pondering subjects for my Master’s thesis, 2 brand new diseases reached the top of the list: toxic shock syndrome and human immunodeficiency virus (HIV) infection/acquired immune deficiency syndrome. Both had burst onto the scene recently and remained somewhat mysterious. One of the novel and fascinating things about infectious diseases, as exemplified by my choices, is the continued emergence of new diseases. In 1992, the Institute of Medicine issued its landmark report, “Emerging Infections: Microbial Threats to Health in the United States.”1 This report focused attention on the recognized, but underappreciated, threat of newly emerging, newly recognized, and re-emerging infectious diseases to our national health. The intervening 20 years have brought both more new infections, and more methods and tools to address the challenges of emerging infectious diseases (EID).2As diagnostic tools evolve, our ability to identify new infectious agents and new diseases improves. A partial list of EID from the past decades includes bacterial infections such as legionellosis, toxic shock syndrome, Lyme disease, Helicobacter pylori, Clostridium difficile-associated diarrhea, and, most recently, Borrelia miyamotoi3,4; parasitic infections, including Plasmodium knowlesi; and viral infections, exemplified by HIV but also including bovine spongiform encephalopathy, severe acute respiratory syndrome (SARS) coronavirus, 2009 pandemic H1N1 influenza, Ebola and other hemorrhagic fever viruses, and West Nile virus in the Western Hemisphere. On the flip side, only 2 diseases have ever been eradicated from the world5: smallpox in 1980 and rinderpest (an epizootic disease and likely precursor to measles in humans6) in 2011. Dracunculiasis (Guinea worm disease) has been targeted for eradication.7 Similarly, eradication of poliomyelitis is tantalizingly close to being achieved. Efforts to eradicate other infections, such as measles, lymphatic filariasis, and onchocerciasis (river blindness), have been less successful but remain on the global health agenda.5Considering the coming and going of infectious diseases, some key points arise. New diagnostic techniques allow identification of emerging pathogens. Support for the research that underlies development of these methods is vitally important. Infectious agents develop novel antibiotic resistance mechanisms, underscoring the importance of antimicrobial stewardship and the identification of new antimicrobials. The public health infrastructure requires strengthening and ongoing support, as the rapid recognition of EID begins with careful epidemiology. Global support for eradication of infectious diseases must be encouraged. Finally, we must ensure vaccination of all humans against measles, so that the opportunity to eradicate yet another viral scourge from the world does not slip from our grasp.