Portal de Periódicos da CAPES

Emerging infections—a coordinated European approach

2001; Elsevier BV; Volume: 7; Issue: 1 Linguagem: Inglês

10.1046/j.1469-0691.2001.00192.x

1469-0691

Robert A. Wise,

Influenza Virus Research Studies

There is a grim fascination in observing the appearance of new infectious diseases, many of which pose a significant risk to human health. In 1992 the US Institute of Medicine [1Lederberg J Shope RE Oaks SC Emerging infections Microbial threats to health in the United States. The National Academy of Sciences, Washington DC1992Google Scholar] was “confident that new diseases will emerge, although it is impossible to predict their individual emergence in time and place”. This prediction has most certainly come true and no doubt will continue to cause concern in the coming years. Can the governments of the European Union (EU) harmonize and improve their response to such threats? Recently we have seen the avian influenza H5NI in humans in China and Hong Kong [2Shortridge KF Zhou NN Guan Y et al.Characterisation of avian H5NI influenza viruses from poultry in Hong Kong.Virology. 1998; 252: 331-342Crossref PubMed Scopus (497) Google Scholar], which most certainly caused major global concerns. Nipah virus in Malaysia [3Chew MH Arguin PM Shay DK et al.Risk factors for Nipah virus infection among abbatoir workers in Singapore.J Infect Dis. 2000; 181: 1760-1763Crossref PubMed Scopus (84) Google Scholar], West Nile Fever in New York [4Anonymous Outbreak of West Nile-like viral encephalitis.Morbid Mortal Wkly Rep. 1999; 48: 845-849PubMed Google Scholar] and, recently, Lassa fever cases from Africa [5Communicable Disease Reports. WHO Outbreak News 2000; 13 January 2000, 3 March 2000, 4 April 2000, 25 July 2000.Google Scholar] all posed a threat primarily to civilians. With Western governments engaged in peace-keeping operations in many parts of the world, other threats are possible. For example, in Kosovo [6Anonymous Tulareamia.Kosovo Wkly Epidemiol Record. 2000; 75: 133-134PubMed Google Scholar], typhus, tularemia and Congo hemorrhagic fever are real threats to the military. Overall this must be added to the concerns of urban bio-terrorist attack [7Walker DH Chemical and biological terrorism. National Academy Press, Washington DC1999Google Scholar]. The reasons new diseases appear are intriguing but are most probably related to man's disturbance of an environment where viruses and bacteria have coexisted with animals, allowing an increase in the numbers of either the pathogen or its animal host [8Walker DH Global infectious diseases. Springer-Verlag, Vienna1992Crossref Google Scholar]. Deforestation has invited hemorrhagic fevers into the human population of South America; re-forestation has encouraged Lyme disease. Importing exotic birds (or altered migratory patterns) may be behind the New York West Nile fever, and man interfering with the previously sequestered world of some wild animals is associated with risk of Hanta virus, Marburg and Ebola infections. Yellow fever could be considered an older example with the virus living in monkeys in the tree canopy of West Africa and then spreading to the New World. Changing agricultural practices with increasing contact with mosquitoes, or allowing them to breed in urban areas, plays an important role in dengue, Japanese encephalitis and the LaCross and California group of encephalitis pathogens. Add to this warfare (the cause of epidemics down the centuries), global warming and tourism and there is ample reason for governments to be concerned. The role that the Center for Diseases Control and Prevention (CDC) in Atlanta has had in investigating and controlling emerging problems (together with teaching and research) cannot be underestimated. The ability to bring to a potential problem a wide breadth of talent is formidable and is the most obvious way to approach an unknown threat. But what response can the EU mount, or should we rely upon the US? The expanded EU will stretch from arctic tundra to Mediterranean shores and will have a population well in excess of that of the US; it will increasingly be involved in military ventures, hopefully of a peace-keeping nature. There is a need for a flexible and coordinated response to future infection threats. In the UK there is considerable expertise at the Centre for Applied Microbiology Research Salisbury and the Public Health Laboratory Service. There are centers of excellence around Europe, such as Pasteur Institutes, the Max Planck Institute and national centers of tropical medicine. The concept of a European Center for Infectious Diseases (ECID) was raised 2 years ago, to a very mixed response. The Lancet [9Editorial Not another European institution.Lancet. 1998; 352: 1237Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar] was antagonistic to another European institution and favored the current network possibly being developed into a “virtual” organization. The proponents who formed a steering group [10Stephenson J Creation of a European CDC, debated.JAMA. 1999; 281: 1477-1478Crossref PubMed Scopus (3) Google Scholar] felt very different. It is so easy to see both sides of the argument. Public health is such a political issue, one can understand that the government of one country might not take kindly to a multinational task force entering a Member State to take control of a possible emergency. On the other hand, is any one country totally equipped to diagnose and advise on an unknown threat? The answer must be no. There is a great danger that the matter may well degenerate into “Euro-bickering” with no meaningful progress. There must be considerable doubts if another large European agency modeled on CERN or the Space Agency is appropriate. A middle road seems appropriate, perhaps a modest central agency with firm links to a number of national centers committed and funded to offer diagnostic expertise and clinical advice (including a “fire-fighting” capacity) to member countries. Research could be organized on a less piecemeal basis, with field stations in a number of places in the less developed world being an important aspect of their work in order to monitor epidemiological changes. This would, of course, benefit both the EU and those less developed countries. Currently, the compromise suggested by the European Commission is an Epidemiological Surveillance Network and Charter Group [11Giesecke J Weinberg J A European centre for infectious disease?.Lancet. 1998; 352: 1308Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar]. I doubt whether these are robust enough to face a threat. For example, the recent problem with contaminated heroin in the UK and Ireland was solved in a modestly expeditious way by one country [12Boan D Clostridium novii revealed as heroin contaminant.Lancet. 2000; 355: 2230Abstract Full Text Full Text PDF Google Scholar] only after the assistance by the CDC. Equally, could any one European country mount the extensive and expensive exercise that the northeastern States in the US are currently undertaking against West Nile Fever [13Anonymous Update: West Nile fever activity in the northeastern US.MMR. 2000; 49: 714-717PubMed Google Scholar]? Better structures need to be in place in order to combat the varied and unknown threats.