Emerging parasitic zoonoses: leishmaniosis

Leishmanioses are a group of parasitic diseases that affect man and other mammals. They are caused by different species of trypanosomatids of the genus Leishmania Ross, 1903 and have tegumentary and/or visceral manifestations. The distribution of this re-emerging disease, which is found throughout the world (except in Antarctica), is influenced by various factors linked to both human activity and climatic change. The heteroecious life cycle of the Leishmania includes an invertebrate host (sandflies of the Phlebotomidae family). The dog is the main reservoir for many of the Leishmania species, simultaneously presenting both cutaneous and visceral clinical signs. The most frequent signs are skin abnormalities (dry exfoliative dermatitis, ulcers, periorbital alopecia and onychogryphosis), but ocular signs (keratoconjunctivitis and uveitis) and lymphadenomegaly are also common. Clinical diagnosis is difficult because of the great variety of symptoms and should, therefore, be confirmed by parasitological, serological and molecular methods. Several strategies are used to control the disease, including the treatment of infected animals. However, treatment failure is common and there is a risk that drug resistance will develop.     

Emerging zoonoses.

In the past few years, emergent disease episodes have increased; nearly all have involved zoonotic or species-jumping infectious agents. Because there is no way to predict when or where the next important new zoonotic pathogen will emerge or what its ultimate importance might be, investigation at the first sign of emergence of a new zoonotic disease is particularly important. Such investigation may be described in terms of a discovery-to-control continuum: from recognition of a new disease in a new setting to complex phases involving the hard science disciplines pertaining to discovery, the epidemiologic sciences pertaining to risk assessment, and activities pertaining to risk management. Today, many activities involving zoonotic disease control are at risk because of a failed investigative infrastructure or financial base. Because zoonotic diseases are distinct, their prevention and control will require unique strategies, based more on fundamental research than on traditional approaches. Such strategies require that we rebuild a cadre of career-committed professionals with a holistic appreciation of several medical and biologic sciences.     

Emerging zoonoses: crossing the species barrier

The ability of infectious disease agents to cross the species barrier has long been recognised for many zoonotic diseases. New viral zoonotic diseases, such as acquired immune deficiency syndrome (AIDS), caused by human immunodeficiency viruses 1 or 2, emerged in the 1980s and 1990s, and have become established in the human population. Influenza virus continues to find new ways to move from avian species into humans. The filoviruses and the newer paramyxoviruses, Hendra and Nipah, highlight the increasing proclivity of some animal viral agents to infect human populations with devastating results. A previously unknown transmissible spongiform encephalopathy, bovine spongiform encephalopathy, has emerged in cattle in Europe and spread to humans as well as other animal species. A novel toxicosis, caused by Pfiesteria spp. dinoflagellates, has become a secondary problem in some areas where large fish kills have occurred. The increasing proximity of human and animal populations has led to the emergence of, or increase in, bacterial zoonoses such as plague, leptospirosis and ehrlichiosis. The factors which influence the ability of each infectious agent to effectively across the species barrier and infect new cells and populations are poorly understood. However, for all of these diseases, the underlying theme is the growth of the human population, the mobility of that population, and the efforts expended to keep that population nourished.     

Emerging viral zoonoses: hantavirus infections

Hantaviruses are rodent-borne agents belonging to the Bunyaviridae family. These viruses, which are found throughout Europe, Asia and the Americas, are maintained by different species of rodents, in which they produce chronic, inapparent infections. Humans become infected through contact with urine, saliva or faeces from infected rodents, mainly via the aerosol route. In humans, clinical disease occurs in the form of two major syndromes: haemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). Haemorrhagic fever with renal syndrome mainly occurs in Europe and Asia and HPS has only ever been reported in the Americas. Person-to-person transmission of hantaviruses, although uncommon, was described during an outbreak of HPS in southern Argentina. Most epidemics of HFRS and HPS occur in areas with large populations of rodents that have a relatively high prevalence of infection.     

Emerging zoonoses and vector-borne infections affecting humans in Europe

The purpose of this study was to assess and describe the current spectrum of emerging zoonoses between 2000 and 2006 in European countries. A computerized search of the Medline database from January 1966 to August 2006 for all zoonotic agents in European countries was performed using specific criteria for emergence. Fifteen pathogens were identified as emerging in Europe from 2000 to August 2006: Rickettsiae spp., Anaplasma phagocytophilum, Borrelia burgdorferi, Bartonella spp., Francisella tularensis, Crimean Congo Haemorrhagic Fever Virus, Hantavirus, Toscana virus, Tick-borne encephalitis virus group, West Nile virus, Sindbis virus, Highly Pathogenic Avian influenza, variant Creutzfeldt-Jakob disease, Trichinella spp., and Echinococus multilocularis. Main risk factors included climatic variations, certain human activities as well as movements of animals, people or goods. Multi-disciplinary preventive strategies addressing these pathogens are of public health importance. Uniform harmonized case definitions should be introduced throughout Europe as true prevalence and incidence estimates are otherwise impossible.     

Emerging zoonoses and pathogens of public health significance--an overview

Emerging zoonotic diseases have assumed increasing importance in public and animal health, as the last few years have seen a steady stream of new diseases, each emerging from an unsuspected quarter and causing severe problems for animals and humans. The reasons for disease emergence are multiple, but there are two main factors--expansion of the human population and globalisation of trade. Current issues such as the increasing movement of a variety of animal species, ecological disruption, uncultivatable organisms, and terrorism, all imply that emerging zoonotic diseases will in all probability, not only continue to occur, but will increase in the rate of their emergence. The recurring nature of the crises dictates that closer integration of veterinary and medical communities is warranted, along with improved education of the general public and policy makers.     

Emerging diseases, zoonoses and vaccines to control them

Vaccination, when available, is undoubtedly the most cost-effective means of preventing and controlling, and even eradicating, infectious diseases. In recent years vaccination has also been used for other purposes in animal health, production and welfare, e.g. immunocastration.Vaccination of animals serves many different purposes, such as controlling animal infections and infestations, thus improving animal health and welfare; controlling anthropozoonoses and food poisoning in humans, thereby protecting public health; solving problems associated with antibiotic and anthelmintic resistance; helping to leave food-producing animals free of chemical residues; protecting the environment and biodiversity and ensuring animal farming sustainability. The problem is nevertheless more complex when facing emerging or re-emerging infections particularly zoonotic ones.     

Integrated health promotion strategies: a contribution to tackling current and future health challenges

This paper was presented as a technical background paper at the WHO sixth Global Conference on Health Promotion in Bangkok Thailand, August 2005. It describes what we know about the effectiveness of four of the Ottawa Charter health promotion strategies from eight reviews that have been conducted since 1999. The six lessons are that (i) the investment in building healthy public policy is a key strategy; (ii) supportive environments need to be created at the individual, social and structural levels; (iii) the effectiveness of strengthening community action is unclear and more research and evidence is required; (iv) personal skills development must be combined with other strategies to be effective; (v) interventions employing multiple strategies and actions at multiple levels are most effective; (vi) certain actions are central to effectiveness, such as intersectoral action and interorganizational partnerships at all levels, community engagement and participation in planning and decision-making, creating healthy settings (particularly focusing on schools, communities, workplaces and municipalities), political commitment, funding and infrastructure and awareness of the socio-environmental context. In addition, four case studies at the international, national, regional and local levels are described as illustrations of combinations of the key points described earlier. The paper concludes that the four Ottawa Charter strategies have been effective in addressing many of the issues faced in the late 20th century and that these strategies have relevance for the 21st century if they are integrated with one another and with the other actions described in this paper.     

Emerging challenges for European general practice

This paper, based upon a plenary talk delivered at the 1995 WONCA World meeting in Hong Kong, speculates upon the evolving role of general practice within Europe, focusing on family medicine in the UK. Recent pressures for change have identified numerous challenges to family doctors and have resulted in an expanding and exciting potential for the future provision of primary care services. The relevance to a multinational readership is that elements of the UK experience are being replicated throughout Europe and the consequences for general practice are enormous.     

Smoking: tackling the silent epidemic

Currently, approximately 25% of the UK population smokes and the percentage of those quitting has slowed to about 0.4% per year. Legislation against smoking in workplaces and public places came into force in England on 1 July 2007, bringing England into line with the rest of the UK. This legislation may give more smokers an incentive to quit, and health professionals are well placed to advise and support them. Smokers' chances of success are low if they attempt to quit unaided, but doubled if they use a treatment product. The use of nicotine replacement therapy, bupropion and varenicline is explained. NHS Stop Smoking services are available to support smokers through the difficulties of withdrawal symptoms, and training for this work is available. Health professionals should take every opportunity to raise the topic of quitting, especially with pregnant women and with parents whose smoking is harmful to their children's health.     

Viral zoonoses

In different areas of the World, whether in industrialized or developing countries, zoonoses represent an emerging Public Health concern either as known agents appear in areas or species in which they had not been reported or as new pathogens parasite Human as consequence of successful host switching. Epidemiological data outlined that vectorborne viral zoonoses are of particular relevance. This paper review the changes in epidemiology of bat rabies and arbovirus encephalitis.     

新发传染病流行特点及应对策略

  目的  了解拉萨市不同受教育程度人群传染病相关知识认知、行为习惯和技能掌握情况,为制定传染病相关的健康教育提供参考。  方法  2013年12月,采用多阶段整群系统抽样方法在西藏拉萨市城关区抽取1 415名≥18岁居民为研究对象,使用统一编制的调查问卷进行面对面询问式调查。  结果  拉萨市居民教育程度相对较低,其中文盲/半文盲、小学学历者分别占52.1 %与25.2 %。居民传染病知识知晓率随教育程度升高呈现增加趋势（P < 0.05）,其中“乙肝传播途径”“艾滋病传播途径”“发热判断标准”“甲肝传播途径”等知晓率较低,分别为4.6 %、9.9 %、10.1 %、18.1 %。相关行为中除“出现流感样症状减少与同事同学接触”“出现流感样症状减少与家人接触”“加工食品生熟分开”“就餐注意餐馆卫生”等4个条目外,居民行为报告率呈现随教育程度提高而增长的趋势（P < 0.05）,“被猫抓（咬）伤后接种疫苗”“过去一周锻炼身体≥3天”“出行关注目的地疫情信息”等行为报告率较低,分别为27.8 %、28.8 %、32.2 %。  结论  拉萨市居民传染病相关知识知晓率、行为形成率均较低,尤其是教育程度低下者,因此应加大对当地居民相关知识的宣传与培训活动,从而提高居民防范传染病的能力。     

Benchmarking progress in tackling the challenges of intellectual property, and access to medicines in developing countries

The impact of intellectual property protection in the pharmaceutical sector on developing countries has been a central issue in the fierce debate during the past 10 years in a number of international fora, particularly the World Trade Organization (WTO) and WHO. The debate centres on whether the intellectual property system is: (1) providing sufficient incentives for research and development into medicines for diseases that disproportionately affect developing countries; and (2) restricting access to existing medicines for these countries. The Doha Declaration was adopted at WTO in 2001 and the Commission on Intellectual Property, Innovation and Public Health was established at WHO in 2004, but their respective contributions to tackling intellectual property-related challenges are disputed. Objective parameters are needed to measure whether a particular series of actions, events, decisions or processes contribute to progress in this area. This article proposes six possible benchmarks for intellectual property-related challenges with regard to the development of medicines and ensuring access to medicines in developing countries.     

Hedgehog zoonoses

Exotic pets, including hedgehogs, have become popular in recent years among pet owners, especially in North America. Such animals can carry and introduce zoonotic agents, a fact well illustrated by the recent outbreak of monkeypox in pet prairie dogs. We reviewed known and potential zoonotic diseases that could be carried and transmitted by pet hedgehogs or by wild-caught hedgehogs that have been rescued.