519367 research-article2013
APHXXX10.1177/1010539513519367Asia-Pacific Journal of Public HealthBinns and Low
Editorial
Infections and Public Health: Who Will Win?
Asia-Pacific Journal of Public Health 2014, Vol. 26(1) 4–6 © 2013 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539513519367 aph.sagepub.com
Colin Binns, MBBS, PhD1 and Wah-Yun Low, PhD2
Epidemiology and public health were born out of the need to control infectious disease. Infections remain a major threat to the health of nations and while chronic disease is now responsible for more deaths, infections have the possibility to reemerge as the major killer at any time. The story of the human race is that of the continuing fight between humans and the microbes that cause morbidity and mortality. In documenting the distribution and spread of cholera in London in the 19th century, John Snow made a significant step forward in infectious disease epidemiology.1 In the 20th century, the campaign against smallpox brought further major advances in epidemiology.2 The randomized controlled trial, now fundamental to all modern drug trials, was first used in the trial of streptomycin in the treatment of tuberculosis by a team led by Sir Austin Bradford-Hill.3,4 In the 21st century, we are facing an epidemic of chronic disease and epidemiology, and public health has adapted to the new paradigm. But at the same time the microbes persist and in some cases, have emerged stronger and resistant to all medications. We face the possibility of newly emerging pandemics, perhaps even assisted by our efforts in the laboratory to explore the fundamental nature of viruses.5 The study and practice of infectious disease must remain a core component of public health. This issue of the journal brings together a number of articles that relate to infectious disease in the Asia-Pacific Region. In the fight against infectious disease, 2014 is the year of decision for the World Health Assembly and indeed for the world. In May of this year the World Health Assembly must decide if the last remaining stocks of the smallpox virus, kept in Russia and the United States, will be destroyed. There are approximately 600 isolates of the variola virus stored in these 2 countries, including some strains that were selected for increased virulence for use in biological warfare.6 Why do they still exist? The reasons given for retaining the virus usually relate to basic research and the need to have stock of the virus available for vaccine development in case further samples of the virus come to light and are released. Now that the full genomic structure of the virus is available, the rationale for keeping the virus seems to have lessened. Many virologists believe the virus should be kept for research, but from a public health perspective, it would seem most appropriate to destroy the virus stocks to remove any possibility of its accidental release or its use in bioterrorism.7 The Asia-Pacific Journal of Public Health advocates the final destruction of stocks of the virus in order to finally rid the world of the threat of any recurrence of smallpox. The mortality of smallpox cases was very high for an infectious disease at 20% to 30% and those who survived were scarred for life, with their marked distorted faces a constant reminder of the disease. In my (CB) early days of medical practice I saw a number of patients who were 1Curtin
University, Perth, Western Australia, Australia of Malaya, Kuala Lumpur, Malaysia
2University
Corresponding Author: Wah-Yun Low, PhD, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Email: [email protected]
Downloaded from aph.sagepub.com at Univ of Connecticut / Health Center / Library on April 12, 2015
5
Binns and Low
survivors of smallpox with their faces and bodies covered with pockmarks. Fortunately, that is now a rare sight. The last case of smallpox reported was from Somalia on October 26, 1977, after which the World Health Organization officially declared smallpox to be eradicated in 1980. It is estimated that 300 to 500 million people died of smallpox in the 20th century alone. During the whole of the 20th century, there were about 1.7 billion deaths due to infections, accounting for 30% of the total number of worldwide deaths.8 For comparison, there were 100 million deaths due to tobacco, although this number is expected to rise markedly in the present century. In 2010, out of an estimated 52 million deaths worldwide, 25% were from infections, a slight reduction from the 30% rate of the 20th century but still a high proportion.9 Fauci and Morens,10 in discussing the epidemiology of infectious disease, have listed the characteristics that make epidemics a continuing challenge to public health. Outbreaks of infectious disease have the potential for unpredictable and explosive global impact and sometimes result in a carrier state that can reignite the epidemic at any time. There is a close relationship between human behavior and the spread of epidemics. In recent years the spread of viruses from their animal hosts to humans has been the cause of severe epidemics. Many bacteria and viruses have an evolutionary advantage over their human hosts because they can be highly adaptable and develop defenses and new antigenic properties. But at the same time, infectious diseases are potentially preventable and can occasionally be eradicated. It is all these aspects of infectious disease epidemiology that are important in the curriculum for public health education. In recognition of their continuing importance, the World Health Statistics 2013 has a special emphasis on infectious diseases and provides more challenging statistics.11 An estimated 2 billion of the world’s population are infected by helminthes—it is indeed a wormy world.12 During 2012, the World Health Organization reported 232 857 new cases of leprosy and 8.6 million new cases of tuberculosis registered annually worldwide, despite improvements in treatment and living conditions. Against this background of the continuing threat of infections, this issue of the journal includes a major review of leptospirosis, a historical perspective on a plague outbreak in Hawaii, and articles on tuberculosis and polio. The next issue of the journal will bring more articles on this theme as we will include further articles on sexually transmitted diseases. It is impossible to answer the question we posed at the commencement of the article—Who will win?—but we have learned that the world of microbes is constantly changing and so we as public health professionals must always be on the alert and we hope that this journal will continue to play a part in communicating information to combat existing and potential epidemics. References 1. Paneth N. Assessing the contributions of John Snow to epidemiology: 150 years after removal of the Broad Street pump handle. Epidemiology. 2004;15:514-516. 2. Henderson DA. Surveillance of smallpox. Int J Epidemiol. 1976;5:19-28. 3. Doll R, Peto R, Clarke M. First publication of an individually randomized trial. Control Clin Trials. 1999;20:367-368. 4. Medical Research Council Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment of pulmonary tuberculosis. Br Med J. 1948;2(4582):769-782. 5. Fouchier R, Osterhaus AB, Steinbruner J, et al. Preventing pandemics: the fight over flu. Nature. 2012;481:257-259. 6. Weinstein RS. Should remaining stockpiles of smallpox virus (variola) be destroyed? Emerg Infect Dis. 2011;17:681-683. 7. Srinivasan T, Dedeepiya VD, John S, et al. Smallpox still haunts scientists: results of a questionnaire-based inquiry on the views of health care and life science experts and students on preserving the remaining variola virus stocks. ScientificWorldJournal. 2013;2013:672813. 8. McCandless D. Wellcome Collection exhibition “Death—A Self-Portrait”. http://www.wellcomecol lection.org/whats-on/exhibitions/death-a-self-portrait.aspx. Accessed 27 November, 2013.
Downloaded from aph.sagepub.com at Univ of Connecticut / Health Center / Library on April 12, 2015
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Asia-Pacific Journal of Public Health 26(1)
9. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-2128. 10. Fauci AS, Morens DM. The perpetual challenge of infectious diseases. N Eng J Med. 2012;366:454461. 11. World Health Organization. World Health Statistics 2013. Geneva, Switzerland: World Health Organization; 2013. 12. Colley DG, LoVerde PT, Savioli L. Infectious disease. Medical helminthology in the 21st century. Science. 2001;293:1437-1438.
Downloaded from aph.sagepub.com at Univ of Connecticut / Health Center / Library on April 12, 2015
APHXXX10.1177/1010539513519367Asia-Pacific Journal of Public HealthBinns and Low
Editorial
Infections and Public Health: Who Will Win?
Asia-Pacific Journal of Public Health 2014, Vol. 26(1) 4–6 © 2013 APJPH Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1010539513519367 aph.sagepub.com
Colin Binns, MBBS, PhD1 and Wah-Yun Low, PhD2
Epidemiology and public health were born out of the need to control infectious disease. Infections remain a major threat to the health of nations and while chronic disease is now responsible for more deaths, infections have the possibility to reemerge as the major killer at any time. The story of the human race is that of the continuing fight between humans and the microbes that cause morbidity and mortality. In documenting the distribution and spread of cholera in London in the 19th century, John Snow made a significant step forward in infectious disease epidemiology.1 In the 20th century, the campaign against smallpox brought further major advances in epidemiology.2 The randomized controlled trial, now fundamental to all modern drug trials, was first used in the trial of streptomycin in the treatment of tuberculosis by a team led by Sir Austin Bradford-Hill.3,4 In the 21st century, we are facing an epidemic of chronic disease and epidemiology, and public health has adapted to the new paradigm. But at the same time the microbes persist and in some cases, have emerged stronger and resistant to all medications. We face the possibility of newly emerging pandemics, perhaps even assisted by our efforts in the laboratory to explore the fundamental nature of viruses.5 The study and practice of infectious disease must remain a core component of public health. This issue of the journal brings together a number of articles that relate to infectious disease in the Asia-Pacific Region. In the fight against infectious disease, 2014 is the year of decision for the World Health Assembly and indeed for the world. In May of this year the World Health Assembly must decide if the last remaining stocks of the smallpox virus, kept in Russia and the United States, will be destroyed. There are approximately 600 isolates of the variola virus stored in these 2 countries, including some strains that were selected for increased virulence for use in biological warfare.6 Why do they still exist? The reasons given for retaining the virus usually relate to basic research and the need to have stock of the virus available for vaccine development in case further samples of the virus come to light and are released. Now that the full genomic structure of the virus is available, the rationale for keeping the virus seems to have lessened. Many virologists believe the virus should be kept for research, but from a public health perspective, it would seem most appropriate to destroy the virus stocks to remove any possibility of its accidental release or its use in bioterrorism.7 The Asia-Pacific Journal of Public Health advocates the final destruction of stocks of the virus in order to finally rid the world of the threat of any recurrence of smallpox. The mortality of smallpox cases was very high for an infectious disease at 20% to 30% and those who survived were scarred for life, with their marked distorted faces a constant reminder of the disease. In my (CB) early days of medical practice I saw a number of patients who were 1Curtin
University, Perth, Western Australia, Australia of Malaya, Kuala Lumpur, Malaysia
2University
Corresponding Author: Wah-Yun Low, PhD, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. Email: [email protected]
Downloaded from aph.sagepub.com at Univ of Connecticut / Health Center / Library on April 12, 2015
5
Binns and Low
survivors of smallpox with their faces and bodies covered with pockmarks. Fortunately, that is now a rare sight. The last case of smallpox reported was from Somalia on October 26, 1977, after which the World Health Organization officially declared smallpox to be eradicated in 1980. It is estimated that 300 to 500 million people died of smallpox in the 20th century alone. During the whole of the 20th century, there were about 1.7 billion deaths due to infections, accounting for 30% of the total number of worldwide deaths.8 For comparison, there were 100 million deaths due to tobacco, although this number is expected to rise markedly in the present century. In 2010, out of an estimated 52 million deaths worldwide, 25% were from infections, a slight reduction from the 30% rate of the 20th century but still a high proportion.9 Fauci and Morens,10 in discussing the epidemiology of infectious disease, have listed the characteristics that make epidemics a continuing challenge to public health. Outbreaks of infectious disease have the potential for unpredictable and explosive global impact and sometimes result in a carrier state that can reignite the epidemic at any time. There is a close relationship between human behavior and the spread of epidemics. In recent years the spread of viruses from their animal hosts to humans has been the cause of severe epidemics. Many bacteria and viruses have an evolutionary advantage over their human hosts because they can be highly adaptable and develop defenses and new antigenic properties. But at the same time, infectious diseases are potentially preventable and can occasionally be eradicated. It is all these aspects of infectious disease epidemiology that are important in the curriculum for public health education. In recognition of their continuing importance, the World Health Statistics 2013 has a special emphasis on infectious diseases and provides more challenging statistics.11 An estimated 2 billion of the world’s population are infected by helminthes—it is indeed a wormy world.12 During 2012, the World Health Organization reported 232 857 new cases of leprosy and 8.6 million new cases of tuberculosis registered annually worldwide, despite improvements in treatment and living conditions. Against this background of the continuing threat of infections, this issue of the journal includes a major review of leptospirosis, a historical perspective on a plague outbreak in Hawaii, and articles on tuberculosis and polio. The next issue of the journal will bring more articles on this theme as we will include further articles on sexually transmitted diseases. It is impossible to answer the question we posed at the commencement of the article—Who will win?—but we have learned that the world of microbes is constantly changing and so we as public health professionals must always be on the alert and we hope that this journal will continue to play a part in communicating information to combat existing and potential epidemics. References 1. Paneth N. Assessing the contributions of John Snow to epidemiology: 150 years after removal of the Broad Street pump handle. Epidemiology. 2004;15:514-516. 2. Henderson DA. Surveillance of smallpox. Int J Epidemiol. 1976;5:19-28. 3. Doll R, Peto R, Clarke M. First publication of an individually randomized trial. Control Clin Trials. 1999;20:367-368. 4. Medical Research Council Streptomycin in Tuberculosis Trials Committee. Streptomycin treatment of pulmonary tuberculosis. Br Med J. 1948;2(4582):769-782. 5. Fouchier R, Osterhaus AB, Steinbruner J, et al. Preventing pandemics: the fight over flu. Nature. 2012;481:257-259. 6. Weinstein RS. Should remaining stockpiles of smallpox virus (variola) be destroyed? Emerg Infect Dis. 2011;17:681-683. 7. Srinivasan T, Dedeepiya VD, John S, et al. Smallpox still haunts scientists: results of a questionnaire-based inquiry on the views of health care and life science experts and students on preserving the remaining variola virus stocks. ScientificWorldJournal. 2013;2013:672813. 8. McCandless D. Wellcome Collection exhibition “Death—A Self-Portrait”. http://www.wellcomecol lection.org/whats-on/exhibitions/death-a-self-portrait.aspx. Accessed 27 November, 2013.
Downloaded from aph.sagepub.com at Univ of Connecticut / Health Center / Library on April 12, 2015
6
Asia-Pacific Journal of Public Health 26(1)
9. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095-2128. 10. Fauci AS, Morens DM. The perpetual challenge of infectious diseases. N Eng J Med. 2012;366:454461. 11. World Health Organization. World Health Statistics 2013. Geneva, Switzerland: World Health Organization; 2013. 12. Colley DG, LoVerde PT, Savioli L. Infectious disease. Medical helminthology in the 21st century. Science. 2001;293:1437-1438.
Downloaded from aph.sagepub.com at Univ of Connecticut / Health Center / Library on April 12, 2015
