Qualitative assessment of risk for monkeypox associated with domestic trade in certain animal species, United States

A Snapshot of the Global Trade of South African Native Vertebrate Species Not Listed on CITES

The Convention on International Trade in Endangered Species of Wild Fauna and Flora (CITES) aims to prevent the overexploitation of species by controlling their trade. However, there is currently no international regulatory framework to protect the trade of non-CITES species. We examined the LEMIS database, online trade, and scientific literature with the aim of identifying and compiling a list of South African native species traded as pets and wildlife products. We found that there are 223 non-CITES species traded as wildlife products and 95 species traded as pets. Mammals and birds were the most traded taxa for wildlife products, while reptiles and amphibians were mostly traded as pets. At the least, species traded as wildlife products and pets are currently not facing extinction, as most are categorized as Least Concern. However, some endemic species have an unknown population size, with Sclerophrys pantherina and Neamblysomus gunningi being Endangered. The international pet trade involves 10 countries, with the USA, the Czech Republic, and the UK being the largest importers. The trade of species as wildlife products involves 20 countries, with the USA being the major importer. This study emphasizes the necessity of strict regulations and international cooperation to control the wildlife trade effectively.

Monkeypox: Past, Present, and Future

Monkeypox (Mpox) is a zoonotic disease caused by a virus (monkeypox virus-MPV) belonging to the Poxviridae family. In humans, the disease has an incubation period of 5-21 days and then progresses in two phases, the prodromal phase and the rash phase. The prodromal phase is characterized by non-specific symptoms such as fever, muscle pain, malaise, lymphadenopathy, headache, and chills. Skin lesions appear in the rash phase of the disease. These lesions progress through different stages (macules, papules, vesicles, and pustules). In May 2022, WHO reported an outbreak of human Mpox in several countries which were previously Mpox-free. As per the CDC report of March 01, 2023, a total of 86,231 confirmed cases of Mpox and 105 deaths have been reported from 110 countries and territories across the globe. Notably, more than 90% of these countries were reporting Mpox for the first time. The phylogenetic analysis revealed that this outbreak was associated with the virus from the West African clade. However, most of the cases in this outbreak had no evidence of travel histories to MPV-endemic countries in Central or West Africa. This outbreak was primarily driven by the transmission of the virus via intimate contact in men who have sex with men (MSM). The changing epidemiology of Mpox raised concerns about the increasing spread of the disease in non-endemic countries and the urgent need to control and prevent it. In this chapter, we present all the documented cases of Mpox from 1970 to 2023 and discuss the past, present, and future of MPV.

The 2022 monkeypox outbreak 1 year on: The 5 Ws

In May 2022, World Health Organization (WHO) reported an outbreak of Mpox in several European countries which were previously Mpox free. Mpox (formerly known as monkeypox) is a zoonotic viral disease endemic in Central and West Africa. The sudden emergence of Mpox outside Africa and its subsequent rapid spread lead the WHO to declare the outbreak as Public Health Emergency of International Concern. By 15 May 2023, a total of 87,704 confirmed cases and 140 deaths had been reported from 111 countries and territories worldwide. Looking back on this outbreak 1 year later, several important questions have arisen. Here, we address these questions using the classic 5 Ws: What, When, Where, Who and Why? We discuss these questions to understand how this outbreak emerged and how it was effectively managed. We outline what needs to be done to prevent, or at least minimise, outbreaks due to emerging and re-emerging viral infections.

Zoonotic Pathogens Associated with Pet and Feeder Murid Rodent Species: A Global Systematic Review

Background: Pet and feeder rodents are one of the main sources of emerging infectious diseases. These rodents are purchased from pet shops, breeders, and online. Consequently, some of these rodents may subtly transmit diseases as they may be asymptomatic to certain pathogens. Materials and Methods: We systematically searched four academic databases viz. Google Scholar, PubMed, Web of Science, and Scopus to determine zoonotic pathogens associated with pet and feeder rodents globally. Our searches were performed in R statistical software using the packages "metagear" and "revtool". Results: We found 62 studies reporting on zoonotic pathogens between 1973 and 2022 from 16 countries representing 4 continents, namely Africa, Europe, Asia, and North America. The review identified 30 zoonotic pathogens isolated from pet and feeder rodents, including the African pygmy mouse (Mus minutoides), brown rat (Rattus norvegicus), and the house mouse (Mus musculus). The greatest number of pathogens was reported from the United States, followed by Togo and the United Kingdom. Bacterial pathogens were the most prevalent. However, the Seoul virus and rat bite fever (Streptobacillus moniliformis) were the most studied pathogens, found in more than one country, with reported outbreak cases. Most of the zoonotic pathogens were isolated from rodents acquired from pet shops. Conclusions: We recommend that pet and feeder rodents purchased from pet shops should be regularly screened for potential zoonotic pathogens as some of these animals may not show clinical signs of the illness. There is also a critical need to develop strict regulations and policies, especially in underdeveloped and developing regions for an effective surveillance process, which will include early detection, rapid response, and control of zoonotic diseases globally.

Epidemiology, host range, and associated risk factors of monkeypox: an emerging global public health threat

Based on recent multiregional epidemiological investigations of Monkeypox (MPX), on 24 July 2022, the World Health Organization declared it a global public health threat. Retrospectively MPX was an ignored zoonotic endemic infection to tropical rainforest regions of Western and Central African rural communities until a worldwide epidemic in May 2022 verified the potential threat of monkeypox virus (MPXV) to be propagated across the contemporary world via transnational tourism and animal movements. During 2018-2022, different cases of MPX diagnosed in Nigerian travelers have been documented in Israel, the United Kingdom, Singapore, and the United States. More recently, on 27 September 2022, 66,000 MPX cases have been confirmed in more than 100 non-endemic countries, with fluctuating epidemiological footprinting from retrospective epidemics. Particular disease-associated risk factors fluctuate among different epidemics. The unpredicted appearance of MPX in non-endemic regions suggests some invisible transmission dynamic. Hence, broad-minded and vigilant epidemiological attention to the current MPX epidemic is mandatory. Therefore, this review was compiled to highlight the epidemiological dynamic, global host ranges, and associated risk factors of MPX, concentrating on its epidemic potential and global public health threat.

Geographic Structuring and Divergence Time Frame of Monkeypox Virus in the Endemic Region

BACKGROUND

Monkeypox is an emerging zoonosis endemic to Central and West Africa. Monkeypox virus (MPXV) is genetically structured in 2 major clades (clades 1 and 2/3), but its evolution is poorly explored.

METHODS

We retrieved MPXV genomes from public repositories and we analyzed geographic patterns using STRUCTURE. Molecular dating was performed using a using a Bayesian approach.

RESULTS

We show that the population transmitted in West Africa (clades 2/3) experienced limited drift. Conversely, clade 1 (transmitted in the Congo Basin) possibly underwent a bottleneck or founder effect. Depending on the model used, we estimated that the 2 clades separated ∼560-860 (highest posterior density: 450-960) years ago, a period characterized by expansions and contractions of rainforest areas, possibly creating the ecological conditions for the MPXV reservoir(s) to migrate. In the Congo Basin, MPXV diversity is characterized by 4 subpopulations that show no geographic structuring. Conversely, clades 2/3 are spatially structured with 2 populations located West and East of the Dahomey Gap.

CONCLUSIONS

The distinct histories of the 2 clades may derive from differences in MPXV ecology in West and Central Africa.

Monkeypox virus: past and present

BACKGROUND

The objective of this paper is to analyze the current status of monkeypox worldwide. In the face of this public health threat, our purpose is to elucidate the clinical characteristics and epidemiology of monkeypox, the developmental progress of monkeypox-related drugs and the vaccines available.

DATA SOURCES

The literature review was performed in databases including PubMed, Science Direct and Google Scholar up to July 2022.

RESULTS

Since May 2022, the World Health Organization has reported more than 45,000 confirmed cases from 92 nonendemic countries, including nine deaths. Although some women and children have been infected so far, most cases have occurred among men who have sex with other men, especially those with multiple sexual partners or anonymous sex.

CONCLUSIONS

Pediatric monkeypox infection has been associated with a higher likelihood of severe illness and mortality than in adults. Severe monkeypox illness in pediatrics often requires adjunctive antiviral therapy. It is crucial for all countries to establish sound monitoring and testing systems and be prepared with emergency preparedness.

Monkeypox Virus Infections in Humans

Human monkeypox is a viral zoonosis endemic to West and Central Africa that has recently generated increased interest and concern on a global scale as an emerging infectious disease threat in the midst of the slowly relenting COVID-2019 disease pandemic. The hallmark of infection is the development of a flu-like prodrome followed by the appearance of a smallpox-like exanthem. Precipitous person-to-person transmission of the virus among residents of 100 countries where it is nonendemic has motivated the immediate and widespread implementation of public health countermeasures. In this review, we discuss the origins and virology of monkeypox virus, its link with smallpox eradication, its record of causing outbreaks of human disease in regions where it is endemic in wildlife, its association with outbreaks in areas where it is nonendemic, the clinical manifestations of disease, laboratory diagnostic methods, case management, public health interventions, and future directions.

Comprehensive literature review of monkeypox

The current outbreak of monkeypox (MPX) infection has emerged as a global matter of concern in the last few months. MPX is a zoonosis caused by the MPX virus (MPXV), which is one of the Orthopoxvirus species. Thus, it is similar to smallpox caused by the variola virus, and smallpox vaccines and drugs have been shown to be protective against MPX. Although MPX is not a new disease and is rarely fatal, the current multi-country MPX outbreak is unusual because it is occurring in countries that are not endemic for MPXV. In this work, we reviewed the extensive literature available on MPXV to summarize the available data on the major biological, clinical and epidemiological aspects of the virus and the important scientific findings. This review may be helpful in raising awareness of MPXV transmission, symptoms and signs, prevention and protective measures. It may also be of interest as a basis for performance of studies to further understand MPXV, with the goal of combating the current outbreak and boosting healthcare services and hygiene practices.Trial registration: ClinicalTrials.gov identifier: NCT02977715..Trial registration: ClinicalTrials.gov identifier: NCT03745131..Trial registration: ClinicalTrials.gov identifier: NCT00728689..Trial registration: ClinicalTrials.gov identifier: NCT02080767..

Global research profile on monkeypox-related literature (1962-2022): A bibliometric analysis

The recent monkeypox or mpox outbreak has been a global concern. The present study evaluated the global research outputs, research trends, and topics of published research on monkeypox using a bibliometric approach. The Scopus database was searched for terms associated with "monkeypox" or "monkey pox" up until 19 November 2022. Maps and bibliometric indicators of the retrieved documents were shown and analyzed. A total of 1,422 documents were obtained from Scopus. Other than monkeypox, the most commonly used terms included epidemic, disease outbreaks, smallpox vaccine, and orthopoxvirus. In total, 90.3% of the documents were published between 2002 and 2022. The United States, the United Kingdom, and India were the top three countries in terms of productivity. Most of the institutions were from the United States. The International Journal of Surgery, the Journal of Medical Virology, and the Travel Medicine and Infectious Disease are some of the top journals currently publishing research on monkeypox. Tecovirimat, coronavirus disease 2019 (COVID-19), homosexuality, and pandemic are emerging topics related to monkeypox.

Reemergence of monkeypox: prevention and management

INTRODUCTION

The reemergence of monkeypox virus in the twenty-first century, calls for an urgency in its control and preventive measures. There is a long-standing concern that the reemergence of monkeypox across countries could lead to another epidemic like the COVID-19 pandemic. Understanding the disease ecology, preventing its transmission could help curbing its spread. The established treatment protocols along with development of new antiviral agents and vaccines could play a pivotal role in controlling its transmission.

AREAS COVERED

In this review, we summarize the different modes of transmission of this disease, the associated symptoms, the standard protocol of treatment, the available vaccines and use of alternative treatments. We have collated recent research on novel entities that could potentially treat monkeypox infection.

EXPERT OPINION

The One Health approach fostered by the World Health Organization (WHO) for emergent and reemerging zoonotic diseases has to be implemented with a view to curb their transmission. The growing global population and increased inter-country travel has led to rapid spread of transmissible pathogens. Stigmatization, associated with lack of knowledge can be prevented by enhancing awareness campaigns. Vaccines need to be administered to high-risk individuals, and drug discovery efforts need to be intensified to combat such diseases.

Monkeypox virus: The changing facets of a zoonotic pathogen

In the last five years, the prevalence of monkeypox has been increasing both in the regions considered endemic for the disease (West and Central Africa) and worldwide. Indeed, in July 2022, the World Health Organization declared the ongoing global outbreak of monkeypox a public health emergency of international concern. The disease is caused by monkeypox virus (MPXV), a member of the Orthopoxvirus genus, which also includes variola virus (the causative agent of smallpox) and vaccinia virus (used in the smallpox eradication campaign). Here, we review aspects of MPXV genetic diversity and epidemiology, with an emphasis on its genome structure, host range, and relationship with other orthopoxviruses. We also summarize the most recent findings deriving from the sequencing of outbreak MPXV genomes, and we discuss the apparent changing of MPXV evolutionary trajectory, which is characterized by the accumulation of point mutations rather than by gene gains/losses. Whereas the availability of a vaccine, the relatively mild presentation of the disease, and its relatively low transmissibility speak in favor of an efficient control of the global outbreak, the wide host range of MPXV raises concerns about the possible establishment of novel reservoirs. We also call for the deployment of field surveys and genomic surveillance programs to identify and control the MPXV reservoirs in West and Central Africa.

New Threat at Doorstep: What an Intensivist should Know

How to cite this article: Das AK, Sharma A, Kumar S, Goyal S, Kothari N. New Threat at Doorstep: What an Intensivist should Know. Indian J Crit Care Med 2022;26(10):1076-1077.

Monkeypox 2022 outbreak in non-endemic countries: Open questions relevant for public health, nonpharmacological intervention and literature review

Starting from mid-May 2022, cases of human monkeypox started to rise in several non-endemic countries. By mid-July, more than 17000 confirmed/suspect cases have been reported by at least 82 countries worldwide, with a regular incremental trend. In order to contain the disease diffusion, risk evaluation is crucial to undertake informed decisions and effective communication campaigns. However, since orthopoxvirus infections so far have attracted low attention, due to the eradication of smallpox 40 years ago, and to the confinement of human monkeypox almost exclusively to endemic areas, several unresolved issues concerning natural history, ecology and pathogenesis remain. To this respect, we identified some open questions and reviewed the relevant literature on monkeypoxvirus and/or related orthopoxviruses. The results will be discussed in the perspective of their relevance to public health decisions, particularly those related to non-pharmacological interventions.

Mammals, wildlife trade, and the next global pandemic

Most new infectious diseases emerge when pathogens transfer from animals to humans.^1,2 The suspected origin of the COVID pandemic in a wildlife wet market has resurfaced debates on the role of wildlife trade as a potential source of emerging zoonotic diseases.^3-5 Yet there are no studies quantitatively assessing zoonotic disease risk associated with wildlife trade. Combining data on mammal species hosting zoonotic viruses and mammals known to be in current and future wildlife trade,⁶ we found that one-quarter (26.5%) of the mammals in wildlife trade harbor 75% of known zoonotic viruses, a level much higher than domesticated and non-traded mammals. The traded mammals also harbor distinct compositions of zoonotic viruses and different host reservoirs from non-traded and domesticated mammals. Furthermore, we highlight that primates, ungulates, carnivores, and bats represent significant zoonotic disease risks as they host 132 (58%) of 226 known zoonotic viruses in present wildlife trade, whereas species of bats, rodents, and marsupials represent significant zoonotic disease risks in future wildlife trade. Thus, the risk of carrying zoonotic diseases is not equal for all mammal species in wildlife trade. Overall, our findings strengthen the evidence that wildlife trade and zoonotic disease risks are strongly associated, and that mitigation measures should prioritize species with the highest risk of carrying zoonotic viruses. Curbing the sales of wildlife products and developing principles that support the sustainable and healthy trade of wildlife could be cost-effective investments given the potential risk and consequences of zoonotic outbreaks.

COVID-19 in comparison with other emerging viral diseases: risk of geographic spread via travel

PURPOSE OF REVIEW

The COVID-19 pandemic poses a major global health threat. The rapid spread was facilitated by air travel although rigorous travel bans and lockdowns were able to slow down the spread. How does COVID-19 compare with other emerging viral diseases of the past two decades?

RECENT FINDINGS

Viral outbreaks differ in many ways, such as the individuals most at risk e.g. pregnant women for Zika and the elderly for COVID-19, their vectors of transmission, their fatality rate, and their transmissibility often measured as basic reproduction number. The risk of geographic spread via air travel differs significantly between emerging infectious diseases. COVID-19 is not associated with the highest case fatality rate compared with other emerging viral diseases such as SARS and Ebola, but the combination of a high reproduction number, superspreading events and a globally immunologically naïve population has led to the highest global number of deaths in the past 20 decade compared to any other pandemic.

Assessing the occurrence of the novel zoonotic variegated squirrel bornavirus 1 in captive squirrels in Germany -A prevalence study

The newly described zoonotic variegated squirrel bornavirus 1 (VSBV-1) in German squirrel holdings has been associated with the death of three private owners and one zoo animal caretaker (confirmed cases). Epidemiological investigations were severely impeded by the general lack of data on holdings of the putative reservoir hosts, the family Sciuridae. To fill this lack of data for detailed epidemiological investigations of the captive squirrel population, a register of private and zoological squirrel holdings was established. The findings show a broad variety of kept species and their frequency distribution. By contacting the different stakeholders via Web-based social groups and societies, information passed in both directions so that disease awareness could be raised and participants could be recruited for further studies. Cross-sectional studies revealed a prevalence of VSBV-1-positive subpopulations of 0% (95% CI 0%-6.2%) among private squirrel collections and 1.9% (95% CI: 0%-9.9%) among zoos in Germany. The approach presented here can be transferred to other populations of non-traditional pets, which may be equally difficult to monitor, in the case of an emerging zoonotic infectious disease.

Dealing in deadly pathogens: Taking stock of the legal trade in live wildlife and potential risks to human health

Zoonotic diseases cause millions of deaths every year. Diseases such as Ebola, severe acute respiratory syndrome (SARS), and avian influenza cause economic losses at the global level and jeopardize diplomatic relations between countries. As wildlife are the source of at least 70% of all emerging diseases and given the on-going concerns associated with wildlife trade as a disease transmission mechanism, we provide a 'global snapshot' of the legal trade in live wild animals and take stock of the potential health risks that it poses to global human health. Our analysis showed that 11,569,796 individual live wild animals, representing 1316 different species were exported from 189 different countries between 2012 and 2016. China was the largest exporter of live mammals (with 98,979 animals representing 58.7% of global trade). Nicaragua was the largest exporter of live amphibians (with 122,592 animals representing 53.8% of global trade). South Africa was the largest exporter of live birds (with 889,607 animals representing 39.2% of global trade). Peru was the largest exporter of live reptiles (with 1,675,490 animals representing 18.8% of global trade). Our analysis showed that mostly the USA and other high-income countries, the largest importers, drive the live animal trade. High-income countries and not the countries where wildlife diseases and pathogens are more likely to occur reported almost all of the disease reports to the World Organisation for Animal Health. Based on our findings, we discuss how maximising trade bans; working on human behaviour change and improving regulatory efforts to improve surveillance will decrease the risk of future pandemics, epidemics and outbreaks.

Emerging infectious diseases of wildlife: a critical perspective

We review the literature to distinguish reports of vertebrate wildlife disease emergence with sufficient evidence, enabling a robust assessment of emergence drivers. For potentially emerging agents that cannot be confirmed, sufficient data on prior absence (or a prior difference in disease dynamics) are frequently lacking. Improved surveillance, particularly for neglected host taxa, geographical regions and infectious agents, would enable more effective management should emergence occur. Exposure to domestic sources of infection and human-assisted exposure to wild sources were identified as the two main drivers of emergence across host taxa; the domestic source was primary for fish while the wild source was primary for other taxa. There was generally insufficient evidence for major roles of other hypothesized drivers of emergence.

Review of various approaches for assessing public health risks in regulatory decision making: choosing the right approach for the problem

Stakeholders in the public health risk analysis community can possess differing opinions about what is meant by "conduct a risk assessment." In reality, there is no one-size-fits-all risk assessment that can address all public health issues, problems, and regulatory needs. Although several international and national organizations (e.g., Codex Alimentarius Commission, Office International des Epizooties, Food and Agricultural Organization, World Health Organization, National Research Council, and European Food Safety Authority) have addressed this issue, confusion remains. The type and complexity of a risk assessment must reflect the risk management needs to appropriately inform a regulatory or nonregulatory decision, i.e., a risk assessment is ideally "fit for purpose" and directly applicable to risk management issues of concern. Frequently however, there is a lack of understanding by those not completely familiar with risk assessment regarding the specific utility of different approaches for assessing public health risks. This unfamiliarity can unduly hamper the acceptance of risk assessment results by risk managers and may reduce the usefulness of such results for guiding public health policies, practices, and operations. Differences in interpretation of risk assessment terminology further complicate effective communication among risk assessors, risk managers, and stakeholders. This article provides an overview of the types of risk assessments commonly conducted, with examples primarily from the food and agricultural sectors, and a discussion of the utility and limitations of these specific approaches for assessing public health risks. Clarification of the risk management issues and corresponding risk assessment design needs during the formative stages of the risk analysis process is a key step for ensuring that the most appropriate assessment of risk is developed and used to guide risk management decisions.

The global dimensions of public health preparedness and implications for US action

The globalization of public health is both real and relevant throughout the United States and to Americans traveling or residing abroad. US public policy responses are evolving, but a crisper and more comprehensive global perspective is needed. I suggest four timely US actions to address today's competing realities of globalization and economic austerity: raise awareness among clinicians and local health departments; capture and share exemplary disaster management practices across countries; ensure that US global health investments are effective, efficient, and sustainable; and think globally while acting locally to enhance US health security. The reauthorization of the Pandemic and All-Hazards Preparedness Act of 2006 provides an opportunity to more clearly address the global dimensions of domestic preparedness.

Zoonoses of rabbits and rodents

Millions of households in the US own rabbits or rodents, including hamsters, guinea pigs, and gerbils. Activities such as hunting and camping also involve human interactions with wild rabbits and rodents. In many environments, feral rabbits and rodents live in close proximity to humans, domesticated animals, and other wildlife. Education of rodent and rabbit owners and individuals with occupational or recreational exposures to these species is paramount to reduce the prevalence of zoonoses associated with rabbit and rodent exposure.

Cidofovir Activity against Poxvirus Infections

Cidofovir [(S)-1-(3-hydroxy-2-phosphonylmethoxypropyl)cytosine, HPMPC] is an acyclic nucleoside analog approved since 1996 for clinical use in the treatment of cytomegalovirus (CMV) retinitis in AIDS patients. Cidofovir (CDV) has broad-spectrum activity against DNA viruses, including herpes-, adeno-, polyoma-, papilloma- and poxviruses. Among poxviruses, cidofovir has shown in vitro activity against orthopox [vaccinia, variola (smallpox), cowpox, monkeypox, camelpox, ectromelia], molluscipox [molluscum contagiosum] and parapox [orf] viruses. The anti-poxvirus activity of cidofovir in vivo has been shown in different models of infection when the compound was administered either intraperitoneal, intranasal (aerosolized) or topically. In humans, cidofovir has been successfully used for the treatment of recalcitrant molluscum contagiosum virus and orf virus in immunocompromised patients. CDV remains a reference compound against poxviruses and holds potential for the therapy and short-term prophylaxis of not only orthopox- but also parapox- and molluscipoxvirus infections.

[Human monkeypox]

Unlike other recent viral emergences, which were in majority caused by RNA viruses, the monkeypox results from infection by a DNA virus, an orthopoxvirus closely related to both vaccine and smallpox viruses and whose two genomic variants are known. Unexpectedly isolated from captive Asiatic monkeys and first considered as an laboratory curiosity, this virus was recognised in 1970 as an human pathogen in tropical Africa. Here it was responsible for sporadic cases following intrusions (for hunting) into tropical rain forests or rare outbreak with human-to-human transmission as observed in 1996 in Democratic Republic of Congo. As monkeypox in humans is not distinguishable from smallpox (a disease globally eradicated in 1977) it was only subjected to vigilant epidemiological surveillance and not considered as a potential threat outside Africa. This point of view radically changed in 2003 when monkeypox was introduced in the USA by African wild rodents and spread to 11 different states of this country. Responsible for 82 infections in American children and adults, this outbreak led to realize the sanitary hazards resulting from international trade of exotic animals and scientific investigations increasing extensively our knowledge of this zoonosis.

[Global threats from emerging viral diseases]

L’histoire nous a appris que les émergences virales ne sont pas des phénomènes nouveaux. La variole, venue d’Asie, est probablement apparue en Europe dès le V^e siècle et la fièvre jaune a émergé en Amérique au XVI^e siècle, importée d’Afrique par la traite des Noirs. La dengue est apparue au XVIII^e siècle simultanément en Asie du Sud-est, en Afrique et en Amérique du Nord. Quant à la « grippe espagnole », elle a tué, en 1918–1919, entre 25 et 40 millions de personnes dans le monde. La deuxième moitié du XX^e siècle a été marquée par de nombreuses émergences virales dont celle du Sida en 1981. Mais, ce qui caractérise l’évolution récente des émergences virales, c’est que non seulement de nouveaux virus émergent de façon répétée, mais qu’ils ont de plus en plus tendance à envahir de nouveaux pays, voire d’autres continents, et de s’y installer de façon plus ou moins durable. Des exemples de cette situation épidémique nouvelle sont donnés avec les infections à virus Nipah, West Nile, de la fièvre de la Vallée du Rift, du SRAS, du monkeypox, de la grippe aviaire H5N1 et Chikungunya. Les causes, multiples et complexes, de ces émergences et réémergences sont brièvement analysées.

[Travelling epidemics]

OBJECTIVES

We have to become aware of the current development of international travels which has contributed to amplify circulation of all sorts of infectious agents. We will describe the current situation.

OBSERVATIONS

Infectious agents are carried by means of travellers, immigrants, as well as by animals, goods and merchandise. The distribution of infections potentially responsible for epidemics tends to become worldwide and some of them are emergent diseases.

SOLUTIONS

Such a situation imposes enhancement of international surveillance and development of resources for control and response to alerts. Developed countries possess most advanced equipments and interventional structures: they are those which may intervene predominantly in the fight against epidemics. The necessary contribution of these industrialized countries is increasing in developing countries in which infectious epidemics are spreading and such intervention must be sustained. The content of the article is a review of major threatening infectious epidemic diseases with the contribution of personal experiences.

[Global threats from emerging viral diseases]

Emerging viral diseases are nothing new. Smallpox probably reached Europe from Asia in the 5th century, and yellow fever emerged in the Americas during the 16th century as a consequence of the African slave trade. Dengue fever arose simultaneously in South-East Asia, Africa, and North America during the 18th century. In 1918-1919 the so-called Spanish flu spread like wildfire through all five continents, killing between 25 and 40 million people. The second half of the 20th century saw the emergence of HIV/AIDS (1981), among other viral diseases. Even more worrying is the fact that emerging and re-emerging viral diseases have had a tendency to spread more quickly and more widely during the last decade, invading whole countries and continents; witness the recent outbreaks of Nipah virus, West Nile, Rift Valley fever, SARS, monkeypox, avian flu (H5N1) and Chikungunya. The complex factors underlying these new trends are briefly discussed.