EcoHealth 6, 1–2, 2009DOI: 10.1007/s10393-009-0253-x
Ó 2009 International Association for Ecology and Health
A Call for ‘‘Smart Surveillance’’: A Lesson Learned from H1N1
As we adjust to life within the H1N1 pandemic, we find
unimaginative in strategy and fractionated in operation.
ourselves asking the same questions posed about the global
Almost all the key international agencies targeted countries
economic crisis: ‘‘How did this happen?’’ ‘‘Where did this
such as Indonesia and Vietnam because that was where the
begin?’’ and most importantly, ‘‘Why didn’t we know this
virus ‘‘spilled over’’ from birds to people most often. They
would happen?’’ Since the emergence of H5N1 avian flu in
assumed that if the first chains of human-to-human
1997, the USA alone has spent billions of dollars on pan-
transmission were discovered, then perhaps the pandemic
could be thwarted. But H5N1 has already spread to Europe
strengthening Homeland Security, stockpiling the two most
and Africa, increasing the interface between bird and hu-
effective antivirals (Oseltamivir and Zanamivir), and
man dramatically over the past 5 years. Efforts to target
improving vaccine production capacity. The world seemed
surveillance to detect the introduction of these viruses into
to act, for once, with appropriate urgency: Funds from
the Americas were also based on some simple assumptions,
intergovernmental agencies were targeted to bolster sur-
and easily challenged by analyses that brought data on bird
veillance in regions where evidence of human-to-human
migration and trade together (Kilpatrick et al.,
transmission (the very origins of a new pandemic) were
But perhaps most important of all, our pandemic
strongest. So, we all watched eagerly as one, then another,
prevention strategy fails to take the broader view as it fo-
report discussed the possibility, probability, or impossibil-
cuses so intensely on the machinations of each strain, and
on the politics of surveillance, reporting, and trade regu-
Then, seemingly over the course of a weekend last May,
lation. Taking our mind off H5N1 for a minute, we can ask
we came face-to-face with the real foe—a new H1N1 virus
a simple question: ‘‘What are the key factors that drive the
with genes of bird, swine, and human origin, and an
emergence of new diseases?’’ For zoonotic diseases, it’s a
alarmingly high initial suspected mortality rate. Like so
combination of human changes to the environment, agri-
many of its ancestors, influenza A (H1N1) took us by
culture, and healthcare, and changes in demography, all
surprise. While the world’s attention (and billions of dol-
against a background of a large pool of potential new
lars) focused on the highly pathogenic H5N1 avian influ-
zoonoses—Morse’s ‘‘zoonotic pool’’ (Morse, Where
enza bubbling over in Indonesia and Vietnam, this virus
do these factors coincide, overlap, or clash? The answer: In
emerged and escaped any possibility of containment. What
places with recent and rapid demographic changes, where
livestock production has been recently intensified, and
The truth is, despite our best efforts, pandemic pre-
where wildlife is diverse. In short, our recent analyses show
paredness failed to fully address the global problem. It is
that parts of Mexico are as significant a hotspot for the next
hard to argue that the chosen target, H5N1, was the correct
new zoonosis as parts of Indonesia or West Africa. Indeed,
strategy. This was, and continues to be, a significant threat
the proposed origin of the latest H1N1 outbreak, La Gloria,
to global health should it become truly pandemic, with
lies squarely on one of the ‘‘hottest’’ pixels in our predictive
mortality estimates in the tens to hundreds of millions, and
map for future zoonotic disease emergence (Jones et al.,
an economic impact in the hundreds of billions of dollars.
That article called for a priority-setting approach to
However, efforts to step up surveillance for this virus were
global surveillance for pandemics that targets our limited
global resources to those regions most likely to foster the
of farming strategies and how they foster pathogen spill-
next new disease, and those activities most likely to pick it
over; one which takes on board people’s perceptions of risk,
of disease, and of the environment; one which truly fuses
This ‘‘Smart Surveillance’’ approach means focusing
Ecology and Health. The name of this new approach can be
not just on the backyard poultry operations of Indonesia
summed up in a word well known to you, the readers of the
and Vietnam, but also on livestock production facilities in
all of the ‘‘hotspots.’’ It means targeting wildlife species
known to harbor other zoonoses, and using new technol-ogies to measure the depth of the zoonotic pool, and dis-
cover new zoonoses before they jump the gap to people.
Most importantly, it means analyzing the pathways toemergence that viruses such as H1N1 travel along—a truefusion of the Social, Behavioral, Ecological, and Health
Sciences, and addressed for influenza in the current issue(Leibler et al., ). A global effort to address this big
Jones KE, Patel N, Levy M, Storeygard A, Balk D, Gittleman JL,
et al. (2008) Global trends in emerging infectious diseases.
vision would provide a dose of stimulus that, for a small
up-front cost, may save billions in preventing the pandemic
Kilpatrick AM, Chmura AA, Gibbons DW, Fleischer RC, Marra
collapse we fear. This approach will be good for our global
PP, Daszak P (2006) Predicting the global spread of H5N1 avianinfluenza. Proceedings of the National Academy of Sciences of the
United States of America 103:19368–19373
Of course, we do not yet know if this new H1N1
Leibler JH, Otte J, Roland-Holst D, Pfeiffer DU, Soares Magalhaes
pandemic is the first wave harbinger of a second wave
R, Rushton J, et al. (2009) Industrial food animal productionand global health risks: exploring the ecosystems and economics
doom as appears to have happened in the lead up to the
1918–1919 pandemic. But, perhaps we can breathe a brief
sigh of relief and ponder on a new approach to pandemic
Morse SS (1993) Examining the origins of emerging viruses. In:
preparedness: one which brings together Human and
Emerging Viruses, Morse SS (editor), New York: Oxford Uni-versity Press, pp 10–28
Animal Medicine, Virology, Microbiology, Ecology, andthe Social Sciences; one which analyzes the different types
District Profile Saharsa district falls within -25.37 to 26.32 degree N latitude& 86. 22to87.90 degree E longitude respectively. Saharsa is both the district and commissionery( Madhepura, Supaul &Saharsa districts headquarters )through upcoming nh-107 it is linked with nh-31 has road link with other important terms of the koshi zone and beyond upon which the state private buses pli
Ön az alábbiak közül mely problémákhoz kapcsolódó kiadásokkal szembesült már?Gyermekbetegségek – lázcsillapító (Panadol), lázmérő Háztartási baleset – sebtapasz, BetadinVédőoltások – infl uenza elleni oltás, agyhártyagyulladás Szakorvosi vizsgálatok – fogorvos, szemész stb. Magánorvosi vizsgálatok – fog