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


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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

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