Avian Flu Diary: Top Global Infectious Disease Threats (2013-2016) From The CDC's GDD

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Four years ago scientists from the CDC's Global Disease Detection (GDD) Operations Center published a review in the Emerging Health Threats Journal called What we are watching—five top global infectious disease threats, 2012: a perspective from CDC’s Global Disease Detection Operations Center.

Described as `global disease threats of particular concern to the CDC' - although not necessarily the disease threats the CDC found most important or those that required the most resources - the top threats of 2012 were listed as:

Avian influenza A (H5N1)
Cholera
Poliomyelitis (polio)
Enterovirus-71
Extensively drug-resistant tuberculosis

Submitted in February of 2013, the article wasn't published until the summer, when an addendum was added mentioning two late-breaking threats; MERS-CoV on the Arabian Peninsula, and H7N9 in China.

Fast forward to today, and researchers from the CDC's GDD have published a new review covering those infectious disease threats that came to the fore between 2013 and 2016. While several of the older threats remain, today's list has expanded considerably.

Some excerpts, and some comments, but you'll want to follow the link to read the report in its entirety.

What We Are Watching—Top Global Infectious Disease Threats, 2013-2016: An Update from CDC's Global Disease Detection Operations Center To cite this article: Christian Kira A., Iuliano A. Danielle, Uyeki Timothy M., Mintz Eric D., Nichol Stuart T., Rollin Pierre, Staples J. Erin, and Arthur Ray R.. Health Security. August 2017, ahead of print. https://doi.org/10.1089/hs.2017.0004

Online Ahead of Print: August 14, 2017

ABSTRACT

To better track public health events in areas where the public health system is unable or unwilling to report the event to appropriate public health authorities, agencies can conduct event-based surveillance, which is defined as the organized collection, monitoring, assessment, and interpretation of unstructured information regarding public health events that may represent an acute risk to public health. The US Centers for Disease Control and Prevention's (CDC's) Global Disease Detection Operations Center (GDDOC) was created in 2007 to serve as CDC's platform dedicated to conducting worldwide event-based surveillance, which is now highlighted as part of the “detect” element of the Global Health Security Agenda (GHSA). The GHSA works toward making the world more safe and secure from disease threats through building capacity to better “Prevent, Detect, and Respond” to those threats. The GDDOC monitors approximately 30 to 40 public health events each day.

In this article, we describe the top threats to public health monitored during 2012 to 2016: avian influenza, cholera, Ebola virus disease, and the vector-borne diseases yellow fever, chikungunya virus, and Zika virus, with updates to the previously described threats from Middle East respiratory syndrome-coronavirus (MERS-CoV) and poliomyelitis.

Detecting, reporting, and responding to significant public health events occurring in areas where the public health system is unable or unwilling to report the event to appropriate public health authorities is a constant challenge for those monitoring global disease activity. To better track public health events in these situations, agencies can conduct event-based surveillance, which is defined as the organized collection, monitoring, assessment, and interpretation of unstructured information regarding public health events that may represent an acute risk to human health.¹

When conducting event-based surveillance, information can be collected through formal channels, such as already-established public health surveillance systems; in such instances, event-based surveillance can be complementary to indicator- or case-based surveillance systems that collect information on individual cases rather than events. Event-based surveillance can also be conducted through informal channels, such as through monitoring media reports, blogs, or even social media. Because events reported through informal channels commonly involve unconfirmed media reports, they must be verified before any action is taken.

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What follows are detailed sections on the top potential infectious disease threats of the past 3 years; Influenza (human, avian & swine), Cholera, Ebola, Vector Borne diseases (Zika, Yellow Fever, Chikungunya), and updates on MERS-CoV and Poliomyelitis.

Progress against Polio, and fewer high profile outbreaks of EV-71 in Asia (see 2012's The Emerging Threat Of EV71) have - at least for now - helped to reduce their threat ranking among top infectious disease threats since the 2012 report.

Influenza (human, avian & swine) deservedly gets a good deal more attention in this latest release, and this past winter's record setting H7N9 epidemic in China obviously has the GDD's full attention. The authors write:

We closely monitor novel influenza A viruses, because influenza A viruses continue to evolve and because zoonotic transmission could herald an increasing pandemic influenza health threat. If a novel influenza A virus acquires the ability for sustained human-to-human transmission, a pandemic can result. Accordingly, early detection of pandemic-potential viruses may aid in the control and possible prevention of the next pandemic.

Although a swine-origin influenza A virus caused the 2009 H1N1 pandemic,^10,11 and sporadic transmission of swine-origin influenza A viruses to humans (termed “variant viruses”) continue to be detected in the United States and in other countries with appropriate laboratory capacity, the public health threat posed by avian influenza A viruses appears to be higher because of their diversity and wide circulation among birds worldwide; the birds' migratory flyways may also be conducive to spread of influenza A viruses. Furthermore, some previous pandemic influenza A viruses have been partly of avian origin.¹¹

The report concludes with:

Summary
This report describes top potential global infectious disease threats that the GDDOC was monitoring during 2013-2016, and does not necessarily describe those public health events that CDC finds most important or events that require the most resources. With the unique platform from which event-based surveillance is conducted, the GDDOC is in a unique position to rapidly identify new threats to public health, including those that could lead to a pandemic.

A sign of the times, perhaps, this latest report is more than 60% longer (6057 words vs. 3732) than the 2012 report. Another metric, as if we needed it, suggesting that the global threats posed by emerging and re-emerging infectious diseases continues to increase.

For more on this threat, you may wish to revisit: