All Hands on Deck: Transdisciplinary Approaches to Emerging Infectious Disease

The increasing burden of emerging infectious diseases worldwide confronts us with numerous challenges, including the imperative to design research and responses that are commensurate to understanding the complex social and ecological contexts in which infectious diseases occur. A diverse group of scientists met in Hawaii in March 2005 to discuss the linked social and ecological contexts in which infectious diseases emerge. A subset of the meeting was a group that focused on “transdisciplinary approaches” to integrating knowledge across and beyond academic disciplines in order to improve prevention and control of emerging infections. This article is based on the discussions of that group. Here, we outline the epidemiological legacy that has dominated infectious disease research and control up until now, and introduce the role of new, transdisciplinary and systems-based approaches to emerging infectious diseases. We describe four cases of transboundary health issues and use them to discuss the potential benefits, as well as the inherent difficulties, in understanding the social–ecological contexts in which infectious diseases occur and of using transdisciplinary approaches to deal with them. The views expressed here by Marian McDonald and Josh Rosenthal are those of the authors and do not represent official views or policies of the U.S. Centers for Disease Control and Prevention or the National Institutes of Health.     

Emerging Infectious Disease Leads to Rapid Population Declines of Common British Birds

Emerging infectious diseases are increasingly cited as threats to wildlife, livestock and humans alike. They can threaten geographically isolated or critically endangered wildlife populations; however, relatively few studies have clearly demonstrated the extent to which emerging diseases can impact populations of common wildlife species. Here, we report the impact of an emerging protozoal disease on British populations of greenfinch Carduelis chloris and chaffinch Fringilla coelebs, two of the most common birds in Britain. Morphological and molecular analyses showed this to be due to Trichomonas gallinae. Trichomonosis emerged as a novel fatal disease of finches in Britain in 2005 and rapidly became epidemic within greenfinch, and to a lesser extent chaffinch, populations in 2006. By 2007, breeding populations of greenfinches and chaffinches in the geographic region of highest disease incidence had decreased by 35% and 21% respectively, representing mortality in excess of half a million birds. In contrast, declines were less pronounced or absent in these species in regions where the disease was found in intermediate or low incidence. Also, populations of dunnock Prunella modularis, which similarly feeds in gardens, but in which T. gallinae was rarely recorded, did not decline. This is the first trichomonosis epidemic reported in the scientific literature to negatively impact populations of free-ranging non-columbiform species, and such levels of mortality and decline due to an emerging infectious disease are unprecedented in British wild bird populations. This disease emergence event demonstrates the potential for a protozoan parasite to jump avian host taxonomic groups with dramatic effect over a short time period.     

Hazard Analysis of Critical Control Points Assessment as a Tool to Respond to Emerging Infectious Disease Outbreaks

Highly pathogenic avian influenza virus (HPAI) strain H5N1 has had direct and indirect economic impacts arising from direct mortality and control programmes in over 50 countries reporting poultry outbreaks. HPAI H5N1 is now reported as the most widespread and expensive zoonotic disease recorded and continues to pose a global health threat. The aim of this research was to assess the potential of utilising Hazard Analysis of Critical Control Points (HACCP) assessments in providing a framework for a rapid response to emerging infectious disease outbreaks. This novel approach applies a scientific process, widely used in food production systems, to assess risks related to a specific emerging health threat within a known zoonotic disease hotspot. We conducted a HACCP assessment for HPAI viruses within Vietnam’s domestic poultry trade and relate our findings to the existing literature. Our HACCP assessment identified poultry flock isolation, transportation, slaughter, preparation and consumption as critical control points for Vietnam’s domestic poultry trade. Introduction of the preventative measures highlighted through this HACCP evaluation would reduce the risks posed by HPAI viruses and pressure on the national economy. We conclude that this HACCP assessment provides compelling evidence for the future potential that HACCP analyses could play in initiating a rapid response to emerging infectious diseases.     

Impact of Climate Variability on Infectious Disease in West Africa

The importance of infectious disease as a determinant (as well as an outcome) of poverty has recently become a prominent argument for international and national investment in the control of infectious disease, as can be seen in the recently articulated United Nations (UN) Millennium Development Goals (MDGs). Climate variability and land use change have an enormous impact on health in West Africa, and may yet undermine the potential for achieving the MDGs, in certain economic-ecological zones. However, their underlying role in determining the burden of disease in the region on a yearly or decadal basis has never been systematically studied. In order to improve our understanding of the future impacts of climate change, it may be more effective to start by investigating the impact of inter-annual climate variability, and short-term shifts in climate (e.g., decadal), on disease transmission dynamics. This information may inform both current and future policy decisions with regard to prediction, prevention, and management of adverse climate-related health outcomes. This article reviews current knowledge of changes in the epidemiology of infectious diseases associated with climate variability in West Africa over the last 40 years. Selected examples are considered from bacterial (meningococcal meningitis), protozoan (malaria), and filarial (onchocerciasis and lymphatic filariasis) infections where spatial and temporal disease patterns have been directly influenced by seasonal, inter-annual, or decadal changes in climate.The views expressed herein are those of the authors and do not necessarily reflect the views of the National Oceanic and Atmospheric Administration (NOAA) or any of its sub-agencies.     

Poxviral Disease in Red Squirrels Sciurus vulgaris in the UK: Spatial and Temporal Trends of an Emerging Threat

The squirrel poxvirus (SQPV) is the probable mediator of apparent competition between the introduced invading gray squirrel (Sciurus carolinensis) and the red squirrel (Sciurus vulgaris) in the UK, and modeling studies have shown that this viral disease has had a significant impact on the decline of the red squirrel in the UK. However, given our limited understanding of the epidemiology of the disease, and more generally the effects of invasive species on parasite ecology, there is a need to investigate the transmission dynamics and the relative pathogenicity of the virus between species. We aimed to increase our knowledge of these processes through an empirical study in which we: (i) used pathological signs and transmission electron microscopy (TEM) to diagnose SQPV disease in red squirrels found dead during scanning surveillance between 1993 and 2005; (ii) detected antibody to SQPV using an enzyme-linked immunosorbent assay (ELISA) in the same animals; and (iii) mapped cases of the disease, and the gray squirrel distribution, using a geographical information system. We analyzed the distribution of cases of SQPV disease according to woodland type, a measure of squirrel density. SQPV disease occurred only in areas of England also inhabited by seropositive gray squirrels, and as the geographical range of gray squirrels expanded, SQPV disease occurred in these new gray squirrel habitats, supporting a role for the gray squirrel as a reservoir host of the virus. There was a delay between the establishment of invading gray squirrels and cases of the disease in red squirrels which implies gray squirrels must reach a threshold number or density before the virus is transmitted to red squirrels. The spatial and temporal trend in SQPV disease outbreaks suggested that SQPV disease will have a significant effect on Scottish populations of red squirrels within 25 years. The even spread of cases of disease across months suggested a direct rather than vector-borne transmission route is more likely. Eight juvenile and sub-adult free-living red squirrels apparently survived exposure to SQPV by mounting an immune response, the first evidence of immunity to SQPV in free-living red squirrels, which possibly suggests a changing host-parasite relationship and that the use of a vaccine may be an effective management tool to protect remnant red squirrel populations.     

Invasive Snails and an Emerging Infectious Disease: Results from the First National Survey on Angiostrongylus cantonensis in China

Background

Eosinophilic meningitis (angiostrongyliasis) caused by Angiostrongylus cantonensis is emerging in mainland China. However, the distribution of A. cantonensis and its intermediate host snails, and the role of two invasive snail species in the emergence of angiostrongyliasis, are not well understood.

Methodology/Principal Findings

A national survey pertaining to A. cantonensis was carried out using a grid sampling approach (spatial resolution: 40×40 km). One village per grid cell was randomly selected from a 5% random sample of grid cells located in areas where the presence of the intermediate host snail Pomacea canaliculata had been predicted based on a degree-day model. Potential intermediate hosts of A. cantonensis were collected in the field, restaurants, markets and snail farms, and examined for infection. The infection prevalence among intermediate host snails was estimated, and the prevalence of A. cantonensis within P. canaliculata was displayed on a map, and predicted for non-sampled locations. It was confirmed that P. canaliculata and Achatina fulica were the predominant intermediate hosts of A. cantonensis in China, and these snails were found to be well established in 11 and six provinces, respectively. Infected snails of either species were found in seven provinces, closely matching the endemic area of A. cantonensis. Infected snails were also found in markets and restaurants. Two clusters of A. cantonensis–infected P. canaliculata were predicted in Fujian and Guangxi provinces.

Conclusions/Significance

The first national survey in China revealed a wide distribution of A. cantonensis and two invasive snail species, indicating that a considerable number of people are at risk of angiostrongyliasis. Health education, rigorous food inspection and surveillance are all needed to prevent recurrent angiostrongyliasis outbreaks.     

The Evolutions of Medical Building Network Structure for Emerging Infectious Disease Protection and Control

Emerging infectious disease is one of the most minatory threats in modern society. A perfect medical building network system need to be established to protect and control emerging infectious disease. Although in China a preliminary medical building network is already set up with disease control center, the infectious disease hospital, infectious diseases department in general hospital and basic medical institutions, there are still many defects in this system, such as simple structural model, weak interoperability among subsystems, and poor capability of the medical building to adapt to outbreaks of infectious disease. Based on the characteristics of infectious diseases, the whole process of its prevention and control and the comprehensive influence factors, three-dimensional medical architecture network system is proposed as an inevitable trend. In this conception of medical architecture network structure, the evolutions are mentioned, such as from simple network system to multilayer space network system, from static network to dynamic network, and from mechanical network to sustainable network. Ultimately, a more adaptable and corresponsive medical building network system will be established and argued in this paper.     

Zoonotic Emerging Infectious Disease in Selected Countries in Southeast Asia: Insights from Ecohealth

Most emerging diseases of humans originate in animals, and zoonotic emerging infectious diseases (EIDs) threaten human, animal, and environment health. We report on a scoping study to assess actors, linkages, priorities, and needs related to management of these diseases from the perspective of key stakeholders in three countries in Southeast Asia. A comprehensive interview guide was developed and in-depth interviews completed with 21 key stakeholders in Vietnam, Lao People’s Democratic Republic, and Cambodia. We found numerous relevant actors with a predominance of public sector and medical disciplines. More capacity weaknesses than strengths were reported, with risk analysis and research skills most lacking. Social network analysis of information flows showed policy-makers were regarded as mainly information recipients, research institutes as more information providers, and universities as both. Veterinary and livestock disciplines emerged as an important “boundary-spanning” organization with linkages to both human health and rural development. Avian influenza was regarded as the most important zoonotic EID, perhaps reflecting the priority-setting influence of actors outside the region. Stakeholders reported a high awareness of the ecological and socioeconomic drivers of disease emergence and a demand for disease prioritization, epidemiological skills, and economic and qualitative studies. Evaluated from an ecohealth perspective, human health is weakly integrated with socioeconomics, linkages to policy are stronger than to communities, participation occurs mainly at lower levels, and equity considerations are not fully considered. However, stakeholders have awareness of ecological and social determinants of health, and a basis exists on which transdisciplinarity, equity, and participation can be strengthened.     

Emerging and Reemerging Infectious Diseases: Biocomplexity as an Interdisciplinary Paradigm

Understanding factors responsible for reemergence of diseases believed to have been controlled and outbreaks of previously unknown infectious diseases is one of the most difficult scientific problems facing society today. Significant knowledge gaps exist for even the most studied emerging infectious diseases. Coupled with failures in the response to the resurgence of infectious diseases, this lack of information is embedded in a simplistic view of pathogens and disconnected from a social and ecological context, and assumes a linear response of pathogens to environmental change. In fact, the natural reservoirs and transmission rates of most emerging infectious diseases primarily are affected by environmental factors, such as seasonality or meteorological events, typically producing nonlinear responses that are inherently unpredictable. A more realistic view of emerging infectious diseases requires a holistic perspective that incorporates social as well as physical, chemical, and biological dimensions of our planet’s systems. The notion of biocomplexity captures this depth and richness, and most importantly, the interactions of human and natural systems. This article provides a brief review and a synthesis of interdisciplinary approaches and insights employing the biocomplexity paradigm and offers a social–ecological approach for addressing and garnering an improved understanding of emerging infectious diseases. Drawing on findings from studies of cholera and other examples of emerging waterborne, zoonotic, and vectorborne diseases, a “blueprint” for the proposed interdisciplinary research framework is offered which integrates biological processes from the molecular level to that of communities and regional systems, incorporating public health infrastructure and climate aspects.     

Ecology of Infectious Disease: Forging an Alliance

The Ecology of Infectious Diseases (EID) program is a joint National Science Foundation–National Institutes of Health initiative to produce predictive understanding of disease dynamics, with a focus on diseases with an environmental component. The interdisciplinary research projects funded by this program take advantage of the wide range of theoretical and methodological advances developed over the past 30 years. The challenge for disease ecology is to unravel these systems, discover how complex they truly are, and to determine if they can be predicted and controlled using targeted environmental, public health, or medical interventions. Between 1999 and 2005, a total of 42 research awards were made under the EID program. EID projects have had affects on policy in two areas: adoption of novel interventions on a local scale and use of models by government agencies for the purpose of allocating public health resources. The past 6 years have been an exciting time for the field of disease ecology; we expect the coming years to be even more exciting and productive. As US federal government employees writing an article as part of our official duties, copyright of all publications is retained by the US government. The views expressed here by Samuel M. Scheiner and Joshua P. Rosenthal are those of the authors and do not represent official views or policies of the National Science Foundation, the National Institutes of Health, or the United States Government.     

一类人禽间传染病模型的动力学分析

讨论了一类人禽传染病模型,其中禽类被病毒感染后人们采取措施治疗病禽．治疗有助于禽类的存活,但人们可能通过接触病禽而被感染．禽间的疾病传播服从饱和接触率函数,人与禽的接触服从线性接触率．完成了稳定性和持久性研究,且进行了数值模拟以评估治疗的效果和风险．     

Evidence of Spread of the Emerging Infectious Disease, Finch Trichomonosis, by Migrating birds

Finch trichomonosis emerged in Great Britain in 2005 and led to epidemic mortality and a significant population decline of greenfinches, Carduelis chloris and chaffinches, Fringilla coelebs, in the central and western counties of England and Wales in the autumn of 2006. In this article, we show continued epidemic spread of the disease with a pronounced shift in geographical distribution towards eastern England in 2007. This was followed by international spread to southern Fennoscandia where cases were confirmed at multiple sites in the summer of 2008. Sequence data of the ITS1/5.8S/ITS2 ribosomal region and part of the small subunit (SSU) rRNA gene showed no variation between the British and Fennoscandian parasite strains of Trichomonas gallinae. Epidemiological and historical ring return data support bird migration as a plausible mechanism for the observed pattern of disease spread, and suggest the chaffinch as the most likely primary vector. This finding is novel since, although intuitive, confirmed disease spread by migratory birds is very rare and, when it has been recognised, this has generally been for diseases caused by viral pathogens. We believe this to be the first documented case of the spread of a protozoal emerging infectious disease by migrating birds.     

The Role of Ecotones in Emerging Infectious Diseases

Recognition of the significance of the boundary between ecological systems, often referred to as the ecotone, has a long history in the ecological sciences and in zoonotic disease research. More recent research in landscape ecology has produced an expanded view of ecotones and elaboration of their characteristics and functions in ecosystems. Parallel research on emerging infectious diseases (EIDs) and the causes of increased rates of pathogen transmission, spread, and adaptation suggests a correspondence between ecotonal processes and the ecological and evolutionary processes responsible for zoonotic and vector-borne emerging infections. A review of the literature suggests that ecotones play a role in a number of the most important EIDs. Yet these are the only diseases for which specific landscape ecological information exists in the literature or disease reports. However, the similar disease ecologies of these with about half of the approximately 130 zoonotic EIDs suggests ecotones, particularly their anthropogenic origination or modification, may be generally associated with ecotones and the global trend of increasing EIDs.