Review
Hot spots in a wired world: WHO surveillance of emerging and re-emerging infectious diseases

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Summary

The resurgence of the microbial threat, rooted in several recent trends, has increased the vulnerability of all nations to the risk of infectious diseases, whether newly emerging, well-established, or deliberately caused. Infectious disease intelligence, gleaned through sensitive surveillance, is the best defence. The epidemiological and laboratory techniques needed to detect, investigate, and contain a deliberate outbreak are the same as those used for natural outbreaks. In April 2000, WHO formalised an infrastructure (the Global Outbreak Alert and Response Network) for responding to the heightened need for early awareness of outbreaks and preparedness to respond. The Network, which unites 110 existing networks, is supported by several new mechanisms and a computer-driven tool for real time gathering of disease intelligence. The procedure for outbreak alert and response has four phases: systematic detection, outbreak verification, real time alerts, and rapid response. For response, the framework uses different strategies for combating known risks and unexpected events, and for improving both global and national preparedness. New forces at work in an electronically interconnected world are beginning to break down the traditional reluctance of countries to report outbreaks due to fear of the negative impact on trade and tourism. About 65% of the world's first news about infectious disease events now comes from informal sources, including press reports and the internet.

Section snippets

Hot spots: emerging and re-emerging diseases

The microbial world is complex, dynamic, and constantly evolving. Microbes proliferate rapidly, mutate frequently, and adapt with relative ease to new environments and hosts. They also eventually develop resistance to the drugs used to treat them. Factors linked to a host of human activities can accelerate and amplify these natural phenomena. Moreover, when a complacent world relaxes its vigilance and lets down its defences, the consequences can be rapid as well as dramatic. Microbes are quick

A post-antibiotic era?

On another front, resistance to inexpensive and effective antimicrobial drugs has emerged and spread at an alarming rate, raising the prospect that many common diseases could become prohibitively expensive or impossible to treat.27 The bacterial infections that contribute most to human disease are also those in which emerging resistance is of most concern: diarrhoeal diseases such as dysentery, respiratory tract infections, including pneumococcal pneumonia and multidrug-resistant tuberculosis,

The best defence: real time surveillance and response

In the volatile new milieu of emerging, adapting, and highly mobile pathogens, the best defence is good infectious disease intelligence, on a global scale, gleaned through sensitive surveillance. Surveillance systems keep the world alert to changes in the infectious disease threat and provide the background data needed to detect an unusual event, whether involving an upsurge in cases of a well-known endemic disease, the appearance of a previously unknown pathogen, or an outbreak caused by the

The framework for response: a three-pronged approach

The framework for responding to outbreaks and epidemics relies on a three-pronged approach, with different strategies for combating known risks and unexpected events, and for improving both global and national preparedness.

Disease reporting in a wired world

Traditionally, one of the main factors undermining the effectiveness of infectious disease surveillance has been the reluctance of countries to report outbreaks due to fear of the negative impact this news would have on travel, trade, and tourism.39 Outbreaks are always costly, and most especially so when reactions are inflamed by sensational media coverage. Widespread and sometimes exaggerated media coverage of the 1994 plague epidemic in India contributed to trade and tourism losses in the

Preparedness for the unthinkable

As public health authorities have long been aware, the many behind-the-scenes efforts needed to safeguard public health often go unnoticed and are inadequately funded—until something dramatic goes wrong. High-profile events such as an outbreak of foodborne disease, contamination of the water supply, or dangerously high levels of environmental pollution that arouse deep popular concern can suddenly bring into focus the need to strengthen the otherwise invisible infrastructures that protect

Search strategy and selection criteria

We primarily cite articles containing global infectious disease surveillance data verified by WHO (Weekly epidemiological record; technical report series; World Health Assembly documentation). The WHO outbreak alert and response database was also scrutinised for material. Medline searches were carried out for each infectious disease referred to in the text.

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    Members of the WHO Operational Support Team to the Global Outbreak Alert and Response Network are R Arthur, C-L Chaignat, O Cosivi, D Coulombier, P Creese, P Drury, S Edgerton, M Hardiman, D Klaucke, KB O'Kamara, D Lavanchy, R Nowak, C Roth, M Ryan, and K Taniguchi

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