Gerald T. Keusch

Sustaining Global Surveillance and Response to Emerging Zoonotic Diseases

Outbreaks in the past decade of avian influenza H5N1 (“bird flu”), severe acute respiratory syndrome (SARS), and pandemic H1N1 2009 (so called “swine flu”) are examples of how zoonotic diseases—those caused by bacteria, viruses, parasites, or unconventional agents and are transmissible between humans and animals—can threaten health and economies around the world. Unfortunately, for several reasons, disease surveillance in the United States and abroad is not very effective in alerting officials to emerging zoonotic diseases. This report calls for the United States to take the lead, working with global health organizations, to establish a global zoonotic disease surveillance system that better integrates the human and animal health sectors for improved early detection and response. Zoonotic pathogens have caused more than 65 percent of emerging infectious disease events in the past six decades. Zoonotic diseases are often novel and ones societies are medically unprepared to treat, as was the case when HIV/AIDS and variant Creutzfeldt-Jakob Disease (the human form of “mad cow disease”) emerged. Moreover, the severity of illness in different species is unpredictable and widely variable. For example, the 1918 influenza pandemic (“Spanish flu”) was a particularly virulent strain of H1N1 that killed millions of people worldwide. Although mortality from recent human avian influenza outbreaks has been relatively low—notably just 257 reported deaths worldwide from the ongoing highly pathogenic avian influenza H5N1(HPAI H5N1) outbreak—there is still much cause for concern. In response to this concern, the U.S. Agency for International Development (USAID) approached the Institute of Medicine and the National Research Council for advice about how to achieve more sustainable global capacity for surveillance and response to emerging zoonotic diseases. A committee was convened to examine several infectious disease surveillance systems already in operation, identify effective systems, uncover gaps in efforts, and recommend improvements toward the goal of an effective global disease surveillance system. Experts in human and animal disease surveillance provided input to the committee at a workshop held in June 2008 in Washington, D.C. In addition to human and animal illness and potential loss of lives, the economic losses due to zoonotic disease outbreaks can be staggering. Economic consequences can include trade sanctions, travel warnings or restrictions, animal disease control efforts such as animal culling (intentional slaughter), and declining public confidence in animals products, as was the case with pork