Running head: SPECIAL ASSIGNMENT 1

Nickole Argentieri

Professor William Vandyke

May 15, 2019

HSCI 616

How Urbanization affects the epidemiology of emerging infectious diseases

SPECIAL ASSIGNMENT 2

Introduction

Infectious diseases continue to put a threat on society. Regardless of age, sex,

lifestyle, ethnic background, they continue to cause issues. Although some of the

diseases have been helped with antibiotics and vaccines, new ones continue to

emerge. According to CDC, “the ones emerging are human immunodeficiency virus and

acquired immunodeficiency syndrome {HIV/AIDS}, Lyme disease, and Hantavirus

pulmonary syndrome), whereas others reemerge in drug-resistant forms (e.g., malaria,

tuberculosis, and bacterial pneumonias) (CDC, 2001). There have been many more

infectious diseases we have faced in society that will be further be discussed.

Urbanization refers to the process of making an area more urban, in relating to

more city or town like. The United Nations estimates that 54% of the world’s population,

3,9 billion, live in urban areas Neiderud, 2015, 1). “Asia has been the highest urban

population in the last decade with 0.88 million urban migrants per week and Africa was

second with 0.23 million and a total of new urban residents per week was an average

1.2 million” (Neiderud, 2015, 1). Urbanization leads to many challenges for health, and

the epidemiology of infectious diseases. “Living in a city can provide you with several

advantages, such as higher education, higher income, security of better health, and

safety of social services” (Neiderud, 2015,1). Although socioeconomic has a major

impact on someone life, an infectious diseases outbreak can ultimately affect anyone.

Cities around the world can look very different because of their living conditions

for residents, for example living in the slums, which is an overcrowded area of poor

people, compared to a wealthy area. Living in the slums can include an increase of

infectious diseases. Close contact between people in urban areas are dangerous areas
SPECIAL ASSIGNMENT 3

for emerging infectious diseases such as, (SARS) severe acute respiratory system, and

the avian flu which can be pandemic affect I the urban areas resulting in a worldwide

health crisis. (Neiderud, 2015, 1).

Emerging infectious diseases are infections that have recently appeared within a

population, or those who incidence or geographic range is increasing rapidly. The World

Health organization reports, “infectious diseases are emerging at a rate that has not

been seen before. Since the 1970s, about 40 infectious diseases have been

discovered, including SARS, MERS, Ebola, chikungunya, avian flu, swine flu and, most

recently, Zika” (Baylor College of Medicine, 1). Due to the increase, this can be travel

related, living in more dense populated areas, and coming in contact with wild animals.

With traveling, more and more people are traveling in and out of country that the past. If

an individual travels from Brazil to the United States there is a chance this individual can

carry the Zika virus, then this can result in spreading of the disease among US

residents, this then can become a US issue.

Remerging infectious diseases

Cholera known as the diarrhoeal disease has repeatedly been reemerging over

than two centuries. Cholera is in “association with global travel, changing seasons, war,

natural disasters, and conditions that lead to inadequate sanitation, poverty, and social

disruption” (NCBI, 2013). Incidence is highest in urban regions with high population

density. Overcrowding housing in slum population can cause an outbreak of infectious

disease such as, tuberculosis. Overall in the U.S tuberculosis has declined, due to

factors such as nutrition status, socioeconomic status, and new drug regimens

(Neiderud, 2015, 1). In Dhaka City, Bangladesh, there was a high rate of tuberculosis,
SPECIAL ASSIGNMENT 4

which was almost twice as high compared to the overall national average and four times

higher than the overall urban levels (Neiderud, 2015, 1).

The zoonotic disease is a challenge for the future, of 355 emerging diseases, 60

% have been zoonotic. “Living in close contact with domesticated animals can increase

the infectious disease to make the jump from animals to host to humans” (Neiderud,

2015, 1). A big Zoonotic virus is Ebola Virus, the mortality rate has been high in

outbreaks, up to 90%, A better understanding, surveillance, and prevention, would be

great value to prevent this disease (Neiderud, 2015, 1). Malaria, which is a parasite

transmitted by a mosquito, is still a major health concern in large parts of the world,

estimates 198 million cases and 584,000 deaths (Neiderud, 2015, 1).

Poor housing can also lead to rodent vector diseases. Due to poor water

sanitation and waste management, it is a favorable setting for rodents and insects which

carry pathogens and soil-transmitted helminth infections. “These infections are among

the most important causes of physical and intellectual growth retardation in the world”

(Neiderud, 2015, 1). Good hygiene and sanitary practices have lowered the rates of

contamination. Poor housing can also contribute a vector increase, an example is the

Chagas disease, which is a parasitic infection by the protozoan Trypanosoma cruzi,

living close to domestic animals and poor hygienic habits is the cause (Neiderud, 2015,

1). Chagas affects an estimated 8 million people every year, and a health challenge in

Latin America, an estimated 300,000 individuals in the U.S are infected.

Newly emerging infectious diseases

One example of an emerging Infectious disease is HIV/AIDS, which developed a

century ago after the virus jumped from primate host to another. This disease is rapidly
SPECIAL ASSIGNMENT 5

increasing due to the complexity of social and demographic factors that spread fast

within the population. Initially, the risk groups were associated with men who have sex

with men, recipients of blood products, needle injection. Although this was a risk group,

According to NCBI, “The bulk of HIV infections globally has resulted from heterosexual

transmission that has been heavily weighted within the developing world, particularly

sub-Saharan Africa where a number of factors were responsible for this rapid spread;

chief among these were human movement along truck routes accompanied by a high

level of commercial sex work, inadequate public health infrastructures, poverty, and

social inequality” (NCBI, 2013). Socioeconomic status seems to play a role in the

growth of this infectious disease, with built environment and poverty playing a key role.

Lack of public health education could ultimately be a major factor also.

Another disease emerging includes severe acute respiratory syndrome (SARS),

which first emerged from bats and spread to humans by person-to-person small spaces,

to hospitals, then lastly human movement between international air centers. The Nipah

virus occurred in bats first, then affected an immense herd of bred pigs, which then the

virus was passed to humans. “The 2009 H1N1 pandemic influenza virus emerged from

pigs as well, but only after complex exchanges of human, swine, and avian influenza

genes” (NCBI, 2013). H5N1 was also a pandemic, which emerged from wild birds to

cause epizootics that intensified virus transmission in domestic poultry.

The environment in urban cities has proven to be favorable for the rat population.

Close encounters between rats and humans can lead to transmission of zoonotic

infectious diseases, with New York having the highest populations of rats in the U.S.

(Neiderud, 2015, 1). The growing trend of urbanization around the world has shifted
SPECIAL ASSIGNMENT 6

some infectious diseases, which have usually been rural, to now urban. Geographic

movement of humans has spread West Nile and dengue virus. Another vector that is

adapting to urban areas is the mosquito Aedes aegypti, which is a key component for

dengue transmission. There is a high rate in tropical areas with 390 million cases a

year, and India having the highest rate. (Neiderud, 2015, 1). West Nile virus was a big

vector-borne disease, which became a reality in the urban environment. Dallas, TX

experienced an Epidemic of this virus, reporting 25% of the cases were there.

(Neiderud, 2015, 1).

West Nile virus has become adapted to multiple mosquito and avian species,

which is a major factor with the growth and opportunity to infect humans. Some other

key diseases have been lymphatic filariasis with 2 billion people at risk due to lack of

proper sanitation. (Neiderud, 2015, 1). Modern cities can be a catalyst for the rapid

spread of infectious diseases. International travel has connected the world, and the

mobility creates a potential threat to emerging diseases in urban population.

The most recent outbreak of an Infectious disease was the Zika Virus. Aedes

mosquitos carry the Zika virus, “a total of 86 countries and territories have reported

evidence of mosquito-transmitted Zika infection” (WHO, 2018). Brazil had a major

outbreak with Zika virus infection and microcephaly. Microcephaly is when the

circumference of the head is smaller than normal. This will cause, “dwarfism or short

stature, delayed motor and speech functions, mental retardation, seizures, facial

distortions, hyperactivity, balance and coordination problems, and other brain-related or

neurological problems” (Medicine Net, 2019). There is no prevention or treatment for the
SPECIAL ASSIGNMENT 7

Zika virus, but there is on going research to investigate the effects on how to control and

come up with strategies to prevent obtaining the disease.

Eliminating Infectious diseases

There has been success in the past with eliminating certain infectious diseases,

For example, Small pox, measles, polio, dracunculiasis, etc. Although there has been

success, it is very unlikely that we will completely eliminate most infectious diseases in

the future. Pathogenic microorganisms can undergo rapid genetic changes, leading to

new phenotypic properties that take advantage of changing host and environmental

opportunities” (NCBI, 2013). An example would be the Influenza virus due to the

remerging infectious agents and their ability to evolve fast and take advantage of

changing host under environmental changes. Although it will be hard to eliminate

infectious diseases, we can control. Public health and vector control become important

roles in this issue. “We have many tools in our armamentarium, including preparedness

plans and stockpiles of drugs and vaccines” (NCBI, 2013). Each new infectious disease

brings a new challenge, and public health, and vector control will have to continue to

adapt and getting ahead to prevent these diseases.

Solution

City planning can be a key factor for the overall health of a population. More than

half of the world’s population has access to piped water connected to their homes.

Since 1990 well over 2 billion people have gained improved drinking water facilities, and

almost 2 billion people have access to improved sanitation, however 700 million people

still lack access to these improvements (Neiderud, 2015, 1). Control programs and

adequate surveillance is important, WHO can provide for better control and knowledge
SPECIAL ASSIGNMENT 8

and assist in effective vaccine. Better factors such as education, direct primary care

services; government’s response to health threats can also help the urban area improve

with the emerging infectious diseases (Neiderud, 2015, 1).

As mentioned Public health officials and vector control are major assets to finding

solutions to infectious disease outbreaks. A key solution to control the emerge of

infectious diseases can be to obtain a better understanding of risk factor for the

development of the infection and disease could provide new opportunities for disease

prevention. According to the CDC, “Diagnostic and reference reagents will be available

for use by public health laboratories. CDC will have enhanced capacity to serve as the

national reference center for diagnosis of infectious diseases and for drug-resistance

testing” (CDC, 2001). Providing research into vaccines, or antibiotics for the infectious

diseases will be a huge factor in eliminating the pandemic effects.

“Technology can play an integral role in equipping communities to recognize

disease faster. For example, investments in the research and development of low-cost,

easy-to-use point of care diagnostic tests can drastically cut down the amount of time

needed to go from suspicion of disease to diagnosis” (The Hill, 2018). Money is also a

big factor in emerging infectious disease problems, but community-based demonstration

programs can beneficial in supporting cost effective approaches. Recognizing the

disease as soon as possible is a major solution; this can provide prevention sooner, and

treatment. The U.S must think globally also, more travel in today’s society is causing the

spread of infectious diseases more rapidly. “The sooner and the more effectively our

global neighbors identify and address a public health threat where and when it emerges,

the less likely the disease will spread and affect us at home. That is why we must
SPECIAL ASSIGNMENT 9

support global programs and partnerships to support early diagnoses, linkage to care

and treatment abroad” (The Hill, 2018). When addressing these solutions with existing

emerging diseases, time is the essence. Having control, implementation of low-cost

preventative treatment, will ultimately have a huge impact of the human population.
SPECIAL ASSIGNMENT 10

Reference Page

Bollinger, R. C. (2018, May 09). Infectious diseases can be tackled, here are 3
solutions. Retrieved from https://thehill.com/opinion/healthcare/386901-infectious-
diseases-can-be-tackled-here-are-3-solutions

Emerging Infectious Diseases. (n.d.). Retrieved from

https://www.bcm.edu/departments/molecular-virology-and-microbiology/emerging-
infections-and-biodefense/emerging-infectious-diseases

Microcephaly Prognosis, Causes, Symptoms, and Diagnosis. (n.d.). Retrieved from

https://www.medicinenet.com/microcephaly/article.htm#microcephaly_facts

Morens, D. M., & Fauci, A. S. (n.d.). Emerging infectious diseases: Threats to human
health and global stability. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701702/

Neiderud, C. (2015). How urbanization affects the epidemiology of emerging infectious

diseases. Infection Ecology & Epidemiology, 5(1), 27060. doi:10.3402/iee.v5.27060

Preventing Emerging Infectious Diseases: A Strategy for the 21st Century Overview of
the Updated CDC Plan. (n.d.). Retrieved from
https://www.cdc.gov/mmwr/preview/mmwrhtml/00054779.htm

Zika virus. (n.d.). Retrieved from https://www.who.int/news-room/fact-sheets/detail/zika-

virus
SPECIAL ASSIGNMENT 11