Globalization and Emerging of New Disease 2023 by Chimdesa Jabesa

Globalization and Emerging
Infectious Diseases
globalization and emerging of new 1

disease 2023 By Chimdesa
Learning Objectives
• By the end of the course the
student will be able:
 To discuss the “epidemiologic transition” and
globalization
 Define emerging infectious diseases
 Describe mechanisms of emergence and reemergence
 Discuss international solutions to emerging and
reemerging infections
 Explain some common elements of global emerging
disease control plans.

Globalization and Emerging Infectious Diseases

THE “EPIDEMIOLOGIC TRANSITION”
AND GLOBALIZATION
• Less than a century ago, before the advent

of antimicrobial therapy and oral
contraceptives, most people died from
infectious diseases and many women died in
childbirth.
• Although the typical family had many
children, the infant mortality rate was high
and life expectancy even for those surviving
childhood was relatively low.
• Modern medical technologies and improved
nutrition have in some parts of the world
led to a shift from high fertility, short life
expectancy, and deaths from infectious
diseases and under nutrition (the pre-
transition profile) to low fertility, long life
expectancy, and deaths from non-
communicable diseases like heart disease,
cancers, and stroke (the post-transition
profile).
• This “epidemiologic transition” was
expected to predictably follow the
“demographic transition” as the economic
status of a population improved.
• According to this model, the US, Canada,
Japan, and most European countries would
be considered “post-transition” whereas
sub-Saharan Africa and some Asian and
Latin American countries would be
considered “pre-transition.”

• While the epidemiologic transition is a helpful
model for understanding the differences in health
status between more and less industrialized
countries and regions, the health changes that
occur with development are much less predictable
than the model implies.
• For example, in many low-income countries both
pre-and post-transition population can be found
within one city.
• Urban professionals may have increasing rates of
cancer while poor urban families continue to
experience high rates of infectious disease.

• Furthermore, although many illnesses and
deaths in low-income nations are due to
infection and under-nutrition and most
illnesses and death in high income nations
are due to non-communicable conditions
like heart disease and cancers, globalization
is reintroducing infectious diseases into
industrialized nations and introducing new
chronic diseases into developing nations.

• “Lifestyle diseases” related to obesity and
physical inactivity are now found even in
countries where the burden of infectious
diseases remains high.
• This means that rather than experiencing a
health transition, these countries are facing
a dual burden of infectious and chronic
diseases.

• Globalization has many meanings, most
of which are very specific to a particular
discipline, like economics.
• Economics uses globalization to refer to the
expansion and integration of economic
activity and policies between nations.

• Globalization is seen in the increasing
number of:
– global governmental and non-governmental
organizations,
– the proliferation of multilateral trade
agreements,
– increases in foreign direct investment,
– changing production modes,
– increased population mobility (including
tourism, urban migration, and forced
displacements), and
– increased cultural diffusion.
• The globalization of the world economy is
also very evident in the items people use on
daily basis:
– it is likely that most of our clothes, shoes, and
appliances are made in other countries, and
– that many of the food items that we purchase at
local grocery stores are grown in another part
of the world.

• Globalization is not new to the field of
public health.
• Infectious diseases were spread across the
globe when sea and land trade routes like
the Silk Road and Spice Route that linked
China, India, and the Mediterranean.
• Massive outbreaks occurred with the
Mongol expansion to Europe in the 13th
century.

• The infectious diseases carried by the
Europeans who explored the Americas in
the 15th century caused the decimation of
many indigenous American populations.

• Infectious diseases have never stopped at
national boundaries, and modern
transportation allows for a new infectious
disease that emerges in any part of the
world to be transported by aircraft to any
other part of the world within hours, rather
than weeks or months.

• The original case of SARS (Severe Acute
Respiratory Syndrome), which emerged in
2003 was probably acquired in an animal
market.
• The infection then was transmitted from
person to person across parts of Asia, and
within months cases were found in Canada,
the US, South Africa, Brazil, and many
European nations.
• (This led to the culling of millions of chickens).
• If a strain of highly pathogenic avian
influenza develops the ability to spread
easily from human to human, an even faster
and more widespread dissemination of the
infection across the globe is expected.
• Globalization means that humans are tied

together and a problem in one part of the
world can quickly become a global issue.

Definition: (Wikipedia, the free encyclopedia)
“An emerging infectious disease is an infectious disease
whose incidence has increased in the past 20 years and
threatens to increase in the near future.
This includes diseases caused by a newly identified

microorganism or newly identified strain of a known
microorganism (e.g, SARS, AIDS), new infections
resulting from change or evolution of an existing
organism (e.g, influenza), a known infection which
spreads to a new geographic area or population (e.g,
West Nile virus), newly recognized infection in an area
undergoing ecologic transformation (e.g, Lyme disease),
and pre-existing and recognized infections reemerging
due to drug resistance of their agent or to a breakdown
in public health (e.g tuberculosis)”.
• The U.S. journal ‘’Emerging Infectious
Diseases’’ is dedicated to emerging
infectious diseases.

Mechanisms of emergence & reemergence
• Microbial adaptation; e.g. genetic drift and

genetic shift in influenza A;
• Changing human susceptibility e.g, mass
immuno-compromisation with HIV/AIDS;
• Climate and weather; e.g. diseases with
zoonotic vectors such as West Nile Disease
(transmitted by mosquitoes) are moving
further from the tropics as the climate
warms;

• Change in human demographics and
trade; e.g, rapid travel enabled SARS,
bird flue and swine flue to rapidly
propagate around the globe;
• Economic development; e.g, use of
antibiotics to increase meat yield of
farmed animals leads to antibiotic
resistance;
• Breakdown of public health; e.g,
negligence to public health (cholera
outbreak in Zimbabwe in 2009);
• Poverty and social inequality; e.g, TB is
primarily a problem in low-income
areas;
• War and famine;
• Bioterrorism; e.g, 2001 Anthrax attacks
in the U.S.;
• Dam irrigation system construction;
e.g, malaria and other mosquito borne
diseases.
• Even as we succeed in controlling and
eradicating some disease, other diseases
previously not found in humans are
emerging.
• Emerging infectious diseases occur when a
new pathogen begins to affect human
populations or an existing pathogen changes
the kind of disease it causes.

• It might evolve in a way that makes it easier
to transmit to a susceptible person
(increased transmissibility) and, therefore,
more common (increased incidence).

• It might change so that it causes a new set of
symptoms or more severe symptoms
(increased virulence).
• In some cases an infectious agent that
usually affects only non-human hosts may
adapt in a way that makes it infectious to
humans.

• Sometimes an infectious agent may change
in a way that allows for a different portal of
entry, perhaps developing the ability to be
spread through airborne transmission.
• Other infections, called re-emerging

infections,
infections were controlled at some point in
the past but are becoming problematic
again.
• The Institute of Medicine, one of the National
Academies of the US, issued a report on microbial
threats to health in the twenty-first century.
• The report emphasizes that the emergence of

new health threats derives from a complex
interaction of:
– Genetic and biological factors,
– Physical environmental factors,
– Ecological factors, and
– Social, political, and
– Economic factors.
• Thirteen(13) specific risk factors have
been identified:
identified
1. Microbial adaptation and change,
2. Human susceptibility to infection,
3. Climate and weather,
4. Changing ecosystems,

5. Economic development and land use,
6. Human demographics and behavior,
7. Technology and industry,
8. International travel and commerce,
9. Breakdown of public health measures,

10. Poverty and social inequality,
11. War and famine,
12. Lack of political will, and
13. Intent to harm (Bioterrorism).
• These factors are interrelated.
• As the world population increases,
humans and domestic animals move into
previously uninhibited natural
environments and are exposed to new
plants, animals, and microbes.

• Alternation of the environment, such as
deforestation, reforestation, dam-building,
and manipulation of wetlands, creates new
environmental reservoirs for infectious
agents.
• And natural disasters like floods and

droughts can alter the landscape and
introduce new agents to a region.

• Cultural and behavioral practices ,
including food practices, outdoor activities,
and risky sexual behavior and drug use,
that become trendy and spread globally
may also facilitate transmission.

• Both movement to urban areas and
movement to rural areas can cause new
diseases to emerge.
• Urbanization facilitates the emergence of

new infections as people with different
infections interact with one another and
creates new habitats for vectors (e.g
Bubonic fever/Black Death in the middle
ages when cities started to rise).
• Dengue fever, also called break-
bone fever (because it causes severe
joint pain), is a viral infection
spread by Aedes aeqypti and other
Aedes mosquitoes that thrive in
urban environments where there
are many small bodies of standing
water that collects in old cans and
discarded tires.
• There are four serotypes/strains of dengue,
that the body’s immune system recognizes
as different from one another.
• People who have prior exposure to one of
the strains may be at increased risk to
another one of the serotypes.
• It will be very difficult to develop a vaccine
for dengue; a vaccine would have to be
effective against all four serotypes.

• Movement of people into rural areas,
or tree-lined suburbs, also exposes
people to new risks.
• Lyme disease is caused by a bacterium
spread by bites from infected deer
ticks.

• Technology is also speeding up the rate of
emergence.
• Modern transportation has made it possible
for an infectious person to travel nearly
anywhere in the world within hours and
brings susceptible people into areas endemic
for disease.
• This was clearly demonstrated during the
SARS epidemic, which spread across the
globe as visitors in Asia flew back to their
home countries.
• The SARS epidemic was also a stark
reminder of the need for responsive global
public health communication systems,
which have been strengthened in the years
since the outbreak.

• Health care innovations have created new
risk groups.
• Advanced medical therapies like the
immunosuppressive drugs used by people
with organ transplants and the technology
for keeping premature infants alive have
created new populations of highly
susceptible people.

• Nosocomial (hospital acquired) infections
may be very hardy and difficult to treat,
and antimicrobial resistance is increasing.
• Other technological advances have created

new places for infectious agents to grow
and new methods of dispersion.

• Some infections emerge because of new
distribution systems.
– Legionnaire’s disease is a serve type of
pneumonia that was first identified in 1976
following a conference of the American Legion
(Organization of ex-military personnel) in
Philadelphia.
– The bacteria that cause Legionnaire’s disease
live in artificial water distribution systems like
air cooling units, and humidifiers.
– And infection is acquired by inhaling the
aerosolized bacteria.

– Toxin-producing Staphylococcus aureus causes
toxic shock syndrome (TSS) and was first
identified in 1980 in menstruating women using
high-absorbency tampons.
– Escherichia coli 0157:H7 is a deadly strain of
bacteria that causes bloody diarrhea and
kidney failure, and outbreaks of the disease
have been traced to undercooked fast food
burgers and contaminated swimming pools.
• Some infection emerge by appearing in a
new location.
• Although relatively common in Egypt,
Sudan, and Uganda for decades, West Nile
Virus (WNV) was found in the US for the
first time in 1999.
• WNV is spread by the bite of infected
mosquitoes, it can affect birds and other
vertebrates, including humans.
• Five years after the first cases were
identified in New York, the virus was found
in birds in all 48 contiguous states.
• Some newly emergent infectious are still a
mystery.
• Several types of tropical hemorrhagic fever,
like the Ebola and Marburg viruses, have
emerged in central Africa, and the reservoir
and modes off transmission for these
infections are not entirely clear.
• Although rare, the infections have a high
case fatality, which means that a large
percentage of infected people die.
• New infectious diseases can emerge
anywhere in the world, and the distinction
between a local public health problem and a
global one is increasingly limited.
• HIV crosses borders along with truck
drivers and professionals traveling for
work.
• Bovine spongiform encephalopathy (“mad
cow” disease) crosses borders when cattle or
beef products are shipped to markets.
• Cholera, a waterborne bacterial infection
that can travel in ocean waters from one
nation’s shores to another, appeared in
South America for the first time in nearly
100 years in 1991.
• It was first identified in Peru but quickly
spread to Ecuador and Colombia, and in
less than a year it had spread throughout
South America and Central America.

• Drug-resistant strains of bacteria are often
hardier than drug-sensitive strains, so
inappropriate access to drugs in one nation
(infected persons taking too little of an
antibiotic or healthy persons using
antibiotics unnecessarily) can rapidly
become a global problem.

• Non-communicable diseases are also being
exported.
• As tobacco use declines in the US tobacco
sales by American companies to Asian
nations is rapidly increasing.

• When considering the causes of health and
disease, it is increasingly necessary to think
globally.

Influenza
• Global health professionals are always concerned
about the potential for a worldwide influenza
outbreak.
• All infectious agents, whether newly emerging or
long established in a population, are constantly
adapting and changing in ways that can make
them more or less transmissible, infective,
pathogenic, and virulent.
• Influenza occurs in humans and also in birds, pigs,
and other animals, and the virus constantly
changes so most people and animals are
susceptible to each new strain that circulates.

• Influenza is a prime example of how global
travel can contribute to the spread of newly
modified infectious agents by allowing an
infected person to fly to any part of the
world and start new epicenters of infection.
• On the other hand, global travel and
communication may also help contain a
pandemic by quickly sending supplies and
medical specialists to affected areas and
alerting public health officials to be aware
of possible cases.

BIOTERRORISM
• Bioterrorism is the deliberate/intentional/

release of infectious agents that can cause
illness and possibly death of people,
animals, or plants.

• A biological weapon may be selected
because:
– It produces severe disease,
– Has a desirable incubation period (either
short so immediate disease is produced or
long so that the asymptomatic contagious
stage is lengthy),
– Is highly infectious,

• Has a low infectious dose,
• Is environmentally stable,
• Is inexpensive,
• Can be produced relatively easily and
rapidly, or
• Has a simple delivery mechanism (such as
through air, water, or food).

• While the goal of some potential
bioterrorists is to kill or seriously injure
people,
the most common goal of bioterrorists is to
cause -fear,
-public panic, and
- social disruption.

• Chemical and biological warfare are not
new.
• During the Tartar siege of the city of Kaffa
(now in the Ukraine) in the fourteenth
century, the bodies of plague victims were
launched over city walls to spark an
epidemic.

• In 1963, during the French and Indian War,
the British army sent smallpox infected
blankets to American Indians.
• During World War I, several European
nations used biological agents against
livestock of enemies.
• What is new is that there are now more
tools available for causing and spreading
infectious diseases and the scale on which
such acts can occur is much larger.
• In the United States, potential bioterror
agents are classified into three categories.
– Category A: presents high-priority agents
that pose a high risk because they can be
easily transmitted from one person to
another or have high mortality rates.
– Category A agents include anthrax,
smallpox, plague, botulism, tularemia,
and viral hemorrhagic fevers like Ebola
and Marburg virus.
– Category B agents are moderately easy to
spread, have a moderate illness rate, and cause
few deaths.
– Examples of Category B agents include:
• Brucellosis, ricin (a toxin from Ricinus
communis, which is found in castor beans), Q
fever, typhus fever, and viral encephalitis
infections.
• This category also includes food safety
threats such as Salmonella, shilgella, or E.
coli 0157:H7 and water supply threats such
as cholera and cryptosporidium.
– Category C agents: are emerging
infectious agents like hantavirus, Nipah
virus that are potential threats because
they are unknown.

– The best defense against a biological
attack is early detection so that an
outbreak can be contained and exposed
people can receive medical treatment.
– Treatment will include, when possible,
post-exposure prophylaxis or
immunization.

• Defense also requires education of the
public in order to prevent mass hysteria.
• Since the events of September 11, 2001, the
US has developed early warning systems
and checklists to help households, schools,
businesses, and communities prepare for
natural disasters and possible terrorist
attacks.
• For example, households are encouraged to
develop an evacuation plan and to stockpile
water, food, batteries, and first-aid supplies.
International solutions to emerging
infections
• International efforts are under way to

respond to the threat of emerging
infectious diseases.
• WHO & CDC have drafted action plans
that stress the need to strengthen
global surveillance of these diseases
and to allow the international
community to anticipate, recognize,
control and prevent them.

• Also have established a new unit to control
and prevent emerging infections by
mobilizing resources rapidly at the first signs
of outbreaks.
• The Pan American Health Organization have
adopted a regional plan for controlling
emerging infections in the Americas.
• Health authorities from Central American
countries have adopt an emergency plan to
control emerging diseases like dengue fever.

• Physicians in EU recognize the need
for better surveillance of infectious
diseases.
• A summit held in 1995 (in Halifax) of the
major industrialized countries adopted
a project called ‘’Toward a Global
Health Network” to help governments
deal with emerging infections and other
health problems.

• Clearly, the emerging infections threat
and the need for concerted effort are on
the International Diplomatic and Public
Health Agendas.

Some common elements of global emerging-
disease control plans
• Strengthen international surveillance

networks to detect, control, and reduce
emerging diseases;
• Improve the international public health
infrastructure (e.g., labs., research
facilities, technology, and
communication links);
• Develop international standards,
guidelines, and recommendations;
• Improve international capabilities to respond
to disease outbreaks with adequate medical
and scientific resources and expertise;
• Strengthen international research efforts on
emerging diseases, particularly with regards
to antibiotic-resistant strains of diseases;
• Focus attention and resources on training
and supporting medical and scientific
expertise;

• Encourage national governments to
improve their public health care
systems, devote resources to
eliminating or controlling causes of
emerging diseases and coordinate their
public health activities with WHO and
the international community.

Discussion point
• What are your reflections to the global

threats of emerging infectious diseases
and the threat to developing countries
like Ethiopia?

Reference: Sources
• http://www.cdc.gov/ncidod/eid/vol2no2/fidl
er.htm
(7/8/2009)
• http://en.wikipedia.org/wiki/Emerging_infec
tious_disease
, June,10/2009


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Globalization and Emerging

globalization and emerging of new 1

globalization and emerging of new 2

globalization and emerging of new 3

• Less than a century ago, before the advent

globalization and emerging of new 6

globalization and emerging of new 7

globalization and emerging of new 8

globalization and emerging of new 9

globalization and emerging of new 10

globalization and emerging of new 12

globalization and emerging of new 13

globalization and emerging of new 14

globalization and emerging of new 15

• Globalization means that humans are tied

globalization and emerging of new 17

This includes diseases caused by a newly identified

globalization and emerging of new 19

• Microbial adaptation; e.g. genetic drift and

globalization and emerging of new 20

globalization and emerging of new 23

globalization and emerging of new 24

globalization and emerging of new 25

• Other infections, called re-emerging

• The report emphasizes that the emergence of

globalization and emerging of new 28

globalization and emerging of new 29

globalization and emerging of new 30

• And natural disasters like floods and

globalization and emerging of new 31

globalization and emerging of new 32

• Urbanization facilitates the emergence of

globalization and emerging of new 35

globalization and emerging of new 36

globalization and emerging of new 38

globalization and emerging of new 39

• Other technological advances have created

globalization and emerging of new 40

globalization and emerging of new 41

globalization and emerging of new 46

globalization and emerging of new 47

globalization and emerging of new 48

globalization and emerging of new 49

globalization and emerging of new 50

globalization and emerging of new 51

• Bioterrorism is the deliberate/intentional/

globalization and emerging of new 52

globalization and emerging of new 53

globalization and emerging of new 54

globalization and emerging of new 55

globalization and emerging of new 56

globalization and emerging of new 60

globalization and emerging of new 61

• International efforts are under way to

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globalization and emerging of new 66

• Strengthen international surveillance

globalization and emerging of new 68

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• What are your reflections to the global