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EDITORIAL Emerging infectionsöa coordinated European approach R. Wise Department of Medical Microbiology, City Hospital NHS Trust, Dudley Road, Birmingham, UK There is a grim fascination in observing the appearance of new infectious diseases, many of which pose a signi®cant risk to human health. In 1992 the US Institute of Medicine [1] was `con®dent that new diseases will emerge, although it is impos- sible to predict their individual emergence in time and place'. This prediction has most certainly come true and no doubt will continue to cause concern in the coming years. Can the governments of the European Union EU) harmonize and improve their response to such threats? Recently we have seen the avian in¯uenza H5NI in humans in China and Hong Kong [2], which most certainly caused major global concerns. Nipah virus in Malaysia [3], West Nile Fever in New York [4] and, recently, Lassa fever cases from Africa [5] all posed a threat primarily to civilians. With Western governments engaged in peace-keeping operations in many parts of the world, other threats are possible. For example, in Kosovo [6], typhus, tularemia and Congo hemorrhagic fever are real threats to the military. Overall this must be added to the concerns of urban bio-terrorist attack [7]. The reasons new diseases appear are intriguing but are most probably related to man's disturbance of an environment where viruses and bacteria have coexisted with animals, allowing an increase in the numbers of either the pathogen or its animal host [8]. Deforestation has invited hemorrhagic fevers into the human population of South America; re-forestation has encour- aged Lyme disease. Importing exotic birds or altered migratory patterns) may be behind the New York West Nile fever, and man interfering with the previously sequestered world of some wild animals is associated with risk of Hanta virus, Marburg and Ebola infections. Yellow fever could be considered an older example with the virus living in monkeys in the tree canopy of West Africa and then spreading to the New World. Changing agricultural practices with increasing contact with mosquitoes, or allowing them to breed in urban areas, plays an important role in dengue, Japanese encephalitis and the LaCross and California group of encephalitis pathogens. Add tothiswarfare the cause of epidemics down the centuries), global warming and tourism and there is ample reason for governments to be concerned. The role that the Center for Diseases Control and Prevention CDC) in Atlanta has had in investigating and controlling emerging problems together with teaching and research) can- not be underestimated. The ability to bring to a potential problem a wide breadth of talent is formidable and is the most obvious way to approach an unknown threat. But what response can the EU mount, or should we rely upon the US? The expanded EU will stretch from arctic tundra to Med- iterranean shores and will have a population well in excess of that of the US; it will increasingly be involved in military ventures, hopefully of a peace-keeping nature. There is a need for a ¯exible and coordinated response to future infection threats. In the UK there is considerable expertise at the Centre for Applied Micro- biology Research Salisbury and the Public Health Laboratory Service. There are centers of excellence around Europe, such as Pasteur Institutes, the Max Planck Institute and national centers of tropical medicine. The concept of a European Center for Infectious Diseases ECID) was raised 2 years ago, to a very mixed response. The Lancet [9] was antagonistic to another European institution and favored the current network possibly being deve- loped into a `virtual' organization. The proponents who formed a steering group [10] felt very different. It is so easy to see both sides of the argument. Public health is such a political issue, one can understand that the government of one country might not take kindly to a multinational task force entering a Member State to take control of a possible emergency. On the other hand, is any one country totally equipped to diagnose and advise on an unknown threat? The answer must be no. There is a great danger that the matter may well degenerate into `Euro-bicker- ing' with no meaningful progress. There must be considerable doubts if another large European agency modeled on CERN or the Space Agency is appropriate. A middle road seems appro- priate, perhaps a modest central agency with ®rm links to a number of national centers committed and funded to offer diagnostic expertise and clinical advice including a `®re-®ghting' capacity) to member countries. Research could be organized on a less piecemeal basis, with ®eld stations in a number of places in the less developed world being an important aspect of their work in order to monitor epidemiological changes. This would, of course, bene®t both the EU and those less developed countries. ß 2001 Copyright by the European Society of Clinical Microbiology and Infectious Diseases Corresponding author and reprint requests: R. Wise, Department of Medical Microbiology, City Hospital NHS Trust, Dudley Road, Birmingham B18 7QH, UK Tel: 44 21 554 3801 Fax: 44 21 551 7763 E-mail: [email protected]

Emerging infections—a coordinated European approach

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Page 1: Emerging infections—a coordinated European approach

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