ISSN- 0301-1216
Indian J. Prev. Soc. Med. Vol. 54, No.1, 2023 EDITORIAL
Emerging and Re-emerging infectious diseases in Post COVID-19 era: A call for action MD. Abu Bashar
1, Imran Ahmed Khan
2, Hari Shanker Joshi
3Infectious diseases remain one of the leading causes of morbidity and mortality around the globe accounting for a total of 52 million annual deaths i.e., one third of alldeaths worldwide with half of the world's population remaining at risk of emerging and re-emerging infectious diseases1. The most badly affected are the low-and-middle-income countries;
though a subset of population in high income countries are also under constant threat 2, 3. Iinfectious disease prevention and control have faced significant challenges over the last few decades, although advances in medical science and public health measures have made a number of health threats due to the infectious diseases under control. Eradication of smallpox4 and elimination of polio5, measles6 etc. are few noticeable examples of this success.
Fig. 1: Examples of outbreaks of emerging and remerging infections globally with their geographic location since 1980’s [Adopted from Reference No. 16].
Submission 16.01.2023 Revision 28.01.2023 Accepted 05.02.2023 Printing 30.03.2023
Prior Publication: Nil; Source of Funding: Nil; Conflicts of Interest: None, Article # 530/1101 __________________________
1. Assistant Professor, Department of Community Medicine &Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh; Email: imback20006@yahoo.in
2. Senior Resident, Department of Community Medicine, Baba Raghav Das Medical College, Gorakhpur, UP.
3. Professor & Head, of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, UP.
Corresponding Address: Assistant Professor, Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh; Email: imback20006@yahoo.in
Kastaurika Saikia et al Community voices in attaining health and wellness
Indian J. Prev. Soc. Med Vol. 54, No. 1
2 January - March, 2023
A continuous effort is needed to maintain this scenario. On the other hand, every living creature including the pathogenic microbes tries to evolve and maintain its existence. They adopt various methods for survival in the form of resistance to various antiseptics and antimicrobials7, change their genetic content and morphology through genetic shift and genetic drift8, find new hosts and at times develop a symbiotic relationship with some hosts too9. With the advent of antimicrobials anddevelopment of vaccines, an impression was formed in 1960s and 1970s that the battle against the infectious diseases has been won by the humans 10, 11 but this was later found out to be a misconception. The subsequent epidemics and pandemics, especially the one due to the HIV virus, deconstructed the misconception and reminded us of the threats that infectious diseases continued to pose to human health. However, it seems that lessons from these outbreaks were not well learned, and history repeated itself in form of of SARS-CoV-2, resulting in the severe impact of the COVID-19 pandemic globally.Emerging and re-emerging infectious diseases are commonly zoonotic in origin. Various emerging and re- emerging diseases have been reported across the globe earlier too. The 1918-1919 "Spanish" influenza pandemic, which killed around 50 million people worldwide, remains a baleful warning to public health12. Emerging infectious diseases (EIDs) are described as "infections that have recently manifested in a community or that have existed in the past but are rapidly expanding in incidence or geographic range"13. Infections that existed in the past but are now rapidly increasing in incidence or extending to new geographical areas or human host range are referred to as re-emerging or resurging infections 14. Many re-emergences have been triggered by wars, loss of social lattice, and natural calamities such as earthquakes, floods and climate change demonstrating the importance of factors other than microbial in nature 15. Newly emerging infections are those, in particular, that have not previously been found in man. Some previously known causative organisms may be found responsible for new diseases which are another form of emerging diseases. Some of the outbreaks of emerging and reemerging infectious diseases since 1980s is shown in Fig.1 16
The year 2019 was a new chapter in the history of microbes when the world faced a new and unprecedented pandemic in the form of COVID-19. COVID-19 affected the entire globe irrespective of race, geography, socioeconomic status and almost every aspect of life including but not limited to economy, health, development etc.17. In the absence of effective treatment and specific protection, general preventive measures were the only method available to contain the spread of SARS COV-2 virus18. A number of treatment modalities were tried and tested with varying degrees of success.
These included antivirals19, antibiotics 20, anthelmintics 21, vitamins and other micronutrients 22, traditional medicine and home remedies23. Different guidelines were formulated and revised as per the available evidences by World Health Organization (WHO) and other responsible authorities 24. Few of them were continued and others were questioned and dropped. Then government and NGOs across the globe started working on the development of vaccines on priority basis.
Finally, several vaccines were licensed for immunization against Covid-19 which is still continuing. Covid-19 also disrupted routine immunization and other healthcare activities like tuberculosis management, AIDS control etc.25 The prejudiced use of the country's already limited resources to contain the propagation of COVID-19 pandemic weakened the targets required for infectious disease control. Various emerging and re-emerging infections started propagating owing to this disruption26. A wide variety of microbes (bacteria, rickettsiae, chlamydiae, viruses, fungi, parasites) has been identified as the causative agents. Indiscriminate and unscientific uses of antibiotics during management of suspected and confirmed cases of Covid-19 may develop resistant bacterial infections. Various antiviral agents were also tried without sound scientific rationale. Extensive use of corticosteroids was found behind the alarming increased emergence of Mucormycosis infection 27.
Kastaurika Saikia et al Community voices in attaining health and wellness
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Epidemiology of some of the infectious diseases has also been impacted positively by the Covid-19 pandemic.Several countries reported a decrease in the incidence of infectious diseases during the pandemic period 28 as a result of the implementation of COVID-19 protocol such as the use of face masks, hand washing, physical distancing, restrictions on public gatherings, the closure of shopping malls and educational institutions.
COVID-19 pandemic reminded us few important lessons. Increasing global population, rapid industrialization and deforestation, frequent natural disasters, climate change, war conditions etc., all these factors can lead to disturbance in the harmony of ecosystem. In view of any such pandemic in future, formulating a rationale and targeted comprehensive preparedness plan to design, allocate, and needful utilization of scarce resources should be the top priority. One Health approach (OHA) is very apt in the current scenario which looks at health in the context of interrelationships of human, animal and environment29. Appropriate use of Health Technology assessment (HTA) and implementation may help in proper management of health-related issues 30. Survival requires adaptation to changing environments. We should strive to conserve and maintain the balance between man and nature31.
In the light of available evidence, it is reasonable to anticipate that EIDs/REIDs will continue to present a significant burden due to the interconnection among humans, animals, and the environment. A continuous surveillance is needed for early identification of such emerging and/or re-emerging infectious agents and to plan accordingly with appropriate management of the diseases they cause. This would require involvement of various stakeholders including clinical, pathological (laboratory), epidemiological and public health approaches. In conclusion, implementing better early warning systems and effective disease control and prevention, e.g., effective global surveillance, development of technology for better diagnostics, effective treatments, and vaccines, the global political will to respond to any threats along with multidisciplinary collaboration involving all sectors concerned with human and animal health would be required to combat the challenge of emerging and re-emerging infections in future.
References
1. Rana MS, Usman M, Alam MM, Tahir M, Ikram A, Zaidi SSZ, Kashif M, Massab U, Faryal R, Anas M, Ullah N, Salman M.
Changes in the prevalence of infectious diseases before and after the COVID-19 pandemic in Pakistan. J Infect. 2023: S0163- 4453(23)00025-7.
2. Guerrant RL, Blackwood BL. Threats to global health and survival: the growing crises of tropical infectious diseases—our
“unfinished agenda”. Clinical Infectious Diseases. 1999 May 1; 28 (5):966-86.
3. Butler JC, Crengle S, Cheek JE, Leach AJ, Lennon D, O'Brien KL, Santosham M. Emerging infectious diseases among indigenous peoples. Emerging infectious diseases. 2001; 7 (3 Suppl):554.
4. Henderson DA. The eradication of smallpox–an overview of the past, present, and future. Vaccine. 2011 Dec 30; 29: D7-9.
5. Mohammed A, Tomori O, Nkengasong JN. Lessons from the elimination of poliomyelitis in Africa. Nature Reviews Immunology. 2021 Dec; 21(12):823-8.
6. Perry RT, Gacic-Dobo M, Dabbagh A, Mulders MN, Strebel PM, Okwo-Bele JM, Rota PA, Goodson JL. Global control and regional elimination of measles, 2000–2012. Morbidity and Mortality Weekly Report. 2014 Feb 2; 63 (5):103.
7. Maillard JY, Kampf G, Cooper R. Antimicrobial stewardship of antiseptics that are pertinent to wounds: The need for a united approach. JAC-antimicrobial resistance. 2021 Mar; 3(1): dlab027.
8. Hall JS, TeSlaa JL, Nashold SW, Halpin RA, Stockwell T, Wentworth DE, Dugan V, Ip HS. Evolution of a reassortant North American gull influenza virus lineage: drift, shift and stability. Virology journal. 2013 Dec; 10 (1):1-9.
9. Littman DR, Pamer EG. Role of the commensal microbiota in normal and pathogenic host immune responses. Cell host &
microbe. 2011 Oct 20; 10 (4):311-23.
10. Fauci AS. Infectious diseases: Considerations for the 21st century. Clin. Infect. Dis. 2001; 32:675–85.
11. Spellberg B. Dr. William H. Stewart: Mistaken or maligned? Clin. Infect. Dis. 2008; 47:294.
12. Banholzer N, Van Weenen E, Lison A, Cenedese A, Seeliger A, Kratzwald B, Tschernutter D, Salles JP, Bottrighi P, Lehtinen S, Feuerriegel S. Estimating the effects of non-pharmaceutical interventions on the number of new infections with COVID-19 during the first epidemic wave. PLoS one. 2021 Jun 2; 16 (6):e0252827.
Kastaurika Saikia et al Community voices in attaining health and wellness
Indian J. Prev. Soc. Med Vol. 54, No. 1
4 January - March, 2023
13. Tang JL, Li LM. Importance of public health tools in emerging infectious diseases. bmj. 2021 Dec 2; 375.
14. Celik I, Saatci E, Eyüboğlu AF. Emerging and reemerging respiratory viral infections up to Covid-19. Turkish journal of medical sciences. 2020; 50(9):557-62.
15. Pollard AJ, Dobson SR. Emerging infectious diseases in the 21st century. Current opinion in infectious diseases. 2000 Jun 1;
13 (3):265-75.
16. Morens DM, Fauci AS. Emerging Pandemic Diseases: How We Got to COVID-19. Cell. 2020 Sep 3; 182 (5): 1077-1092.
17. Khan IA, Srivastava DK, Misra S. Assessment of challenges faced by Health Care Workers caring COVID-19 patients at Level-3 COVID-19 Hospital. JMSCR. 2021; 9 (4):58-64.
18. Marya A, Karobari MI, Selvaraj S, Adil AH, Assiry AA, Rabaan AA, Horn R, Venugopal A, Messina P, Scardina GA. Risk perception of SARS-CoV-2 infection and implementation of various protective measures by dentists across various countries.
International Journal of Environmental Research and Public Health. 2021 May 29; 18(11):5848.
19. Burki TK. The role of antiviral treatment in the COVID-19 pandemic. The Lancet Respiratory Medicine. 2022 Feb 1; 10(2):
e18.
20. Adebisi YA, Jimoh ND, Ogunkola IO, Uwizeyimana T, Olayemi AH, Ukor NA, Lucero-Prisno DE. The use of antibiotics in COVID-19 management: a rapid review of national treatment guidelines in 10 African countries. Tropical medicine and health. 2021 Dec; 49(1):1-5.
21. Paumgartten FJ, Oliveira AC. Off label, compassionate and irrational use of medicines in Covid-19 pandemic, health consequences and ethical issues. Ciencia & saude coletiva. 2020 Aug 28; 25:3413-9.
22. Milani GP, Macchi M, Guz-Mark A. Vitamin C in the Treatment of COVID-19. Nutrients. 2021 Apr 1; 13(4):1172.
23. Charan J, Bhardwaj P, Dutta S, Kaur R, Bist SK, Detha MD, Kanchan T, Yadav D, Mitra P, Sharma P. Use of complementary and alternative medicine (CAM) and home remedies by COVID-19 patients: a telephonic survey. Indian Journal of Clinical Biochemistry. 2021 Jan; 36:108-11.
24. Nicola M, O'Neill N, Sohrabi C, Khan M, Agha M, Agha R. Evidence based management guideline for the COVID-19 pandemic-Review article. International Journal of Surgery. 2020 May 1; 77:206-16.
25. Ota MO, Badur S, Romano-Mazzotti L, Friedland LR. Impact of COVID-19 pandemic on routine immunization. Annals of Medicine. 2021 Jan 1; 53(1):2286-97.
26. Ahn JG. Epidemiological changes in infectious diseases during the coronavirus disease 2019 pandemic in Korea: a systematic review. Clinical and Experimental Pediatrics. 2022 Apr; 65(4):167.
27. Singh AK, Singh R, Joshi SR, Misra A. Mucormycosis in COVID-19: a systematic review of cases reported worldwide and in India. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2021 Jul 1; 15 (4):102146.
28. Taubenberger JK, Morens DM. 1918 Influenza: The mother of all pandemics. Rev Biomed. 2006; 17(1):69-79.
29. Destoumieux-Garzón D, Mavingui P, Boetsch G, Boissier J, Darriet F, Duboz P, Fritsch C, Giraudoux P, Le Roux F, Morand S, Paillard C. The one health concept: 10 years old and a long road ahead. Frontiers in veterinary science. 2018:14.
30. Khan IA, Malik N. Few More Lessons Learnt from Covid-19: Health Technology Assessment (HTA) Perspective. National Journal of Community Medicine. 2022 Aug 31; 13(08):576-7.
31. Khan IA, Bashri G. Environment and Health: Need to Rebuild and Maintain Balance. The Indian Practitioner. 2022 Sep; 75 (9): 28-9.
Citation: Bashar Abu MD, Khan IA, Joshi HS. Emerging and Re- emerging infectious diseases in Post COVID-19 era: A call for action. Indian J Prev Soc Med, 2022; 54 (1): 1- 4.
