Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Changing patterns of infectious disease


Despite a century of often successful prevention and control efforts, infectious diseases remain an important global problem in public health, causing over 13 million deaths each year. Changes in society, technology and the microorganisms themselves are contributing to the emergence of new diseases, the re-emergence of diseases once controlled, and to the development of antimicrobial resistance. Two areas of special concern in the twenty-first century are food-borne disease and antimicrobial resistance. The effective control of infectious diseases in the new millennium will require effective public health infrastructures that will rapidly recognize and respond to them and will prevent emerging problems.

Your institute does not have access to this article

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1: The ten leading causes of death in the United States in 1900 and 1997.
Figure 2: Factors influencing the decrease in infectious diseases in the twentieth century.
Figure 3: Factors leading to the emergence of infectious diseases.


  1. Sigerist, H. E. The Great Doctors 372 (Dover Publications, New York, 1971).

  2. Garrett, L. In: AIDS in the World (eds Mann, J. M., Tarantola, D. J. M. & Netter, T. W.) 825–839 (Harvard Univ. Press, Cambridge, Massachusetts, 1992).

  3. Culotta, E. Funding crunch hobbles antibiotic resistance research. Science 264, 362–363 ( 1994).

    ADS  CAS  Article  Google Scholar 

  4. Bax, R. P. Antibiotic resistance: a view from the pharmaceutical industry. Clin. Infect. Dis. 24(Suppl), 5151– 5153 (1997).

    Google Scholar 

  5. Centers for Disease Control and Prevention. 1994 Fact Book 7 (CDC, Atlanta, 1994).

  6. National Center for Health Statistics. Trends and Current Status in Childhood Mortality, United States, 1900–85 (Vital and Health Statistics Series 3, no. 26, US Govt Printing Office, Washington, DC, 1989).

  7. McKeown, T. & Lowe, C. R. An Introduction to Social Medicine (F. A. Davis, Philadelphia, 1966).

  8. Ackerknecht, E. H. History and Geography of the Most Important Diseases (Hafner, London, 1965).

    Google Scholar 

  9. Garrod, L. P., Lambert, H. P. & O'Grady, F. Antibiotic and Chemotherapy 4 (Churchill Livingstone, Edinburgh, 1973).

  10. Armstrong, G. L., Conn, L. A. & Pinner, Y. Trends in infectious disease mortality in the United States during the 20th century. J. Am. Med. Assoc. 281, 61–66 (1999).

    CAS  Article  Google Scholar 

  11. Centers for Disease Control. Poliomyelitis Surveillance Summary 1980-81 (CDC, Atlanta, 1982).

  12. National Center for Health Statistics. Health, United States, 1999 (US Govt Printing Office, Washington, DC, 1999).

  13. World Health Organization. Removing Obstacles to Healthy Development (World Health Organization, Geneva, 1999).

  14. Institute of Medicine. Emerging Infections: Microbial Threats to Health in the United States (National Academy Press, Washington, DC, 1992).

  15. US Department of Commerce, Bureau of the Census. 1990 Census of Population. General Population Characteristics (US Govt Printing Office, Washington, DC, 1990).

  16. Ezzell, C. Care for a dying continent. Sci. Am. 282 (5), 96–105 (2000).

    ADS  CAS  Article  Google Scholar 

  17. Centers for Disease Control and Prevention. National Prevalence of Diabetes in the U.S. Diabetes Fact Sheet (CDC, Atlanta, 1995).

  18. American Cancer Society. Cancer Facts and Figures — 1996 (American Cancer Society, Atlanta, 1996 ).

  19. Fisher-Hoch, S. P. & Hutwagner, L. Opportunistic candidiasis: an epidemic of the 1980s. Clin. Infect. Dis. 21, 897–904 (1995).

    CAS  Article  Google Scholar 

  20. Dixon, D. M., McNeil, M. M., Cohen, M. L., Gellin, B. G. & LaMontagne, J. R. Fungal infections: a growing threat. Publ. Hlth Rep. 111, 226– 239 (1996).

    CAS  Google Scholar 

  21. Nuorti, J. P. et al. Cigarette smoking and invasive pneumococcal disease. N. Engl. J. Med. 342, 681–689 (2000).

    CAS  Article  Google Scholar 

  22. Marx, R., Aral, S. O., Rolfs, R. T., Sterk, C. E. & Kahn, J. G. Crack, sex, and STD. Sex. Transm. Dis. 18, 92–101 (1991).

    CAS  Article  Google Scholar 

  23. Altekruse, S. F., Cohen, M. L. & Swerdlow, D. L. Emerging foodborne diseases. Emerg. Infect. Dis. 3, 285–293 ( 1997).

    CAS  Article  Google Scholar 

  24. Ampel, N. M. et al. Coccidioidomycosis in Arizona: increase in incidence from 1990 to 1995. Clin. Infect. Dis. 27, 1528 –1530 (1998).

    CAS  Article  Google Scholar 

  25. Institute of Medicine. Antimicrobial Resistance: Issues and Options (National Academy Press, Washington, DC, 1998).

  26. McCraig, L. F. & Hughes, J. M. Trends in antimicrobial drug prescribing among office- based physicians in the United States. J. Am. Med. Assoc. 273, 214–219 (1995).

    Article  Google Scholar 

  27. Hennessy, T. W. et al. A national outbreak of Salmonella enteritidis infections from ice cream. N. Engl. J. Med. 334, 1281 –1286 (1996).

    CAS  Article  Google Scholar 

  28. Garrett, L. The Coming Plague: Newly Emerging Diseases in a World out of Balance (Farrar, Straus, & Giroux, New York, 1993).

    Google Scholar 

  29. Hjelle, B. & Glass, G. E. Outbreak of hantavirus infection in the Four Corners region of the United States in the wake of the 1997–1998 El Nino — Southern Oscillation. J. Infect. Dis. 181, 1569–1573 (2000).

    CAS  Article  Google Scholar 

  30. Daniels, N. A. et al. Vibrio parahaemolyticus infections in the United States, 1973–1998. J. Infect. Dis. 181, 1661 –1666 (2000).

    Google Scholar 

  31. Centers for Disease Control and Prevention. Outbreaks of influenza A infections among travelers – Alaska and the Yukon territories. Morbid. Mortal. Weekly Rep. 48, 545– 556 (1999).

  32. Centers for Disease Control and Prevention. Outbreak of West Nile-like viral encephalitis — New York, 1999. Morbid. Mortal. Weekly Rep. 48, 845–848 (1999).

  33. Herwaldt, B. L., Ackers, M.L. and the Cyclospora Working Group. An outbreak in 1996 of cyclosporiosis associated with imported raspberries . N. Engl. J. Med. 336, 1548– 1556 (1997).

    CAS  Article  Google Scholar 

  34. Whittam, T. S. et al. Clonal relationships among Escherichia coli strains that cause hemorrhagic colitis and infantile diarrhea. Infect. Immun. 61, 1619–1629 ( 1993).

    CAS  Google Scholar 

  35. Bloom, B. R. & Murray, C. J. L. Tuberculosis: commentary on a reemergent killer. Science 257, 1055– 1064 (1992).

    ADS  CAS  Article  Google Scholar 

  36. Cantwell, M. F. & Binkin, N. J. Tuberculosis in sub-Saharan Africa: a regional assessment of the impact of the human immunodeficiency virus and National Tuberculosis Control Program quality. Tubercle Lung Dis. 77, 220–225 ( 1996).

    CAS  Article  Google Scholar 

  37. Mead, P. S. et al. Food-related illness and death in the United States. Emerg. Infect. Dis. 5, 607–625 (1999).

    CAS  Article  Google Scholar 

  38. Cohen, M.L. Epidemiology of drug resistance: implications for a post-antimicrobial era . Science 257, 1050–1055 (1992).

    ADS  CAS  Article  Google Scholar 

  39. Centers for Disease Control and Prevention. National nosocomial infections surveillance (NNIS) report, data summary from January 1990–May 1999, issued June 1999. Am. J. Infect. Control 27, 520–532 (1999).

  40. Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin. Morbid. Mortal. Weekly Rep. 48, 1165– 1167 (2000).

  41. Ries, A. A. et al. Epidemic Shigella dysenteriae type 1 in Burundi: panresistance, and implications for prevention. J. Infect. Dis. 169 , 1035–1041 (1994).

    CAS  Article  Google Scholar 

  42. Lee, L. A. et al. Increase in antimicrobial-resistant Salmonella infections in the United States, 1989–1990. J. Infect. Dis. 170, 18–34 (1994).

    Google Scholar 

  43. Centers for Disease Control and Prevention National Antimicrobial Resistance Monitoring System: Enteric Bacteria. 1998 Annual Report (CDC, Atlanta, 1999).

  44. Centers for Disease Control and Prevention. Geographic variation in penicillin resistance in Streptococcus pneumoniae — selected sites, United States, 1997. Morbid. Mortal. Weekly Rep. 48, 656–661 ( 1999).

  45. Centers for Disease Control and Prevention. Preventing Emerging Infectious Diseases. A Strategy for the 21st Century (US Department of Health and Human Services, Atlanta, 1998).

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and Permissions

About this article

Cite this article

Cohen, M. Changing patterns of infectious disease. Nature 406, 762–767 (2000).

Download citation

  • Issue Date:

  • DOI:

Further reading


By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate.


Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing