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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.

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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.

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  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).

    Article  ADS  CAS  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).

    Article  CAS  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).

    Article  ADS  CAS  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).

    Article  CAS  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).

    Article  CAS  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).

    Article  CAS  Google Scholar 

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

    Article  CAS  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).

    Article  CAS  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).

    Article  CAS  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).

    Article  CAS  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).

    Article  CAS  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).

    Article  CAS  Google Scholar 

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

    Article  ADS  CAS  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).

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  ADS  CAS  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).

    Article  CAS  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).

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

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