jueves, 31 de mayo de 2018

Setting Priorities

Dear Colleagues,
The ProMED "latest" tab this morning posts reports of outbreaks of MERS-CoV in Abu Dhabi, Ebola in the DRC, Nipah in India, and Crimean-Congo hemorrhagic fever in Uganda.
I was struck by this because these are four of the diseases with potential to cause an epidemic of international proportions that a WHO-convened expert panel have prioritized because of their likelihood of emergence and the absence of efficacious prevention and treatment options. One doesn't need to search too far to find recent ProMED reports on Lassa fever, Rift Valley fever, and Zika, other diseases on the priority list. In fact, the only disease on the most recent Blueprint for Research and Development preparedness roster that hasn't had a report in ProMED in the past two weeks is Disease X, which by definition is an as yet nameless illness caused by a pathogen currently unknown to cause human disease (although it may be in there among the "undiagnosed" diseases that ProMED covers).
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The WHO effort to drive cross-cutting research and development began in 2015; the list of top targets has been updated twice since then. An outbreak of any of these diseases could conceivably lead to a serious global public health emergency, as could the many other disease that were discussed and considered by the panel.
Much work needs to be done. At present no vaccines or antiviral drugs are available for Nipah Virus disease; the treatment is solely supportive and current prevention strategies focus on raising disease awareness in affected areas. The same is true for CCHF. Use of an experimental vaccination against the Ebola virus disease was launched in the DRC last week targeting front-line health professionals, people who have been in contact with confirmed cases of Ebola, and contacts of these contacts. While no vaccine or specific treatment has been developed for MERS-CoV, improved infection prevention and control practices in hospitals have significantly reduced the number of hospital-acquired cases since 2015. Further research is needed to understand and mitigate the threats posed by these diseases; investment in the development of preventive vaccines, diagnostics, and treatments is crucial.

Bats, particularly fruit bats from the Pteropodidae family, are believed to form the natural reservoir of Nipah Virus. The primary Ebola host may also be bats, but the virus has been detected in chimpanzees, gorillas, monkeys, antelopes, and other mammals, too. Current scientific evidence suggests dromedary camels are a major reservoir host for MERS-CoV and an animal source of MERS infection in humans. CCHF is caused by the tick-borne bunyavirus; its wide geographic range correlates with the global distribution of the Hyalomma tick. A parallel R&D effort spurred by global consensus on an animal health blueprint could be vital to curtailing spill-over; the development of new animal vaccines may contribute to the prevention of public health emergencies.
ProMED can play a major role in these efforts. The WHO is clear that, in addition to vaccines and treatments, we must make advances in disease surveillance to effectively address the challenge. ProMED is a major force in international disease surveillance, collecting and disseminating news and expert commentary to over 90,000 subscribers worldwide. The zoonotic nature of these emerging diseases requires an interdisciplinary approach. ProMED's long-standing commitment to the One Health perspective is evident in its reporting, through its attention to animal, plant, and human disease surveillance reports. But ProMED can only contribute if you contribute.  Please support our work - please donate to ProMED today. Thank you, and
Best regards,
Larry Madoff, MD
Editor, ProMED-mail
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