Biology:Emerging infectious disease

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Short description: New or rapidly increasing disease

When Anthony Fauci became director of the NIAID, he drew a map of the world for presentation at a congressional hearing that showed a single notable emerging infectious disease threat: HIV. Since then, he has continually updated the map, now showing the emergence of numerous infectious disease threats to illustrate the experiences of his years in office as well as highlighting certain infections that had emerged before HIV.[1]

An emerging infectious disease (EID) refer to infectious diseases that have either newly appeared in a population or have existed but are rapidly increasing in incidence, geographic range, or severity due to factors such as environmental changes, antimicrobial resistance, and human-animal interactions.[2][3] The minority that are capable of developing efficient transmission between humans can become major public and global concerns as potential causes of epidemics or pandemics.[4] Their many impacts can be economic and societal, as well as clinical.[5] EIDs have been increasing steadily since at least 1940.[6]

For every decade since 1940, there has been a consistent increase in the number of EID events from wildlife-related zoonosis. Human activity is the primary driver of this increase, with loss of biodiversity a leading mechanism.[7]

Emerging infections account for at least 12% of all human pathogens.[8] EIDs can be caused by newly identified microbes, including novel species or strains of virus[9] (e.g. novel coronaviruses, ebolaviruses, HIV). Some EIDs evolve from a known pathogen, as occurs with new strains of influenza. EIDs may also result from spread of an existing disease to a new population in a different geographic region, as occurs with West Nile fever outbreaks. Some known diseases can also emerge in areas undergoing ecologic transformation (as in the case of Lyme disease[10]). Others can experience a resurgence as a re-emerging infectious disease, like tuberculosis[11] (following drug resistance) or measles.[12] Nosocomial (hospital-acquired) infections, such as methicillin-resistant Staphylococcus aureus are emerging in hospitals, and are extremely problematic in that they are resistant to many antibiotics.[13] Of growing concern are adverse synergistic interactions between emerging diseases and other infectious and non-infectious conditions leading to the development of novel syndemics.

Many EID are zoonotic,[4] deriving from pathogens present in animals, with only occasional cross-species transmission into human populations.[14] For instance, most emergent viruses are zoonotic[4] (whereas other novel viruses may have been circulating in the species without being recognized, as occurred with hepatitis C[15]).

History of the concept of emerging infectious diseases

The French doctor Charles Anglada (1809–1878) wrote a book in 1869 on extinct and new diseases.[16] He did not distinguish infectious diseases from others (he uses the terms reactive and affective diseases, to mean diseases with an external or internal cause, more or less meaning diseases with or without an observable external cause). He writes in the introduction:

A widely held opinion among physicians admits the invariability of pathologies. All the illnesses which have existed or which have an outbreak around us are categorized according to arrested and preconceived types, and must enter one way or the other into the frameworks established by the nosologists. History and observation protest wildly against this prejudice, and this is what they teach: Diseases which have disappeared and whose traces are confined to the archives of science, are followed by other diseases, unknown to the contemporary generation, and which come for the first time to assert their rights. In other words, there are extinct and new diseases.

Charles Nicolle, laureate of the Nobel Prize in Physiology or Medicine elaborated the concept of emergence of diseases in his 1930 book Naissance, vie et mort des maladies infectieuses (Birth, Life and Death of Infectious Diseases), and later in Destin des maladies infectieuses (Fate of Infectious Diseases)[17] published in 1933 which served as lecture notes for his teaching of a second year course at the Collège de France. In the introduction of the book he sets out the program of the lectures:

It is this historical existence, this destiny that will be the subject of our talks. I will have to answer, to the extent that our current knowledge allows, questions that you have asked yourself, that every thoughtful or simply curious mind asks: have the infectious diseases that we observe today always existed? Or have some of them appeared in the course of history? Can we assume that new ones will appear? Can we assume that some of these diseases will disappear? Have some of them already disappeared? Finally, what will become of humanity and domestic animals if, as a result of more and more frequent contacts between people, the number of infectious diseases continues to increase?

The term emerging disease has been in use in scientific publications since the beginning of the 1960s at least[18] and is used in the modern sense by David Sencer in his 1971 article "Emerging Diseases of Man and Animals"[19] where in the first sentence of the introduction he implicitly defines emerging diseases as "infectious diseases of man and animals currently emerging as public health problems" and as a consequence also includes re-emerging diseases:

Infectious diseases of man and animals currently emerging as public health problems include some old acquaintances and some that are new in respect to identity or concept.

He also notes that some infectious agents are newly considered as diseases because of changing medical technologies:

But there are also many familiar organisms formerly considered nonpathogenic that are now associated with nosocomial infections, use of artificial kidneys, and the acceptance or rejection of organ transplants, for example.

He concludes the introduction with a word of caution:

And so infectious disease, one of man's oldest enemies, survives as an adversary that calls forth our best efforts.

However, to many people in the 1960s and 1970s the emergence of new diseases appeared as a marginal problem, as illustrated by the introduction to the 1962 edition of Natural History of Infectious Disease by Macfarlane Burnet:[20]

to write about infectious disease is almost to write of something that has passed into history

as well as the epilogue of the 1972 edition:[21]

On the basis of what has happened in the last thirty years, can we forecast any likely developments for the 1970s? If for the present we retain a basic optimism and assume no major catastrophes occur [...] the most likely forecast about the future of infectious disease is that it will be very dull. There may be some wholly unexpected emergence of a new and dangerous infectious disease, but nothing of the sort has marked the past fifty years.

Throughout the 20th century until 1980, with the exception of the 1918 Spanish flu pandemic, the death rate from infectious diseases in the United States was steadily decreasing. However, because of the AIDS epidemic, the death rate from infectious diseases increased by 58% between 1980 and 1992.

The concept gained more interest at the end of the 1980s as a reaction to the AIDS epidemic. On the side of epistemology, Mirko Grmek worked on the concept of emerging diseases while writing his book on the history of AIDS[22] and later in 1993 published an article[23] about the concept of emerging disease as a more precise notion than the term "new disease" that was mostly used in France at that time to qualify AIDS among others.

Also under the shock of the emergence of AIDS, epidemiologists wanted to take a more active approach to anticipate and prevent the emergence of new diseases. Stephen S. Morse from The Rockefeller University in New York was chair and principal organizer of the NIAID/NIH Conference "Emerging Viruses: The Evolution of Viruses and Viral Diseases" held 1–3 May 1989 in Washington, DC. In the article summarizing the conference the authors write:[24]

Challenged by the sudden appearance of AIDS as a major public health crisis [...] jointly sponsored the conference "Emerging Viruses: The Evolution of Viruses and Viral Diseases" [...] It was convened to consider the mechanisms of viral emergence and possible strategies for anticipating, detecting, and preventing the emergence of new viral diseases in the future.

They further note:

Surprisingly, most emergent viruses are zoonotic, with natural animal reservoirs a more frequent source of new viruses than is the sudden evolution of a new entity. The most frequent factor in emergence is human behavior that increases the probability of transfer of viruses from their endogenous animal hosts to man.

In a 1991 paper[25] Morse underlines how the emergence of new infectious diseases (of which the public became aware through the AIDS epidemic) is the opposite of the then generally expected retreat of these diseases:

The striking successes achieved with antibiotics, together with widespread application of vaccines for many previously feared viral diseases, made it appear to many physicians and the public that infectious diseases were retreating and would in time be fully conquered. Although this view was disputed by virologists and many specialists in infectious diseases, it had become a commonplace to suggest that infectious diseases were about to become a thing of the past [...].

As a direct consequence of the 1989 conference on emerging viruses, the Institute Of Medicine convened in February 1991 the 19-member multidisciplinary Committee on Emerging Microbial Threats to Health, co-chaired by Joshua Lederberg and Robert Shope, to conduct an 18-month study. According to the report produced by the committee in 1992,[26] its charge "was to identify significant emerging infectious diseases, determine what might be done to deal with them, and recommend how similar future threats might be confronted to lessen their impact on public health." The report recommended setting up a surveillance program to recognize emerging diseases and proposed methods of intervention in case an emergent disease was discovered.

A well-designed, well-implemented surveillance program can detect unusual clusters of disease, document the geographic and demographic spread of an outbreak, and estimate the magnitude of the problem. It can also help to describe the natural history of a disease, identify factors responsible for emergence, facilitate laboratory and epidemiological research, and assess the success of specific intervention efforts.

The proposed interventions were based on the following: the U.S. public health system, research and training, vaccine and drug development, vector control, public education and behavioral change. A few years after the 1989 Emerging Viruses conference and the 1992 IOM report, the Program for Monitoring Emerging Diseases (ProMED) was formed by a group of scientists as a follow-up in 1994[27] and the Centres for Disease Control (CDC) launched the Emerging Infectious Diseases journal in 1995.[18]

A decade later the IOM convened the Committee on Emerging Microbial Threats to Health in the 21st Century which published its conclusions in 2003.[28]

In April 2000 the WHO organized a meeting on Global Outbreak Alert and Response,[29] which was the founding act of the Global Outbreak Alert and Response Network.

In 2014, the Western African Ebola virus epidemic demonstrated how ill-prepared the world was to handle such an epidemic. In response, the Coalition for Epidemic Preparedness Innovation was launched at the World Economic Forum in 2017 with the objective of accelerating the development of vaccines against emerging infectious diseases to be able to offer them to affected populations during outbreaks.[30] CEPI promotes the idea that a proactive approach is required to "create a world in which epidemics are no longer a threat to humanity".[31]

Classification

One way to classify emerging infections diseases is by time and how humans were involved in the emergence:[32]

  • Newly emerging infectious diseases – diseases that were not previously described in humans, such as SARS-CoV-2 (COVID-19) and MERS
  • Re-emerging infectious diseases – diseases that have spread to new places or which previous treatments no longer control, such as methicillin-resistant Staphylococcus aureus, tuberculosis (due to drug resistance, measles (due to declining vaccination rates), and cholera (due to climate-related factors)
  • Deliberately emerging infectious diseases – diseases created by humans for bioterrorism, such as bioterrorism-related agents like anthrax and smallpox
  • Accidentally emerging infectious diseases – diseases created or spread unintentionally by humans, such as vaccine-derived poliovirus

Contributing factors

The 1992 IOM report[26] distinguished six factors contributing to emergence of new diseases (Microbial adaptation and change; Economic development and land use; Human demographics and behavior; International travel and commerce; Technology and industry; Breakdown of public health measures) which were extended to 13 factors in the 2003 report[28] (Chapter 3 of the report detailing each of them):

  • Microbial adaptation and change
  • Human susceptibility to infection
  • Climate and weather
  • Changing ecosystems
  • Human demographics and behavior
  • Economic development and land use
  • International travel and commerce
  • Technology and industry
  • Breakdown of public health measures
  • Poverty and social inequality
  • War and famine
  • Lack of political will
  • Intent to harm

Their classification serves as a basis for many others. The following table gives examples for different factors:

Factor of emergence Example
Microbial adaption Genetic drift and genetic shift in Influenza A
Changing human susceptibility Mass immunocompromisation with HIV/AIDS
Climate change Diseases transmitted by animal vectors such as mosquitoes (e.g. West Nile fever or dengue) are moving further from the tropics as the climate warms. By increasing the range of these animal vectors, the diseases are appearing in previously unaffected regions.
Changes in human demographics and travel facilitating rapid global spread Globalization and travel facilitates the rapid spread of pathogens, ex SARS-related coronaviruses
Economic development Use of antibiotics to increase meat yield of farmed cows leads to antibiotic resistance
War and famine Clearing of animal habitats that increase the range of diseases such as ebola
Inadequate public health services
Poverty and social inequality Tuberculosis is primarily a problem in low-income areas
Bioterrorism 2001 Anthrax attacks
Land use Dam construction and irrigation systems can encourage malaria and other mosquito-borne diseases
Use of indiscriminate pesticides in industrial farming reduces/eliminates biological controls (e.g. dragonflies, amphibians, insectivorous birds, spiders) of known disease vectors (e.g. mosquito, tick, biting midge).

Deforestation and habitat destruction increase human exposure to zoonotic pathogens, Nipah virus which is linked to bat-to-human transmission.

Anti-vaccination or Vaccine hesitancy Re-emergence of measles[33][34]
Wildlife trade

Climate change and environmental drivers

Climate change has emerged as a significant driver of emerging infectious diseases by altering ecosystems, vector distribution, and patterns of human–animal interaction. Rising global temperatures and changes in precipitation patterns expand the geographic range of vectors such as mosquitoes and ticks, facilitating the spread of diseases like dengue, malaria, Lyme disease, and West Nile virus into previously unaffected regions.[35][36]

Environmental disruptions such as deforestation, biodiversity loss, and habitat fragmentation increase contact between humans and wildlife, raising the likelihood of zoonotic spillover events. Reduced biodiversity has been associated with increased transmission of certain pathogens, as ecological imbalance may favor reservoir species that carry infectious agents.[37]

Extreme weather events, including floods, droughts, and heatwaves, can further influence disease dynamics by disrupting infrastructure, displacing populations, and compromising sanitation systems. These conditions can lead to outbreaks of waterborne and vector-borne diseases, particularly in vulnerable populations.[38]

The interconnected impacts of climate, ecosystems, and human health are often described within a One Health framework, which emphasizes the integration of environmental, animal, and human health systems in understanding and mitigating emerging infectious diseases.[39]

Zoonotic diseases

Zoonotic diseases, originating from animal sources, pose a significant threat to human health. Proximity to wildlife, and climate change have created favorable conditions for the transmission of zoonotic diseases, leading to outbreaks such as Zika, Ebola, and COVID-19. Up to 75% of emerging infectious diseases are zoonotic, originating from viruses and other pathogens that are transmitted from animals to humans. Understanding the mechanisms of transmission, the role of wildlife trade, and the importance of surveillance and early detection is crucial for mitigating the impact of zoonotic diseases on human health. Surveillance efforts involving wastewater have been identified as valuable tools for detecting early warning signs of disease emergence and providing timely interventions.[40][41]

List

NIAID list of Biodefense and Emerging Infectious Diseases

The U.S. National Institute of Allergy and Infectious Diseases (NIAID) maintains a list of Biodefense and Emerging Infectious Diseases. The list is categorized by biodefense risk, which is mostly based on biological warfare and bioterrorism considerations. As of 2004, it recognized the following emerging and re-emerging diseases.[42]

Newly recognized (since the 1980s):

Re-emerging:

Diseases with bioterrorism potential, CDC category A (most dangerous):

Diseases with bioterrorism potential, CDC category B:

Diseases with bioterrorism potential, CDC category C (least dangerous):

Since 2004, NIAID has added to its biodefense emerging pathogen list:[43]

NIAID also monitors antibiotic resistance, which can become an emerging threat for many pathogens.

WHO list of most important emerging infectious diseases

In December 2015, the World Health Organization held a workshop on prioritization of pathogens "for accelerated R&D for severe emerging diseases with potential to generate a public health emergency, and for which no, or insufficient, preventive and curative solutions exist."[44] The result was a list containing the following six diseases:

These were selected based on the following measures:

  1. Human transmissibility (including population immunity, behavioural factors, etc.)
  2. Severity or case fatality rate
  3. Spillover potential
  4. Evolutionary potential
  5. Available countermeasures
  6. Difficulty of detection or control
  7. Public health context of the affected area(s)
  8. Potential scope of outbreak (risk of international spread)
  9. Potential societal impacts

Newly reported infectious diseases

In 2007 Mark Woolhouse and Eleanor Gaunt established a list of 87 human pathogens first reported in the period between 1980 and 2005.[45] These were classified according to their types.

Numbers of pathogen species by taxonomic category
Number of species

known in 2005

Number of species

reported from 1980 to 2005

TOTAL 1399 87
Bacteria 541 11
Fungi 325 13
Helminths 285 1
Prions 2 1
Protozoa 57 3
Viruses 189 58
DNA viruses 36 9
RNA viruses 153 49

Major outbreaks

The following table summarizes the major outbreaks since 1998 caused by emerging or re-emerging infectious diseases.[46]

Disease Country or region Year of start of outbreak
Ngari virus[47] Kenya, Tanzania, Somalia 1998
Nipah virus Malaysia 1998
West Nile virus US 1999
Itaya virus[48] Peru 1999
Rift Valley fever Saudi Arabia and Yemen 2000
EBLV-2 Scotland 2002
SARS-CoV 2002
Influenza A virus subtype H7N2 2002
Monkeypox US 2003
Chapare virus Bolivia 2003
Plague Algeria 2003
HTLV-3, HTLV-4 Cameroon 2005
Melaka virus Malaysia 2006
LuJo virus southern Africa 2008
Multi-drug resistant P. falciparum South-East Asia 2008
Candida auris 2009
Heartland virus US 2009
Bas-Congo virus DRC 2009
Lassa fever Mali 2009
Pandemic H1N1/09 virus Global pandemic 2009
Huaiyangshan banyangvirus 2009
Plague Libya 2009
Cholera Haiti 2010
Lassa fever Ghana 2011
Plasmodium cynomolgi[49] Malaysia 2011
H3N2v 2011
MERS -CoV 2012
Mojiang paramyxovirus[50] 2012
H7N9 2013
Sosuga pararubulavirus 2013
H10N8[51] 2013
Chikungunya Caribbean 2013
Variegated Squirrel Bornavirus 1 (de) 2013
Colpodella sp. Heilongjiang[52] China 2013
Ebola virus disease[53] West Africa 2014
H5N6 2014
Lassa fever Benin 2014
Bourbon virus US 2014
Zika virus[54] Americas 2015
Crimean–Congo hemorrhagic fever Spain 2016
Chikungunya Pakistan 2016
Lassa fever Togo 2016
Ntwetwe virus[55] Uganda 2016
Monkeypox Nigeria 2017
Yellow fever Brazil 2017
Rat hepatitis E virus[56] 2017
Guinea worm Chad 2018
Lyme disease 2018
H7N4 2018
Monkeypox Liberia, UK 2018
Nipah virus India 2018
COVID-19[14] Global pandemic 2019

Methicillin-resistant Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus (MRSA) evolved from methicillin-susceptible Staphylococcus aureus (MSSA), otherwise known as common S. aureus. Many people are natural carriers of S. aureus, without being affected in any way. Infections occur in healthcare settings (Healthcare acquired-MRSA) and in the community (Community acquired-MRSA), often leading to severe skin infections, pneumonia, and bloodstream infections. Community-acquired MRSA, is increasingly found in healthy individuals such as athletes, prisoners, and schoolchildren outside of hospital settings.[57] MSSA was treatable with the antibiotic methicillin until it acquired the gene for antibiotic resistance.[13] MRSA is a major public health threat due to its resistance to antibiotics.[58] Through genetic mapping of various strains of MRSA, scientists have found that MSSA acquired the mecA gene in the 1960s, which accounts for its pathogenicity, before this it had a predominantly commensal relationship with humans. It is theorized that when this S. aureus strain that had acquired the mecA gene was introduced into hospitals, it came into contact with other hospital bacteria that had already been exposed to high levels of antibiotics. When exposed to such high levels of antibiotics, the hospital bacteria suddenly found themselves in an environment that had a high level of selection for antibiotic resistance, and thus resistance to multiple antibiotics formed within these hospital populations. When S. aureus came into contact with these populations, the multiple genes that code for antibiotic resistance to different drugs were then acquired by MRSA, making it nearly impossible to control.[59] It is thought that MSSA acquired the resistance gene through the horizontal gene transfer, a method in which genetic information can be passed within a generation, and spread rapidly through its own population as was illustrated in multiple studies.[60] Horizontal gene transfer speeds the process of genetic transfer since there is no need to wait an entire generation time for gene to be passed on.[60] Since most antibiotics do not work on MRSA, physicians have to turn to alternative methods based in Darwinian medicine. Efforts to combat MRSA include improved tracking,[61] enhanced hospital hygiene protocols to reduce healthcare-associated infections,[62] and development of new antimicrobial agents and alternative therapies, such as bacteriophage therapy.[63] However, prevention is the most preferred method of avoiding antibiotic resistance.[61]

Scientific Advisory Group for Origins of Novel Pathogens

On 16 July 2021, the Director-General of WHO announced the formation of the Scientific Advisory Group for Origins of Novel Pathogens (SAGO),[64][65][66] which is to be a permanent advisory body of the organisation. The Group was formed with a broad objective to examine emerging infectious diseases, including COVID-19.[64][67] The group's primary objective is to provide scientific guidance on identifying the origins of emerging pathogens, including SARS-CoV-2.[68] The group has also recommended enhanced global surveillance systems.[69] According to the WHO Director-General, "SAGO will play a vital role in the next phase of studies into the origins of SARS-CoV-2, as well as the origins of future new pathogens."[64]

See also

References

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  3. ↑ A brief guide to emerging infectious diseases and zoonoses. WHO Regional Office for South-East Asia. 2014. ISBN 9789290224587. https://apps.who.int/iris/handle/10665/204722. 
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  44. ↑ "Blueprint for R&D preparedness and response to public health emergencies due to highly infectious pathogens" (in en). https://www.who.int/who-documents-detail/blueprint-for-r-d-preparedness-and-response-to-public-health-emergencies-due-to-highly-infectious-pathogens. 
  45. ↑ "Ecological origins of novel human pathogens". Critical Reviews in Microbiology 33 (4): 231–242. January 2007. doi:10.1080/10408410701647560. PMID 18033594. 
  46. ↑ "Emerging infections: how and why they arise". 27 February 2019. https://www.gov.uk/government/publications/emerging-infections-characteristics-epidemiology-and-global-distribution/emerging-infections-how-and-why-they-arise. 
  47. ↑ "Ngari virus is a Bunyamwera virus reassortant that can be associated with large outbreaks of hemorrhagic fever in Africa". Journal of Virology 78 (16): 8922–8926. August 2004. doi:10.1128/JVI.78.16.8922-8926.2004. PMID 15280501. 
  48. ↑ "Itaya virus, a Novel Orthobunyavirus Associated with Human Febrile Illness, Peru". Emerging Infectious Diseases 21 (5): 781–788. May 2015. doi:10.3201/eid2105.141368. PMID 25898901. 
  49. ↑ "Rare human outbreak of monkey malaria detected in Malaysia" (in en). Nature: d41586–018–04121–4. 2018-04-16. doi:10.1038/d41586-018-04121-4. ISSN 0028-0836. http://www.nature.com/articles/d41586-018-04121-4. 
  50. ↑ "Novel Henipa-like virus, Mojiang Paramyxovirus, in rats, China, 2012". Emerging Infectious Diseases 20 (6): 1064–1066. June 2014. doi:10.3201/eid2006.131022. PMID 24865545. 
  51. ↑ "Emergence in China of human disease due to avian influenza A(H10N8)--cause for concern?". The Journal of Infection 68 (3): 205–215. March 2014. doi:10.1016/j.jinf.2013.12.014. PMID 24406432. 
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  53. ↑ "The emergence of ebola as a global health security threat: from 'lessons learned' to coordinated multilateral containment efforts". Journal of Global Infectious Diseases 6 (4): 164–177. October 2014. doi:10.4103/0974-777X.145247. PMID 25538455. 
  54. ↑ "The Emergence of Zika Virus as a Global Health Security Threat: A Review and a Consensus Statement of the INDUSEM Joint working Group (JWG)". Journal of Global Infectious Diseases 8 (1): 3–15. 11 February 2016. doi:10.4103/0974-777X.176140. PMID 27013839. 
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  58. ↑ "Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic". Clinical Microbiology Reviews 23 (3): 616–687. July 2010. doi:10.1128/CMR.00081-09. PMID 20610826. 
  59. ↑ "Evolution of hypervirulence by a MRSA clone through acquisition of a transposable element". Molecular Microbiology 93 (4): 664–681. August 2014. doi:10.1111/mmi.12682. PMID 24962815. 
  60. ↑ 60.0 60.1 "Horizontal gene transfer". Journal of Genetics 75 (2): 219–232. 1996. doi:10.1007/bf02931763. 
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  62. ↑ "Evidence that contaminated surfaces contribute to the transmission of hospital pathogens and an overview of strategies to address contaminated surfaces in hospital settings". American Journal of Infection Control 41 (5 Suppl): S6-11. May 2013. doi:10.1016/j.ajic.2012.12.004. PMID 23622751. 
  63. ↑ "Bacteriophage Therapy for Staphylococcus Aureus Infections: A Review of Animal Models, Treatments, and Clinical Trials". Frontiers in Cellular and Infection Microbiology 12. 2022-06-17. doi:10.3389/fcimb.2022.907314. PMID 35782148. 
  64. ↑ 64.0 64.1 64.2 Staff (16 July 2021). "WHO Director-General's opening remarks at the Member State Information Session on Origins". World Health Organization. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-member-state-information-session-on-origins. 
  65. ↑ "With call for 'raw data' and lab audits, WHO chief pressures China on pandemic origin probe - A new team of scientists may replace agency group already probing the start of COVID-19". Science. 17 July 2021. https://www.science.org/news/2021/07/who-chief-sharpens-call-china-further-help-probe-origin-pandemic. 
  66. ↑ "New WHO group aims to improve efforts to find pathogen origins - The World Health Organization's Maria Van Kerkhove on the hunt for COVID-19 origins and what's next". Science. 25 August 2021. https://www.science.org/news/2021/08/new-who-group-aims-improve-efforts-find-pathogen-origins. 
  67. ↑ Staff (8 September 2021). "Deadline extension - call for experts to join the Scientific Advisory Group for the Origins of Novel Pathogens (SAGO).". World Health Organization. https://www.who.int/news-room/articles-detail/who-scientific-advisory-group-for-the-origins-of-novel-pathogens-(sago). 
  68. ↑ "WHO establishes new scientific group to study COVID origins, prevent future pandemics | UN News" (in en). 2021-10-13. https://news.un.org/en/story/2021/10/1102992. 
  69. ↑ "WHO launches global framework for understanding the origins of new or re-emerging pathogens" (in en). https://www.who.int/news/item/04-09-2024-who-launches-global-framework-for-understanding-the-origins-of-new-or-re-emerging-pathogens. 

Further reading

  • Nathan Wolfe (2012). The Viral Storm: The Dawn of a New Pandemic Age. St. Martin's Griffin. ISBN 978-1250012210. 

Template:Concepts in infectious disease



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