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PLOS BLOGS Speaking of Medicine

2017 Global Infectious Diseases Threats to the United States

PLOS Neglected Tropical Diseases co-Editor-in Chief Peter Hotez predicts the major infections that will threaten the US in the coming year.

By the fall of 2015 it was pretty clear that Zika virus infection was going to threaten much of Latin America and the Caribbean, and shortly thereafter I wrote how 2016 would become the year of Zika, highlighting the vulnerability of our US Gulf Coast, Texas and Florida.

Insect-transmitted diseases in Texas, Florida, and the US Gulf Coast.  Zika transmission has begun in South Texas and it will likely continue into next year.  Indeed, we have to be alert for the likelihood that Zika transmission will become widespread next summer as Aedes aegypti populations predictably rise again. I also fear that we missed multiple Zika outbreaks in 2016 due to lack of federal funds and active surveillance across the US Gulf Coast.  We won’t know the full extent of the 2016 Zika outbreak until next spring if and when microcephalic babies appear on obstetrical wards.  Beyond Zika, we can expect outbreaks of West Nile virus infection to continue and with it an uptick in renal disease and even kidney failure.  We remain vulnerable to dengue and chikungunya, and now Mayaro virus has appeared in the Caribbean.  Transmission of Chagas disease, a debilitating parasitic heart infection (acquired by the bite of kissing bugs) is also now underway in Texas.  The major forces promoting these diseases still require investigation, but among the leading candidates are extreme poverty, warm climate and climate change, human migrations, and changes in transportation patterns such as the doubling in size of the Panama Canal together with an expansion in Gulf Coast ports.

Vaccine-preventable childhood illnesses: Measles, mumps, and pertussis.   In addition to its insect-transmitted diseases Texas may also have become the epicenter of the American anti-vaxxer movement.  Leading anti-vaxxer spokespersons have set up in Austin to produce a slick pseudoscience and conspiracy-theory laden faux documentary, while ‘Texans for Vaccine Choice’ have established a new political action committee (PAC) to help parents exempt their kids out of receiving school vaccinations.  Sadly it’s working! The number of non-medical exemptions for vaccines is reaching 50,000 and as a result we can expect measles and other disease outbreaks to follow.

Diseases Emerging from the Conflict Zones and Killing Fields.  Next to poverty, 21st century conflicts and the resulting health system collapses have become important disease drivers.  Ebola virus infection arose in West Africa from these forces, and now an equally devastating tropical disease known as kala-azar is spreading across East Africa, while multiple diseases are arising from the ISIS-occupied areas of Syria and Iraq, with some like cutaneous leishmaniasis spreading to adjoining areas of the Middle East.  As national borders collapse animals are being trafficked and we can expect the additional emergence of zoonotic diseases within the Middle East and North African region.

Southern Europe: Still more Vector-borne (insect and snails) diseases.  In parallel to the situation in the Middle East and Africa, we have also seen a rise of vector-borne diseases from insects and snails in Southern Europe.  The diseases include malaria in Greece, dengue in Portugal, West Nile virus and chikungunya in places such as Italy, Spain, and France, and even schistosomiasis, a neglected tropical disease of Africa, in Corsica.  While human migrations may be partly responsible, other factors may be in play including economic downturns, and climate change.   Overall, the Middle East, North Africa, and Southern Europe have emerged as one big “hot zone” and we need to consider their impact on economic trade and the health of the US.

Antimicrobial resistance (AMR).  A combination of factors including human and livestock antibiotic use, together with the absence of a robust pharmaceutical pipeline of new antibiotics, has created a serious global AMR crisis.  Especially worrisome are the carbapenem-resistant and multidrug gram negative bacteria capable of causing hospital-acquired infections.   For the first time in the US last year a patient in Pennsylvania was found to be infected with bacteria that acquired the mcr-1 gene that can make bacteria resistant to colistin, often considered the antibiotic of “last-resort” for multi-drug resistant organisms

Flu.  Influenza remains one of the greatest threats to the US population killing on average 3,000-49,000 Americans annually.  People at the greatest risk of severe flu and death are pregnant women, residents of long-term care facilities, the very old (adults over the age of 65), the very young (children less than 2), Native American populations, and those with underlying chronic conditions such as asthma, COPD, heart disease, obesity, and other conditions.  Timely vaccination remains the most proven and effective way to avoid serious injury from influenza.

The new Trump Administration will face a formidable array of global and indigenous infectious disease threats in 2017.  A Global Health Security Agenda will help provide a framework for tackling some of these tough issues, but enhanced efforts will be needed to prevent new epidemics, especially from vector-borne and zoonotic neglected tropical diseases, measles, and the ever-constant threats from AMR and flu.

Peter Hotez MD PhD is Editor-in-Chief of PLOS NTDs and Dean, Professor, and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics at the National School of Tropical Medicine at Baylor College of Medicine.  He is also President of the Sabin Vaccine Institute.

Dec. 22 2016, 14:38PST: Featured image credit: jacinta lluch valero, Flickr.

Discussion
  1. I would wonder why there is any concern what so ever of diseases, if the United States is all ready vaccinated. Read of a measles out break in Calif. Couple of years ago a Mumps out break in a college that 90 of the students had been vaccinated. Some say the non vaccinated pose a threat to those vaccinated. Yet you would think the reason to be vaccinated would be to prefect you when around those unvaccinated. Makes you wonder which lie is the truth. If polo was eradicated from the population how do we now have polo. For the last 50 years they have collected donations for Muscular dystrophy. Fifty years and no cure just rich research. You don’t really think any vaccine is really collected from the infected tit do you.

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