Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Reviews
Year : 2012 | Month : August | Volume : 6 | Issue : 6 | Page : 1095 - 1100 Full Version

Emerging and Re-emerging Infectious Diseases, Future Challenges and Strategy


Published: August 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2341
Sanjeev K. Gupta, Prashant Gupta, Parul Sharma, Ashish Kumar Shrivastava, Sudhir Kumar Soni

1. Mahatma Gandhi Medical College & Research Institute, Cuddalore Main Road Pillayarkuppam Pondicherry, India. 2. Research Consultant in Indian Institute of Public Health Delhi, India. 3. Assistant Professor, Department of Community Medicine, Subharti Medical College and Subharti University, Subhartipuram Meerut, India. 4. Surveillance Medical Officer in National Polio Surveillance Project, Government of India-World Health Organization (WHO) Collaboration, Noida, India. 5. Surveillance Medical Officer in National Polio Surveillance Project, Government of India-World Health Organization (WHO) collaboration, Indore Madhya Pradesh, India.

Correspondence Address :
Dr. Sanjeev K Gupta
Type-2, 1D, Doctor resident quarters,
Mahatma Gandhi Medical College & Research Institute,
Cuddalore Main Road Pillaiyarkuppam Pondicherry, India.
E-mail: drsanjeev15@gmail.com

Abstract

The emerging infectious diseases and their basic causes present a threat to the stability of the nations worldwide. The factors for the emergence/re-emergence of infectious diseases are complex and interrelated. The spread of antimicrobial resistance is another emerging global public health issue. New pathogens and antimicrobial-resistant forms of the older pathogens continue to emerge, some with the potential for a rapid and a global spread, with high morbidity and mortality and these are of public health importance.

Keywords

Emerging diseases, Re-emerging diseases, Antimicrobial resistance, Mortality, Morbidity, Public health

INTRODUCTION
There has been a worldwide explosion of infectious diseases: emerging diseases like the HIV/AIDS pandemic, or old diseases like cholera, tuberculosis, diphtheria, plague, yellow fever, dengue, or malaria. These re-emerging diseases are on the surge because of multiple factors: environmental changes, transformation of the ecosystems, the ongoing socio-economic degradation and the deterioration of the public health systems in many countries. The emerging infectious diseases and their basic causes present a threat to the stability of the nations worldwide. The factors for the emergence/re-emergence of infectious diseases are complex and interrelated (1).

In the human history, numerous infectious diseases have emerged and re-emerged. Besides many others, the so-called ‘exotic’ agents in particular, are a threat to our public health systems due to our limited experience in the case management and due to the lack of appropriate resources. Many of these agents are zoonotic in origin and these are transmitted from animals to man either directly or via vectors. The reservoirs are often infected sub- clinically or asymptomatically and the distribution of the diseases basically reflects the range and the population dynamics of their reservoir hosts. As examples, emergence/re-emergence is discussed here for the diseases which are caused by filoviruses, hantaviruses, paramyxoviruses, flaviviruses and Yersinia pestis (Table/Fig 1). In addition, bioterrorism has been addressed as one factor which now has to be considered in infectious disease emergence/re-emergence. The preparedness for the known and unknown infectious diseases will be a top priority for our public health systems.

The emerging communicable diseases are those for which the incidence in humans has increased in the past 2 decades or is threatening to increase in the near future. The re-emerging communicable diseases are those which are known and which reappear after a decline in their incidences. The term, ‘emerging diseases’, which is used interchangeably with the term, ‘emerging infectious diseases’, means ‘the infections that newly appear in a population, or which have existed but are increasing in incidence or geographic range’ (2). Over the past 3 decades, more than two thirds of the emerging infectious diseases have had an origin in animals (3). These include HIV/AIDS, Ebola haemorrhagic fever and the new variant of the Creutzfeldt-Jakob disease (nvCJD). Some of these, especially HIV/AIDS and hepatitis C, have seriously affected large numbers of people worldwide (Table/Fig 2), (Table/Fig 3) & (Table/Fig 4). Others, such as Ebola, nvCJD and the influenza A (H5N1) virus which is known to cause swine flu, have posed significant threats and million of cases and thousands of deaths have been recorded worldwide (21),(22). Meanwhile, the well-known diseases which were once thought to have been conquered, such as tuberculosis, plague, cholera, Dengue fever/Dengue haemorrhagic fever, yellow fever and diphtheria are re-emerging as public health threats in many countries, after a period of decline in their incidences. The spread of antimicrobial resistance is another emerging global public health issue (4).

New pathogens and antimicrobial-resistant forms of the older pathogens continue to emerge, some with the potential for a rapid and a global spread, with high morbidity and mortality and these are of public health importance (5).

The infectious diseases have always afflicted mankind and they always will. New infectious diseases will emerge and old diseases will re-emerge as the microbes adapt to new hosts and new environments. To remain one step ahead of our pathogenic microbial foes, we must understand in detail how the pathogens interact with their hosts, and how biological, environmental, and social factors combine to allow pathogens to infect new organisms. Deciphering each step in the different processes by which microbes adapt to their new hosts, is critical to developing effective countermeasures to detect, prevent, and to treat infectious diseases.

Common causes
Antimicrobial drug resistance, as a major factor in the emergence and the re-emergence of infectious diseases deserves special attention. Although significant reductions in the infectious disease mortality have occurred since the introduction of antimicrobials for general use in the 1940s, drug resistance has emerged because of their widespread use. “The drugs that once seemed to be invincible are losing their effectiveness for a wide range of community-acquired infections which include tuberculosis, gonorrhoea and pneumococcal infections and for hospital-acquired enterococcal and staphylococcal infections. The resistance to anti-viral, anti-fungal, and antiprotozoal drugs is also emerging. Drug-resistant malaria has spread to nearly all the areas of the world where malaria occurs. Point towards also have arisen over the strains of HIV which are resistant to anti-viral drugs. An aggressive public health response to these new, emerging and re-emerging infectious disease threats must be made to characterize them better and to mount an effective response for their control. The World Health Organization has outlined the following high priority areas: to strengthen the global surveillance of the infectious diseases; to establish national and international infrastructures to recognize the reports and to respond to new disease threats; to further develop applied research on the diagnosis, epidemiology, and the control of emerging infectious diseases; and to strengthen the international capacity for infectious disease prevention and control.

Only through a global concerted action will the efforts which are being made to control infectious diseases be effective. We have now entered an era where, as Nobel Laureate Dr. Joshua Lederberg has stated, “The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow” (quoted in CDC 1994). Hans Zinsser had stated this over 60 years ago (6).

THE INTERNATIONAL HEALTH REGULATION 2005
Infectious diseases do not respect international borders. Global partnerships and the rapid sharing of data and other information enhance the preparedness and the evidence-based control strategies. The World Health Organization has a mandate of providing technical support to all the countries for health development and specific responsibilities for global health protection under the International Health Regulation (IHR) 2005. The IHR (2005) is a legally binding international instrument with the purpose of preventing, protecting against, controlling and providing a public health response to the international spread of diseases while avoiding unnecessary interference with the international traffic and trade. The emerging infectious diseases are real and they pose an overt threat to societies and their economies. With strong political support and a commitment to the global public goods and the effective public health systems, the challenge can be met. The advent of SARS and avian influenza underscores the importance of emerging diseases and their impact on the health and economic development. The Asia Pacific region is unfortunately, at the epicentre of such epidemics. Over 30 new infectious agents have been detected in the last 3 decades, 75% of which have originated in animals (zoonoses). New pathogens, particularly viruses, remain unpredictable and they continue to emerge and spread across the countries. Several have profoundly affected the countries and the areas in the Asia Pacific region that is home to over 3.4 billion people, or to 53% of the world’s population (7).

Dengue fever, Japanese encephalitis, Leptospirosis, Nipah virus and drug-resistant malaria are some of the diseases that have become entrenched within this region. Though several socioeconomic, demographic, environmental and ecological factors facilitate the emergence and the spread of these diseases, their impact could be minimized through a well-prepared and strong public health system. To effectively respond to these diseases, a well-developed strategy and programme must be implemented through a coordinated and a pragmatic plan of action.

To meet the global challenge that the emerging disease outbreaks present, the International Health

Regulation (8) provide a legal framework for an international public health response to the global spread of diseases, while avoiding unnecessary interference with the international traffic and trade. The purpose and the scope of the revised IHR are “to prevent, protect against, control and to provide a public health response to the international spread of diseases in ways that are commensurate with and are restricted to public health risks, and which avoid unnecessary interference with the international traffic and trade.” The Millennium Development Goals (MDG) (9), which is the expression of global solidarity in improving the quality of life, are also concerned with reducing the impact of the emerging diseases. The MDG addresses the issues of HIV/AIDS, TB, malaria, water and sanitation, and other development-related health determinants in the least developed countries that usually act as the trigger sites for the emerging diseases.

The factors which are responsible for the emergence and the re-emergence of infectious diseases in the developed and the developing countries are unplanned and under planned urbanization, overcrowding and rapid population growth, microbial adaptation and change, the human susceptibility to infections, the climate and weather, the changing ecosystems, the human demographics and behaviour, economic development and land use, rapid and intense international travel, poor sanitation, inadequate public health infrastructures, resistance to antibiotics, increase of humans to disease vectors, technology and industry, breakdown of the public health measures, poverty and social inequality, war and famine, lack of political will, an intent to harm, natural and man made disasters and reservoirs of infections, etc (10).

Despite the remarkable advances in medical research and treatments during the 20th century, infectious diseases remain among the leading causes of death worldwide(20) for three reasons: (a) Emergence of new infectious diseases; (b) Re-emergence of the old infectious diseases; and (c) Persistence of the intractable infectious diseases. The emerging diseases include the outbreaks of previously unknown diseases or known diseases whose incidences in humans have significantly increased in the past two decades. The re-emerging diseases are the known diseases that have reappeared after a significant decline in their incidences. Within the past 2 decades, the innovative research and the improved diagnostic and detection methods have revealed a number of previously unknown human pathogens. Within the last decade, chronic gastric ulcers which were formerly thought to be caused by stress or diet, were found to be the result of infections which were caused by the bacterium, Helicobacter pylori.

New infectious diseases continue to evolve and “emerge.” Changes in the human demographics, behaviour, land use, etc., are contributing to new disease emergence by changing the transmission dynamics, to bring people into a closer and a more frequent contact with pathogens. This may involve an exposure to animals or arthropod carriers of the disease. The increasing trade of exotic animals as pets and food sources has contributed to a rise in the opportunities for the pathogens to jump from the animal reservoirs to humans. In the United States, close contact with exotic rodents was found to be the origin of the recent U.S. outbreak of monkey pox, and the use of exotic civet cats for meat in China was found to be the route by which the SARS corona virus made the transition from animals to its human hosts.

In spite of the continued discovery of new human pathogens, the old infectious disease enemies are “re-emerging.” Natural genetic variations, recombinations, and adaptations allow new strains of known pathogens to appear, to which the immune system has not been previously exposed and is therefore not primed to recognize (e.g., influenza, bird flu, swine flu, etc ). Furthermore, human behaviour plays an important role in the re-emergence of known pathogens. The increased and sometimes imprudent use of antimicrobial drugs and pesticides has led to the development of resistant pathogens, thus allowing many diseases that were formerly treatable with drugs, to make a comeback. Recently, the decreased compliance with the vaccination policy has also led to the re-emergence of diseases such as measles and pertussis, which were previously under control. The use of deadly pathogens such as smallpox or anthrax as the agents of bioterrorism, is an increasingly acknowledged threat to the civilian population. Moreover, many important infectious diseases have never been adequately controlled on either the national or the international level. The infectious diseases that have posed ongoing health problems in the developing countries are re-emerging in the United States (11).

These trends amount to produce a crisis for today and a challenge for the future (12). The theme of the World Health Day, April 7, 1997 “Emerging infectious Diseases- Global Alert: Global Response” is of great value (13).

STRATEGY /POSSIBLEINTERVENTIONS
Re-affirming the importance of developing and implementing a biregional strategy to achieve common goals and to provide a strategic framework for strengthening the national and the regional capacity for communicable disease surveillance and response, which include the emerging infectious diseases; Recognizing that the importance of the timely and the transparent sharing of information on the public health emergencies of international concern is crucial to prevent and limit the risk of the international spread of diseases.

The development of newer techniques for surveillance (14): The traditional passive surveillance refers to the health authoritie’s receipt of the reports of diseases or conditions which were submitted by physicians, laboratories, and other healthcare providers as was required by the public health legislation. However, the reportable diseases are often underreported to the health departments (15),(16). Syndromic surveillance has been defined as “an investigational approach where the health department staff, assisted by the automated data acquisition and the generation of statistical alerts, monitor the disease indicators in real-time or near real-time to detect the outbreaks of diseases earlier than would otherwise be possible with traditional surveillance” (17). Now this is the real time to develop an electronic surveillance system, for example, the Geographic Information System (GIS) (18), or theHealth Alert Network (HAN) (19) for the early notification of epidemics.

Establishment of health systems at different levels: The regional stockpiles of items such as insecticides and cholera kits and essential drugs were stockpiled, beginning right from the sub centre to the apex care level of the health system.

Pandemic surveillance for antimicrobial resistance: The surveillance of antimicrobial resistance is being strengthened through training courses and through the distribution of WHONET, a surveillance-supporting computer programme. In the western Pacific region, there are three regional antimicrobial surveillance systems – one for the general bacterial diseases (Network on Antimicrobial Resistance) and the others for gonococcal infections (Gonococcal Antimicrobial Surveillance Programme). For tuberculosis in India, the DOTS plus therapy for the treatment of multidrug resistance tuberculosis has been launched. In India, the Integrated Disease Surveillance Project (IDSP) has been launched for the surveillance, for communicable as well as non communicable diseases. Each surveillance system covers the whole region to detect antimicrobial resistance. The laboratory-based surveillance of various communicable diseases has been strengthened in many member states through technology transfer, training of the national staff, workshops which were conducted by the WHO and through the distribution of the WHO Communicable Disease Surveillance Kit.

Up gradation of the International Health Regulations: In order to ensure an effective international response for all the outbreaks of international importance, the WHO is now in the process of revising the IHR to apply a syndromic approach to the disease reporting. This will enable the outbreaks of the as yet unidentified disease syndromes to be reported globally at an earlier stage, for the appropriate international measures to be taken. Acknowledging the need to strengthen the local and the national capacity of each country and area to detect, verify, report and to respond to significant public health events, which include those which are caused by emerging diseases, in accordance with the International Health Regulations (2005) is essential.

Outbreak response: In April 2000, the WHO formalized an infrastructure, GORAN (the Global Outbreak Alert and Response Network) for responding to the heightened need for an early awareness of the outbreaks and for the preparedness to respond to them.

The procedure for the outbreak alert and response has four phases: Systematic detection, outbreak verification, real time alerts, and rapid response. For the response, the framework uses different strategies for combating the known risks and the unexpected events, and for improving both the global and the national preparedness to face them. The new forces which are at work in an electronically interconnected world are beginning to break down the traditional reluctance of the countries to report the outbreaks due to the fear of their negative impact on trade and tourism. About 65% of the world’s first news about infectious disease events now comes from informal sources, which include press reports and the internet.

The basic objectives of GORAN are, combating the international spread of outbreaks, ensuring that the appropriate technical assistance reaches the affected states rapidly and contributing to the long-term epidemic preparedness and the capacity building. In the region/ tertiary care centre, the Regional Office rapidly dispatches a Rapid Response Team (RRT) to the epidemic sites. Logistical support is also provided.

The dissemination of information: If the outbreak has been established, the accurate and timely information has to be disseminated to the member states and to the public through various media sources so that a timely and prompt action can be taken.

Administrative support and training of the staff: The out break control will be effective only if all the staff who are working at different levels understands the importance of their roles. As a part of the training, each health care worker and staff member should receive job category-specific instructions. The training should be conducted before the initial assignment and a continuing education should be provided to all.

YET TO BEACHIEVED
The speed of the notification is essential if the outbreaks of the emerging and the re-emerging diseases have to be combated effectively. In the past, the shortcomings in some countrie’s surveillance systems had resulted in delays in notifying the WHO and other countries about disease outbreaks. The revised International Health Regulations, 2005 will help in addressing this issue.

CONCLUSIONS
Strengthening and promoting the basic and applied research on the pathogens, hosts and the environmental factors by using the knowledge on the pathogens, hosts, and the environment interactions to enhance our ability to predict and to prevent the conditions that led to the human diseases are important. The invention of newer diagnostics, vaccines, therapies and sequencing and the post-genomics research of the emerging infectious disease agents and the animal vectors to reveal the genetic basis for the microbial/vector evolution, adaptation, and pathogenicity is the next step. Tracking better control strategies and developing the national and the international scientific expertise which is required to respond to the future health threats by supporting research and training programs are also necessary.

FUTURE
We have to give more emphasis on the surveillance, research and training, better diagnostic facilities and improved public health systems. The preparedness for emergency situations must continue to improve at both the regional and the national levels. The regional stockpiles will be periodically monitored and updated. The regional information networks on communicable diseases that link the WHO collaborating centres, international agencies, and institutions will be established by using an electronic-mail system. These networks will be linked to the global communicable diseases information system which has been coordinated by the WHO Headquarters. The antimicrobial resistance surveillance in the region will be strengthened by increasing the number of monitoring laboratories at different locations. The regional antimicrobial resistance system for general bacterial diseases (Network on Anti-microbial Resistance) will be integrated into the global surveillance on antimicrobial resistance, like IDSP in India.

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Date of Submission: Jan 31, 2012
Date of Peer Review: Apr 09, 2012
Date of Acceptance: Jul 11, 2012
Date of Publishing: Aug 10, 2012

Financial OR OTHER COMPETING INTERESTS:
None.

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