Areas of Work
Communicable diseases, also known as infectious or transmissible diseases, are illnesses that result from the infection, presence and growth of pathogenic biologic agents in an individual human or other animal host. Disease-causing biologic agents include viruses, bacteria, fungi, protozoa, multicellular parasites, and aberrant proteins known as prions.
Transmission of these biologic agents can occur in a variety of ways, including direct physical contact with an infectious person, consuming contaminated foods or beverages, contact with contaminated body fluids (feces, saliva, blood, genital secretions, etc.), contact with contaminated inanimate objects, airborne (inhalation) as in influenza and tuberculosis, or being bitten by an infected insect or tick as in malaria, dengue, and Lyme’s disease. Some disease agents can be transmitted from animals to humans (zoonoses), and some of these agents can be transmitted in more than one way.
The transmission of infectious/communicable diseases can lead to outbreaks and epidemics with wide-ranging effects, especially among vulnerable individuals and populations, the very young and the elderly. In many cases, these diseases can lead to either death or a diminished quality of life.
Although antibiotic, antiviral, and anti-parasitic drugs (antimicrobials) are widely available and usually effective, there has been a steady increase in microbial resistance to these drugs, mostly due to their widespread and indiscriminate use in animal feed and the improper treatment of patients. These practices may render antimicrobials ineffective and force physicians to resort to multidrug treatments or to use different, new and more expensive drugs.
Neglected diseases are a group of transmissible infections that affect the least protected and poorest populations in many low-income countries. These diseases include cutaneous and visceral leishmaniasis, schistosomiasis, blinding trachoma, onchocerciasis, intestinal worms (geohelminths), Chagas' disease, leprosy, and others. In addition to their mortality and morbidity (some cause permanent disability or disfigurement), neglected diseases are an expression of the inequity and dramatic disparities between the rich and the poor.
Communicable disease surveillance and control activities. Maintaining surveillance and monitoring infectious diseases is the first public health measure to prevent an outbreak or epidemic from occurring. Some infectious diseases such as polio, measles, mumps, tetanus, influenza, and many others are vaccine-preventable and should be included in the regular vaccine schedule. Frequently, and particularly in cases of serious or life-threatening diseases such as Ebola, meningitis, and tuberculosis, strict measures such as patient isolation, and management of contacts are required. In all cases, information and education on the specific modes of transmission and prevention of communicable diseases should be widely disseminated. Proper treatment of patients with infectious diseases in health facilities and in the community is essential for their prevention and control.
Antimicrobial resistance should be addressed through judicious prescription of these drugs in the treatment of human infections as well as through control of their indiscriminate use in the pecuniary (cattle, chicken, etc.) food industry.
Neglected diseases are now the target of a worldwide campaign for their elimination through community surveys and case finding followed by individual management or mass treatment of entire populations, as required.
Epidemiological Alert Systems
Epidemiological alert and response systems are organized operations and mechanisms that provide an early warning on threats to the population’s health. These systems are designed to improve the early detection and rapid response to epidemic-prone diseases with pandemic potential and other public health emergencies”.
Alert and response systems allow countries and institutions to detect and track evolving infectious disease outbreaks, as well as events related to contaminated goods, food safety, or of chemical or radio-nuclear origin. By sharing information and expertise, and gathering and mobilizing resources, countries are then able to mount and implement an effective response to protect populations from the consequences of epidemics and other public health risks.
Epidemiological alerts are primarily of events caused by infectious agents, as infectious diseases (e.g. cholera, smallpox, influenza, HIV, SARS, Ebola, etc.) have been the single most important contributors to epidemics with high morbidity and mortality throughout history. In addition, globalization has the potential to affect a broad range of biological, environmental, and social factors that influence human interactions and allow infectious diseases to spread rapidly within and between countries.
Effective epidemiological surveillance and alert operations require a comprehensive and dynamic system that can manage critical information and ensure accurate and timely communication between key national and international public health professionals.
Alert and rapid response activities must be strengthened through collaboration, integration of efforts, and good inter-country management in order to control international outbreaks and enhance international public health security.
The International Health Regulations of 2005 (IHR-2005), provide a new framework for the coordinated management of events that may constitute a public health emergency of international concern. Its implementation will improve the capacity of all countries to detect, assess, notify and respond to public health threats (1).
IHR has been in force since 15 June 2007. Its purpose and scope is to “prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade” (1). Across regions, 196 countries have agreed to implement IHR in response to the exponential increase in international travel and trade, and emergence and reemergence of international disease threats and other health risks (4).
The four inter-related phases of a successful epidemiological alert system consist of:
1. Event surveillance
2. Risk assessment
3. Information management and dissemination
The key operational elements introduced by the IHR under “Alert and Response Operations” include:
- Specific procedures for disease surveillance, notification and reporting of public health events and risks to the World Health Organization (WHO) by countries.
- Requests by WHO for verification of public health events occurring within countries.
- Rapid collaborative risk assessment and assistance to countries.
- Determinations as to whether an event constitutes a public health emergency of international concern.
- Coordination of international response.
Guiding Principles for International Outbreak Alert and Responses:
Since April 2000, the Global Outbreak Alert and Response Network has been bringing agreed standards to international epidemic response through the development of Guiding Principles for International Outbreak Alert and Response and operational protocols to standardize epidemiological, laboratory, clinical management, research, communications, logistics support, security, evacuation and communications systems.
Partners include scientific institutions in WHO Member States, medical and surveillance initiatives, regional technical networks, networks of laboratories, United Nations organizations (e.g. UNICEF, UNHCR), the Red Cross (International Committee of the Red Cross, International Federation of Red Cross and Red Crescent Societies and national societies) and international humanitarian nongovernmental organizations (e.g. Médecins sans Frontières, International Rescue Committee, Merlin and Epicentre). Participation is open to technical institutions, networks and organizations that have the capacity to contribute to international outbreak alert and response.
In 1994, the United Nations Development Programme (UNDP) Report on Human Development, “New Dimensions of Human Security”, coined the term “human security” within the UN system. The report highlighted four characteristics of human security: universal, people-centered, interdependent and prevention-based. It further outlined seven interconnected elements of human security: economic, food-related, health, environmental, personal, community and political.
As stated in paragraph 143 of the 2005 World Summit Outcome (A/RES/60/1), entitled ‘Human Security”, the Heads of State and Government stressed “the right of all people to live in freedom and dignity, free from poverty and despair”, and recognized that “all individuals, in particular vulnerable people, are entitled to freedom from fear and freedom from want, with an equal opportunity to enjoy all their rights and fully develop their human potential”. Human security aims at ensuring the survival, livelihood and dignity of people in response to current and emerging threats – threats that are widespread and cross cutting. Thus, “human security” acknowledges the inter-linkages between security, development, and human rights and considers these to be the building blocks of human and, therefore, national security.”
The evolution of threats, especially during the last decade, has considerably altered the understanding of insecurities. Populations throughout the world are subjected not only by international war and internal conflicts but also by chronic and persistent poverty, climate-related disasters, organized crime, terrorism, human trafficking, health pandemics, and sudden economic and financial downturns.
Old and new threats seriously challenge the lives and livelihoods of millions of people around the world. Such threats are not limited to those living in absolute poverty or conflict. Today, people throughout the world, in developing and developed countries alike, live under varied conditions of insecurity. These threats seriously challenge both Governments and people (2). Today’s threats are complex, multidimensional, caused by external or internal factors, and often spill over broader, national, regional and international security threats.
To promote, improve and achieve human security, decision-makers and practitioners must use a combination of technological tools, knowledge, and resources. Human security requires a new framework where “the survival, livelihood and dignity of people form the basis for achieving peace, development and human progress at every level – local, national, regional and international”.
The United Nations Commission on Human Security Report, “Human Security Now” (2003), points to a paradigm shift from traditional notions of nation-based security, to a people-centered security. This approach consists of a more comprehensive, multi-sectoral approach in identifying threats to individuals and communities. It also includes prevention across two dimensions: protecting the population and empowering the population to act.
The principles and practices underlying human security and public health approaches are also deeply related. Human security and public health both conceive of population threats broadly and seek to proactively address and prevent their root causes—often called social determinants—rather than treat their consequences. “
The need to adopt and implement health and human security approaches is driven by the complex, interrelated nature of the most pervasive insecurities currently affecting many countries in the world (e.g. poor water and sanitation, toxic substances, food and work insecurity, violence, etc.), threats for which a health and human security’s holistic and proactive approach is urgent and necessary.