Towards a coordinated strategy for intercepting human disease emergence in Africa
Towards a coordinated strategy for intercepting human disease emergence in Africa
复制标题
制定拦截非洲人类疾病出现的协调战略
DOI：
10.1016/s2666-5247(20)30220-2
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Mwaengo, Dufton M
中科院分区：
文献类型：
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作者：
Forbes, Kristian M;Anzala, Omu;Carlson, Colin J;Kelvin, Alyson A;Kuppalli, Krutika;Leroy, Eric M;Maganga, Gael D;Masika, Moses M;Mombo, Illich M;Mwaengo, Dufton M
新出现的人畜共患病病毒是对人类健康和安全的最大威胁之一，疾病爆发频率的增加就是证明。1迄今为止，对这些疫情的主要先发制人的反应是广泛的、成本高昂的努力，以记录野生动物中的病毒多样性（例如，PREDICT和全球病毒组项目）。虽然这些努力已经鉴定出数千种新型病毒，但迄今为止描述的病毒不到1%，但围绕病毒发现计划的获取和利益共享仍然存在重大挑战，而且-也许对公共卫生应用来说最成问题的是-目前只能粗略推断这些病毒的溢出危害。4-6我们控制和限制传染病传播的能力关键取决于早期发现。这种警惕应包括可能不会造成立即或广泛的公共卫生威胁，但在人类中反复溢出或持续、不受控制的传播链为致病性增加、宿主免疫逃避机制和有效的人际传播的演变提供了空间的病毒。7在现有研究的基础上，我们强调了协调和有针对性的战略对于早期发现病毒在人类中的溢出和出现的重要性。该模型基于相互关联的研究或证据类型，是一个面向非洲和其他低收入和中等收入国家的协作框架，这些国家的疾病发生风险往往很大，与高收入地区相比，传染病相关的发病率和死亡率过高，未描述的病毒多样性很高，对于这一策略，我们强调了四种补充研究或证据类型，表明过去或现在的未知感染：从未确诊的病人身上采集和筛查诊断样本，分析不明原因的可疑死亡病例的样本，对高危人群或哨点人群进行血清学调查，并分析存档样本（附录p 1）。方法可能重叠（例如，未确诊患者的死亡和尸检分析），但能够独立检测病原体的单独证据
Emerging zoonotic viruses are one of the greatest threats to human health and security, as evidenced by the increasing frequency of disease outbreaks. 1 To date, the main pre-emptive response to these outbreaks has been extensive, cost-heavy efforts to document virus diversity in wildlife (eg, PREDICT and the Global Virome Projects). 2, 3 Although these efforts have resulted in the identification of thousands of novel viruses, fewer than 1% are described to date, substantial challenges remain around access and benefit sharing from viral discovery programmes, and—perhaps most problematic for public health application—the spillover hazard of these viruses can only be coarsely inferred at present. 4–6 Our ability to control and restrict the spread of infectious diseases is critically dependent on early detection. This vigilance should include viruses that might not pose immediate or widespread public health threats, but where repeated spillover or persistent, unchecked transmission chains in humans provides latitude for the evolution of increased pathogenicity, host immune evasion mechanisms, and efficient human-to-human transmission. 7 Building on existing research, here we emphasise the importance of a coordinated and targeted strategy for early detection of virus spillover and emergence in humans. This model is based on inter-related study or evidence types and is a collaborative framework geared towards African and other low-income and middle-income countries where risk of disease emergence is often great, infectious disease-related morbidity and mortality are overrepresented compared with in high-income regions, undescribed virus diversity is high, and resources are constrained.For this strategy we highlight four complementary study or evidence types indicative of past or current unknown infection: procurement and screening of diagnostic samples from undiagnosed patients, analysis of samples from suspicious fatalities of unknown cause, serosurveys of high-risk or sentinel groups, and analysis of archived samples (appendix p 1). Approaches might overlap (eg, death and post-mortem analysis of undiagnosed patients) but are independently capable of detecting separate evidence for pathogen