Infectious Diseases Dominate WHO's List of 2019 Health Threats

While the world is facing many public health threats, the World Health Organization (WHO) has compiled a list of the top 10 threats to global health to focus on in 2019.

The list contains a number of serious issues from climate change to inadequate health care facilities. Unsurprisingly, more than half of the list is made up of infectious disease challenges, both emerging and historic.

Here is a recap, in no particular order:

1. Global Influenza Pandemic

As flu season settles in across the world, many clinicians and patients are questioning just how severe the strains will be this season.

The WHO acknowledges that another flu pandemic is unavoidable, but the severity and time frame are unknown.

The WHO continues to recommend receiving the influenza vaccine each season and continues to monitor antiviral treatment throughout the world.

In August of 2018, the US Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices indicated that vaccination options for the current flu season include the intranasally-administered live attenuated influenza vaccine and recombinant influenza vaccine as quadrivalent vaccines, and inactivated influenza vaccines as both a high-dose IIV trivalent and adjuvanted IIV trivalent.

In the latest Contagion® flu update featuring mid-season estimates from the CDC, it was reported that there have been approximately 7 million influenza infections in the US thus far, resulting in an estimated 84,000 hospitalizations.

Further, of the 4460 respiratory specimens that tested positive for influenza in public health and clinical laboratories around the country, 97.1% were identified as influenza A and 2.5% were influenza B. Influenza A (H1N1) pdm09 is currently the most predominant subtype.

2. Antimicrobial Resistance

Unlike the looming influenza pandemic, antibiotic resistance is happening, and it’s happening now.

As the WHO points out, resistance to rifampicin, the most effective first-line antibiotic for tuberculosis, occurred in approximately 600,000 cases in 2017. Of those cases, approximately 82% were resistant to multiple treatment options.

The WHO also points out the need to address the overuse of antibiotics in animals and has indicated a project to confront this issue by implementing a global action plan focused on awareness of prudent use of antimicrobials.

The WHO is not the only entity addressing resistance. In September of 2018, the US Food and Drug Administration announced a comprehensive plan to combat antimicrobial resistance in the United States.

This 3-tiered strategy includes creating more incentives for antibiotics that tackle resistant pathogens by “develop[ing] innovative payment mechanisms that allow companies to capture a greater upfront share of the social value of antibiotic drug development.”

The remainder of the plan focuses on enhanced stewardship initiatives in veterinary medicine, and an expansion of the National Antimicrobial Resistance Monitoring System, which is designed to track drug resistance in Salmonella, Escherichia coli, and other harmful foodborne bacteria.

3. Ebola and high-threat pathogens, including disease X

Ebola is back in the mainstream news as the North Kivu outbreak in the Democratic Republic of the Congo, approaches its 6^th month. As of January 20, 2019, the WHO reported 640 confirmed cases and 373 confirmed deaths.

In the current outbreak, the threat of insecurity and violence has impacted the epidemiologic response, with CDC health workers being removed from the outbreak zone to prevent any exposure concerns. Additionally, WHO health workers have been attacked by rebel groups, leading to temporary evacuations in November, which has resulted in disruptions in vaccination and contact tracing.

The hard-to-contain outbreak is a threat for global health, as the highly transmissible pathogen can spread more easily to other continents through air travel. Earlier this year an American was monitored for symptoms of Ebola following potential exposure in the outbreak zone. He has since been released by Nebraska Medical, after determining he was not infected.

It raised the concern though: Are American facilities prepared to accept Ebola patients?

In a 2017 survey, described in a new report by the Office of the Inspector General, 14% of hospital administrators felt their facilities were unprepared for a patient with Ebola or an emerging infectious disease. Conversely, 71% of hospital administrators reported that their facilities were unprepared to receive an Ebola patient in 2014.

The WHO also notes that preparation for disease X, an unknown pathogen that could cause a severe epidemic, should also be a focus.

A simulation designed to pinpoint the challenges in preparedness and current policies that need to be addressed in order to prevent a severe pandemic indicates that the United States is far from ready for a widespread pandemic with a novel pathogen. The Clade X simulation was conducted by the Johns Hopkins Center for Health Security in May 2018 as an exercise focused on high-level strategies, decisions, and policies that are needed to prevent a pandemic from spiraling out of control.

4. Vaccine hesitancy

Vaccine hesitancy is something that made Contagion®’s own list of infectious disease concerns to follow in 2019.

The growing hesitancy to vaccinate children is a threat that could lead to the re-emergence of infectious diseases that were previously eliminated in the United States.

Measles is notably making a comeback in the United States, despite the fact that the disease was considered eliminated by the CDC in 2000.

State health officials are currently monitoring measles outbreaks in New York, New Jersey, and Washington State.

“[Say] an American child who has not been [vaccinated] goes on a trip abroad and acquires measles,” William Schaffner, MD, infectious disease specialist at Vanderbilt University Medical Center, and the former president of the National Foundation for Infectious Diseases, told Contagion® in a previous interview. “They bring it back and then you have an outbreak of measles, a disease that was totally eliminated.”

Additionally, the European Centers for Disease Control are monitoring measles outbreaks in more than 30 European countries.

5. Dengue

Dengue, a mosquito-borne viral infection, is a leading cause of illness and death in the tropics and subtropics, affecting up to 400 million people annually, according to the CDC.

More than 12,000 cases of dengue infection occurred in Puerto Rico in 2010, prior to the equally devastating Zika virus outbreak that affected the country.

Furthermore, dengue was the second most commonly transmitted mosquito-borne disease in the continental United States according to data reported to the National Notifiable Diseases Surveillance System between 2004 and 2016.

The WHO notes that a high number of cases occur in the rainy seasons of countries such as Bangladesh and India. And as the season lengthens, dengue-related death rates are rising.

In response, the WHO has issued a Dengue control strategy, which aims to reduce dengue-related deaths by 50% by 2020.

6. HIV

Many advancements have been made in the field of HIV since the virus was first recognized. Some of these achievements include the introduction of antiretroviral therapy, which when taken daily can suppress HIV to levels that are undetectable while preventing sexual transmission of the virus.

Additional advancements include a range of options to prevent the acquisition of HIV, including pre-exposure prophylaxis (PrEP), which can reduce the risk of acquiring HIV by up to 95% when taken daily, or emergency post-exposure prophylaxis, which can prevent infection if taken 3 days after exposure for a 28-day period.

Although the WHO is encouraging the integration of HIV treatment with other health services, the organization is also providing a reminder to all that being aware of your individual HIV status is critical. According to the WHO, 1 in 4 individuals living with HIV are unaware of their status.

To address the gaps, the WHO has partnered with international organizations to support a self-testing initiative in several African countries, which not only provides testing but also links individuals with treatment and prevention services, which was announced in observance of World AIDS Day 2018 in December.

With 6 of the 10 threats on the WHO’s list having to do with infectious disease, one thing is for sure—2019 will be another big year for fighting infectious diseases and Contagion® will bring you each milestone along the way.