Where Will the Next Pandemic Threat Come From? Public Health Watch Report

In the aftermath of hurricanes Harvey and Irma, which ravaged Texas and Florida (as well as the Caribbean), respectively, wouldn’t it be nice to know what other threats could target our shores?

Well, when it comes to infectious disease pandemics, such knowledge can be a double-edged sword. True, to be forewarned is to be forearmed and “better the devil you know,” etc; but, increased awareness has also led to irrational panic. Think: the US media in the face of the Ebola crisis in 2015.

However, although such shrill reporting of the 3 cases of Ebola to hit North American shores back then led to much hand-wringing (and, to be fair, much-needed public health reform at the national level), actual data highlighting real potential future pandemic threats to the American people have received relatively scant attention in the press.

Indeed, in an article published in the journal Health Security on August 14, 2017, researchers from the Centers for Disease Control and Prevention’s (CDC’s) Global Disease Detection Operations Center (GDDOC) provided an update on several infectious diseases it cited as the “top threats to public health” from 2012 to 2016, and what, if any, concerns they have regarding the threats posed by these diseases in the near term. Perhaps not surprisingly, the report received little to no attention in the mainstream press.

No wonder infectious disease and public health experts sometimes feel like they’re screaming in an echo chamber.

In its update, the GDDOC team provided information on influenza viruses, primarily influenza A, and H5N, in particular. They write that H5N1 “is of major concern because case clusters representing limited, nonsustained human-to-human transmission [have] been reported in multiple countries, and viral evolution is ongoing in infected poultry.”

The group also highlights cholera as a potential threat, given recent epidemics of the disease in Asia and sub-Saharan Africa, and notes that it is still monitoring Ebola (as well as the closely-related viral hemorrhagic fever), which saw a small resurgence in the Democratic Republic of Congo earlier this year. The GDDOC report notes that recent research has found that Ebola virus “can survive in semen for extended periods of time,” meaning that the disease could potentially be transmitted via sexual contact with survivors of the West African outbreak.

Not surprisingly, vector-borne diseases such as chikungunya, Zika virus, and yellow fever are also on the GDDOC’s radar. A recent outbreak of yellow fever in Angola has raised alarm bells, and even resulted in a cluster of cases in Asia (as a result of travel between the 2 locations). Chikungunya has presented a significant public health challenge in the Caribbean, despite having not been reported in the Americas at all prior to 2013. And Zika, of course, plagued Brazil and much of the Caribbean from 2014 to 2016 (and even reached Texas and Florida), although, for now at least, that crisis appears to be over.

Finally, the GDDOC is also closely watching Middle East Respiratory Syndrome-Coronavirus (MERS-CoV), of which there have been more than 1800 cases (resulting in nearly 700 deaths) reported worldwide. The cases have occurred primarily in Middle Eastern and northern African countries; although, “exported cases” were also identified in Europe, the Philippines, and the Republic of Korea. Notably the GDDOC authors write, the exported Republic of Korea case led to an outbreak of 186 cases of MERS-CoV in the country, and resulted in 36 fatalities. “This event… demonstrates how quickly MERS-CoV can be transmitted from person to person in a tertiary care hospital in a developed health infrastructure, further underscoring the necessity to monitor cases of MERS-CoV,” the GDDOC team writes.

In their concluding remarks, the authors note: “This report describes top potential global infectious disease threats that the GDDOC was monitoring during 2013 to 2016, and does not necessarily describe those public health events that CDC finds most important or events that require the most resources… [T]he GDDOC is in a unique position to rapidly identify new threats to public health, including those that could lead to a pandemic.”

Let’s hope the public and government officials start paying attention.

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.