United States Disease Outbreak Essay

In 500 words Choose from one of the following diseases and find an outbreak that occurred in the United States within the last 3 years:

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Norovirus

Salmonella

Shigella

E. coli

Botulism

Clostridium perfringens

Listeria

Vibrio

Campylobacter.

1. Describe the disease.

2. When did this specific outbreak occur and what was the health officials reactions?

3. The virus in details (classification and infection control measures)United States Disease Outbreak Essay

4. What is the incubation period and how is it spread?

5. What are the signs and symptoms?

6. What is the treatment (if any)?

7. Where did the outbreak occur?

8. How many people were involved?

9. What should have been done to prevent its spread?

10. Provide recommendations on what should be done in the future.

Pandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995). These trends likely will continue and will intensify. Significant policy attention has focused on the need to identify and limit emerging outbreaks that might lead to pandemics and to expand and sustain investment to build preparedness and health capacity (Smolinsky, Hamburg, and Lederberg 2003).United States Disease Outbreak Essay

The international community has made progress toward preparing for and mitigating the impacts of pandemics. The 2003 severe acute respiratory syndrome (SARS) pandemic and growing concerns about the threat posed by avian influenza led many countries to devise pandemic plans (U.S. Department of Health and Human Services 2005). Delayed reporting of early SARS cases also led the World Health Assembly to update the International Health Regulations (IHR) to compel all World Health Organization member states to meet specific standards for detecting, reporting on, and responding to outbreaks (WHO 2005). The framework put into place by the updated IHR contributed to a more coordinated global response during the 2009 influenza pandemic (Katz 2009). International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity (Wolicki and others 2016).

Despite these improvements, significant gaps and challenges exist in global pandemic preparedness. Progress toward meeting the IHR has been uneven, and many countries have been unable to meet basic requirements for compliance (Fischer and Katz 2013; WHO 2014). Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including global coordination and response mobilization (Moon and others 2015; Pathmanathan and others 2014). These gaps are especially evident in resource-limited settings and have posed challenges during relatively localized epidemics, with dire implications for what may happen during a full-fledged global pandemic.United States Disease Outbreak Essay

For the purposes of this chapter, an epidemic is defined as “the occurrence in a community or region of cases of an illness . . . clearly in excess of normal expectancy” (Porta 2014). A pandemic is defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people” (Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. For example, in contrast to annual seasonal influenza epidemics, pandemic influenza is defined as “when a new influenza virus emerges and spreads around the world, and most people do not have immunity” (WHO 2010).

This chapter does not consider endemic diseases—those that are constantly present in particular localities or regions. Endemic diseases are far more common than pandemics and can have significant negative health and economic impacts, especially in low- and middle-income countries (LMICs) with weak health systems. Additionally, given the lack of historical data and extreme uncertainty regarding bioterrorism, this chapter does not specifically consider bioterrorism-related events, although bioterrorism could hypothetically lead to a pandemic.United States Disease Outbreak Essay

This chapter covers the following findings concerning the risks, impacts, and mitigation of pandemics as well as knowledge gaps:

Risks
Pandemics have occurred throughout history and appear to be increasing in frequency, particularly because of the increasing emergence of viral disease from animals.
Pandemic risk is driven by the combined effects of spark risk (where a pandemic is likely to arise) and spread risk (how likely it is to diffuse broadly through human populations).
Some geographic regions with high spark risk, including Central and West Africa, lag behind the rest of the globe in pandemic preparedness.
Probabilistic modeling and analytical tools such as exceedance probability (EP) curves are valuable for assessing pandemic risk and estimating the potential burden of pandemics.
Influenza is the most likely pathogen to cause a severe pandemic. EP analysis indicates that in any given year, a 1 percent probability exists of an influenza pandemic that causes nearly 6 million pneumonia and influenza deaths or more globally.
Impacts
Pandemics can cause significant, widespread increases in morbidity and mortality and have disproportionately higher mortality impacts on LMICs.
Pandemics can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth.
Individual behavioral changes, such as fear-induced aversion to workplaces and other public gathering places, are a primary cause of negative shocks to economic growth during pandemics.
Some pandemic mitigation measures can cause significant social and economic disruption.
In countries with weak institutions and legacies of political instability, pandemics can increase political stresses and tensions. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens.
Mitigation
Pathogens with pandemic potential vary widely in the resources, capacities, and strategies required for mitigation. However, there are also common prerequisites for effective preparedness and response.United States Disease Outbreak Essay
The most cost-effective strategies for increasing pandemic preparedness, especially in resource-constrained settings, consist of investing to strengthen core public health infrastructure, including water and sanitation systems; increasing situational awareness; and rapidly extinguishing sparks that could lead to pandemics.
Once a pandemic has started, a coordinated response should be implemented focusing on maintenance of situational awareness, public health messaging, reduction of transmission, and care for and treatment of the ill.
Successful contingency planning and response require surge capacity—the ability to scale up the delivery of health interventions proportionately for the severity of the event, the pathogen, and the population at risk.
For many poorly prepared countries, surge capacity likely will be delivered by foreign aid providers. This is a tenable strategy during localized outbreaks, but global surge capacity has limits that likely will be reached during a full-scale global pandemic as higher-capacity states focus on their own populations.
Risk transfer mechanisms, such as risk pooling and sovereign-level catastrophe insurance, provide a viable option for managing pandemic risk.
Knowledge Gaps
Spending and costs specifically associated with pandemic preparedness and response efforts are poorly tracked.
There is no widely accepted, consistent methodology for estimating the economic impacts of pandemics.
Most data regarding the impacts of pandemics and the benefits and costs of mitigation measures come from high-income countries (HICs), leading to biases and potential blind spots regarding the risks, consequences, and optimal interventions specific to LMICs.
Go to:
PANDEMIC RISKS AND CONSEQUENCES
Importance of Pandemics
Pandemics can cause sudden, widespread morbidity and mortality as well as social, political, and economic disruption. The world has endured several notable pandemics, including the Black Death, Spanish flu, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (table 17.1).United States Disease Outbreak Essay

Table 17.1. Notable Epidemics and Pandemics since the Middle Ages.
Table 17.1
Notable Epidemics and Pandemics since the Middle Ages.

Because the definition of pandemic primarily is geographic, it groups together multiple, distinct types of events and public health threats, all of which have their own severity, frequency, and other disease characteristics. Each type of event requires its own optimal preparedness and response strategy; however this chapter also discusses common prerequisites for effective response. The variety of pandemic threats is driven by the great diversity of pathogens and their interaction with humans. Pathogens vary across multiple dimensions, including the mechanism and dynamics of disease transmission, severity, and differentiability of associated morbidities. These and other factors determine whether cases will be identified and contained rapidly or whether an outbreak will spread (Fraser and others 2004). As a result, pathogens with pandemic potential also vary widely in the scale of their potential health, economic, and sociopolitical impacts as well as the resources, capacities, and strategies required for mitigation.

One must distinguish between several broad categories of pandemic threats. At one extreme are pathogens that have high potential to cause truly global, severe pandemics. This group includes pandemic influenza viruses. These pathogens transmit efficiently between humans, have sufficiently long asymptomatic infectious periods to facilitate the undetected movement of infected persons, and have symptomatic profiles that present challenges for differential diagnosis (particularly in the early periods of infection). A second group of pathogens presents a moderate global threat. These agents (for example, Nipah virus and H5N1 and H7N9 influenzas) have not demonstrated sustained human-to-human transmission but could become transmitted more efficiently as a result of mutations and adaptation. A third group of pathogens (for example, Ebola, Marburg, Lassa) has the potential to cause regional or interregional epidemics, but the risk of a truly global pandemic is limited because of the slow pace of transmission or high probability of detection and containment.United States Disease Outbreak Essay

Among all known pandemic pathogens, influenza poses the principal threat because of its potential severity and semiregular occurrence since at least the 16th century (Morens and others 2010). The infamous 1918 influenza pandemic killed an estimated 20 million to 100 million persons globally, with few countries spared (Johnson and Mueller 2002). Its severity reflects in part the limited health technologies of the period, when no antibiotics, antivirals, or vaccines were available to reduce transmission or mortality (Murray and others 2006).

During the 1918 pandemic, populations experienced significantly higher mortality rates in LMICs than in HICs, likely as a result of higher levels of malnutrition and comorbid conditions, insufficient access to supportive medical care, and higher rates of disease transmission (Brundage and Shanks 2008; Murray and others 2006). The mortality disparity between HICs and LMICs likely would be even greater today for a similarly severe event, because LMICs have disproportionately lower medical capacity, less access to modern medical interventions, and higher interconnectivity between population centers.

Origin of Pandemics
Most new pandemics have originated through the “zoonotic” transmission of pathogens from animals to humans (Murphy 1998; Woolhouse and Gowtage-Sequeria 2005), and the next pandemic is likely to be a zoonosis as well. Zoonoses enter into human populations from both domesticated animals (such as farmed swine or poultry) and wildlife. Many historically significant zoonoses were introduced through increased human-animal interaction following domestication, and potentially high-risk zoonoses (including avian influenzas) continue to emerge from livestock production systems (Van Boeckel and others 2012; Wolfe, Dunavan, and Diamond 2007). Some pathogens (including Ebola) have emerged from wildlife reservoirs and entered into human populations through the hunting and consumption of wild species (such as bushmeat), the wild animal trade, and other contact with wildlife (Pike and others 2010; Wolfe, Dunavan, and Diamond 2007).United States Disease Outbreak Essay

Zoonotic pathogens vary in the extent to which they can survive within and spread between human hosts. As shown in table 17.2, the degree of zoonotic adaptation spans a continuum from transmission only within animal populations (stage 1) to transmission only within human populations (stage 5). Most zoonotic pathogens are not well adapted to humans (stages 2–3), emerge sporadically through spillover events, and may lead to localized outbreaks, called stuttering chains (Pike and others 2010; Wolfe and others 2005). These episodes of “viral chatter” increase pandemic risk by providing opportunities for viruses to become better adapted to spreading within a human population. Pathogens that are past stage 3 are of the greatest concern, because they are sufficiently adapted to humans to cause long transmission chains between humans (directly or indirectly through vectors), and their geographic spread is not constrained by the habitat range of an animal reservoir.

Pandemic Risk Factors
Pandemic risk, as noted, is driven by the combined effects of spark risk and spread risk. The foci of both risk factors often overlap, especially in some LMICs (such as in Central and West Africa and Southeast Asia), making these areas particularly vulnerable to pandemics and their negative consequences.

Spark Risk
A zoonotic spark could arise from the introduction of a pathogen from either domesticated animals or wildlife. Zoonoses from domesticated animals are concentrated in areas with dense livestock production systems, including areas of China, India, Japan, the United States, and Western Europe. Key drivers for spark risk from domesticated animals include intensive and extensive farming and livestock production systems and live animal markets, as well as the potential for contact between livestock and wildlife reservoirs (Gilbert and others 2014; Jones and others 2008).United States Disease Outbreak Essay Wildlife zoonosis risk is distributed far more broadly, with foci in China, India, West and Central Africa, and the Amazon Basin (Jones and others 2008). Risk drivers include behavioral factors (such as bushmeat hunting and use of animal-based traditional medicines), natural resource extraction (such as sylviculture and logging), the extension of roads into wildlife habitats, and environmental factors (including the degree and distribution of animal diversity) (Wolfe and others 2005).

Spread Risk
After a spark or importation, the risk that a pathogen will spread within a population is influenced by pathogen-specific factors (including genetic adaptation and mode of transmission) and human population-level factors (such as the density of the population and the susceptibility to infection; patterns of movement driven by travel, trade, and migration; and speed and effectiveness of public health surveillance and response measures) (Sands and others 2016).

Dense concentrations of population, especially in urban centers harboring overcrowded informal settlements, can act as foci for disease transmission and accelerate the spread of pathogens (Neiderud 2015). Moreover, social inequality, poverty, and their environmental correlates can increase individual susceptibility to infection significantly (Farmer 1996). Comorbidities, malnutrition, and caloric deficits weaken an individual’s immune system, while environmental factors such as lack of clean water and adequate sanitation amplify transmission rates and increase morbidity and mortality (Toole and Waldman 1990). Collectively, all these factors suggest that marginalized populations, including refugees and people living in urban slums and informal settlements, likely face elevated risks of morbidity and mortality during a pandemic.

A country’s expected ability to curtail pandemic spread can be expressed using a preparedness index developed by Oppenheim and others (2017). The index illustrates global variation in institutional readiness to detect and respond to a large-scale outbreak of infectious disease. It draws on the IHR core capacity metrics and other publicly accessible cross-national indicators. However, it diverges from the IHR metrics in its breadth and focus on measuring underlying and enabling institutional, infrastructural, and financial capacities such as the following (Oppenheim and others 2017):United States Disease Outbreak Essay

NOW

Public health infrastructure capable of identifying, tracing, managing, and treating cases
Adequate physical and communications infrastructure to channel information and resources
Fundamental bureaucratic and public management capacities
Capacity to mobilize financial resources to pay for disease response and weather the economic shock of the outbreak
Ability to undertake effective risk communications.
Well-prepared countries have effective public institutions, strong economies, and adequate investment in the health sector. They have built specific competencies critical to detecting and managing disease outbreaks, including surveillance, mass vaccination, and risk communications. Poorly prepared countries may suffer from political instability, weak public administration, inadequate resources for public health, and gaps in fundamental outbreak detection and response systems.

Pandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995). These trends likely will continue and will intensify. Significant policy attention has focused on the need to identify and limit emerging outbreaks that might lead to pandemics and to expand and sustain investment to build preparedness and health capacity (Smolinsky, Hamburg, and Lederberg 2003).United States Disease Outbreak Essay

The international community has made progress toward preparing for and mitigating the impacts of pandemics. The 2003 severe acute respiratory syndrome (SARS) pandemic and growing concerns about the threat posed by avian influenza led many countries to devise pandemic plans (U.S. Department of Health and Human Services 2005). Delayed reporting of early SARS cases also led the World Health Assembly to update the International Health Regulations (IHR) to compel all World Health Organization member states to meet specific standards for detecting, reporting on, and responding to outbreaks (WHO 2005). The framework put into place by the updated IHR contributed to a more coordinated global response during the 2009 influenza pandemic (Katz 2009). International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity (Wolicki and others 2016).

Despite these improvements, significant gaps and challenges exist in global pandemic preparedness. Progress toward meeting the IHR has been uneven, and many countries have been unable to meet basic requirements for compliance (Fischer and Katz 2013; WHO 2014). Multiple outbreaks, notably the 2014 West Africa Ebola epidemic, have exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including global coordination and response mobilization (Moon and others 2015; Pathmanathan and others 2014). These gaps are especially evident in resource-limited settings and have posed challenges during relatively localized epidemics, with dire implications for what may happen during a full-fledged global pandemic.United States Disease Outbreak Essay

For the purposes of this chapter, an epidemic is defined as “the occurrence in a community or region of cases of an illness . . . clearly in excess of normal expectancy” (Porta 2014). A pandemic is defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people” (Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. For example, in contrast to annual seasonal influenza epidemics, pandemic influenza is defined as “when a new influenza virus emerges and spreads around the world, and most people do not have immunity” (WHO 2010).United States Disease Outbreak Essay

This chapter does not consider endemic diseases—those that are constantly present in particular localities or regions. Endemic diseases are far more common than pandemics and can have significant negative health and economic impacts, especially in low- and middle-income countries (LMICs) with weak health systems. Additionally, given the lack of historical data and extreme uncertainty regarding bioterrorism, this chapter does not specifically consider bioterrorism-related events, although bioterrorism could hypothetically lead to a pandemic.

This chapter covers the following findings concerning the risks, impacts, and mitigation of pandemics as well as knowledge gaps:United States Disease Outbreak Essay

Risks
Pandemics have occurred throughout history and appear to be increasing in frequency, particularly because of the increasing emergence of viral disease from animals.
Pandemic risk is driven by the combined effects of spark risk (where a pandemic is likely to arise) and spread risk (how likely it is to diffuse broadly through human populations).
Some geographic regions with high spark risk, including Central and West Africa, lag behind the rest of the globe in pandemic preparedness.
Probabilistic modeling and analytical tools such as exceedance probability (EP) curves are valuable for assessing pandemic risk and estimating the potential burden of pandemics.
Influenza is the most likely pathogen to cause a severe pandemic. EP analysis indicates that in any given year, a 1 percent probability exists of an influenza pandemic that causes nearly 6 million pneumonia and influenza deaths or more globally.
Impacts
Pandemics can cause significant, widespread increases in morbidity and mortality and have disproportionately higher mortality impacts on LMICs.
Pandemics can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth.United States Disease Outbreak Essay
Individual behavioral changes, such as fear-induced aversion to workplaces and other public gathering places, are a primary cause of negative shocks to economic growth during pandemics.
Some pandemic mitigation measures can cause significant social and economic disruption.
In countries with weak institutions and legacies of political instability, pandemics can increase political stresses and tensions. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens.
Mitigation
Pathogens with pandemic potential vary widely in the resources, capacities, and strategies required for mitigation. However, there are also common prerequisites for effective preparedness and response.
The most cost-effective strategies for increasing pandemic preparedness, especially in resource-constrained settings, consist of investing to strengthen core public health infrastructure, including water and sanitation systems; increasing situational awareness; and rapidly extinguishing sparks that could lead to pandemics.
Once a pandemic has started, a coordinated response should be implemented focusing on maintenance of situational awareness, public health messaging, reduction of transmission, and care for and treatment of the ill.United States Disease Outbreak Essay
Successful contingency planning and response require surge capacity—the ability to scale up the delivery of health interventions proportionately for the severity of the event, the pathogen, and the population at risk.
For many poorly prepared countries, surge capacity likely will be delivered by foreign aid providers. This is a tenable strategy during localized outbreaks, but global surge capacity has limits that likely will be reached during a full-scale global pandemic as higher-capacity states focus on their own populations.
Risk transfer mechanisms, such as risk pooling and sovereign-level catastrophe insurance, provide a viable option for managing pandemic risk.
Knowledge Gaps
Spending and costs specifically associated with pandemic preparedness and response efforts are poorly tracked.
There is no widely accepted, consistent methodology for estimating the economic impacts of pandemics.
Most data regarding the impacts of pandemics and the benefits and costs of mitigation measures come from high-income countries (HICs), leading to biases and potential blind spots regarding the risks, consequences, and optimal interventions specific to LMICs.United States Disease Outbreak Essay
Go to:
PANDEMIC RISKS AND CONSEQUENCES
Importance of Pandemics
Pandemics can cause sudden, widespread morbidity and mortality as well as social, political, and economic disruption. The world has endured several notable pandemics, including the Black Death, Spanish flu, and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) (table 17.1).

Table 17.1. Notable Epidemics and Pandemics since the Middle Ages.
Table 17.1
Notable Epidemics and Pandemics since the Middle Ages.

Because the definition of pandemic primarily is geographic, it groups together multiple, distinct types of events and public health threats, all of which have their own severity, frequency, and other disease characteristics. Each type of event requires its own optimal preparedness and response strategy; however this chapter also discusses common prerequisites for effective response. The variety of pandemic threats is driven by the great diversity of pathogens and their interaction with humans. Pathogens vary across multiple dimensions, including the mechanism and dynamics of disease transmission, severity, and differentiability of associated morbidities. These and other factors determine whether cases will be identified and contained rapidly or whether an outbreak will spread (Fraser and others 2004). As a result, pathogens with pandemic potential also vary widely in the scale of their potential health, economic, and sociopolitical impacts as well as the resources, capacities, and strategies required for mitigation.United States Disease Outbreak Essay

One must distinguish between several broad categories of pandemic threats. At one extreme are pathogens that have high potential to cause truly global, severe pandemics. This group includes pandemic influenza viruses. These pathogens transmit efficiently between humans, have sufficiently long asymptomatic infectious periods to facilitate the undetected movement of infected persons, and have symptomatic profiles that present challenges for differential diagnosis (particularly in the early periods of infection). A second group of pathogens presents a moderate global threat. These agents (for example, Nipah virus and H5N1 and H7N9 influenzas) have not demonstrated sustained human-to-human transmission but could become transmitted more efficiently as a result of mutations and adaptation. A third group of pathogens (for example, Ebola, Marburg, Lassa) has the potential to cause regional or interregional epidemics, but the risk of a truly global pandemic is limited because of the slow pace of transmission or high probability of detection and containment.

Among all known pandemic pathogens, influenza poses the principal threat because of its potential severity and semiregular occurrence since at least the 16th century (Morens and others 2010). The infamous 1918 influenza pandemic killed an estimated 20 million to 100 million persons globally, with few countries spared (Johnson and Mueller 2002). Its severity reflects in part the limited health technologies of the period, when no antibiotics, antivirals, or vaccines were available to reduce transmission or mortality (Murray and others 2006).United States Disease Outbreak Essay

During the 1918 pandemic, populations experienced significantly higher mortality rates in LMICs than in HICs, likely as a result of higher levels of malnutrition and comorbid conditions, insufficient access to supportive medical care, and higher rates of disease transmission (Brundage and Shanks 2008; Murray and others 2006). The mortality disparity between HICs and LMICs likely would be even greater today for a similarly severe event, because LMICs have disproportionately lower medical capacity, less access to modern medical interventions, and higher interconnectivity between population centers.

Origin of Pandemics
Most new pandemics have originated through the “zoonotic” transmission of pathogens from animals to humans (Murphy 1998; Woolhouse and Gowtage-Sequeria 2005), and the next pandemic is likely to be a zoonosis as well. Zoonoses enter into human populations from both domesticated animals (such as farmed swine or poultry) and wildlife. Many historically significant zoonoses were introduced through increased human-animal interaction following domestication, and potentially high-risk zoonoses (including avian influenzas) continue to emerge from livestock production systems (Van Boeckel and others 2012; Wolfe, Dunavan, and Diamond 2007). Some pathogens (including Ebola) have emerged from wildlife reservoirs and entered into human populations through the hunting and consumption of wild species (such as bushmeat), the wild animal trade, and other contact with wildlife (Pike and others 2010; Wolfe, Dunavan, and Diamond 2007).

Zoonotic pathogens vary in the extent to which they can survive within and spread between human hosts. As shown in table 17.2, the degree of zoonotic adaptation spans a continuum from transmission only within animal populations (stage 1) to transmission only within human populations (stage 5). Most zoonotic pathogens are not well adapted to humans (stages 2–3), emerge sporadically through spillover events, and may lead to localized outbreaks, called stuttering chains (Pike and others 2010; Wolfe and others 2005). These episodes of “viral chatter” increase pandemic risk by providing opportunities for viruses to become better adapted to spreading within a human population. Pathogens that are past stage 3 are of the greatest concern, because they are sufficiently adapted to humans to cause long transmission chains between humans (directly or indirectly through vectors), and their geographic spread is not constrained by the habitat range of an animal reservoir.United States Disease Outbreak Essay

Table Icon
Table 17.2
Pathogen Adaptation and Pandemic Risk.

Pandemic Risk Factors
Pandemic risk, as noted, is driven by the combined effects of spark risk and spread risk. The foci of both risk factors often overlap, especially in some LMICs (such as in Central and West Africa and Southeast Asia), making these areas particularly vulnerable to pandemics and their negative consequences.

Spark Risk
A zoonotic spark could arise from the introduction of a pathogen from either domesticated animals or wildlife. Zoonoses from domesticated animals are concentrated in areas with dense livestock production systems, including areas of China, India, Japan, the United States, and Western Europe. Key drivers for spark risk from domesticated animals include intensive and extensive farming and livestock production systems and live animal markets, as well as the potential for contact between livestock and wildlife reservoirs (Gilbert and others 2014; Jones and others 2008). Wildlife zoonosis risk is distributed far more broadly, with foci in China, India, West and Central Africa, and the Amazon Basin (Jones and others 2008). Risk drivers include behavioral factors (such as bushmeat hunting and use of animal-based traditional medicines), natural resource extraction (such as sylviculture and logging), the extension of roads into wildlife habitats, and environmental factors (including the degree and distribution of animal diversity) (Wolfe and others 2005).United States Disease Outbreak Essay

Spread Risk
After a spark or importation, the risk that a pathogen will spread within a population is influenced by pathogen-specific factors (including genetic adaptation and mode of transmission) and human population-level factors (such as the density of the population and the susceptibility to infection; patterns of movement driven by travel, trade, and migration; and speed and effectiveness of public health surveillance and response measures) (Sands and others 2016).

Dense concentrations of population, especially in urban centers harboring overcrowded informal settlements, can act as foci for disease transmission and accelerate the spread of pathogens (Neiderud 2015). Moreover, social inequality, poverty, and their environmental correlates can increase individual susceptibility to infection significantly (Farmer 1996).United States Disease Outbreak Essay Comorbidities, malnutrition, and caloric deficits weaken an individual’s immune system, while environmental factors such as lack of clean water and adequate sanitation amplify transmission rates and increase morbidity and mortality (Toole and Waldman 1990). Collectively, all these factors suggest that marginalized populations, including refugees and people living in urban slums and informal settlements, likely face elevated risks of morbidity and mortality during a pandemic.

A country’s expected ability to curtail pandemic spread can be expressed using a preparedness index developed by Oppenheim and others (2017). The index illustrates global variation in institutional readiness to detect and respond to a large-scale outbreak of infectious disease. It draws on the IHR core capacity metrics and other publicly accessible cross-national indicators. However, it diverges from the IHR metrics in its breadth and focus on measuring underlying and enabling institutional, infrastructural, and financial capacities such as the following (Oppenheim and others 2017):

Public health infrastructure capable of identifying, tracing, managing, and treating cases
Adequate physical and communications infrastructure to channel information and resources United States Disease Outbreak Essay
Fundamental bureaucratic and public management capacities
Capacity to mobilize financial resources to pay for disease response and weather the economic shock of the outbreak
Ability to undertake effective risk communications.
Well-prepared countries have effective public institutions, strong economies, and adequate investment in the health sector. They have built specific competencies critical to detecting and managing disease outbreaks, including surveillance, mass vaccination, and risk communications. Poorly prepared countries may suffer from political instability, weak public administration, inadequate resources for public health, and gaps in fundamental outbreak detection and response systems. United States Disease Outbreak Essay

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