RML Rendezvous: Transcending Borders Globally

Editor's Notes

1. Over a hundred years ago, there was research to identify and track cholera epidemics based on trade routes (sea as well as on land– while the methods used to collect and map the data were crude by today’s standards, they didn’t have to deal with the rapidity of movement of humans, animals!) Today, the speed of movement of humans and animals means that infections can be spread globally before we even know there is an outbreak. We need more accurate and speedier ways of identifying disease outbreaks and preventing their spread.
2. Increased vector movement may be just as important as increased human movement in contributing to the global spread of infectious diseases. There is perhaps no better illustration of this point than the global spread of Aedes aegypti and the worldwide resurgence of dengue, as described above. This same mosquito has also been responsible for yellow fever outbreaks worldwide; endemic zones include every country in South America except for Brazil and more than half the countries in Africa. Global climate change is expanding the habitat for disease vectors resulting in expansion of numerous mosquito borne diseases. Vectors are usually introduced into new areas inadvertently via vehicles used to transport people or commodities (e.g., airplanes) or via commodities that are being transported. It has been demonstrated experimentally that a number of different disease vectors can survive in the wheel wells of jet aircraft at high altitudes for long intercontinental flights. Mosquitoes also hitchhike on used car tires that are being transported for retreading or other purposes. For example, the Asian tiger mosquito, Aedes albopictus , a denguevirus vector, was introduced to the North American continent on rubber tires shipped to Houston. The United States–Mexico border, a dumping ground for used tires, is an important breeding site for Aedes mosquitoes. Animal importations are another potential source of introduced zoonoses. Before its first appearance in New York City in 1999, West Nile virus was not present in the western hemisphere. It has now spread throughout the North American continent, into Canada, Mexico, Central America, and the Caribbean. This example of the potential for the introduction of a vectorborne infectious disease into a new hemisphere also illustrates how a multitude of factors can converge to provide a ripe opportunity for emergence: the most common vector of West Nile virus in the United States, the common household mosquito ( Culex pipiens ), was already ubiquitous in the New York metropolitan area; the marshy habitat where the disease emerged was an ideal mosquito breeding ground; the location of emergence was near a major international airport; and international travelers are constantly arriving in Queens, which houses perhaps one of the most ethnically diverse populations in the world. Although the virus was almost certainly introduced via a transportation vehicle, it is unclear whether it was introduced via a vector mosquito or some other means. Other possibilities include the arrival of an infected human, an infected bird on an airplane or other transportation vehicle, an infected migrating bird, or an infected animal reservoir in the New York City area. At this point, there may be no way to trace the precise means of introduction, which in any case is somewhat immaterial, as the virus is well established in animal populations and has spread rapidly down the East Coast of the United States.
3. Problem isn’t that we have NO health information systems – if anything we have too many and they are fragmented and duplicative and wasteful of health workers precious time; have to enter the same data multiple times; silos of databases; lack of connection between important databases;
4. Based upon agreed upon standards for data collection, disease definition and using mobile technologies for data collection and sharing, advanced geographic mapping systems and significant coordination across country boundaries disease surveillance in the Mekong Basin region is greatly improving the ability to identify disease outbreaks