SYMPOSIUM
cause of the importance of antibiotic resistance and the knowledge that a high percentage of antibiotics are used inappropriately, effective anti- biotic stewardship programs must be established. Sensitive and practical methods for inspecting food for mi- crobial safety are necessary to assure public health. New diagnostic meth- ods for infections are needed to help monitor for emerging infections. Pub- lic health officials need to have the resources to quickly respond to out- breaks, and industry must be nimble
in the efficient development of viral vaccines for control.
CONCLUSIONS
Emerging viral infectious agents are currently threatening human health. We will continue to see emergence of new RNA viruses as a result of muta- tion of viruses from established virus families, causing public fear and re- quiring new public health approaches to investigation and control. Emer- gence and reemergence by a virulent microbe cannot be predicted with ac-
curacy with the myriad of moving tar- gets influencing host pathogen inter- action through microbial adaptation, increasing susceptibility of humans, the climate, and the environmental changes and exposure to infected wildlife. Surveillance of diseases and disor-
ders in human populations is critical and will require medical and veteri- nary clinicians and laboratory diag- nosticians to work jointly and to com- municate with public health officials.
TABLE 1. CLINICAL CLASSIFICATION OF RNA VIRUSES WITH EPIDEMIC POTENTIAL: THE NEXT OUTBREAK-INFECTING AGENT
RNA viruses experience high mutation rates leading to virus diversification, resulting in three to four new species in established families emerging each year.
Family
Flaviviridae (infects humans and other mammals usually spread via arthropod vector — tick or mosquito)
Filoviridae (infects humans and nonhuman primates)
Paramyxoviridae (infects humans, vertebrates, and birds)
Bunyaviridae (vectorborne including mosquitoes, ticks, sandflies)
Orthomyxoviridae
Arenaviridae (divided into Old World — Europe, Asia, and Africa, and New World — Western hemisphere)
Coronaviridae (respiratory and enteric infections of humans and vertebrate animals)
Species
100 species including dengue, hepatitis C, Kyasanur Forest disease, hemorrhagic fever, Japanese encephalitis, Murray Valley encephalitis, St. Louis encephalitis, tick-borne encephalitis, West Nile virus, yellow fever, and Zika virus
Two species of Marburg and five species of Ebola hemorrhagic fever viruses
36 species including Hendra respiratory virus, measles, mumps, Nipah encephalitis virus, parainfluenza viruses, respiratory syncytial virus and animal pathogens, Newcastle disease virus for birds, and rinderpest virus for cattle
330 known viruses including Bwamba fever, Crimean-Congo hemorrhagic fever, Hantavirus, Hantaan virus, Hantavirus pulmonary syndrome virus, Rift Valley fever virus (reemerging virus)
Six genera with the major pathogens of human influenza A and B viruses
Eight arenaviruses that cause human disease including Argentine, Bolivian, and Venezualan hemorrhagic fever virus; Lassa hemorrhagic fever virus; lymphocytic choriomeningitis virus; and Machupo virus
25 species including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)
Source: Created by Herbert L. DuPont, MD February 2017 TEXAS MEDICINE 35 Animal Reservoir
Birds, non-human primates, or unknown
Marburg (monkeys, bats), Ebola (bats), possibly non- human primates and dogs
Bats, birds, and livestock
Hantavirus (rodents, especially field mice), Crimean-Congo virus (rodents, hares, and hedgehogs)
Birds (aquatic, wild), chickens, and pigs
Rodents
Himalayan civet cat, raccoon dogs, Chinese ferret badgers, horseshoe bats (SARS), camels and bats (MERS)
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