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Despite improvements in recent years, most existing surveillance systems are still unable to identify emerging infectious diseases.18,49 The very uneven distribution of surveillance capacity in the world is also a major cause for concern. Most emerging infections are zoonotic introductions from other vertebrate species, including wildlife.50-53 For example, HIV (or its ancestors) very likely entered the human population from chimpanzees or other nonhuman primates, probably through hunting and butchering of infected animals for meat.52,54 The ancestor of the virus that causes SARS appears to be a natural infection of certain bats and is thought to have infected humans through mixing of species in live animal markets and food handling practices.55,56 Despite this, and the longstanding recommendations of expert groups such as the Institute of Medicine, there has not been a global program for surveillance of emerging infections before they reach the human population.18 In 2009 the U.S. Agency for International Development (USAID) rose to this challenge by starting the Emerging
Pandemic Threats (EPT) program, which includes PREDICT, a project to build global capacity for surveillance and risk assessment of novel zoonotic infections that have pandemic potential.57 EPT grew out of USAID’s earlier programs in avian influenza, which demonstrated the importance of the One Health approach.51 PREDICT uses the One Health approach to target and integrate surveillance across species, in partnership with governments and agencies such as CDC, FAO, WHO, and OIE. In addition to PREDICT, the EPT program includes RESPOND, a project led by Development Alternatives, Inc. (DAI), to develop training for outbreak investigation and response that merge animal- and human-health approaches, in order to build capacity for disease detection and control; IDENTIFY, which brings together the WHO, the U.N. Food and Agriculture Organization (FAO), and the World Organization for Animal Health (OIE) to develop laboratory networks and to implement strategies for strengthening diagnostic laboratory capacity globally; and PREVENT, led by FHI360, which focuses on behavior change for risk reduction.58 PREDICT, the surveillance component of EPT, is intended to build global capacity for infectious disease surveillance, especially for emerging and zoonotic infections. Many of the risk factors, or drivers, of emergence increase pathogen transfer across the interface between humans and other animals (or between animal species). Human activities that can facilitate this process often involve changes in land use or population patterns. These include, among others, farming, hunting, live animal markets, and urbanization.2,50-52 PREDICT focuses on the animal-human interface to better understand the pathogen background in other species coming into contact with humans and the risk factors for emergence of new zoonoses. Current activities are ongoing in about 20 developing countries. Capacity building, to enable countries to enhance their own surveillance and diagnostic capabilities, is at the heart of the project. Conducted in partnership with national and local governments and in-country scientists and other local personnel, activities include field observation and sample collection, reporting, and both broad viral testing/pathogen discovery and conventional laboratory microbiology as feasible. As of late 2011, the project has already identified approximately 100 viruses (with bats, rodents, and nonhuman primates the most intensively studied), spanning a number of viral families. A digital data system is being used for storing and correlating the data obtained from these diverse sources. An innovative and promising approach developed in the past few years is the concept of mapping ‘‘hotspots,’’ or areas that have historically been associated with the emergence of new infections.59 There are plans to use data from PREDICT to refine hotspot mapping and modeling strategies and to test hypotheses about zoonotic transmission. Data and technical expertise will be shared appropriately with the participating countries for their own public health planning, and subsequently made publicly
available through HealthMap.org on the web.
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