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  Infectious Diseases

  Impact
  Global View
  Mortality & Morbidity
  Co-infection
  Interventions
  Making Progress
  Needs & Costs
  What You Can Do





Global View

Infectious diseases, including HIV/AIDS and lower respiratory infections, cause nearly 40 percent of all deaths in low-income countries and about 18 percent of deaths globally.1 Among children under 5 years of age in low-income countries, infectious diseases cause nearly 70 percent of all deaths.

The greatest impact of infectious diseases is borne by the poorest and most vulnerable people.
  • Some diseases, such as HIV/AIDS, lower respiratory infections and tuberculosis, affect people during their most economically productive stages of life.

    • Those affected by infectious diseases may be subjected to job-, health- and education-related discrimination due to disfiguration and scarring. Fear of social stigma may lead to a delay in seeking treatment and care, which is detrimental to mental and physical health.

    • In some societies, women with infectious diseases suffer disproportionately from stigma and discrimination than men. These diseases may serve as reasons to terminate relationships, prevent marriages, increase partner violence, and withdraw spousal economic support.2

  • Children in developing countries, already lacking proper nutrition, may also lack access to affordable measles vaccinations and simple interventions for diarrheal diseases.3, 4 Children are more likely to die from pneumonia, diarrheal diseases and malaria than adults.1

  • Families in which the adults are disabled by infectious diseases may require that the children leave school to provide or care for the family. This perpetuates the cycle of poverty and under-education.

  • Pregnant women are especially vulnerable – e.g., pregnant women are the most at-risk for malaria and women are three times as likely as men to develop blinding
    trachoma.5, 6
The economic burden of caring for those who are sick is felt not only at the household level, but also at the community and national levels. Efforts to fight infectious diseases consume international, national, and local resources. However, adequate preparedness, prevention, control, elimination and eradication strategies for infectious diseases would also minimize the economic losses at a national level; examples of the economic costs of infectious disease outbreaks include:

Disease Costs (USD)
Cholera
  • Peru lost $770 million (1991)
  • Tanzania lost $36 million (1998)
SARS
  • Reduced Asia's Gross Domestic Product by $18 billion and cost the region $60 billion in lost demand and income earned
  • Canada lost $30 million per day of outbreak
Malaria
  • Sub-Saharan Africa loses $12 billion dollars each year
  • Stunts Africa’s economic growth by 1.3% per year
  • Consumes up to 25% of household income in endemic countries
Avian Influenza
  • Forty percent drop in Thai exports of poultry worth $5 billion (2003-2004)
Blinding Trachoma
  • Global losses of $5.3 billion
Lymphatic Filariasis
  • India loses $1 billion annually


Controlling infectious diseases is complicated, as there are many factors that contribute to the ability to prevent or treat diseases.
  • Diseases once believed to be under control have re-emerged as major global threats. The emergence of drug-resistant strains of bacteria, viruses and other parasites pose new challenges in controlling infectious diseases. Co-infection with multiple diseases creates obstacles to preventing and treating infections.

  • Neglected and diarrheal diseases have proven and affordable interventions, but lack funding and political will to reach the people in need of them.

  • Health system constraints, including a global shortage of health workers, hinder efforts to immunize, treat and monitor the status of patients.

  • Limited surveillance capabilities and laboratory resources in developing countries stunt efforts to find, diagnose and contain infectious diseases.

  • While substantial reductions in cases have been achieved for some diseases – such as polio and measles – others are emerging threats that increase awareness of our global vulnerability, highlight the borderless impact of disease, and underscore the need for strong health care systems.13

    • Avian influenza, SARS and H1N1 (swine flu) recently emerged as public health threats.

    • E. coli, Staphlococcus or “staph” infections, and food borne diseases have the garnered attention of the media.
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Global Deaths and Disability due to Infectious Diseases

An estimated 13.6 million children and adults died in 2008 from an infectious disease.1, 14 One of the main reasons for this large range of deaths is the large range of uncertainty surrounding malaria deaths – estimates of deaths due to malaria range between 1.3 million and 3 million.

Annual Deaths Due to Selected Diseases1, 3, 14-18




Disability-Adjusted Life Years for Selected Infectious Diseases1, 3, 14-17


Global Risk Factors for Infectious Diseases

A number of health, environmental, social and economic factors contribute to the high rates of infectious disease. Poverty, lack of access to health care, evolving human migration patterns, and changing environmental and development activities expand the impact of infectious diseases:
  • Health factors such as malnutrition and smoking can increase a person’s susceptibility to infectious diseases.

  • Environmental factors such as air quality, climate change, deforestation and species migration can alter the environment so that it becomes inhabitable for various disease-carrying vectors, resulting in increased cases of infectious diseases.19, 20

  • The movement of goods and people carry pathogens that are endemic to one area or population to new territories and peoples. Migration and urbanization are key factors in the spread of disease.

    • Migration and Urbanization.21 About three-fourths of those in Latin America and the Caribbean and two-thirds of those in Africa and Asia reside in urban areas. In all three regions, these ratios mark steady increases in the urban populations over the past few decades.22 This trend is expected to continue.

      • Close living quarters aid the spread of airborne infectious diseases such as TB, pneumonia and influenza.

      • In makeshift and overcrowded shantytown and slum neighborhoods located on the outskirts of major cities in the developing world, there is a lack of access to clean water and proper disposal of urine and feces, allowing for the spread of diarrheal diseases.
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      Past, Present and Projected Percentages of the Populations
      Living in Urban Areas, 1950 – 2030      22



    • Increased travel. In 2006, there were more than 2 billion international travelers – in 1950, there were 100 million international travelers.7

      Number of International Travelers 1950-20007



    • Increased trade. In recent decades, the increased trade in agricultural products has paralleled international travel. With increased trade has come increased prevalence of infectious foodborne illnesses and illnesses of animal origin.

      • The volume of agricultural products traded internationally has expanded five-fold since 1950.7

      • Many human infectious diseases began as zoonotic (animal) diseases; more than 60 percent of the 1,000+ human pathogens also provoke disease in animals.23

      • Traded products have harbored and transported infectious diseases and their vectors – for example, mosquitoes traveling in used tires exported to Italy caused outbreaks of Chickungunya virus in 2007.24


      Global Exports in Agricultural Products 1950-20007



Non-Communicable Diseases: The Future Threat
Globally, the burden of disease attributed to infectious diseases is diminishing.17 Slowly, the pattern of disease in developing countries is evolving toward that of wealthier countries, as non-communicable diseases, such as cardiovascular diseases and diabetes, occupy an increasing share of the burden of disease.1 This “epidemiological transition” from infectious to non-communicable diseases poses an added challenge for developing countries that still need to combat infectious diseases while simultaneously building up health systems to address non-communicable, often chronic, diseases.

Between 1990 and 2001, the global burden of disease caused by non-communicable diseases increased by 10 percent.17 In 2001, non-communicable diseases comprised 85 percent, 70 percent and nearly 50 percent of the disease burden in high-, middle- and low-income countries, respectively. The epidemiologic transitions in some regions are moving faster than in other regions. Currently, non-communicable diseases are now the leading causes of death in all Latin American countries. Only in South Asia and sub-Saharan Africa do infectious diseases account for more than half of all deaths.

Injuries
As with non-communicable diseases, injuries are gaining attention as a cause of death and disability in developing countries. In Latin America and the Caribbean, and sub-Saharan Africa, injuries due to violence and war cause a disproportionate share of deaths among those aged 15–59, about 20 percent more than the global level for this age group.25 In 2001, road traffic accidents ranked among the 10 leading causes of deaths for all regions except South Asia.17

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1 World Health Organization. (2008) WHO global burden of disease: 2004 update. Available from: www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html
2 Hunt P, Stewart R, Bueno de Mesquita J, Oldring L. 2007. Neglected diseases: a human rights analysis. Social, Economic and Behavioural Research. WHO & the Special Programme for Research & Training in Tropical Diseases. Report No.: 6. Available from: www.who.int/tdr/publications/publications/pdf/seb_topic6.pdf
3 World Health Organization. 2007. Measles. Fact sheet no 286. Available from: www.who.int/mediacentre/factsheets/fs286/en/print.html
4 Rudan I, El Arifeen S, Black RE, Campbell H. 2007. Childhood pneumonia and diarrhoea: setting our priorities right. Lancet Infec Dis 7:56-61
5 UNAIDS, World Health Organization. 2008. Report on the Global AIDS Epidemic. Available from: www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008/2008_Global_report.asp
6 Nosten F, McGready R, Mutabingwa T. 2007. Case management of malaria in pregnancy. Lancet Infec Dis 7:118-25.
7 Heymann DL. Infectious diseases across borders: the international health regulations. Understanding WHO's new international health regulations. Global Health Council. Washington, DC; 2007.
8 Bloom BR, Michaud CM, La Montagne JR, Simonsen L. Priorities for global research and development of interventions. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. 2 ed. Washington, DC: World Bank & Oxford, 2006. p. 103-18.
9 Roll Back Malaria. 2005. World Malaria Report. Geneva: UNICEF, WHO. Available from: http://rbm.who.int/wmr2005/pdf/WMReport_lr.pdf
10 Malaria Foundation International. The Abuja Declaration on Roll Back Malaria in Africa by the African Heads of State and Government. April 25, 2000. www.malaria.org/abujadeclaration.html
11 Sambo LG. 2007. Defining and defeating the intolerable burden of malaria III: foreward. Am J Trop Med Hyg 77(Suppl 6):iii.
12 Molyneux P, Hotez J, Fenwick A. 2005. Rapid-impact interventions: how a policy of integrated control for Africa's neglected tropical diseases could benefit the poor. PLoS Medicine 2(No 11 e336).
13 Jamison D, Breman J, Measham A, Alleyne G, Claeson M, Evans D, et al. 2006. Disease control priorities in developing countries. Washington, DC: The World Bank.
14 Breman J, Alilio M, Mills A. 2004. Conquering the intolerable burden of malaria: what's new, what's needed: a summary. American Journal of Tropical Medicine & Hygiene 71:1-15
15 UNAIDS, World Health Organization. 2006. AIDS epidemic update: December 2006. Available from: http://data.unaids.org/pub/EpiReport/2006/2006_EpiUpdate_en.pdf
16 Hotez PJ MD, Fenwick A et al. 2007. Incorporating a rapid-impact package for neglected tropical diseases with programs for HIV/AIDS, tuberculosis, and malaria. PLoS Medicine 3(No 5 e102).
17 Mathers CD, Lopez A, Stein C, Fat DM, Rao C, Inoue M, et al. 2005. Deaths and disease burden by cause: global burden of disease estimates for 2001 by World Bank country groups. Disease Control Priorities Project Working Paper No 18. Available from: www.dcp2.org/file/33/wp18.pdf
18 World Health Organization. 2008. Global tuberculosis control: surveillance, planning, financing. Available from: www.who.int/tb/publications/global_report/2008/pdf/fullreport.pdf
19 McMichael AJ, Powles JW, Butler CD, Uauy R. 2007. Food, livestock production, energy, climate change, and health. Lancet 370:1253-63
20 Chaves LF, Cohen JM, Pascual M, Wilson ML. 2008. Social exclusion modifies climate and deforestation impacts on a vector-borne disease. PloS Neg Trop Dis 2(2):1-8.
21 Dye C, Floyd K. Tuberculosis. In: Jamison D, Breman J, Measham A, et al, editors. Disease Control Priorities in Developing Countries. New York: Oxford, 2006. p. 289-306.
22 United Nations Population Fund. 2007. State of world population: unleashing the potential of urban growth. Available from: www.unfpa.org/swp/2007/presskit/pdf/sowp2007_eng.pdf
23 Barbiero VK. 2007. Avian influenza: an international perspective. Presentation slides for 205: Policy Approaches to Public Health. Washington, DC: George Washington School of Public Health.
24 World Health Organization. 2007. Outbreak and spread of chikungunya. Weekly epidemiological record 47(82):409-16.
25 Lopez A, Mathers CD, Ezzati M, Jamison DT, Murray CJ. 2006. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 367:1747-57.
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