Editorial
François Valérian

Foreword: Emerging infections, a “global” challenge
Benoît Lesaffre

 
Inventory and issues

Emerging diseases: Illusion or reality?
Yves Coquin and Jacques Chemardin

The frequent implication of new (or transformed) pathogens, the unexpected occurrence of something unpredictable, the existence of an animal host or vector (an independent variable with its own “logic”), the seriousness of the disease, its economic and social impact, human reactions (technological or behavioral) — these often overlapping factors account for the outbreak of a new illness or the resurgence of a familiar one.

 
The causes underlying the emergence of disease agents
Didier Raoult

Three phenomena come into play in the outbreak of new illnesses: knowledge of the causes, the “globalization” of disease agents and of their vectors (mosquitos, ticks, etc.), and the variability of microbes.

 
The risks of food infections
Catherine Bouvier-Blaizot

The fight against disease agents has not yet reached an end; new ones will always crop up. Their incidence will be limited thanks to: a stability in health and social policies, a continuity in decision-making, the transparency and facility of relations between local and centralized authorities, scientific and technical know-how and the determination to increase it, the improvement of working conditions, and cooperation inside national as well as international networks.

 
The media’s power and a major health emergency
Xavier Emmanuelli interviewed by Benoît Lesaffre and François Valérian

According to this former cabinet member, a major health emergency is inevitable, and our Internet society with its rumors and media is much less prepared than during a more authoritarian era. A crisis will entail a frenetic quest for information, and we will have to be courageous enough to accept information that contradicts ideologies, doctrines and standard procedures.

 
Will the changing climate affect infectious diseases?
François Rodhain

Improving the population’s health has always been a priority used to justify development programs. Nowadays, development, by altering the climate, seriously threatens health. It is necessary to reduce the effects of the underway climate change and find the means for adapting as best possible thanks to a specifically human quality: cultural adaptability. The question of infectious diseases must be placed in its general — bioclimatic, socioeconomic and political — setting.

 
Knowledge, surveillance and alerts

The history and relevancy of the Pasteur Institute’s international network
Maxime Schwartz

There is no equivalent in the world to the creation, maintenance and extension of the Pasteur Institute’s network. Why? In the beginning, Louis Pasteur’s prestige sufficed to explain why the first establishments were set up. Since their motivation was to render service to the host country, the establishments in this network have continued operations regardless of political circumstances.

 
Simulating outbreaks of emerging diseases: Chikungunya fever and influenza
Pierre-Yves Boëlle

For the first time in history, the possibility exists of controlling epidemics at the source if the necessary means are used, as proven by the SARS outbreak (Severe Acute Respiratory Syndrome). However this possibility should not be interpreted as a warrant of success. It turned out to be rather easy to control SARS by isolating patients — an action that would not be possible during a flu pandemia. Interventions have to be based on epidemiological studies grounded on ever improved observations.

Ecosystems, entomology and the fight against disease vectors
Didier Fontenille

As experience has proven, controlling illnesses borne by vectors is seldom achieved through a single approach, whether by fighting against the vectors, their hosts or pathogenic agents. Only an integrated approach is realistic. New knowledge and technology provide us with exceptional opportunities for making a great leap forward in coping with targeted vectors in a way that respects the environment and is accepted by the population.

 
Actions in the field and recent lessons

Chikungunya fever: Looking back on a surprising epidemic and its management
Evelyne Falip, Marie Bâville, Bernard Faliu and Yves Coquin

No one can remain indifferent to the fact that, despite the efforts and means used, more than a third of the population on the islands of Reunion and Mayotte contracted Chikungunya fever in less than two years. It was probably impossible to fend off the epidemic, since several key factors related to this disease, its pathogenic agent and vector came to be understood only afterwards. As a retrospective analysis shows, health authorities were able— even though the means devoted to fight against the vector decreased over time — to organize to cope with the epidemic and draw the lessons from it.

 
The Chikungunya fever epidemic in the Indian Ocean, 2005-2006: The first lessons
Antoine Flahault

In February 2006, the French prime minister decided to set up a multidisciplinary unit of scientists, headed by the author of this article, from various disciplines (clinicians, virologists, immunologists, statisticians, epidemiologists, sociologists, entomologists, veterinaries) for coordinating research on Chikungunya fever in Reunion and Mayotte. This task force’s assignment was later broadened to cover dengue in the French Antilles and Guiana. An initial assessment is presented herein with the first lessons to be learned from the Chikungunya epidemic that struck nearly 40% of the population on the two islands and killed 248 people: one death per thousand cases.

 
Emerging animal diseases in the tropics: The unexpected impact of avian influenza
Emmanuel Camus and Renaud Lancelot

National and international veterinary services have learned from the health crisis and economic problems caused by bird flu and its risk of reaching pandemic proportions. They have carried the day by imposing the idea of a global approach to animal health.

The modified International Health Regulations
Guénaël Rodier

The future of International Health Regulations and, consequently, of international health safety now depends on the ability of countries to pursue, with WHO’s technical support, the mobilization that made the overhaul of the IHR possible.

 
Plan for continuing activities (PCA) in case of an influenza outbreak
Laurence Breton-Kueny and Dr. Sandrine Segovia-Kueny

All organizations must be prepared to carry on with their activities and protect wage-earners during an influenza epidemic. The organization’s or firm’s sense of social responsibility, its ethics and the continuity of its economic activities are at stake. Information is now available in printed material and through work groups, such as the French PCA club.