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Volume 1, Number 1—January 1995
Perspective

Factors in the Emergence of Infectious Diseases

Stephen S. MorseComments to Author 
Author affiliation: The Rockefeller University, New York, New York, USA

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Table 2

Factors in infectious disease emergence*

Factor Examples of specific factors Examples of diseases
Ecological changes(including those due to economic development and land use) Agriculture; dams,changes in water ecosystems; deforestation/reforestation; flood/drought; famine; climate changes Schistosomiasis(dams); Rift Valley fever(dams, irrigation); Argentine hemorrhagic fever(agriculture); Hantaan (Korean hemorrhagic fever) (agriculture); hantavirus pulmonary syndrome, southwestern US, 1993 (weather anomalies)
Human demographics, behavior Societal events: Population growth and migration (movement from rural areas to cities); war or civil conflict; urban decay; sexual behavior; intravenous drug use; use of high-density facilities Introduction of HIV; spread of dengue; spread of HIV and other sexually transmitted diseases
International travel commerce Worldwide movement of goods and people; air travel "Airport" malaria; dissemination of mosquito vectors; ratborne hantaviruses; introduction of cholera into South America; dissemination of O139 V. cholerae
Technology and industry Globalization of food supplies; changes in food processing and packaging; organ or tissue transplantation; drugs causing immunosuppression; widespread use of antibiotics Hemolytic uremic syndrome(E.coli contamination of hamburger meat), bovine spongiform encephalopathy;transfusion-associated hepatitis (hepatitis B, C), opportunistic infections in immunosuppressed patients, Creutzfeldt-Jakob disease from contaminated batches of human growth hormone (medical technology)
Microbial adaptation and change Microbial evolution,response to selection in environment Antibiotic-resistant bacteria, "antigenic drift" in influenza virus
Breakdown in public health measures Curtailment or reduction in prevention programs; inadequate sanitation and vector control measures Resurgence of tuberculosis in the United States; cholera in refugee camps in Africa; resurgence of diphtheria in the former Soviet Union

* Categories of factors (column 1) adapted from ref. 12, examples of specific factors (column 2) adapted from ref. 13. Categories are not mutually exclusive; several factors may contribute to emergence of a disease (see Table 1 for additional information).

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