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Volume 22, Number 4—April 2016

Determinants and Drivers of Infectious Disease Threat Events in Europe

Jan C. SemenzaComments to Author , Elisabet Lindgren, Laszlo Balkanyi, Laura Espinosa, My S. Almqvist, Pasi Penttinen, and Joacim Rocklöv
Author affiliations: European Centre for Disease Prevention and Control, Stockholm, Sweden (J.C. Semenza, L. Balkanyi, L. Espinosa, P. Penttinen); Stockholm University Stockholm Resilience Centre, Stockholm (E. Lindgren, M.S. Almqvist); Umeå University, Umeå, Sweden (J. Rocklöv)

Main Article

Table 1

Determinants and drivers of infectious disease threat events, Europe, 2008–2013

Drivers, by group Examples*
Globalization and environment
Climate Temperature, humidity, wind, rainfall. Can have an effect on exposure pathways of foodborne and waterborne diseases or the distribution of vectorborne diseases.
Natural environment Land cover, vegetation, water ways, oceans, coastlines, water resources, land use, habitats, biodiversity. Can shift the distribution range and influence abundance of vectors (e.g., rodents, mosquitoes, ticks) as well as of host and reservoir animals.
Human-made environment Urbanization, built environment, infrastructure, industries, intensive agriculture. Can enable propagation and dissemination of pathogens.
Travel and tourism Movement of populations by automobile, train, ship, airplane. Can enable the importation of vectors, pathogens and infected persons into Europe and their dispersion within Europe.
Migration Immigrant, emigrant, asylum seeker, settler. Can be vulnerable to or contribute to spread of infectious diseases in origin country, in transit, or in destination country.
Global trade
Import and export of goods and services across international boundaries via ship, airplane, rail, truck. Can result in the exportation or importation (on purpose or involuntarily) of host animals, disease vectors, or pathogens.
Demographic Population composition with regards to age, income, education. Can be associated with greater health vulnerabilities.
Social inequality Uneven distribution of resources in society, including income, wealth, rights, privileges, social power, education. Disadvantaged groups can suffer disproportionately from infectious diseases.
Vulnerable groups Children, premature infants, pregnant women, elderly persons, men who have sex with men, immunocompromised persons. Vulnerability can increase exposure and susceptibility to infectious diseases or decrease access to care and recovery.
Prevention Childhood vaccination programs, adherence to treatment regimes, appropriate prescription practices. Distrust in prevention efforts can undermine control efforts (e.g., childhood vaccination programs. Neglect of prevention when traveling
Lifestyle High-risk behavior, such as intravenous drug use or unprotected sex with multiple partners. Can increase exposure and infection rates.
Occupational Healthcare workers, veterinary and animal care personnel, butchers, farmers, cleaners. Lapses in infection control practices can put healthcare workers at risk.
Intentional release or dissemination of biologic agents. Intentional contamination of drinking water can result in community outbreaks.
Public health systems
Healthcare system European healthcare structure for the delivery of health services, including general practitioners, hospitals, clinics. Access to care, medicines, diagnostics, insurance coverage, for example, can affect health outcomes. Healthcare systems contribute to nosocomial infections.
Animal Health Veterinary services, animal health and welfare measures, intensive livestock practices. High animal densities can promote infectious disease transmission. Infected animals close to human settlements can increase the risk for zoonotic epidemics.
Food and water quality Agriculture, husbandry, farming, processing, handling, preparation and storage of food, man-made water systems (e.g., cooling towers, hot and cold water systems, spa pools, humidifiers), water treatment and distribution systems. Contamination of drinking and irrigation water sources and water distribution systems can result in both localized and community outbreaks. Contamination of foodstuff along the chain from farm to fork can result in multistate epidemics
Surveillance and reporting failure
Systematic ongoing collection, collation, analysis, and dissemination of infectious disease data. Lapses in surveillance can impede a rapid response to infectious disease outbreaks. In contrast, increased surveillance will contribute to increased awareness and thus result in increased reporting of cases
*Examples are purposely not exhaustive and should be considered illustrative.

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Page created: March 15, 2016
Page updated: March 15, 2016
Page reviewed: March 15, 2016
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.