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      Global health security: the wider lessons from the west African Ebola virus disease epidemic

      review-article
      , Prof, MD a , b , * , , MD d , , Prof, MA e , , Prof, BCL f , , MD g , , MPH g , , MD h , , MD i , , MBChB j , k , , FRCP l , m , n , o , , Prof, MD p , q , , Prof, MD q , , PhD r , , Prof, JD s , , MBA t , , Prof, PhD u , , PhD c , v , , MSc c , , Prof, PhD c , w , , Prof, PhD b , , MBA c , , MD x , y , z , , DPH aa
      Lancet (London, England)
      Elsevier Ltd.

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          Summary

          The Ebola virus disease outbreak in West Africa was unprecedented in both its scale and impact. Out of this human calamity has come renewed attention to global health security—its definition, meaning, and the practical implications for programmes and policy. For example, how does a government begin to strengthen its core public health capacities, as demanded by the International Health Regulations? What counts as a global health security concern? In the context of the governance of global health, including WHO reform, it will be important to distil lessons learned from the Ebola outbreak. The Lancet invited a group of respected global health practitioners to reflect on these lessons, to explore the idea of global health security, and to offer suggestions for next steps. Their contributions describe some of the major threats to individual and collective human health, as well as the values and recommendations that should be considered to counteract such threats in the future. Many different perspectives are proposed. Their common goal is a more sustainable and resilient society for human health and wellbeing.

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          Antibiotic resistance-the need for global solutions.

          The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed. Copyright © 2013 Elsevier Ltd. All rights reserved.
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            Factors in the emergence of infectious diseases.

            "Emerging" infectious diseases can be defined as infections that have newly appeared in a population or have existed but are rapidly increasing in incidence or geographic range. Among recent examples are HIV/AIDS, hantavirus pulmonary syndrome, Lyme disease, and hemolytic uremic syndrome (a foodborne infection caused by certain strains of Escherichia coli). Specific factors precipitating disease emergence can be identified in virtually all cases. These include ecological, environmental, or demographic factors that place people at increased contact with a previously unfamiliar microbe or its natural host or promote dissemination. These factors are increasing in prevalence; this increase, together with the ongoing evolution of viral and microbial variants and selection for drug resistance, suggests that infections will continue to emerge and probably increase and emphasizes the urgent need for effective surveillance and control. Dr. David Satcher's article and this overview inaugurate Perspectives, a regular section in this journal intended to present and develop unifying concepts and strategies for considering emerging infections and their underlying factors. The editors welcome, as contributions to the Perspectives section, overviews, syntheses, and case studies that shed light on how and why infections emerge, and how they may be anticipated and prevented.
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              Is Open Access

              Investigation of Bioterrorism-Related Anthrax, United States, 2001: Epidemiologic Findings

              In October 2001, the first inhalational anthrax case in the United States since 1976 was identified in a media company worker in Florida. A national investigation was initiated to identify additional cases and determine possible exposures to Bacillus anthracis. Surveillance was enhanced through health-care facilities, laboratories, and other means to identify cases, which were defined as clinically compatible illness with laboratory-confirmed B. anthracis infection. From October 4 to November 20, 2001, 22 cases of anthrax (11 inhalational, 11 cutaneous) were identified; 5 of the inhalational cases were fatal. Twenty (91%) case-patients were either mail handlers or were exposed to worksites where contaminated mail was processed or received. B. anthracis isolates from four powder-containing envelopes, 17 specimens from patients, and 106 environmental samples were indistinguishable by molecular subtyping. Illness and death occurred not only at targeted worksites, but also along the path of mail and in other settings. Continued vigilance for cases is needed among health-care providers and members of the public health and law enforcement communities.
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                Author and article information

                Contributors
                Journal
                Lancet
                Lancet
                Lancet (London, England)
                Elsevier Ltd.
                0140-6736
                1474-547X
                7 May 2015
                9-15 May 2015
                7 May 2015
                : 385
                : 9980
                : 1884-1901
                Affiliations
                [a ]Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
                [b ]Centre on Global Health Security, London, UK
                [c ]Chatham House, Royal Institute of International Affairs, London, UK
                [d ]China Medical Board, Cambridge, MA, USA
                [e ]Japan House of Councillors, Tokyo, Japan
                [f ]Indiana University Maurer School of Law, Bloomington, IN, USA
                [g ]Division of Global Health Protection, Atlanta, GA, USA
                [h ]Center for Global Health, Atlanta, GA, USA
                [i ]US Centers for Disease Control and Prevention, Atlanta, GA, USA
                [j ]Vitality Institute, New York, NY, USA
                [k ]World Economic Forum Global Agenda Council on Ageing, Geneva, Switzerland
                [l ]Heartfile, Islamabad, Pakistan
                [m ]International Longevity Centre (ILC) Global Alliance and ILC-Brazil, Rio de Janeiro, Brazil
                [n ]New York Academy of Medicine, NY, USA
                [o ]HelpAge International, London, UK
                [p ]UNICEF/UNDP/World Bank/WHO Special Programme on Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
                [q ]Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
                [r ]Public Health Program, Open Society Foundations, New York, NY, USA
                [s ]O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC, USA
                [t ]New Partnership for Africa's Development, Pretoria, South Africa
                [u ]Department of Government, Harvard University, Cambridge, MA, USA
                [v ]Department of Politics, University of Sheffield, Sheffield, UK
                [w ]Tribhuvan University, Kathmandu, Nepal
                [x ]Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
                [y ]Department of Medicine, Harvard Medical School, Cambridge, MA, USA
                [z ]Earth Institute, Columbia University, New York, NY, USA
                [aa ]Institute for Health Policy, Colombo, Sri Lanka
                Author notes
                [* ]Correspondence to: Prof David L Heymann, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK david.heymann@ 123456lshtm.ac.uk
                Article
                S0140-6736(15)60858-3
                10.1016/S0140-6736(15)60858-3
                5856330
                25987157
                1390b76c-8db2-4b1c-b2cf-ff3062c59377
                Copyright © 2015 Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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