A call for One Health approach

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A recent study published in the journal Pediatric Research Emerging and re-emerging viral diseases reviewed.

Increased prevalence of viral diseases

Novel and known viruses have caused multiple epidemics and pandemics in the past two decades. Global cooperation in research, surveillance and preparedness measures to address existing and future outbreaks is urgently needed. The World Health Organization (WHO) has introduced this disease

Study: Emerging and re-emerging pediatric viral diseases: a continuing global challengeStudy: Emerging and re-emerging pediatric viral diseases: a continuing global challenge

The Covid-19 pandemic and disease

Disease X represents a hypothetical pathogen that could trigger an epidemic or pandemic in the future. The coronavirus disease 2019 (COVID-19) pandemic has created an unprecedented global emergency. As of this outbreak, there have been more than 771.8 million COVID-19 cases and 6.9 million deaths so far.

Although the global emergency for COVID-19 ended in May 2023, there is a pressing need to continue developing more effective strategies for the emergence and re-emergence of viral infections. Understanding the trends in these diseases and the status of global prevention and control efforts is essential to address ongoing public health challenges. As such, the current study focused on pediatric populations, reviewing emerging and re-emerging viral diseases.

Effects on child health

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of Covid-19, was first reported in late 2019. Covid-19 appears to have lower mortality in the pediatric population than in adults but is a highly multifactorial disease. In particular, multisystem inflammatory syndrome in children (MIS-C) is a serious complication, which manifests four to six weeks after mild or asymptomatic COVID-19.

Moderna’s mRNA-1273 and Pfizer’s BNT162b2 vaccines are safe and effective in children under 18 years of age to prevent infection, hospitalization, serious illness, MIS-C and death.

Resurgence of the Zika virus and its consequences

Zika virus (ZIKV) is an arbovirus (mosquito-borne), first identified in Uganda in the 1940s. The virus has spread globally due to the ecology of its vector (Aedes aegypti And Aedes albopictus )

In 2022 there were more than 40,000 cases of ZIKV in America. Studies have linked maternal ZIKV infection during the first two trimesters to microcephaly. Management of acute ZIKV cases is supportive, and evidence-based therapy is lacking. The mechanisms of microcephaly and other malformations associated with congenital ZIKV syndrome are poorly defined. Further, vaccines and therapeutics for ZIKV are in various stages of development.

Viral Threats: From Nipah to Mpox

Nipah virus (NiV) was first isolated after an outbreak in Malaysia in 1999. NiV is a research priority due to its high mortality rate (>70%) and its epidemic potential. A study on NiV transmission in Bangladesh highlighted that children aged ≤ 14 years were most affected, with a mortality rate estimated at around 80%.

Mpox, formerly known as monkeypox, is a zoonotic disease caused by the mpox virus. The virus was first isolated in 1958. The mpox case burden in children has historically been uneven. The largest mpox outbreak occurred in 2022, resulting in 86,000 cases worldwide, mainly among men who have sex with men. Although pediatric cases were rare in 2022, earlier reports suggest a higher risk of serious illness in children.

Challenges in Eradication of Endemic Viruses

Measles virus (MV) is highly contagious and spreads through respiratory droplets. Vaccination or infection confers lifelong immunity. Efforts to achieve MV eradication have been a global priority for decades. However, the number of MV cases and deaths has continued to rise since 2016, mainly due to failure to vaccinate, with many deaths recorded among children under the age of five.

Children with weakened immune systems and malnutrition are at risk of serious illness and death. The resurgence of measles and the failure to achieve MV eradication underscore the need for continued investment in surveillance and vaccination efforts. Ebola virus (EBOV) is the cause of Ebola virus disease. EBOV was isolated in 1976 during separate outbreaks of viral hemorrhagic fever in Sudan and the Democratic Republic of Congo (DRC).

At that time, the mortality rate was 53% in Sudan and 88% in the DRC. EBOV outbreaks were mostly recorded in Central Africa until 2013. The largest outbreak occurred between 2013 and 2016, resulting in 28,000 cases and 11,000 deaths. Although children represent a minor proportion of cases, the EBOV incubation period is short, increasing the risk of death in children under five years of age.

Chikungunya virus (CHIKV) is an arbovirus that causes chikungunya fever, a febrile illness associated with severe arthritis, arthralgia, maculopapular rash, and headache. It was first described in southern Tanzania in 1952-53. CHIKV infection is more frequently associated with severe disease than dengue. Neurologic, hematologic, and skin manifestations of the disease are more extensive and common in children than in adults.

Dengue virus (DENV) is an arbovirus that causes dengue fever. Reinfection with a different serotype of DENV results in severe illness associated with dengue hemorrhagic fever and dengue shock syndrome through antibody-dependent enhancement. Dengue is more common in young people and children. Dengue treatment is supportive, with no approved antivirals or therapies.

Growing concern: H5N1 and the impact of climate change

The global spread of a highly pathogenic avian influenza H5N1 virus has led to the death and slaughter of millions of wild birds and poultry since 2022. Moreover, the increasing spillover of H5N1 into mammals raises speculation about the emergence of more transmissible viruses. Furthermore, the spread of misinformation and confusion in a globally interconnected society can further compound the threat.

In addition, climate change has disproportionately impacted underdeveloped communities with limited resources, widening gaps in health disparities. Addressing these challenges requires international collaboration and partnerships that adopt a one-health-planet-health approach, which integrates human, animal and ecosystem health, ensures equitable resource distribution and increased resilience in global communities, and addresses the disproportionate burden of viral diseases.

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