Major Infectious Diseases: Key Messages from Disease Control Priorities, Third Edition

In: Major Infectious Diseases. 3rd edition. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2017 Nov 3. Chapter 1.


Infectious diseases were responsible for the largest global burden of premature death and disability until the end of the twentieth century, when that distinction passed to noncommunicable diseases. Over the previous centuries, global pandemics of infectious diseases, such as smallpox, cholera, and influenza, periodically threatened the survival of entire populations. At least as early as the late 1800s, improved living conditions (such as better sanitation and piped water supplies), particularly in high-income countries (HICs), began to drive down the infectious disease burden.

By the mid-twentieth century, safe, effective, and affordable vaccines and the increasing availability of antibiotics had further reduced the toll of infectious diseases in HICs. Not until the second half of the twentieth century did large-scale efforts begin to better control infectious diseases in low- and middle-income countries (LMICs), where the infectious disease burden was greatest and highly varied. These efforts included a global commitment to immunize the world’s children against the major infections for which vaccines are available and global campaigns to control malaria and diarrheal disease. The International Health Regulations of the World Health Organization (WHO) represent a key agreement among 196 countries to implement metrics and measures to detect and control outbreaks of infectious diseases and to prevent pandemics (World Health Assembly 2005).

Global under-five mortality fell by almost two-thirds (from 14 percent to 5 percent) between 1970 and 2010 (Norheim and others 2015). In 1980, smallpox, responsible for 300 million–500 million deaths in the twentieth century, was declared to be the first disease eradicated from the planet following a global immunization campaign led by the WHO. Wild Poliovirus has been eliminated from all but three countries (Afghanistan, Nigeria, and Pakistan) and currently is the focus of a major eradication program.

The decline of the vaccine-preventable diseases has contributed to a recognition of the potential for using vaccines to prevent other infectious diseases, including human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), tuberculosis (TB), malaria, hepatitis C, and a variety of neglected tropical diseases (NTDs). Hepatitis B and C substantially increase the risk of death from cirrhosis and liver cancer. The effect of viral hepatitis is significant. Indeed, an important recent study (Stanaway and others 2015) found that viral hepatitis led to an estimated 0.9 million deaths in 1990 (including hepatitis-caused deaths from cirrhosis and liver cancer). Furthermore, this number has been increasing rapidly—to an estimated 1.5 million deaths in 2013—despite the fact that hepatitis B is a vaccine-preventable disease and that hepatitis B and C are both treatable.

Emerging pandemic viral infections remain a constant threat, many entering the human population from contact with animals. The most recent such infections include SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and Ebola and Zika viruses (Madhav and others 2018) as well as, perennially, influenza and chikungunya infections. Compared with antibiotics to treat bacterial infections, relatively few antiviral drugs have been developed to treat these emerging viral infections. Therefore, the most important intervention is to break the chain of transmission. A global increase in antibiotic-resistant bacteria includes a small but growing number that are resistant to most or essentially all of the available antimicrobials.

Spectacular progress has been made in reducing mortality from most infectious diseases (table 1.1). For example, in low-income countries (LICs) from 2000 to 2010, the number of deaths before age 70 years from HIV/AIDS, TB, and malaria fell by 46 percent, 35 percent, and 36 percent, respectively (Norheim and others 2015). Rapid progress was also reported in other country income groups. However, table 1.1 shows also that if the death rates of 2010 remain static, about 5.1 million people will still die in 2030 from these three conditions and from other communicable diseases, many of which are concentrated in LMICs. In contrast, mortality in HICs from these conditions (except for HIV/AIDS) will be relatively small, although major pandemics of other pathogens are not predictable. Hence, infectious diseases will remain a major threat to humankind, especially in LMICs, requiring vigilance, surveillance, and new interventions of all types.

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