West Africa 2013 Ebola: From Virus Outbreak to Humanitarian Crisis.

The 2013 outbreak of Ebola virus disease (EVD) in West Africa constituted a major humanitarian crisis. The outbreak numbered over 28,500 cases, more than 10 times the number cumulatively registered from all previous EVD outbreaks combined, with at least 11,000 deaths, and resulted in billions of dollars of lost economic growth to an already impoverished region. The unprecedented scale of West Africa 2013 took the world by surprise and laid bare deficiencies in our response capacity to complex humanitarian disasters of highly infectious and lethal pathogens. However, the magnitude of West Africa 2013 also provided a unique opportunity and obligation to better understand not only the biology and epidemiology of EVD, but also the many scientific, economic, social, political, ethical, and logistical challenges in confronting emerging infectious diseases in the modern era.

The Threat and Response to Infectious Diseases (Revised).

The threat from microorganisms is complex, and the approaches for reducing the challenges the world is facing are also multifaceted, but a combination approach including several simple steps can make a difference and reduce morbidity and mortality and the economic cost of fighting infectious diseases. This paper discusses the continually evolving infectious disease landscape, contributing factors in the rise of the threat, reasons for optimism, and the policies, technologies, actions, and institutions that might be harnessed to further reduce the dangers introduced by pathogens. It builds upon and updates the work of other authors that have recognized the dangers of emerging and re-emerging pathogens and have explored and documented potential solutions.

Economics for assisting policy-makers to take decisions about new and endemic diseases.

Animal health policy-makers are frequently faced with making decisions concerning the control and exclusion of diseases in livestock and wildlife populations. Economics is one of the tools they have to aid their decision-making. It can enable them to make objective decisions based on the expected costs and benefits of their policy. In addition, economics can help them determine both the distribution impact and the indirect impact of their decisions. However, economics is only one of many tools available to policy-makers, who also need to consider non-economic outcomes in their decision-making process. While there are sophisticated epidemic and economic (epinomic) models that are available to help evaluate complex problems, these models typically require extensive data and well-trained analysts to run and interpret their results. In addition, effective communication between analysts and policy-makers is important to ensure that results are clearly conveyed to the policy-makers. This may be facilitated by early and continued discussions between these two potentially disparate groups. If successfully performed and communicated, economic analyses may present valuable information to policy-makers, enabling them to not only better understand the economic implications of their policy, but also to communicate the policy to relevant stakeholders, further ensuring their likelihood of participating in the planned policy and hence increasing its likelihood of success.

Les responsables des politiques de santé animale sont souvent confrontés à la nécessité de prendre des décisions au sujet de la lutte à mener contre les maladies animales affectant les populations domestiques et sauvages ou de leur éradication. L'économie est l'un des outils d'aide à la décision à leur disposition. L'économie peut les aider à prendre des décisions objectives basées sur les coûts et les avantages attendus des politiques envisagées. Elle peut aussi les aider à déterminer l'impact de leurs décisions en termes de portée et d'effets indirects. Néanmoins, l'économie n'est qu'un des nombreux outils disponibles et les décideurs doivent également intégrer les résultats non économiques lors de leur processus décisionnel. Un certain nombre de modèles épidémiques et économiques (« épinomiques ¼) sophistiqués permettent d'évaluer des problèmes complexes ; ils nécessitent cependant un volume considérable de données ainsi que des analystes qualifiés pour les mettre en oeuvre et en interpréter les résultats. En outre, une communication efficace doit être mise en place entre les analystes et les décideurs afin de s'assurer que les résultats obtenus sont rapportés à ces derniers dans un langage clair. Ceci peut être facilité par des échanges précoces et permanents entre ces deux groupes potentiellement hétérogènes. Des analyses économiques bien réalisées et faisant l'objet d'une bonne communication fournissent aux décideurs des informations de qualité grâce auxquelles ils peuvent appréhender plus clairement les conséquences économiques de leurs politiques, mais aussi expliquer ces politiques aux principales parties prenantes, ce qui accroît la probabilité de les faire adhérer aux mesures planifiées et améliore d'autant les chances de succès.

Los planificadores de políticas zoosanitarias se ven con frecuencia en la tesitura de adoptar decisiones acerca del control y la exclusión de enfermedades en poblaciones de ganado o de animales salvajes. La economía es una de las herramientas en las que pueden apoyarse para ello, pues les ayuda a tomar decisiones objetivas basándose en los costos y beneficios previstos de determinada política. Además, la economía puede serles útil para determinar tanto el impacto distributivo como el impacto indirecto de sus decisiones. Sin embargo, la economía es solo una de las muchas herramientas de que disponen los planificadores, que en su proceso decisorio también deben tener en cuenta efectos de carácter no económico. Si bien para ayudarles a aprehender problemas complejos existen sofisticados modelos epidemiológicos y económicos (epinómicos), estos suelen requerir un gran número de datos, así como el concurso de analistas cualificados para aplicar los modelos e interpretar sus resultados. Asimismo, para que los resultados obtenidos por los analistas lleguen con claridad a los planificadores es importante que existan cauces eficaces de comunicación entre los primeros y los segundos, lo que puede verse facilitado si estos dos grupos, en potencia tan dispares, dialogan desde buen comienzo y de forma continua. Si se llevan a cabo y se comunican correctamente, los análisis económicos pueden ofrecer información útil a los planificadores, que les sirva no solo para aprehender mejor las consecuencias económicas de sus políticas, sino también para explicar determinada política a todos los interlocutores del sector, con lo cual estos serán más proclives a participar en dicha política y esta tendrá más probabilidades de éxito.

Where to next with animal health in Latin America? The transition from endemic to disease-free status.

The Latin American and Caribbean region (LAC) is a leading global producer and exporter of animal products. Its livestock production systems are diverse, ranging from large-scale commercial enterprises to family farms. Countries in this region have sought to improve their animal health status through both public and private efforts. Despite significant advances in eradicating such diseases as foot and mouth disease and classical swine fever, other animal health challenges remain; constraining exports, causing negative economic impacts and threatening food security. Obtaining certification of disease-free status is only the first step towards gaining benefits from improvements in animal health. Increasing international trade means that countries must manage the sustainability of their disease-free status in conjunction with trade partners and must comply with additional food safety and animal welfare standards. This paper comments on the challenges created by this new scenario in relation to the epidemiology and economics of animal health, when seeking to improve decisionmaking for animal health management. The authors characterise the current LAC livestock landscape and animal health situation, describing transitions in disease control and the use of economics in improving animal health. They conclude with remarks on the challenges presented by decision-making, economic rationality, sources of benefits, distribution and incentives.

La région Amérique latine et Caraïbes est l'une des principales régions productrices et exportatrices de produits d'origine animale dans le monde. Les systèmes de production du secteur de l'élevage y sont très diversifiés, depuis les petites exploitations familiales jusqu'aux élevages commerciaux à grande échelle. Les pays de la région ont cherché à améliorer la situation de la santé animale sur leur territoire en y consacrant les efforts de leur secteur public et privé. Malgré les avancées considérables réalisées dans l'éradication de maladies comme la fièvre aphteuse et la peste porcine classique, la santé animale est encore confrontée à des problèmes qui freinent les exportations et ont un impact économique négatif, tout en menaçant la sécurité de l'approvisionnement alimentaire. La reconnaissance officielle du statut indemne de maladie ne représente qu'une première étape dans le processus visant à générer des bénéfices grâce à une meilleure santé animale. L'intensification des échanges internationaux impose aux pays de s'assurer de la durabilité de leur statut indemne aux côtés de leurs partenaires commerciaux et de respecter de nouvelles normes relatives à la sécurité sanitaire des aliments et au bien-être animal. Les auteurs analysent les conséquences de ce scénario sur l'épidémiologie et l'économie de la santé animale ainsi que ses enjeux dans la recherche d'une meilleure prise de décisions dans la gestion de la santé animale. Ils définissent ensuite le paysage actuel de l'élevage et la situation de la santé animale en Amérique latine et dans les Caraïbes et décrivent les évolutions à l'oeuvre en matière de lutte contre les maladies animales et d'utilisation de l'économie dans l'amélioration de la santé animale. Ils concluent sur quelques remarques concernant les difficultés qui se présentent en matière de prise de décision, de rationalité économique, de sources de profit, de distribution et d'incitation.

La región de América Latina y el Caribe es uno de los principales productores y exportadores de productos animales del mundo. Sus sistemas de producción ganadera exhiben gran heterogeneidad, pues van desde las grandes empresas de dimensión industrial hasta las pequeñas explotaciones familiares. Apoyándose en la iniciativa tanto pública como privada, los países de la región vienen tratando de mejorar su situación zoosanitaria. Pese a los importantes progresos registrados en la erradicación de enfermedades como la fiebre aftosa o la peste porcina clásica, subsisten otros problemas de sanidad animal que restringen las exportaciones, lastran la economía y amenazan la seguridad alimentaria. La certificación de «ausencia de enfermedad¼ es solo el primer paso para beneficiarse de las mejoras conseguidas en el terreno de la sanidad animal. Habida cuenta de la intensificación del comercio internacional, los países deben gestionar la continuidad a largo plazo de su estatuto de «libres de enfermedad¼ conjuntamente con sus socios comerciales y, para ello, cumplir normas adicionales en material de inocuidad de los alimentos y bienestar animal. Los autores exponen las dificultades que se plantean en esta nueva coyuntura de la epidemiología y la economía de la sanidad animal a la hora de mejorar los procesos decisorios en materia de gestión zoosanitaria. Tras caracterizar el actual paisaje de la ganadería y la situación zoosanitaria en América Latina y el Caribe, describen la transición que se está operando en cuanto al control de enfermedades y al uso de la economía para mejorar la sanidad animal y concluyen con una serie de observaciones sobre los problemas que surgen en relación con la adopción de decisiones, la racionalidad económica, las fuentes de beneficios y las cuestiones ligadas a la distribución y los incentivos.

Economic assessment of an emerging disease: the case of Schmallenberg virus in France.

Schmallenberg virus (SBV) was first detected in 2011 in Germany and then in France in 2012. This study simulates the production of different ruminant systems in France and estimates, through partial budget analyses, the economic cost of SBV at the farm level, under two disease scenarios (a high-impact and low-impact scenario). A partial budget is used to evaluate the financial effect of incremental changes, and includes only resources or production that will be changed. In the high-impact scenario, the estimated impact of SBV ranged from €23 to €43 per cow per year and €19 to €37 per ewe per year. In the low-impact scenario, it was approximately half (for cows) or one-third (for ewes) of this amount. These financial impacts represent 0.6% to 63% of the gross margin, depending on the chosen scenario and the livestock system being considered. The impacts of SBV come mainly from: the extra costs from purchasing and raising replacement heifers and losses in milk production (dairy cows); the losses in calf or lamb production (beef systems and meat sheep); and the losses in milk production and from unsold replacement lambs (dairy sheep). The use of integrated production and economic models enabled the authors to estimate the cost of SBV and to tackle the problem of scarce data, which is a difficulty for most emerging diseases, by their very nature. It also allowed the authors to develop an accurate disease impact assessment for several production systems, over a short time span. Extrapolating from this economic assessment to predict the scenario in coming years depends on the immunity period of the disease and the length of the production cycles.

Le virus de Schmallenberg a été détecté pour la première fois en 2011 en Allemagne, puis en France en 2012. Les auteurs présentent une étude de simulation de plusieurs systèmes de production de ruminants en France, dont l'objectif était d'estimer, à partir d'analyses budgétaires partielles, les coûts économiques du virus de Schmallenberg à l'échelle des exploitations, sous deux scénarios différents (hypothèses d'un fort impact et d'un faible impact de la maladie, respectivement). Une analyse budgétaire partielle sert à évaluer les conséquences financières d'un changement graduel et ne prend en compte que les modifications effectives en termes de ressources et de production. Dans l'hypothèse d'un impact fort de la maladie, l'impact annuel estimé du virus de Schmallenberg variait de 23 à 43 euros par vache et de 19 à 37 euros par brebis. Dans l'hypothèse d'un impact faible, l'impact annuel était deux fois moindre chez les vaches et trois fois moindre chez les brebis que dans la première hypothèse. Ces impacts financiers représentent 0,6 % à 63 % de la marge brute en fonction du scénario choisi et du système de production. Les impacts du virus de Schmallenberg découlent principalement des coûts supplémentaires induits par l'achat et le maintien de génisses de remplacement et d'une baisse de la production de lait (vaches laitières), des pertes de veaux ou d'agneaux (bovins et ovins de boucherie), d'une baisse de la production de lait et du coût des agnelles de remplacement invendues (brebis laitières). L'utilisation de modèles intégrant les aspects économiques et les données de production a permis aux auteurs d'estimer le coût du virus de Schmallenberg malgré la pénurie de données, s'attaquant ainsi à une difficulté inhérente à la plupart des maladies émergentes. Cela leur a également permis d'effectuer une évaluation précise de l'impact sanitaire dans plusieurs systèmes de production, sur une durée courte. La possibilité d'extrapoler à partir de cette évaluation économique un scénario pour les années à venir dépend de la période d'immunité vis-à-vis de la maladie et de la durée des cycles de production.

El virus de Schmallenberg fue detectado por primera vez en 2011 en Alemania y ulteriormente en 2012 en Francia. Los autores describen un estudio en el que se simularon distintos sistemas de producción de rumiantes en Francia y se estimó, con análisis presupuestarios parciales, el coste económico que entrañaría para una explotación el virus de Schmallenberg en dos hipotéticas situaciones sanitarias (una situación con efectos profundos y otra con efectos leves). El análisis presupuestario parcial sirve para evaluar los efectos económicos de cambios graduales, e incluye únicamente aquellos recursos y aspectos de la producción que experimentarán cambios. En la hipótesis de efectos profundos, el impacto estimado de la infección por el virus de Schmallenberg oscilaba entre 23 y 43 euros anuales por vaca y entre 19 y 37 euros anuales por oveja hembra. La hipótesis de efectos leves deparaba importes de aproximadamente la mitad (en el caso de las vacas) o un tercio (en el de las ovejas). Este impacto económico representa del 0,6% al 63% del margen bruto, dependiendo de la hipótesis elegida y del sistema productivo de que se trate. Los efectos de la infección por el virus de Schmallenberg se concretan básicamente en: los costos suplementarios derivados de adquirir y criar vaquillas de sustitución y de obtener una menor producción de leche (vacas lecheras); las pérdidas de terneros o corderos (sistemas de bovino u ovino cárnicos); y los costos derivados de la menor producción de leche y de no vender las corderas de sustitución (ovejas lecheras). El uso de modelos que integran los factores productivos y económicos sirvió a los autores para estimar el costo del virus de Schmallenberg a pesar de la escasez de datos, que, por la propia naturaleza de las enfermedades emergentes, es una dificultad común a la mayoría de ellas. También les permitió evaluar con exactitud el impacto de la enfermedad en distintos sistemas productivos en un breve lapso de tiempo. La realización de extrapolaciones a partir de esta evaluación económica para pronosticar la situación en años venideros depende del periodo de inmunidad respecto de la enfermedad y de la duración de los ciclos productivos.

Financial influence on global risks of zoonotic emerging and re-emerging diseases: an integrative analysis.

BACKGROUND: Emerging and re-emerging infectious diseases (EIDs), such as Ebola virus disease and highly pathogenic influenza, are serious threats to human health and wellbeing worldwide. The financial sector has an important, yet often ignored, influence as owners and investors in industries that are associated with anthropogenic land-use changes in ecosystems linked to increased EIDs risks. We aimed to analyse financial influence associated with EIDs risks that are affected by anthropogenic land-use changes. We also aimed to provide empirical assessments of such influence to help guide engagements by governments, private organisations, and non-governmental organisations with the financial sector to advance a planetary health agenda. METHODS: For this integrative analysis, we identified regions in the world where there was evidence of a connection between EIDs and anthropogenic land-use changes between Nov 9, 1999, and Oct 25, 2021, through a targeted literature review of academic literature and grey literature to identify evidence of drivers of anthropogenic land-use change and their association with commodity production in these regions. We only included publications in English that showed a connection between deforestation and the production of one or more commodities. Publications merely describing spatial or temporal land-use change dynamics (eg, a reduction of forest or an increase of palm-oil plantations) were excluded. As we were assessing financial influence on corporate activities through ownership specifically, we focused our analysis on publicly listed companies. Equity data and data about ownership structure were extracted from Orbis, a company information database. We assessed financial influence by identifying financial entities with the largest equity ownership, descriptively mapping transboundary connections between investors and publicly listed companies. FINDINGS: 227 public and private companies operating in five economic sectors (ie, production of palm oil, pulp and wood products, cocoa, soybeans, and beef) between Dec 15, 2020, and March 8, 2021, were identified. Of these 227, 99 (44%) were publicly listed companies, with 2310 unique shareholders. These publicly listed companies operated in six geographical regions, resulting in nine case-study regions. 54 (55%) companies with complete geographical information were included in the countries network. Four financial entities (ie, Dimensional, Vanguard, BlackRock, and Norway's sovereign wealth fund) each had ownership in 39 companies or more in three of the case-study regions (ie, north America, east Asia, and Europe). Four large US-based asset managers (ie, Vanguard, BlackRock, T Rowe Price, and State Street) were the largest owners of publicly listed companies in terms of total equity size, with ownership amounts for these four entities ranging from US$8 billion to $21 billion. The specific patterns of cross-national ownership depended on the region of interest; for example, financial influence on EIDs risks that was associated with commodity production in southeast and east Asia came from not only global asset managers but also Malaysian, Chinese, Japanese, and Korean financial entities. India, Brazil, the USA, Mexico, and Argentina were the countries towards which investments were most directed. INTERPRETATION: Although commodity supply chains and financial markets are highly globalised, a small number of investors and countries could be viewed as disproportionally influential in sectors that increase EIDs risks. Such financial influence could be used to develop and implement effective policies to reduce ecological degradation and mitigate EIDs risks and their effects on population health. FUNDING: Formas and Networks of Financial Rupture-how cascading changes in the climate and ecosystems could impact on the financial sector.

Emerging infectious diseases in southeast Asia: regional challenges to control.

Southeast Asia is a hotspot for emerging infectious diseases, including those with pandemic potential. Emerging infectious diseases have exacted heavy public health and economic tolls. Severe acute respiratory syndrome rapidly decimated the region's tourist industry. Influenza A H5N1 has had a profound effect on the poultry industry. The reasons why southeast Asia is at risk from emerging infectious diseases are complex. The region is home to dynamic systems in which biological, social, ecological, and technological processes interconnect in ways that enable microbes to exploit new ecological niches. These processes include population growth and movement, urbanisation, changes in food production, agriculture and land use, water and sanitation, and the effect of health systems through generation of drug resistance. Southeast Asia is home to about 600 million people residing in countries as diverse as Singapore, a city state with a gross domestic product (GDP) of US$37,500 per head, and Laos, until recently an overwhelmingly rural economy, with a GDP of US$890 per head. The regional challenges in control of emerging infectious diseases are formidable and range from influencing the factors that drive disease emergence, to making surveillance systems fit for purpose, and ensuring that regional governance mechanisms work effectively to improve control interventions.

Predicting the economic costs and property value losses attributed to sudden oak death damage in California (2010-2020).

Phytophthora ramorum, cause of sudden oak death, is a quarantined, non-native, invasive forest pathogen resulting in substantial mortality in coastal live oak (Quercus agrifolia) and several other related tree species on the Pacific Coast of the United States. We estimate the discounted cost of oak treatment, removal, and replacement on developed land in California communities using simulations of P. ramorum spread and infection risk over the next decade (2010-2020). An estimated 734 thousand oak trees occur on developed land in communities in the analysis area. The simulations predict an expanding sudden oak death (SOD) infestation that will likely encompass most of northwestern California and warrant treatment, removal, and replacement of more than 10 thousand oak trees with discounted cost of $7.5 million. In addition, we estimate the discounted property losses to single family homes of $135 million. Expanding the land base to include developed land outside as well as inside communities doubles the estimates of the number of oak trees killed and the associated costs and losses. The predicted costs and property value losses are substantial, but many of the damages in urban areas (e.g. potential losses from increased fire and safety risks of the dead trees and the loss of ecosystem service values) are not included.

Lumpy skin disease, an emerging transboundary viral disease: A review.

Lumpy skin disease is an emerging bovine viral disease, which is endemic in most African countries and some Middle East ones, and the elevated risk of the spread of disease into the rest of Asia and Europe should be considered. The recent rapid spread of disease in currently disease-free countries indicates the importance of understanding the limitations and routes of distribution. The causative agent, Capripoxvirus, can also induce sheeppox and goatpox. The economic significance of these diseases is of great concern, given that they threaten international trade and could be used as economic bioterrorism agents. The distribution of capripoxviruses seems to be expanding due to limited access to effective vaccines and poverty within farming communities. This is largely due to the economic effects of the Covid-19 pandemic and the imposition of crippling sanctions in endemic regions, as well as an increase in the legal and illegal trade of live animals and animal products, and also global climate change. The present review is designed to provide existing information on the various aspects of the disease such as its clinicopathology, transmission, epidemiology, diagnosis, prevention and control measures, and the potential role of wildlife in the further spread of disease.

Emergence of pregnancy-related listeriosis amongst ethnic minorities in England and Wales.

Listeriosis is a rare but severe food-borne disease that predominantly affects pregnant women, the unborn, newborns, the elderly and immunocompromised people. Following a large outbreak in the 1980s, specific food safety advice was provided to pregnant women and the immunocompromised in the United Kingdom. Following two coincident yet unconnected cases of pregnancy-related listeriosis in eastern European women in 2008, a review of the role of ethnicity in pregnancy-related listeriosis in England and Wales was undertaken in 2009. Cases reported to the national listeriosis surveillance scheme were classified as 'ethnic', belonging to an ethnic minority, or 'non-ethnic' based on their name, and trends were examined. Between 2001 and 2008, 1,510 cases of listeriosis were reported in England and Wales and, of these, 12% were pregnancy-related cases. The proportion of pregnancy-related cases classified as ethnic increased significantly from 16.7% to 57.9% (chi-square test for trend p=0.002). The reported incidence among the ethnic population was higher than that among the non-ethnic population in 2006, 2007 and 2008 (Relative Risk: 2.38, 95% confidence interval: 1.07 to 5.29; 3.82, 1.82 to 8.03; 4.33, 1.74 to 10.77, respectively). This effect was also shown when analysing data from January to September 2009, using extrapolated live births as denominator. Increased immigration and/or economic migration in recent years appear to have altered the population at risk of pregnancy-related listeriosis in England and Wales. These changes need to be taken into account in order to target risk communication strategies appropriately.

Wealth inequality and tuberculosis elimination in Europe.

In Europe, wealth inequality is directly related to tuberculosis (TB) notification (R2 = 0.69), while in countries with lower TB rates, higher proportions of TB cases occur in foreign-born persons. Particularly during times of financial upheaval, efforts to eliminate TB must address social inequality.

Long-term effectiveness and cost-effectiveness of screening for hepatitis C virus infection.

BACKGROUND: Hepatitis C virus (HCV) infection is an emerging problem in public health. In most countries, the majority of HCV infected people are yet undiagnosed. Early detection and treatment may result in better health outcomes and save costs by preventing future advanced liver disease. The evidence for long-term effectiveness and cost-effectiveness of HCV screening was systematically reviewed. METHODS: We performed a systematic literature search on long-term health-economic effects of HCV screening and included Health Technology Assessment (HTA) reports, systematic reviews, long-term clinical trials, full health economic and decision-analytic modelling studies with a sufficiently long time horizon and patient-relevant long-term outcomes such as life-years gained (LYG) or quality-adjusted life years (QALY) gained. Economic results were converted to 2005 Euros. RESULTS: Seven studies were included. Target population, HCV prevalence, study perspective, discount rate, screening and antiviral treatment mode varied. The incremental effectiveness of HCV screening and early treatment compared to no screening and standard care varied from 0.0004 to 0.066 LYG, and from 0.0001 to 0.072 QALY. Incremental cost-effectiveness and cost-utility ratios of HCV screening vs. no screening were 3900-243,700 euro/LYG and 18,300-1,151,000 euro/QALY. HCV screening seems to be cost-effective in populations with high HCV prevalence, but not in low HCV prevalence populations. CONCLUSIONS: HCV screening and early treatment have the potential to improve average life-expectancy, but should focus on populations with elevated HCV prevalence to be cost-effective. Further research on the long-term health-economic impact of HCV screening when combined with appropriate monitoring strategies in different European health care systems is needed.

Household economic impact of an emerging disease in terms of catastrophic out-of-pocket health care expenditure and loss of productivity: investigation of an outbreak of chikungunya in Orissa, India.

BACKGROUND & OBJECTIVES: To examine the household economic impact of an outbreak of chikungunya in terms of out-of-pocket health care expenditure and income foregone due to loss of productive time in Orissa, India. METHODS: Structured interviews were conducted on 150 respondents, bread winners from the affected households of a village with maximum number of reported cases in the state, during August 2007. We looked at the economic profile, treatment history, and patient-side cost of care, loss of productivity and consequent income loss. RESULTS: The median out-of-pocket health care expenditure was US$ 84, of which the proportion of cost of diagnosis was the highest (US$ 77). One hundred and forty nine respondents incurred cost of care more than 10% of their monthly household income (catastrophic health expenditure). The median catastrophic health care expenditure was 37%. The respondents depended more on private health care providers (49%) and 31% of them accessed care from both public and private health care providers. The median work days lost was 35 with a consequent loss of income of US$ 75. INTERPRETATION & CONCLUSION: Outbreak of an emerging disease creates unforeseen catastrophic health care expenditure and reinforcing the poverty ill-health nexus. The priorities of tackling emerging diseases should include; discretionary public health spending, financial protection against the cost of illness and productivity with special emphasis on people living on daily wages with less financial reserves, and further research on therapeutic measures to reduce the duration of suffering and consequent economic loss.

[Cryptosporidiosis: an emerging zoonosis]. / Criptosporidiosis: una zoonosis emergente.

The genus Cryptosporidium, responsible for producing cryptosporidiosis, includes several species. Humans and livestock are the main sources of infection. Waterborne cryptosporidiosis outbreaks are associated with drinking water. The infective parasite stage is the oocyst, which is resistant to conventional potabilization treatments. In immunocompetent hosts it produces acute, self-limiting diarrhoea. In immunocompromised people, it could develop severe, life-threatening pattern forms of the infection. People with AIDS are especially susceptible to these clinical forms. Cryptosporidium infections are also considered a major cause of morbimortality in calves, which leads to important economic losses. In the last years, there has been an increase of patients suffering from different causes of immunosuppression, and the need to find an effective therapy against Cryptosporidium has become greater. In spite of the many attempts of the pharmaceutical industry to develop an effective antiparasitic agent to treat cryptosporidiosis, this infection and its clinical consequences still constitute a major public health problem. This article analizes the taxonomy, morphology, biology and life cycle of Cryptosporidium. Clinical, immunological, epidemiological features and diagnosis of cryptosporidiosis are also included. Treatment and prevention of the infection are discussed, and future tendencies are suggested for this emerging parasitic infection.