Gaza disaster: we need a permanent ceasefire, now!

Another year ends with multiple humanitarian crises ongoing simultaneously across the globe. In the Eastern Mediterranean Region, 9 of the 22 Member States and territory are considered fragile or conflict-affected, with severe health consequences for the population.

The WHO R&D Blueprint: 2018 review of emerging infectious diseases requiring urgent research and development efforts.

The Research and Development (R&D) Blueprint is a World Health Organization initiative to reduce the time between the declaration of a public health emergency and the availability of effective diagnostic tests, vaccines, and treatments that can save lives and avert a public health crisis. The scope of the Blueprint extends to severe emerging diseases for which there are insufficient or no presently existing medical countermeasures or pipelines to produce them. In February 2018, WHO held an informal expert consultation to review and update the list of priority diseases, employing a prioritization methodology which uses the Delphi technique, questionnaires, multi-criteria decision analysis, and expert review to identify relevant diseases. The committee determined that, given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated R&D for (in no order of priority) Crimean-Congo haemorrhagic fever, Ebola virus and Marburg virus disease, Lassa fever, Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), Nipah and henipaviral diseases, Rift Valley fever and Zika virus disease. The experts also included "Disease X," representing the awareness that a previously unknown pathogen could cause a major public health emergency. This report describes the methods and results of the 2018 prioritization review.

World Health Organization Methodology to Prioritize Emerging Infectious Diseases in Need of Research and Development.

The World Health Organization R&D Blueprint aims to accelerate the availability of medical technologies during epidemics by focusing on a list of prioritized emerging diseases for which medical countermeasures are insufficient or nonexistent. The prioritization process has 3 components: a Delphi process to narrow down a list of potential priority diseases, a multicriteria decision analysis to rank the short list of diseases, and a final Delphi round to arrive at a final list of 10 diseases. A group of international experts applied this process in January 2017, resulting in a list of 10 priority diseases. The robustness of the list was tested by performing a sensitivity analysis. The new process corrected major shortcomings in the pre-R&D Blueprint approach to disease prioritization and increased confidence in the results.

Influence of predation on community resilience to disease.

Outbreaks of generalist pathogens are influenced by host community structure, including population density and species diversity. Within host communities predation can influence pathogen transmission rates, prevalence and impacts. However, the influence of predation on community resilience to outbreaks of generalist pathogens is not fully understood. The role of predation on host community resilience to disease was assessed using an epidemiological multi-host susceptible-exposed-infectious-recovered model. Sphaerothecum destruens, an emerging fungal-like generalist pathogen, was used as a model pathogen. Six cyprinid and salmonid fishes, including an asymptomatic carrier, were selected as model hosts that are known to be impacted by S. destruens, and they were used within a model host community. Pathogen release into the host community was via introduction of the asymptomatic carrier. Mortality from infection, pathogen incubation rate, and host recovery rate were set to a range of evidence-based values in each species and were varied in secondary consumers to predict top-down effects of infection on the resilience of a host community. Predation pressure within the fish community was varied to test its effects on infection prevalence and host survival in the community. Model predictions suggested that predation of the asymptomatic hosts by fishes in the host community was insufficient to eliminate S. destruens. Sphaerothecum destruens persisted in the community due to its rapid transmission from the asymptomatic host to susceptible host fishes. Following transmission, pathogen prevalence in the community was driven by transmission within and between susceptible host fishes, indicating low host community resilience. However, introducing low densities of a highly specific piscivorous fish into the community to pre-date asymptomatic hosts could limit pathogen prevalence in the host community, thus increasing resilience. The model predictions indicate that whilst resilience to this generalist pathogen in the host community was low, this could be increased using management interventions. The results suggest that this model has high utility for predicting community resilience to disease and thus can be applied to other generalist parasites to determine risks of disease emergence.

The consequences of reservoir host eradication on disease epidemiology in animal communities.

Non-native species have often been linked with introduction of novel pathogens that spill over into native communities, and the amplification of the prevalence of native parasites. In the case of introduced generalist pathogens, their disease epidemiology in the extant communities remains poorly understood. Here, Sphaerothecum destruens, a generalist fungal-like fish pathogen with bi-modal transmission (direct and environmental) was used to characterise the biological drivers responsible for disease emergence in temperate fish communities. A range of biotic factors relating to both the pathogen and the surrounding host communities were used in a novel susceptible-exposed-infectious-recovered (SEIR) model to test how these factors affected disease epidemiology. These included: (i) pathogen prevalence in an introduced reservoir host (Pseudorasbora parva); (ii) the impact of reservoir host eradication and its timing and (iii) the density of potential hosts in surrounding communities and their connectedness. These were modelled across 23 combinations and indicated that the spill-over of pathogen propagules via environmental transmission resulted in rapid establishment in adjacent fish communities (<1 year). Although disease dynamics were initially driven by environmental transmission in these communities, once sufficient numbers of native hosts were infected, the disease dynamics were driven by intra-species transmission. Subsequent eradication of the introduced host, irrespective of its timing (after one, two or three years), had limited impact on the long-term disease dynamics among local fish communities. These outputs reinforced the importance of rapid detection and eradication of non-native species, in particular when such species are identified as healthy reservoirs of a generalist pathogen.

The alternate role of direct and environmental transmission in fungal infectious disease in wildlife: threats for biodiversity conservation.

Emerging fungal pathogens have substantial consequences for infected hosts, as revealed by the global decline of amphibian species from the chytrid fungus. According to the "curse of the Pharaoh" hypothesis, free-living infectious stages typical of fungal pathogens lengthen the timespan of transmission. Free-living infectious stages whose lifespan exceeds the infection time of their hosts are not constrained by virulence, enabling them to persist at high levels and continue transmitting to further sensitive hosts. Using the only Mesomycetozoea fungal species that can be cultured, Sphaerothecum destruens, we obtained tractable data on infectivity and pathogen life cycle for the first time. Here, based on the outcomes of a set of infectious trials and combined with an epidemiological model, we show a high level of dependence on direct transmission in crowded, confined environments and establish that incubation rate and length of infection dictate the epidemic dynamics of fungal disease. The spread of Mesomycetozoea in the wild raise ecological concerns for a range of susceptible species including birds, amphibians and mammals. Our results shed light on the risks associated with farming conditions and highlight the additional risk posed by invasive species that are highly abundant and can act as infectious reservoir hosts.