Features Of Emerging And Re-emerging Viruses

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Infectious diseases remain a major cause of human and animal morbidity and mortality leading to significant healthcare expenditure.However, enormous successes have been obtained against the control of major epidemic diseases, such as malaria, plague, leprosy and cholera, in the past.The vast terrains and extreme geo-climatic differences and uneven population distribution present unique patterns of distribution of viral diseases. Dynamic interplay of biological, socio-cultural and ecological factors, together with novel aspects of human-animal interphase, pose additional challenges with respect to the emergence of infectious diseases. The important challenges faced in the control and prevention of emerging and re-emerging infectious diseases range from understanding the impact of factors that are necessary for the emergence, to development of strengthened surveillance systems that can mitigate human suffering and death.Viral pathogens are known to cause outbreaks that have epidemic and pandemic potential which would result in severe range of mortality and Health care expenditure on a scale depending on the pathogenicity of the virus.


The emergence of novel human t of emerging infections of humans are zoonotic in origin , with two-third originating in wildlife, including COVID-19.[3] Habitat destruction due to unplanned urbanization has placed human at contact with animals and arthropod vectors of viral infection.[4] Such interactions have been one of the major causes for increased human susceptibility to infections by novel pathogens, in the absence of specific immunity in these population.[5]

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Respiratory viral infections, arboviral infections and bat-borne viral infections represent three major categories of emerging viral infections.[6] Infection aerosols of the tracheo bronchial tree represent efficient means for spread of viral pathogens affecting the respiratory tract. Pandemic influenza H1N1, highly pathogenic avian influenza ase.[9] Theme of re-emergence of the virus is often seen in a more virulent forms following their initial discovery.[10] There have also been cases of discal produce and products from affected regions.The major emerging and re-emerging viral infections of public health importance have been reviewed that have already been included in the Integrated Disease Surveillance Programme so that control and prevention of emerging and re-emerging infectious diseases could be handled through understanding the impact of factors that are necessary for the emergence and to develop and strengthen surveillance systems that can mitigate human suffering and death.

Materials and methods

Article collection for this systematic review was collected and analysed from the PMC database, Mediline embrace Cochrane. Necessary articles selected based on this importance to this review article on emerging and re-emerging viral threat. From which 30 articles were reviewed and selected using scholarly search engines of PubMED & Google,Inc.

Emerging Viral infections identified as public health threats

Viral pathogens are known to cause outbreaks that have epidemic and pandemic potential. [13,14]Integrated Disease Surveillance Programme (IDSP) is a laboratory-based, IT enabled system in the country for Surveillance of epidemic prone disease. During 2017, the IDSP showed a total of 1683 outbreaks of such disease of which 71 % of those outbreaks were caused by viral pathogens while the rest 29 % were non-viral. Subclinical and sporadic infection as well as those not identified by the health facility are often missed by the surveillance system.[4,13]

Impact of Mass gatherings and emerging viral infections

Mass gathering opportunities create situations for human proximity within very close distances and the challenges they present to the maintenance of sanitation, a considerable public health concern. Transmission of respiratory and gastrointestinal infection remains a major concern during several large-scale assemblies, for example outbreak of cholera at Kumbh Mela festival in 1817. [15]Large scale gatherings provide platforms for exchange of genomic material and thereby evolution of pathogens, including viruses.[16][17]

Nosocomial Transmission and Emerging infection

Institutional care of vulnerable people with compromised immune systems may present opportunities for transmission of viral infection.[16,18] Appreciable risks also exist at dental clinics, haemodialysis units etc. where sterilization/disinfection practices for patient care instruments are not followed stringently. Hospital-associated transmission of infection was a prominent finding during the outbreak of Nipah infection in Bengal and Kerala, where several health care staff fell victims to the infections.[19]

Laboratory Accidents/Lapses in Biosafety practices

There is a current investigation going on at WHO regarding the outbreak of COVID-19 at Wuhan, China. Several experts believe that the initial outbreak of COVID-19 is from the Wuhan Institute of Virology, a microbiology laboratory under the Chinese Academy Science and investigations are ongoing.[20,21] Neglect of laboratory biosafety requirements as well as laboratory accidents may also lead to the occurrences of emerging/re-emerging infections. Recently there was a report on the development of buffalopox (BPX) lesions on the palm of a biomedical researcher following a shrapnel injury,warranting surgical treatment and leading to delayed healing.[22] Such reports, through infrequent emphasize the need for stringent adherence to biosafety guidelines to be observed in research involving viral agents with human pathogenic potential.[23]

Current Scenario of Emerging Viral Infections

Acute respiratory disease claims over four million deaths every year and causes millions of hospitalization in developing countries every year. Over 200 viral pathogens, belonging to the families Orthomyxoviridae, Paramyxoviridae, Picornaviridae, Coronaviridae, Adenoviridae and Herpesviridae cause respiratory infections in humans. Influenza, parainfluenza, respiratory syncytial virus (RSV) and adenoviruses remain important respiratory pathogens. Human meta pneumovirus has been recognised worldwide as a pathogen of significance.[24]

Respiratory viral infections


Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified amid an outbreak of respiratory illness cases in Wuhan City, Hubei Province, China. It was initially reported to the WHO on December 31, 2019. On January 30, 2020, the WHO declared the COVID-19 outbreak a global health emergency. On March 11, 2020, the WHO declared COVID-19 a global pandemic, its first such designation since declaring H1N1 influenza a pandemic in 2009.[25,26]

Illness caused by SARS-CoV-2 was termed COVID-19 by the WHO, the acronym derived from 'coronavirus disease 2019. ' The name was chosen to avoid stigmatizing the virus's origins in terms of populations, geography, or animal associations[20]


Influenza viruses, belonging to the Orthomyxoviridae family, are the frequent causes of epidemics and pandemics affecting humans. Influenza pandemics have occurred earlier in 1918 (Swine influenza), 1957 (Asian flu), 1968 (Hong Kong flu), 1977 (Russian flu) and the recent pandemic of 2009 (pandemic influenza A H1N1). Influenza virus type A is highly variable, shows continuous antigenic variation and is a major cause of epidemics and pandemics. The surface antigenic glycoproteins undergo two major types of antigenic variation, viz. antigenic shift and antigenic drift. Antigenic shift is the result of major changes in one or both the surface antigens [haemagglutinin (HA) and neuraminidase (NA)] and causes occasional pandemics. Three mechanisms might be operative in the antigenic shift, leading to emergence of pandemic influenza strains, viz. genetic reassortment, direct transfer from avian/mammalian host to humans and virus recycling. Antigenic drift results due to minor changes in HA or NA and causes frequent epidemics. Influenza viruses are continuously evolving and show ubiquitous distribution in the environment, animals and humans.[27]

Severe acute respiratory syndrome-associated coronavirus (SARS-CoV)

SARS was first reported in the Guangdong province of China in February 2003 showing human-to-human transmission. The disease caused an estimated 8000 cases and more than 750 deaths in more than 12 countries]. The WHO issued a global alert about the disease on March 13, 2003. Although the cases mostly remained confined to China, a few cases were reported from North and South America, Europe and Asia. No case, however, has been reported fromIndia.[28]


MERS-CoV is a zoonotic viral illness causing respiratory infection which was first reported in Saudi Arabia in 2012 and has since spread to 26 different countries. Over 2207 laboratory-confirmed cases and 787 deaths have occurred due to MERS-CoV infection globally, since 2012. The clinical spectrum of illness associated with MERS-CoV ranges from asymptomatic infections to acute respiratory distress syndrome, resulting in multi-organ failure and death. The case-fatality rates (CFRs) have remained high at 3-4 per 10 cases. [29]Limited information currently exists about the transmission dynamics of this virus, and definitive treatment and a prophylactic vaccination remain unavailable till date. Evidence for secondary, tertiary and quaternary cases of MERS ensuing from a single infected patient also exists, even in the absence of mutations conferring hyper-virulence. No case of infection with this virus has been detected in India so far. Bats are thought to be the natural reservoirs of this virus, and many patients developed the illness after contact with camels. India is home to a great diversity of bat species and has a substantial camel population. The country also reports heavy passenger traffic from the Middle East, as part of pilgrimage, employment, tourism and trade. These facts call for preparedness and surveillance against this virus in the country.[30]

Avian influenza (AI)

Humans are susceptible to infection with AI and swine influenza viruses, including the AI virus subtypes - A(H5N1), A(H7N9) and A(H9N2). Exposure to infected birds or contaminated environments is thought to underlie human infection with these viruses. Human cases of AI might occur in future, in view of the ongoing circulation of AI viruses in birds. There have been sporadic reports of human infections with AI and other zoonotic influenza viruses, but sustained human-to-human infection and transmission have been lacking. Although the public health risk from the currently known influenza viruses at the human-animal interface remains the same, the sustained human-to-human transmission of this virus is low.[31]


RSV is an important pathogen causing acute lower respiratory tract infection (ALRTI) in young children. It can also affect older adults and immunocompromised individuals. Estimates indicate an annual incidence of approximately 34 million episodes of ALRTI associated with RSV infection in children aged five years or less.[25] RSV infections also lead to about three million cases of hospitalization and about 66,000-199,000 deaths, with more than 99 per cent of the deaths reported from developing country. In view of the public health significance, the WHO has started a pilot project for RSV surveillance in its six regions, utilizing the well-established platform of Global Influenza Surveillance and Response Network. The exact burden and impact of RSV infections in the country need to be studied in depth.[31,32]


The earth of extreme geo-climatic diversity, faces a constant threat of emerging and re- emerging viral pathogens of public health importance. There is a need for strengthening disease surveillance in the world focusing on the epidemiology and disease burden. There is also a pressing need to gain detailed insight into disease biomics, including vector biology and environmental factors influencing the diseases. It is also important to strengthen the emergency preparedness for these diseases and response by focusing on ‘one health‘ approach.


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