China’s great wall, Israel’s Bar Lev Line, and passive infectious disease surveillance

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Title:
China’s great wall, Israel’s Bar Lev Line, and passive infectious disease surveillance
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English
Creator:
Elbadry, Maha A.
Merrill, Mary M.
Ma, Meng-Meng
Ma, Mai-Juan
Lu, Jia-Hai
Cao, Wu-Chun
Gray, Gregory C.
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Bio-Med Central ( MMR, military Medical Research)
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Abstract:
Emerging infectious diseases are some of modern society’s greatest threats. Like some great construction efforts designed to protect mankind, current public health measures against these emerging pathogens have not always been successful. This paper highlights the importance of embracing new interdisciplinary approaches towards emerging pathogen threats. One such approach, termed One Health, is quickly being embraced by professional organizations and public health institutions across the world as a way forward. This paper briefly discusses the above problems and preliminary steps taken by Chinese academic institutions to embrace the One Health approach. Keywords: Zoonoses, Communicable diseases, Emerging, Epidemiology, Public health, One health
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Elbadry et al. Military Medical Research 2014, 1:15 http://www.mmrjournal.org/content/1/1/15; Pages 1-3
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doi:10.1186/2054-9369-1-15 Cite this article as: Elbadry et al.: China’s great wall, Israel’s Bar Lev Line, and passive infectious disease surveillance. Military Medical Research 2014 1:15.

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University of Florida
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© 2014 Elbadry et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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PERSPECTIVEOpenAccessChina ’ sgreatwall,Israel ’ sBarLevLine,and passiveinfectiousdiseasesurveillanceMahaAElbadry1,MaryMMerrill1,Meng-MengMa2,Mai-JuanMa3,Jia-HaiLu2,Wu-ChunCao3andGregoryCGray1*AbstractEmerginginfectiousdiseasesaresomeofmodernsociety ’ sgreatestthreats.Likesomegreatconstructionefforts designedtoprotectmankind,currentpublichealthmeasuresagainsttheseemergingpathogenshavenotalways beensuccessful.Thispaperhighlightstheimportanceofembracingnewinterdisciplinaryapproachestowards emergingpathogenthreats.Onesuchapproach,termedOneHealth,isquicklybeingembracedbyprofessional organizationsandpublichealthinstitutionsacrosstheworldasawayforward.Thispaperbrieflydiscussesthe aboveproblemsandpreliminarystepstakenbyChineseacademicinstitutionstoembracetheOneHealthapproach. Keywords: Zoonoses,Communicablediseases,Emerging,Epidemiology,Publichealth,OnehealthMaintextSinceancienttimes,oneofthechiefreasonspeople bandedtogetherwasforthepurposeofdefendingthemselvesagainstthreatstotheirsafetyandwell-being.Protectivemeasureshavetakenmanyformsovermany years.Oneofthemostwidely-knownmarvelsofsuch protectioneffortsistheGreatWallofChina,asightvisitedbymorethan10milliontravelerseachyear[1]. Historiansagreethat~220B.C.thefirstEmperorof anewlyunifiedChina,QinShiHuang,envisioneda grandplantoprotecthiskingdomfromtheinvading Xiongnunomadichorsemenofthenorth.Qinexpanded theexistingsystemofdefensivewallsalongthenorthern borderofChinaintooneGreatWallinhopesthisbarrier wouldquellthebarbarianattacks.Qinsucceededincreating aformidabledefensestructure,estimatedtobe3,100miles uponcompletion.Thewallincludedwatchtowersbuiltat intervals,withasophisticatedwarningandcommunication systemofsmokesignals,lanterns,andbeaconfires. ThoughtheGreatWallslowedtheattacks,thispassive strategywasnotenoughtoendtheassaultsofthefierce Xiongnuhorsemenwhooftenrodeingroupsofupto 300,000archers.Roughly100yearslater,EmperorWudi initiatedanactivecampaignagainstthebarbarians,tofinallyendtheirattacks.Bysendingoutstrongexpeditions todisbandthebarbarianwarriorgroupsattheirsources, theChinesefinallyestablishedabsoluteruleforaperiod. Thishistoricalexperienceillustratestheneedtosupplementapassiveprotectivestrategywithanefforttoactively engageathreatatitssource. Inmodernhistory,Israelembracedasimilarmethod forprotectionbybuildinga100-milelineofdefensive wallsandtrenchesalongtheeasternsideoftheSuez CanaltoprotectIsraelisfromEgyptianartillerybombardmentduringtheWarofAttrition(1967 – 70).Itwas estimatedthatIsraelinvested$300millioninthis massivedefensiveconcreteandsandstructurecalledthe BarLevLine,reachingaheightof66 – 82feet[2].Just behindthelinewasthefirstlineoffortificationwith22 fortsresembling31strongpoints.Eachstrongpointwas supportedwithtrenches,minefields,barbedwireandup to26bunkersarmedwithmediumtoheavymachine guns.Israeltookalmosteverypossibleandpotential threatintoconsiderationastheybuilttheline,evenconsideringtheinstallationofanunderwaterpipesystemto pumpfueltoignitethecanalandcreateasheetofflame ifanattacktookplace.Despiteofalltheseprecautionary measuresandextensiveeffortstokeeptheenemyoutside,thelineofBarLevwasbreachedinlessthantwo hours,duetotheelementofsurpriseandthehelpofa verysimpleweaponthatwasnotconsidered-water. UsingaBritishandGerman-madewaterpumpin1973 Egyptiansmanagedtoteardown1,500cubicmetersof sandintwohourscreating81breachesinthelineand *Correspondence: gcgray@phhp.ufl.edu1OneHealthCenterofExcellenceforResearchandTrainingandCollegeof PublicHealthandHealthProfessions,UniversityofFlorida,P.O.Box100188, Gainesville,FL32610,USA Fulllistofauthorinformationisavailableattheendofthearticle 2014Elbadryetal.;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreative CommonsAttributionLicense(http://creativecommons.org/licenses/by/4.0),whichpermitsunrestricteduse,distribution,and reproductioninanymedium,providedtheoriginalworkisproperlycredited.TheCreativeCommonsPublicDomain Dedicationwaiver(http://creativecommons.org/publicdomain/zero/1.0/)appliestothedatamadeavailableinthisarticle, unlessotherwisestated.Elbadry etal.MilitaryMedicalResearch 2014, 1 :15 http://www.mmrjournal.org/content/1/1/15

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allowingtroopstopass.Althoughthelinewaseffective for4years,itsprotectiveeffectdidnotlastwhentheinvadersweredeterminedandtheircampaignfocused. SimilartotheGreatWallEmperorQincreatedtoprotecthisnationfrominvadingthreatsinancientChina, andtheBarLevlinecreatedbyIsraelinrecenttimes, thereexistmany “ GreatWallsofHealth ” surveillancesystemsinplacetoprotectthepublichealthofnationstoday. Thesesystemsoftendependonsurveillanceofdisease eventstoalertauthoritiesofthepresenceofanovelthreat anditspotentialforepidemics.Theoretically,onceanovel threatisdetectedandanalarmresounded,acascadeof eventsshouldoccurtoprotectthepopulation.Inthecase ofinfectiousdiseasethismayinclude:improveddiagnostics,focusedsurveillance,isolationofinfectedpatients, andvariousinterventions. Whiletheselargelypassivesurveillancesystemsaredesignedtodetectandinitiateresponsetonovelpathogens, alonetheymaynotbeeffectiveenoughtostopathreat.A goodexampleisthe2009H1N1pandemicwherethe novelvirusspreadsoquicklyacrosssuchlargegeographicalareasthatnationswereunabletofullyengagetheir pandemicresponseplans[3].Hence,likealargedefensive wall,apassivethreatsurveillancesystemalonemaynotbe enoughtoavertdisaster.Thechallengetodayistocombinelargelypassiveemergingdiseasesurveillancesystems withmodestactiveengagementprogramsatthesourceof anovelpathogen ’ sgeneration.Wesurelyneedsurveillancebutwealsoneedanoffensivepolicysimilartothe campaignsledbytheambitiousEmperorWudi.Ininfectiousdiseases,weneedtotargetpotentialdiseasehotspots ofnovelpathogengenerationbeforenovelpathogensfully adapttotheirhosts(humanoranimal)andbecomemore virulentandmoreefficientathost-to-hosttransmission. JustastheGreatWallwasbuilttodefendinatime whenman ’ schiefmilitaryweaponsweretheswordand arrows,manyexistingpublichealthstrategieswerecreatedtodefendagainstdiseaseagentsofthepast.We mustadaptourstrategiestomatchthechangingdisease landscape.SimilartothebreachoftheBarLevline, novelpathogenscancatchusoffguardevenwhenwe doourbesttoanticipatethem.Whenweexaminetoday ’ sinfectiousdiseases,weseethatroughly75%of emerginginfectiousdiseasesarezoonotic,meaningthey spreadbetweenhumansandotheranimals[4].Thestudy andcontrolofthesenovelzoonoticpathogensrequirean integrated,interdisciplinaryapproachinvolvinghuman, veterinary,andenvironmentalhealthexperts,alsocalled the “ OneHealth ” approach.Thisapproachisbeingendorsedbymanyprofessionalandacademicorganizations including:TheWorldBank,TheUSInstituteofMedicine, TheUSCDC,etc.[5-8].Onlythroughinterdisciplinary andofteninternationalcooperationcanthecharacteristics andtransmissionpatternsofthesenovelagentsbeproperlyunderstoodandthepublichealthbestprotected. Thisconceptisbeingwidely embracedinternationally. IntheUSaloneatleastacademicinstitutionshaveinitiatedsomesortofOneHealthresearchortraining programs(Figure1). SunYat-SenUniversity,SouthChinaAgricultural University,BeijingInstituteofMicrobiologyand Epidemiology,theUniversityofFlorida,andmultiple Chinesecollaboratinginstitutionswillsoonhostan InternationalSymposiumforOneHealthResearch,the Figure1 MapofhigheracademicinstitutionsintheUnitedStatesofAmericacurrentlyengagedinOneHealth-relatedresearchor trainingprograms. Elbadry etal.MilitaryMedicalResearch 2014, 1 :15 Page2of3 http://www.mmrjournal.org/content/1/1/15

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purposeofwhichistofostermodernapproachestodisease threats.TheNovember22 – 23meetingsinGuangzhou Chinawillbringtogetherexpertsfromaroundtheworld andacrossChinatoexaminesuccessfulOneHealth approachestoemergingpublichealththreatssuchaszoonoticpathogens,foodsecurity,antimicrobialresistance,and environmentaltoxins.Moreinformationregardingthese meetingscanbefoundattheSymposiumwebsite: http://onehealth.csp.escience.cn/dct/page/1.Competinginterests Theauthorshavenocompetingintereststodeclare. Authors ’ contributions Allauthorscontributedtotheintellectualdevelopmentofthismanuscript. MAE,MMM,MM,andGCGdraftedmostofthemanuscript.Allauthorshave reviewedthemanuscriptforcontentandapprovedthefinalversion.All authorsreadandapprovedthefinalmanuscript. Authordetails1OneHealthCenterofExcellenceforResearchandTrainingandCollegeof PublicHealthandHealthProfessions,UniversityofFlorida,P.O.Box100188, Gainesville,FL32610,USA.2SchoolofPublicHealth,KeyLaboratoryof TropicalDiseaseControlResearch,MinistryofEducation,SunYat-sen University,Guangzhou,Guangdong,P.R.China.3StateKeyLaboratoryof PathogenandBiosecurity,BeijingInstituteofMicrobiologyand Epidemiology,Beijing,P.R.China. Received:18June2014Accepted:23June2014 Published:21July2014 References1. China'sGreatWallCrumblesasTourismSoars. Availableat:http://news. discovery.com/earth/great-wall-of-china-deteriorating.htm.Accessed6/9/ 2014. 2. Bar-LevLine. Availableat:http://www.globalsecurity.org/military/world/ israel/bar-lev-line.htm. 3.USDepartmentofHealthandHumanServices: AnHHSRetrospectiveon the2009H1N1InfluenzaPandemictoAdvanceAllHazards Preparedness. 2012. 4.UnitedStatesCentersforDiseaseControlandPrevention: Zoonotic Disease:WhenHumansandAnimalsIntersect. Availableat:http://www. cdc.gov/24-7/pdf/zoonotic-disease-factsheet.pdf. 5.ZhengX,LuJ,WhiteSK,Sabo-AttwoodT,GrayGC: Adoptingand ImplementingaOneHealthApproachforSolvingComplexHealth IssuesinChina. 2014.Manuscriptsubmittedforpublication. 6.AmericanMedicalAssociation: Resolution:530. AssociationAM ;2007. 7.USCentersforDiseaseControlandPrevention: DivisionofHighConsequencePathogensandPathology(DHCPP),OneHealthOffice. Availableat:http://www.cdc.gov/ncezid/dhcpp/one_health/index.html. AccessedJune15,2014. 8.WorldOrganisationforAnimalHealth(OIE): FifthStrategicPlan: 2011 – 2015. availableat:http://www.rr-africa.oie.int/docspdf/en/2010/ 5th_strategic_plan.pdf.doi:10.1186/2054-9369-1-15 Citethisarticleas: Elbadry etal. : China ’ sgreatwall,Israel ’ sBarLevLine, andpassiveinfectiousdiseasesurveillance. MilitaryMedicalResearch 2014 1 :15. Submit your next manuscript to BioMed Central and take full advantage of: € Convenient online submission € Thorough peer review € No space constraints or color “gure charges € Immediate publication on acceptance € Inclusion in PubMed, CAS, Scopus and Google Scholar € Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit Elbadry etal.MilitaryMedicalResearch 2014, 1 :15 Page3of3 http://www.mmrjournal.org/content/1/1/15