Globalization of Infectious Diseases
By Gordon M. Dickinson, M.D.


Today virtually every country around the globe is linked through communication networks, banking, trade, and travel. Corollaries of this dramatic globalization are the acquisition of geographically isolated pathogens by travelers and the rapid spread of emerging pathogens. At UHealth-University of Miami Health System and the Miller School, we have a team of infectious disease physicians who are focused on the issues of pathogen transmission and preparation for managing epidemic diseases.

Development of an infectious disease caused by a pathogen not found at home is a relatively frequent event as more and more people travel widely. For instance, an adventurous traveler may present with life-threatening malaria the very day he returns to Miami from India. Sylvatic plague acquired on a camping trip to the Four Corners area of the southwestern United States may present as a deadly septicemia upon the camper’s return home to the East Coast. Typhoid fever, infrequently acquired in the United States, is an all-too-common souvenir of travel through endemic areas.

Gordon M. Dickinson, M.D.

A more troubling byproduct of globalization is the ability of an emerging pathogen to quickly spread globally. Case in point: New strains of Influenza A typically move rapidly, but the speed at which the H1N1 influenza made its way around the world was breathtaking. The first cases can be traced to late March or early April of 2009. By June H1N1 reached global proportions and was declared a pandemic by the World Health Organization.

The threat of the worldwide spread of emerging pathogens is twofold: illness and possible death for those who become infected, and the crippling impact on the lives of others as travel and commerce are severely curtailed. In Mexico the H1N1 outbreak was associated with a rapid drop in tourism and travel as airlines and cruise lines attempted to limit exposure. And only a few years ago, the contagiousness and lethality of SARS (Severe Acute Respiratory Syndrome) threatened segments of the world economy. According to the World Health Organization, SARS caused a 50 to 70 percent drop in international travel and a 60 percent decrease in hotel occupancy in affected areas.

Epidemiologists, infectious disease specialists, and scientists have established a number of organizations for the purpose of rapidly identifying and tracking emerging infections, as well as keeping tabs on known pathogens. With the goal of rapidly identifying a new pathogen, characterizing how it is transmitted, and developing vaccines and treatment, these organizations link primary care-based providers and local health departments with national and international surveillance programs. Although there initially were delays in recognizing that a new pathogen was spreading, it took only a few months to prove that the Corona virus of civet cats was the culprit in SARS. This result was arguably one of the most successful examples of global cooperation for the common good.

Although much of the day-to-day work of our UHealth infectious disease specialists entails ensuring the safety of patients and health care workers—work that largely involves pathogens endogenous to the human body and environment—the team also collaborates with public health departments by monitoring new developments and disseminating public health information. And when there’s a threat of an epidemic, the team helps hospitals prepare to handle any outbreak. As every firefighter knows, it is much easier to extinguish a small fire than control a conflagration. The same principle applies to the control of epidemics.

Gordon M. Dickinson, M.D., is a professor of medicine and chief of the Division of Infectious Diseases at the Miller School of Medicine and The Miami VA Medical Center.