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      Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence


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          Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges. The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities. The centers’ objectives would be 3-fold: a) to provide information to local communities about the links between environmental change and public health; b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research; and c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.

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          Most cited references47

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          Effects of environmental change on emerging parasitic diseases.

          Ecological disturbances exert an influence on the emergence and proliferation of malaria and zoonotic parasitic diseases, including, Leishmaniasis, cryptosporidiosis, giardiasis, trypanosomiasis, schistosomiasis, filariasis, onchocerciasis, and loiasis. Each environmental change, whether occurring as a natural phenomenon or through human intervention, changes the ecological balance and context within which disease hosts or vectors and parasites breed, develop, and transmit disease. Each species occupies a particular ecological niche and vector species sub-populations are distinct behaviourally and genetically as they adapt to man-made environments. Most zoonotic parasites display three distinct life cycles: sylvatic, zoonotic, and anthroponotic. In adapting to changed environmental conditions, including reduced non-human population and increased human population, some vectors display conversion from a primarily zoophyllic to primarily anthrophyllic orientation. Deforestation and ensuing changes in landuse, human settlement, commercial development, road construction, water control systems (dams, canals, irrigation systems, reservoirs), and climate, singly, and in combination have been accompanied by global increases in morbidity and mortality from emergent parasitic disease. The replacement of forests with crop farming, ranching, and raising small animals can create supportive habitats for parasites and their host vectors. When the land use of deforested areas changes, the pattern of human settlement is altered and habitat fragmentation may provide opportunities for exchange and transmission of parasites to the heretofore uninfected humans. Construction of water control projects can lead to shifts in such vector populations as snails and mosquitoes and their parasites. Construction of roads in previously inaccessible forested areas can lead to erosion, and stagnant ponds by blocking the flow of streams when the water rises during the rainy season. The combined effects of environmentally detrimental changes in local land use and alterations in global climate disrupt the natural ecosystem and can increase the risk of transmission of parasitic diseases to the human population.
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            Fatal encephalitis due to Nipah virus among pig-farmers in Malaysia.

            Between February and April, 1999, an outbreak of viral encephalitis occurred among pig-farmers in Malaysia. We report findings for the first three patients who died. Samples of tissue were taken at necropsy. Blood and cerebrospinal-fluid (CSF) samples taken before death were cultured for viruses, and tested for antibodies to viruses. The three pig-farmers presented with fever, headache, and altered level of consciousness. Myoclonus was present in two patients. There were signs of brainstem dysfunction with hypertension and tachycardia. Rapid deterioration led to irreversible hypotension and death. A virus causing syncytial formation of vero cells was cultured from the CSF of two patients after 5 days; the virus stained positively with antibodies against Hendra virus by indirect immunofluorescence. IgM capture ELISA showed that all three patients had IgM antibodies in CSF against Hendra viral antigens. Necropsy showed widespread microinfarction in the central nervous system and other organs resulting from vasculitis-induced thrombosis. There was no clinical evidence of pulmonary involvement. Inclusion bodies likely to be of viral origin were noted in neurons near vasculitic blood vessels. The causative agent was a previously undescribed paramyxovirus related to the Hendra virus. Close contact with infected pigs may be the source of the viral transmission. Clinically and epidemiologically the infection is distinct from infection by the Hendra virus. We propose that this Hendra-like virus was the cause of the outbreak of encephalitis in Malaysia.
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              The increase in risk factors for leishmaniasis worldwide.

              P Desjeux (2001)
              Economic development leads to changing interactions between humans and their physical and biological environment. Worldwide patterns of human settlement in urban areas have led in developing countries to a rapid growth of mega-cities where facilities for housing, drinking-water and sanitation are inadequate, thus creating opportunities for the transmission of communicable diseases such as leishmaniasis. Increasing risk factors are making leishmaniasis a growing public health concern for many countries around the world. Certain risk factors are new, while others previously known are becoming more significant. While some risk factors are related to a specific eco-epidemiological entity, others affect all forms of leishmaniasis. Risk factors are reviewed here entity by entity.

                Author and article information

                Environ Health Perspect
                Environmental Health Perspectives
                National Institue of Environmental Health Sciences
                July 2004
                22 April 2004
                : 112
                : 10
                : 1092-1098
                1Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies and the Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin, USA
                2Consortium for Conservation Medicine, Palisades, New York, USA
                3Wilburforce Foundation, Bozeman, Montana, USA
                4Wildlife Trust, Palisades, New York, USA
                5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
                6School of Natural Resources and Environment, University of Michigan, Ann Arbor, Michigan, USA
                7Lymphatic Filariasis Support Centre, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
                8Centre on Global Change and Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
                Author notes
                Address correspondence to J.A. Patz, Center for Sustainability and the Global Environment (SAGE), Nelson Institute for Environmental Studies and the Department of Population Health Sciences, University of Wisconsin–Madison, 1710 University Avenue, Room 202A, Madison, WI 53726-4087 USA. Telephone: (608) 265-9119. Fax: (608) 265-4113. E-mail: jpatz@wisc.edu

                Members of the Working Group on Land Use Change and Disease Emergence, convened at the biennial meeting of the International Society for Ecosystem Health: A.A. Aguirre, F.P. Amerasinghe, R.W. Ashford, D. Barthelemy, R. Bos, D.J. Bradley, A. Buck, C. Butler, E.S. Chivian, K.B. Chua, G. Clark, R. Colwell, U.E. Confalonieri, C. Corvalan, A.A. Cunningham, P. Daszak, J. Dein, A.P. Dobson, J.G. Else, J. Epstein, H. Field, J. Foufopoulos, P. Furu, C. Gascon, D. Graham, A. Haines, A.D. Hyatt, A. Jamaluddin, A.M. Kilpatrick, E.F. Kleinau, F. Koontz, H.S. Koren, S. LeBlancq, S. Lele, S. Lindsay, N. Maynard, R.G. McLean, T. McMichael, D. Molyneux, S.S. Morse, D.E. Norris, R.S. Ostfeld, J. Patz, M.C. Pearl, D. Pimentel, L. Rakototiana, O. Randriamanajara, J. Riach, J.P. Rosenthal, E. Salazar-Sanchez, E. Silbergeld, G.M. Tabor, M. Thomson, A.Y. Vittor, N.D. Wolfe, L. Yameogo, and V. Zakarov.

                Funding for the Special Colloquium, “Unhealthy Landscapes: How Land Use Change Affects Health,” was provided by the National Fish and Wildlife Foundation, V. Kann Rasmussen Foundation, Overbrook Foundation, and New York Community Trust. The colloquium was cosponsored by the World Health Organization and the United Nations Environment Program.

                The authors declare they have no competing financial interests.

                This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original DOI.
                : 25 November 2003
                : 22 April 2004
                Meeting Report

                Public health
                ecosystems,biodiversity,deforestation,zoonosis,urban sprawl,malaria,land use,emerging infectious diseases,wildlife,lyme disease


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