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OVERVIEW OF INFECTIOUS DISEASE PREVENTION

This chapter addresses the prevention and control of infectious diseases associated with the greatest burden of global morbidity and mortality. We begin by highlighting overall global progress toward infectious disease control. Subsequent sections focus on the critical role of cross-cutting interventions that decrease host susceptibility and exposure across many infectious diseases, including the optimization of nutritional status and environmental modification through the provision of clean water and improved sanitation. The remainder of the chapter is dedicated to prevention and control strategies for specific syndromes of global importance. The communicable disease sections of this book provide a comprehensive overview of the recommended treatments for specific infectious diseases; this chapter only includes these treatments if they are an essential element of control programs.

Prevention of infectious diseases refers to the avoidance of infection in individuals, while control refers to reduction in the impact of disease across a population. Prevention and control of infectious diseases can be achieved through interventions designed to kill or inactivate a pathogen (such as mass drug administration, MDA), interventions to limit the spread of a vector or reservoir of the pathogen (such as bed net distribution), interventions to reduce underlying host susceptibility (such as management of malnutrition), or interventions targeting modification of the environment to reduce exposure (such as water and sanitation).

Infectious disease prevention and control efforts can be viewed across a spectrum of four categories: control, elimination, eradication, and extinction. Control is defined as reducing the incidence, prevalence, morbidity, or mortality of a condition to locally acceptable levels. This is distinct from elimination (reduction in the incidence of infection to zero within a given geographical area), eradication (permanent reduction in worldwide incidence of an infection to zero), or extinction which implies complete removal of an infectious agent from nature, including no longer being present in any laboratory.1

GLOBAL PROGRESS, GOALS, AND TARGETS TOWARD REDUCING MORTALITY AND MORBIDITY DUE TO INFECTIOUS DISEASES

Significant reductions in global morbidity and mortality have been achieved over the past several decades with greatest impact seen in under-5 mortality rates.2 However, infectious diseases continue to account for a substantial proportion of global deaths.3 For example, lower respiratory infections, diarrhea, and tuberculosis (TB) continue to be among the top ten drivers of mortality for all ages and sexes and pneumonia and diarrhea remain the leading causes of death for children under 5.4

Despite substantial progress made in reducing morbidity and mortality in response to the Millennium Development Goals (MDGs), the health-related targets for MDG 4 (reduce child mortality), 5 (reduce maternal mortality), and 6 (reduce infectious diseases) were not met. Although MDG 4 was not achieved, mortality in the >5 age group declined remarkably during the MDG era (2000–15), with a considerably lower number of children dying in 2015 (5.8 million), as compared to in 1990 (12.7 million).5...

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