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Maladies Émergentes Et Réémergentes Chez L’Homme Maladies émergentes et réémergentes chez l’homme Maladies émergentes et réémergentes chez l’homme Concepts Facteurs d’émergence Alertes Riposte mondiale Dossier de synthèse Rédigé par Hélène Fagherazzi-Pagel, Docteur en médecine, Ingénieur de recherche CNRS Dernière mise à jour : avril 2012 (première version en 2006) Maladies émergentes et réémergentes chez l’homme SOMMAIRE INTRODUCTION ................................................................................................. 4 FAITS MARQUANTS 2010-2011- 2012... ............................................................ 5 1. CONCEPTS ................................................................................................ 6 1.1 Histoire d’un concept .......................................................................................... 6 1.2 Définitions ............................................................................................................ 7 1.3 Classifications ..................................................................................................... 8 1.3.1 Nouvelle maladie ..................................................................................................... 8 1.3.2 Maladie connue ..................................................................................................... 10 1.3.3 Vraies émergences ? ............................................................................................. 14 2. FACTEURS D’EMERGENCE ......................................................................... 17 2.1 Facteurs humains et environnementaux ......................................................... 17 2.2 Facteurs médicaux ............................................................................................ 19 2.2.1 Sécurité transfusionnelle et risques émergents .......................................................... 19 2.2.2 Affections liées aux techniques médicales ................................................................ 20 2.2.3 Programmes de prévention et surtout moindre vaccination .......................................... 20 2.2.4 Lutte dans les pays en développement ..................................................................... 21 2.3 Facteurs liés à l’agent ....................................................................................... 22 2.3.1 Apparition d’un nouvel agent ................................................................................... 22 2.3.2 Modifications antigéniques ...................................................................................... 23 2.3.3 Introduction dans une nouvelle région ...................................................................... 24 2.3.4 Expansion d’un agent ancien .................................................................................. 25 2.4 Facteurs liés aux vecteurs ................................................................................ 25 2.4.1 Nouveau vecteur pour la région ............................................................................... 25 2.4.2 Vecteur avec des propriétés différentes .................................................................... 25 2.5 Facteurs liés à l’hôte vertébré .......................................................................... 26 2.5.1 Hôte réservoir ou amplificateur ................................................................................ 26 2.5.2 Propriétés de l’hôte ................................................................................................ 27 2.6 Facteur géographique ....................................................................................... 28 3. ALERTES ................................................................................................. 29 3.1 Maladies d’origine alimentaire ......................................................................... 29 3.2 Maniement des antimicrobiens ........................................................................ 31 3.2.1 Résistance aux antimicrobiens ................................................................................ 31 3.2.2 Maladie nouvelle : Clostridium difficile ...................................................................... 34 3.2.3 Infections opportunistes .................................................................................. 35 3.3 Viroses ............................................................................................................... 36 3.3.1 Arboviroses émergentes et réémergentes ................................................................. 36 3.3.2 Fièvres hémorragiques ........................................................................................... 37 3.3.3 Risques d’émergence ............................................................................................ 39 3.4 Bactérioses ........................................................................................................ 40 3.4.1 Zoonoses bactériennes .......................................................................................... 40 3.4.2 Bactérioses endémiques réémergentes .................................................................... 41 3.5 Parasitoses ........................................................................................................ 42 3.5.1 Protozooses.......................................................................................................... 42 3.5.2 Helminthiases ....................................................................................................... 42 3.6 Autres maladies non infectieuses a priori....................................................... 43 Maladies émergentes et réémergentes chez l’homme 4. RIPOSTE MONDIALE .................................................................................. 45 4.1 Détecter le risque d’émergence ....................................................................... 45 4.1.1 Collaboration multisectorielle ................................................................................... 45 4.1.2 Les réseaux de veille épidémiologique ..................................................................... 46 4.1.3 Sources d’information ............................................................................................ 48 4.1.4 Veille microbiologique et entomologique ................................................................... 49 4.2 Riposte et action ................................................................................................ 50 4.2.1 Droit international .................................................................................................. 50 4.2.2 Déclaration obligatoire ............................................................................................ 51 4.2.3 Le Règlement sanitaire international ........................................................................ 51 4.2.4 Alerte et action : réseau mondial .............................................................................. 52 4.3 Perspectives ...................................................................................................... 53 4.3.1 Renforcement des moyens et de la préparation ......................................................... 53 4.3.2 Recherche scientifique ........................................................................................... 53 4.3.3 Communication ..................................................................................................... 55 4.3.4 Solidarité .............................................................................................................. 56 CONCLUSION ................................................................................................. 58 ANNEXES ...................................................................................................... 59 WEBOGRAPHIE .............................................................................................. 78 BIBLIOGRAPHIE .............................................................................................. 85 Maladies émergentes et réémergentes chez l’homme Introduction Une maladie émergente est une maladie dont l’incidence réelle augmente de manière significative, d’une population donnée, dans une région donnée, par rapport à la situation habituelle de cette maladie1[1]. Les instances officielles françaises (et les médias) abordent ce thème des « maladies émergentes » depuis moins de 10 ans2... Les maladies émergentes chez l’homme seraient des zoonoses dans plus de 60 à 70 % des cas[2- 3]34. Le nombre d’espèces animales, sauvages ou d’élevage, d’agents pathogènes mieux différenciés sont les acteurs innombrables de l’écologie des maladies transmissibles à l’homme, homme indissociable de son écosystème[4]. Depuis les années 1980, des dizaines de microorganismes5 pathogènes nouveaux ont été isolés, des dizaines d’épidémies ont émergé ou réémergé. Ces événements ont été plus ou moins médiatisés, selon la nature de l’agent (nouveau ou connu) et le territoire atteint : pays riches ayant une communication efficace ou pays pauvres où les maladies sont dites négligées[5]. Ces dernières suscitent depuis moins de 20 ans une mobilisation sans précédent (laboratoires, et philanthropes réunis dans des Fondations6). Dans le monde entier, la pauvreté et les mauvaises conditions d’hygiène, de même que les conflits armés font redouter des flambées de maladies infectieuses réémergentes. Sont en cause également la promiscuité, la richesse de vecteurs animaux dans des populations dites à risque. Les
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