Is the Unexpected Pandemic Expansion of an Already Known Arbovirus Really a Surprise?

I think of a surprise as something unexpected. Was the pandemic expansion of Zika truly unexpected?  

Kevin Outterson has had me thinking about this since Saturday when, in opening remarks at  the American Journal of Law and Medicine sponsored "Global Infectious Diseases: New Challenges and Solutions" conference he pointed out that the December 3, 2015 special supplement in Nature, predicting the next possible pandemics, did not mention Zika.  

This is true. This is notable. But the very last entry on Nature's list was the idea of the predictably unpredictable rise of a formerly known virus to pandemic levels through  a combination of possible mutation and certain increasing human travel and disturbance.  

As Anthony Fauci and David Forens have noted in the NEJM, "[Zika] has already reinforced one important lesson: in our human-dominated world, urban crowding, constant international travel, and other human behaviors combined with human-caused microperturbations in ecological balance can cause innumerable slumbering infectious agents to emerge unexpectedly."

We should, in short, expect the unexpected.  That a disease first identified in 1947 in Uganda,  then  lived in relative obscurity, primarily in wild primates and arboreal mosquitoes,  until its spectacular expansion beyond a relatively narrow geographic niche is a compelling story.  It is, in part,  a story about 5,000 years of adaptation by the  mosquito to life with humans using domestic water storage containers. And it is also a story about the rise of large scale domestic water storage in and near dwellings in water-starved parts of  Brazil.  That this evolutionary cascade would yield this kind of surprise, seen from this perspective, may not be entirely surprising. 

The real shock will be if we continue, in light of this, with our one bug one drug approach to treatment, rather than developing vaccine platforms for varied virus groups that can be quickly modified to attack newly emerging viruses.

I guess it all depends on how you feel about surprises. 


x-posted  at prawfsblawg

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