The Perpetual Challenge of Infectious Diseases

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Abstract
Fauci and Morens (Feb. 2 issue)1 describe the global burden of infectious diseases and the evolving realization of their potential to cause chronic disease, the primary example being viral hepatitis and resultant cirrhosis and liver cancer. Part of the challenge inherent in this new vista is proper evaluation of the burden of chronic disease caused by infections. The Global Burden of Disease Study has previously not attributed deaths from cirrhosis or liver cancer to their viral causes, although a follow-up study aims to address the issue of “diseases as risk factors,” including viral hepatitis.2 The result of this historical lack of consideration of long-term consequences of infections is a drastic underestimate of their impact, as shown in Figure 1 of the article by Fauci and Morens. This figure, which suggests that the hepatitis B virus causes 10% of the deaths estimated in other studies, does not include deaths due to hepatitis C virus infection.3,4 This omission contributes to the lack of recognition of viral hepatitis as a global public health problem which has hampered progress in prevention and control, especially in developing countries.5

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