Academic journal article Environmental Health Perspectives

A Niche for Infectious Disease in Environmental Health: Rethinking the Toxicological Paradigm

Academic journal article Environmental Health Perspectives

A Niche for Infectious Disease in Environmental Health: Rethinking the Toxicological Paradigm

Article excerpt

OBJECTIVE: In this review we highlight the need to expand the scope of environmental health research, which now focuses largely on the study of toxicants, to incorporate infectious agents. We provide evidence that environmental health research would be strengthened through finding common ground with the tools and approaches of infectious disease research.

DATA SOURCES AND EXTRACTION: We conducted a literature review for examples of interactions between toxic agents and infectious diseases, as well as the role of these interactions as risk factors in classic "environmental" diseases. We investigated existing funding sources and research mandates in the United States from the National Science Foundation and the National Institutes of Health, particularly the National Institute of Environmental Health Sciences.

DATA SYNTHESIS: We adapted the toxiological paradigm to guide reintegration of infectious disease into environmental health research and to identify common ground between these two fields as well as opportunities for improving public health through interdisciplinary research.

CONCLUSIONS: Environmental health encompasses complex disease processes, many of which involve interactions among multiple risk factors, including toxicant exposures, pathogens, and susceptibility. Funding and program mandates for environmental health studies should be expanded to include pathogens in order to capture the true scope of these overlapping risks, thus creating more effective research investments with greater relevance to the complexity of real-world exposures and multifactorial health outcomes. We propose a new model that integrates the toxicology and infectious disease paradigms to facilitate improved collaboration and communication by providing a framework for interdisciplinary research. Pathogens should be part of environmental health research planning and funding allocation, as well as applications such as surveillance and policy development.

KEY WORDS: biomarkers, colon cancer, conceptual framework, environmental health, infectious disease, liver cancer, NIEHS, pathogens, toxicology. Environ Health Perspect 118:1165-1172 (2010). doi:10.1289/ehp.0901866 [Online 12 April 2010]

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Environmental health and infectious disease have been intertwined in the study of public health since at least the mid-1850s, when John Snow used an environmental map to determine origins of a London cholera outbreak, thus highlighting the concept of place as a determinant of infectious disease prevalence and transmission risks. Since that time, the fields of environmental health and infectious disease have diverged in many regions, particularly in the United States, where these fields are currently treated as distinct entities, leading to separate research funding tracks and distinct training programs in schools of public health. Although environmental health research continues to contribute to understanding key factors relevant to infectious diseases such as malaria, Lyme disease, and hantavirus pulmonary syndrome (Peterson et al., in press), environmental health research and practice predominantly focus on chemical and physical agents despite the inherent role of the environment in pathogen dynamics and host response.

Environmental health's focus on the abiotic factors of toxicology has meant that the field produces relatively little research on how pathogens and toxic agents interact to increase risks and severity of diseases and dysfunctions. Several of the major toxicant exposures studied within environmental health research alter risks for pathogen transmission and disease severity. Exposures to toxic agents may lead to immunotoxic changes in hosts that reduce the threshold for infection, increase the persistence of an infection, increase pathogen shedding, and alter the severity and burden of infectious disease. Pathogens can modify inflammatory pathways and other responses induced by environmental toxicants and modify the likelihood and severity of chronic disease progression. …

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