Emerging Disease or Diagnosis?

Some viral infections may not represent emerging diseases, but improved detection and diagnosis of common diseases. Outbreaks this year of the deadly and highly contagious Ebola and Marburg viruses in the Democratic Republic of Congo and Uganda and Lassa virus in Nigeria raised concerns about possible epidemic spread of these hemorrhagic fevers. These pathogens seemed to appear out of nowhere around the middle of the 20th century: Marburg virus in 1967, Lassa virus in 1969, and Ebola virus in 1976. By the early 1990s, public health concerns were crystallized in a landmark report ( 1 ) that was the first to popularize the concept of “emerging pathogens” (fig. S1). But could “emerging diagnosis” explain the rise in appearance of hemorrhagic fevers caused by these pathogens? Recent epidemiologic and genetic studies of Lassa and Ebola fevers suggest that these diseases may have widespread prevalence and ancient origins. They raise the possibility that some viral infections may reflect “emerging diagnoses” of diseases that are circulating more widely than thought, with an emerging character primarily a matter of improved detection of the culprit pathogens.