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Most emerging infections appear to be caused by pathogens already present in the environment, brought out of obscurity or given a selective advantage by changing conditions and afforded an opportunity to infect new host populations on rare occasions, a new variant may also evolve and cause a new disease 2,4. The process by which infectious agents may transfer from animals to humans or disseminate from isolated groups into new populations can be called microbial traffic 3,4. A number of activities increase microbial traffic and as a result promote emergence and epidemics. In some cases, including many of the most novel infections, the agents are zoonotic, crossing from their natural hosts into the human population; because of the many similarities, I include here vector borne diseases. In other cases, pathogens already present in geographically isolated populations are given an opportunity to disseminate further. Surprisingly often, disease emergence is caused by human actions, however inadvertently; natural causes, such as changes in climate, can also at times be responsible 6. Although this discussion is confined largely to human disease, similar considerations apply to emerging pathogens in other species. Table 2 summarizes the underlying factors responsible for emergence. Any categorization of the factors is, of course, somewhat arbitrary but should be representative of the underlying processes that cause emergence. I have essentially adopted the categories developed in the Institute of Medicine report on emerging infections 12, with additional definitions from the CDC emerging infections plan 13. Responsible factors include ecological changes, such as those due to agricultural or economic development or to anomalies in climate; human demographic changes and behavior; travel and commerce; technology and industry; microbial adaptation and change; and breakdown of public health measures.

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