A Review of Infectious Disease Publications in Europe
Work package 17
University of Genoa
Roberto Gasparini and Paolo Durando
August 31st 2006
Background
The vast majority of citizens living in Europe have significantly increased their life
expectancy and quality through the last fifty years. This great result has mainly due to the
improvement in both economic and social status of our societies but also to the better
general hygienic conditions after the II World War. Undoubtedly, the improvement in
scientific research and the effects of this on the routinely used health care practices has
played an important role to clearly understand this phenomenon. In particular, some of the
best results in medicine during the last decades, unfortunately observed only for Western
Countries, concern the field of prevention and control of inftectious diseseas (IDs). Both
vaccines and antibiotics has contributed to this. It is well known that important IDs in term
of morbidity and mortality, expanded world wide in the recent past, have currently been
eradicated or eliminated, such as smallpox, polio, diphteria, measles and others are under
control (tetanus, HBV infection, etc.). In particular, children’s health has mainly improved,
obtaining the best advantages of well-planned vaccination strategies, beeing available
national immunization schedules targeted for this age group in all EU Countries.
On the other part, some problems remain to be solved: not only old but also new emerging
or re-emerging IDs have occurred in our area in the recent past. HIV infection,
microrganisms multiresistant to antibiotics and antivirals or the possible next pandemic of
influenza are only examples of main current Public Health problems that need to be
focused by Public Health policy makers as soon as possible.
The problem is more complex than it seems at a first technical approach. The dramatic
changes in demographic composition of our population, due to mass migration, wide work
relathionships, tourism and all that concern “globalization”, with conseguent impact on
social and cultural scenarios, need to be fully considered. Due to this, health inequalities
within and between Countries have been growing, as has the use and cost of health care.
Considerable and convincing evidence exists indicating that significant economic benefits
can be achieved by improving population health not only in developing, but also in
developed Countries. As a consequence, a more dinamic approch to the prevention and
control of IDs has to be done, to consolidate previously discussed good obtained results
and to continue improving health status of people.
Fortunately, the improvement in basic and applied research, reached in the last decades,
with the dramatic new knowledge in biotechnologies, molecular epidemiology, etc. makes
available for use new effective instruments of prevention (i.e., new vaccines against
meningitis, varicella, HPV infection, etc.), diagnosis (i.e., NAT based tecnology, screening
1
tests, etc.) and therapy (i.e., new drugs such as HAART for HIV infection, antibiotics for
non susceptible strains, etc.) in this field.
Research have already contributed and will continue in the next future to optimize Public
Health control of IDs, resulting in a further better health status of European people.
Just to have a picture of what have been done in Europe in the recent past concerning
research applied to IDs control and prevention, as requested in Work package 6 of the
SPHERE project, funded by the EU FP6 programme, we have reviewed the Public Health
literature published in English covering the European Economic area over the past 10
years.
We hope this work will almost in part contribute to have a picture of the state of the art of
the scientific production focused on this important field of medicine and Public Health. The
aims are to observe current trends and main research fields but also to show gaps and
possible differences between member States, indicating new strategies and options for the
research applied to IDs in the next future in Europe.
General objective
• To describe scientific research concerning IDs in Europe, as a whole, reviewing all
published European literature
Specific objectives
• To describe scientific paper production and its temporal trend in the last decade
• To define main research areas inside all IDs
• To compare scientific production between all EU member States, not only as crude
number of published articles, but also considering Gross Domestic Product (GPD) and
number of population
• To indicate gaps and new implementation perspectives
2
Methods
We have made a web search of “all type” scientific publications, starting from 1995/07/01
to 2005/06/30, using PUBMED engine (http://www.pubmed.gov). We have performed the
search for all European Countries, considered both together and by single Country in our
analysis.
As a proxy for Country production, we have used author address or affiliation.
In our strategy, we have identified a “main topic” and more selected “subtopics” (main
groups of IDs) and “main research areas” (i.e., “Epidemiology-Surveillance” and
“Prevention and Control”) used as key-words, differently matched together for the web
search.
The “main topic” was obviously considered as the whole of “Infectious Diseases”, while the
“subtopics” were chosen on the basis of the Centre for Diseases Control and Prevention
(CDC) classification of IDs (http://www.cdc.gov) and listed in 9 groups (“Sexually
Transmitted Diseases”, “Animal-Related Diseases”, “Bioterrorism Agents/Diseases”,
“Childhood Diseases”, “Drug Resistant Infections”, “Emerging Infectious Diseases”, “Food-
Related Diseases”, “Occupational Risk In Healthcare” and “Insects or Arthropod-Related
Diseases”).
We have arbitrarily chosen some fields of interest concerning IDs, such as “Epidemiology-
Surveillance” and “Prevention and Control”, named as “main research areas”, to be
considered in our opinion as priority activities for EU Public Health research.
Furthermore, in order to perform a more analytical approach, we have done a further web
search, directly choosing one “specific disease” inside a main “subtopic” (i.e., “HIV” for the
“subtopic” concerning “STDs”) and matching it with our previously selected “main research
areas”. This approach is currently in progress also for other diseases, considered of main
importance for Public Health (data not shown).
Additionally, in order to investigate the burden of specific disease groups, not initially
included among the CDC “subtopics”, we have selected a “new subtopic” concerning
vaccine preventable diseases (“Vaccine” used as key-word), conducting the web search
using the same strategy as before.
These two last specific searches were also done to validate our first approach in order to
underline bias and gaps in sensitivity of our search strategy.
Our search strategy is schematized as below, in Fig. 1.
3
Fig. 1. General scheme of the web-search stragegy.
4
Results
All results are presented as crude number of published papers both for all European
Countries and by single State. When possible, data have also been analysed in relation to
the number of the population of each member State and its GDP. Data have also been
studied by specific “subtopics”.
In Fig. 2, results concerning the temporal trend of scientific production among the last 10
years in Europe, identified matching together as key-words “Epidemiology and
Surveillance” and “Prevention and Control” AND “Infectious Diseases”, are illustrated.
During 2005, the highest peak of production has been registered, being the increase in
production more relevant starting form 2000.
180
160
140
120
100
80
60
40
20
0
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
Years
epidemiology and surveillance prevention and control
Fig. 2. Scientific production on “Epidemiology and Surveillance” and “Prevention and Control” AND
“Infectious Diseases” during the period 1995-2005
5
In Fig. 3 and 4, a general overview of the scientific papers identified using the same
search approach as before is presented for both “main research areas” for “IDs”
“subtopic”: Countries have been divided in 3 groups, arbitrarily created on the basis of the
scientific production (0-10; 11-50 and >50 scientific papers).
0-10
11-50
>50
Fig. 3. Overview on EU scientific production by member States (“Epidemiology and Surveillance”
AND “IDs”)
6
0-10
11-50
>50
Fig. 4. Overview on EU scientific production by member States (“Prevention and Control” AND “IDs”)
7
1201 articles concerning the “main topic” “IDs”, collected from the search of this key-word
for both our selected “main research areas”, have been found: in Fig. 5, data are
presented, separated by EU Countries.
180
160
140
120
100
80
60
40
20
0
Austria
Fig. 5. 1201 published papers on “Prevention and Control” (376 articles) and “ Epidemiology and
Surveillance” (825 articles) AND “IDs”, by EU Countries: a comparison between our selected “ main
research areas”
France, Germany, Italy, Netherlands, Spain, Sweden, Switzerland and United Kingdom
seem to be the most prolific actors.
Nevertheless, if we consider these results on the basis of both State population number
and GDP, data show a significant different scenario. In Fig. 6 and 7, results from the
search “Epidemiology and Surveillance” AND “IDs” are reported considering these two
variables (State population and GDP).
8
12
10
8
6
4
2
0
Austria
Fig. 6. Scientic production on “Epidemiology and Surveillance” AND “IDs”, by EU Countries and
State Population (Published papers number/1.000.000 inhabitants)
400
350
300
250
200
150
100
50
0
Netherlands
Czech Republic
Luxembourg
Liechtenstein
United Kingdom
Hungary
Norway
Lithuania
Cyprus
Finland
Iceland
Ireland
Greece
Poland
Belgium
Denmark
Germany
Austria
Estonia
Malta
Portugal
Slovenia
Slovak Republic
France
Switzerland
Sweden
Italy
Spain
Latvia
Countries
Fig. 7. Scientific production on “Epidemiology and Surveillance” AND “IDs”, by EU Countries and
State GDP (Published papers number/1.000.000.000.000 of US dollars of GDP)
9
Countries as Denmark, Luxemburg, Netherlands, Sweden and Switzerland are the only
States that produeced more than 4 papers/1.000.000 inhabitants, resulting the most
productive among all EU member States.
On the basis of the analysis of the GDP, Estonia, Hungary, Lithuania, Netherlands,
Slovakia, Slovenia, Sweden and Switzerland had the highest production, publishing more
than 200 articles/trilion of US dollars of GDP.
In Fig. 8, 9 and 10, we have summerized, both separatly and in comparison, our results
obtained matching our two “main research areas” with each of our selected “subtopics”.
561
533 3114
sexually transmitted
diseases
100 drug resistant
infectious
Bioterrorism
555
Occupational Risk in
Healthcare
Animal borne diseases
food related diseases
181
childhood diseases
emerging infectious
102 diseases
Insects or arthropods
36 related diseases
1184
Fig. 8. Published papers on “ Epidemiology and Surveillance” AND each single “Subtopic” in Europe
383
1499 sexually transmitted
diseases
drug resistant
353 infectious
Bioterrorism
39 Occupational Risk in
Healthcare
Animal borne diseases
food related diseases
childhood diseases
139
emerging infectious
55 diseases
Insects or arthropods
77 related diseases
61
349
Fig. 9. Published papers on “Prevention and Control” AND each single “Subtopic” in Europe
10
3500
3114
3000
2500
Published papers
2000
1499
1500
1184
1000
555 533 353 561 383
349
500
102 77 181 139
36 61 55 100 39
0
Bioterrorism
Animal borne
transmitted
drug resistant
food related
childhood
arthropods
Occupational
infectious
emerging
Insects or
diseases
diseases
Healthcare
diseases
diseases
sexually
diseases
related
infectious
diseases
Risk in
epidemilogy Surveillance prevention and control
Fig. 10. Scientific production on “Epidemiology and Surveillance” and “Prevention and Control”
AND each single “Subtopic”, in Europe: comparison by selected “main research areas”
Just at a first view, it becomes evident that the found crude number of published papers on
each single “subtopic” is significantly higher than that observed for the “main subtopic”
“IDs”. This paradoxical result will be discussed later in discussion.
“Sexually Transmitted Diseases” (STDs), “Drug Resistant Infections”, “Emerging Infectious
Diseases” and “Insects or Arthropod-Related Diseases” seem to be the main fields of
scientific production, for both our “main research areas”.
STDs “subtopic” results as the main studied one, with an overall number of published
articles of 4613. Data concerning this group of diseases are shown in Fig. 11.
11
700
600
500
400
300
200
100
0
Liechtenstein
Germany
Ireland
Czech Republic
Lithuania
Sweden
Belgium
France
United Kingdom
Greece
Denmark
Iceland
Italy
Luxembourg
Finland
Poland
Switzerland
Cyprus
Netherlands
Austria
Estonia
Latvia
Malta
Portugal
Slovakia
Slovenia
Spain
Hungary
Norway
Countries
prevention and control epidemiology and surveillance
Fig. 11. 4613 published papers on “Prevention and Control” (1499 articles) and “Epidemiology and
Surveillance” (3114 articles) AND “Sexually Transmitted Diseases” (STDs), by EU Countries: a
comparison between our selected “main research areas”
As previously observed for the “main subtopic” “IDs”, also for nearly all “subtopics”, the
research area concerning “Epidemiology and Surveillance” seems to be more relevant
than the other on “Prevention and Control”, in term of number of published articles.
In regards to the most important “subtopic” concerning “STDs”, we have also analysed our
results Country by Country, considering, as before, the variables State population and
GDP. In Fig. 12-13, these data for the search “Epidemiology and Surveillance” are
reported.
12
State GDP (Published papers number/1.000.000.000.000 of US dollars of GDP)
Fig. 13. Scientific production on “Epidemiology and Surveillance” AND “STDs”, by EU Countries and
State Population (Published papers number/1.000.000 inhabitants)
Fig. 12. Scientic production on “Epidemiology and Surveillance” AND “STDs”, by EU Countries and
10
15
20
25
30
35
1000
1500
2000
2500
3000
0
5
500
0
Austria
Austria Belgium
Belgium Cyprus
Cyprus Czech Republic
Czech Republic Denmark
Denmark Estonia
Estonia Finland
Finland
France
France
Germany
Germany
Greece
Greece
Countries
Hungary
Countries
Hungary
Iceland
Iceland
Ireland
Ireland
Italy
Italy
Latvia
Latvia
Liechtenstein
Liechtenstein
Lithuania
Lithuania
Luxembourg
Luxembourg
Malta Malta
Netherlands Netherlands
Norway Norway
Poland Poland
Portugal Portugal
Slovak Republic Slovak Republic
Slovenia Slovenia
Spain Spain
Sweden Sweden
Switzerland Switzerland
United Kingdom United Kingdom
13
Belgium, Denmark, Estonia, Finland, France, Luxemburg, Netherlands, Norway, Spain,
Sweden and Switzerland showed the best research production among all EU member
States, considering the variable State population, with a production of 10 or more
papers/1.000.000 inhabitants. These data are in line with those observed for the “main
topic” “IDs”.
The same conclusion can be done for the variable GDP: in fact, Denmark, Estonia, Italy,
Latvia, Lithuania, Luxemburg, Netherlands, Slovenia, Spain, Sweden and Switzerland had
the highest production, publishing 500 or more articles/trilion of US dollars of GDP,
arbitrarily considered as cut-off.
For a more analytical and deep evaluation, we have performed in our study a web search
also directly focused one “specific disease” and a “new subtopic”, not initially included
among the CDC ones, that we believe of high sensitivity for our web search: “HIV” and
“Vaccine” were selected as key-words for this pourpose, to be used in combination with
our “main research areas”.
In the study period, 3368 and 1554 published articles on “HIV” have been found in the
literature respectively for “Epidemiology and Surveillance” and “Prevention and Control” in
Europe, with an overall crude number of articles of 4922 (Fig.14).
800
700
600
500
400
300
200
100
0
Liechtenstein
Germany
Ireland
Czech Republic
Lithuania
Sweden
Belgium
France
United Kingdom
Greece
Denmark
Iceland
Italy
Luxembourg
Finland
Poland
Switzerland
Cyprus
Netherlands
Austria
Estonia
Latvia
Malta
Portugal
Slovakia
Slovenia
Spain
Hungary
Norway
Countries
prevention and control epidemiology and surveillance
Fig. 14. 4922 published papers on “Prevention and Control” (1554 articles) and “Epidemiology and
Surveillance” (3368 articles) AND “HIV”, by EU Countries: a comparison between our selected “main
research areas”
14
Considering “Epidemiology and Surveillance” AND “HIV”, Belgium, Denmark, France, Italy,
Luxemburg, Netherlands, Norway, Spain, Sweden and Switzerland showed the best
research production among all member States, considering the variable State population,
with a production of 10 or more papers/1.000.000 inhabitants. With the exception of the
new entry of Italy and the exclusion of Estonia and Finland, these data are the same of
those observed for “STDs”, using the same cut-off (Fig. 15).
40
35
30
25
20
15
10
5
0
Austria
Fig. 15. Scientic production on “Epidemiology and Surveillance” AND “HIV”, by EU Countries and
State population (Published papers number/1.000.000 inhabitants)
15
At the same time, considering the variable GDP, these are the results: using for "HIV” the
same cut-off of 500 or more articles/trilion of US dollars of GDP as for “STDs”, Denmark,
Estonia, France, Italy, Lithuania, Luxemburg, Netherlands, Spain and Switzerland had the
highest production. These data are still superimposable to those observed in the “STDs”
group (Fig. 16).
2500
2000
1500
1000
500
0
Austria
Fig.16. Scientific production on “Epidemiology and Surveillance” AND “HIV”, by EU Countries and
State GDP (Published papers number/1.000.000.000.000 of US dollars of GDP)
16
Concerning our search using the combination between the “new subtopic” “Vaccine” and
the two “main research areas”, results are illustrated in Fig. 17.
800
700
600
500
400
300
200
100
0
Austria
Fig. 17. 6243 published papers on “Prevention and Control” (4433 articles) and “Epidemiology and
Surveillance” (1810 articles) AND “ Vaccine”, by EU Countries: a comparison between our selected
“main research areas”
As seen before for other “subtopics” in comparison with the “main topic” “IDs”, these
results highlight the same phenomenon of a significantly higher crude number of articles
found in our search using this more sensitive approach.
Differently to the search done for the “main topic” and for all other “subtopics”, in this case
the area concerning “Prevention and Control” seems to be of greater importance than that
of “Epidemiology and Surveillance”. This fact is obvious: vaccines themselves are main
instruments of prevention of numerous IDs.
Due to this, our further analyses on web search on vaccines have been focused on
“Prevention and Control”.
Austria, Belgium, Denmark, France, Germany, Italy, Netherlands, Spain, Sweden,
Switzerland and UK seem to be the most prolific actors as crude number of published
papers, with more than 100 published articles in the last 10 years.
If we consider results as crude number of papers, also analysing them by State population
and GDP, only a slightly different scenario emerges. These data are shown in Fig. 18 and
19.
17
60
50
40
30
20
10
0
Countries
Fig. 18. Scientic production on “Prevention and Control” AND “Vaccine”, by EU Countries and State
population (Published papers number/1.000.000 inhabitants)
2000
1800
1600
1400
1200
1000
800
600
400
200
0
United Kingdom
Finland
Luxembourg
Countries
Netherlands
Czech Republic
Germany
Slovak Republic
Liechtenstein
Estonia
Latvia
Lithuania
Slovenia
Belgium
France
Greece
Denmark
Iceland
Ireland
Poland
Portugal
Switzerland
Hungary
Spain
Sweden
Austria
Malta
Cyprus
Italy
Norway
Countries
Fig. 19. Scientific production on “Prevention and Control” AND “Vaccine”, by EU Countries and State
GDP (Published papers number/1.000.000.000.000 of US dollars of GDP)
18
Discussion
Before analysing our presented results, it appears very useful to underline some limits that
we have found in our methodological approach to the present research, just to have clear
in our mind some elements to focus on during discussion. Thanks to this, it will be possible
to have a critical view of our data, consequently trying to describe the state of the art on
research concerning IDs in Europe.
The use of Pubmed as a single web search engine, if undoubtedly assures a good and
adequate scientific approach, on the other may be considered itself as limiting for our
study: other web engines, in fact, exist, such as Medline, Embase, etc., that we could have
used. Limits of time and resources obliged us to an approach using only one engine: this
problem, anyway, even if to be considered in studies on scientific literature review to be
planned in the next future, can be easily solved.
More important, just at a preliminary look of our results, we found evident that main limits
of our web search depend on the choise of our selected key-words. Both the need to
describe research concerning IDs field as a whole, rather than in a very specific and
analytical way and the same vastness of this field of medicine, anyway, necessarily
brought us to take some “brave” choises: this is the cause we have chosen for the web
search “main research areas” to be matched with “main topic” and “subtopics”. Besides, if
on one end we really think that “main research areas” could be considered as sensitive
key words, on the other, some doubts are arisen during the research for the “main topic”
and for some “subtopics”: in fact, data obtained using some of these key-words, such as
“IDs” itself or “childhood diseases”, seem to be biased by this low sensitivity. On the other
end, results for “STDs”, “HIV” and “Vaccine” and other “subtopics” demonstrated a better
attitude to really describe the respective field of the research in Europe.
Furthermore, we have planned our search for “all type” publications rather than
distinguishing papers between original articles, reviews and letters. At the same time,
quality of publications have not been fully investigated, perhaps, stratifing results of the
search by Journals, using Impact Factor.
Even if considering what we have already said, some results from our study seem to be of
interest and need to be largely discussed.
The first highlight concerns the temporal trend of scientific production in Europe during the
last 10 years. Starting from 1995, literature production shows a progressive increase,
particularly starting from 2000, to reach a peak just in the last year of the study period.
This trend can be considered as real, in our opinion: in fact, if methodologic limits in our
19
approach exist, as previously discussed, they were present during the overall study period.
Consequently, no bias occurred.
Improvements in basic and applied research, particularly in biotechnologies, molecular
epidemiology, genetics, etc., may explain this phenomenon: we know numerous new
vaccines and pharmacological molecules and diagnostic tests applied to IDs have been
studied in recent past: their availability and routinary use in health care practices have
significantly changed natural history and general epidemiology of several diseases.
Conjugate pneumococcal and meningococcal vaccines and those against varicella, HPV,
Rotavirus, etc., in the field of prevention, antivirals and antibiotics for multiresistant
microrganisms, new molecular techniques, such as PCR and genetic sequencing, etc. are
only main examples of this improvement in knowlege in this reseach field.
In our study, we observed a wide heterogeneity concerning overall scientific production on
IDs in Europe, measured as published papers by Country. These data was suddenly
described at our first web search, performed to have a very general overview of the
problem: using “IDs” as key-word, France, Germany, Italy, Netherlands, Spain, Sweden,
Switzerland and UK seem to be the most prolific actors overall in Europe, with significant
differences between this group and other Countries. Besides, the situation is more
complex than it seems at a first view, only analysing crude numbers of published papers.
In fact, if we evalutate previous results on the basis of both State population and GDP, a
different scenario seems to emerge, particularly for the last variable, GDP: Countries from
Eastern Europe, in fact, seem to acquire more importance, the same as Netherlands,
Sweden and Switzerland that confirm the supremacy in the research field on “IDs”.
As crude number for “STDs” “subtopic”, we found 4613 published articles, significantly
more than those obtanined by the first web search on “IDs” when we collected 1201
papers. This confirms what we have stressed about methological limits in our research,
depending from the particular sensitivity of each used key-word.
By crude number of published papers, it appers evident that data for this “subtopic” are
superimposable to those found for “IDs”. Also comments on data from the State population
and GDP analysis of this “subtopic” do not significantly defer from what we have said
before.
About “HIV” “subtopic”, we have collected 4922 papers. The comments on the higher
crude numbers of found papers in respect to “IDs” “subtopic”, also made before for
“STDs”, are also valid. Moreover, a very similar crude number of publications emerges by
the comparison of these two “subtopics”, “STDs” and “HIV”: this result is not so strange if
20
we consider that recent HIV pandemic may have deeply influenced European scientific
production in the last two decades.
If we consider the search on “Vaccine”, Austria, Belgium, Denmark, France, Germany,
Italy, Netherlands, Spain, Sweden, Switzerland and UK seems to be the most prolific
actors as crude number of published papers with more than 100 published articles in the
last 10 years on “Prevention and Control” area. Also if we compare crude numbers by
State population and GDP, only a slightly different scenario emerges, substantially
confirming these data.
Considering all the search previously discussed, some general comments may be done.
As previously said, it appears evident that data on “STDs”, “HIV” and “Vaccine” used as
key-words are more sensitive than those on “IDs”, beeing results obtained on these fields
more realistic and in line with the real state of the research in EU.
In respect to heterogeneity observed in Europe, with different results emerging from the
analysis for each specific item, definitive conclusions can not be done. Anyway, it appears
evident that a first priority is to cooperate to help States with no scientific production and
that there is a clear need to harmonize research in Europe.
Another general trend clearly emerges: the research area concerning “Epidemiology and
Surveillance” seems to be more relevant than the other on “Prevention and Control”, as
measured in term of number of published articles. This result could be a consequence of
the major interest, during the last years, of Governments of Developed Countries in
measuring the frequence of main Public Health diseases (i.e., HIV, Vaccine Preventable
Diseases, etc.), with the final aim to better organize health care strategies and to evaluate
results of them. The only exception to this is represented by the “subtopic” “Vaccine”: in
this case, the area concerning “Prevention and Control” seems to be of greater importance
than that on “Epidemiology and Surveillance”. This is not strange: vaccines themselves are
main instruments of prevention of numerous IDs.
From data emerging in the analysis of the “main research areas” studied by CDC
“subtopics”, it seems that European Public Health policy makers have to focus attention
and forces in the next future to optimize research production in “Prevention and Control”
setting.
Just in respect to our selected “subtopics”, “Sexually Transmitted Diseases”, “Drug
Resistant Infections”, “Emerging Infectious Diseases”, “Insects or Arthropod-Related
Diseases” and “Vaccine” are the main fields of scientific production, for both our “main
21
research areas”. The research on vaccines showed the highest scientific production
between “subtopics” during the study period, with more than 6.000 articles.
In respect to the first two “subtopic”, comments previously done are still valid: these groups
of diseases are focused on main Public Health problems in EU Countries and it is not so
strange that research is mainly focused on them, with already demonstrated good results
in the last years in terms of prevention, diagnosis and therapy. The experience of SARS,
the potential next Flu pandemic and old diseases that are re-emerging (i.e., TBC) justify
the great attention to the subtopic concerning “Emerging Infectious Diseases”.
On the other end, subtopics as “Bioterrorism”, “Occupational Risk in Healthcare” and
“Food related Diseases” are undoubtedly, in our personal opinion, areas on which
research needs to be significantly improved, due respectively to the new recently different
world political scenario, to the necessity of an always better safety for health care workers
and lastly to the new social and cultural behaviours of European citizens.
We think that “Childhood diseases” and “Animal borne Infections” represent not very
sensitive key-words for our pourpose. The demonstration of it is indirect, by the high
number of papers published on vaccines in our research: it is well known that most of
immunization practices have children as target of the intervention and that most of vaccine
preventable diseases strike this age population.
22