A framework for the study of zoonotic disease emergence and its drivers: spillover of bat pathogens as a case study

Wood, James L. N.; Leach, Melissa; Waldman, Linda; MacGregor, Hayley; Fooks, Anthony R.; Jones, Kate E.; Restif, Olivier; Dechmann, Dina; Hayman, David T. S.; Baker, Kate S.; Peel, Alison J.; Kamins, Alexandra O.; Fahr, Jakob; Ntiamoa-Baidu, Yaa; Suu-Ire, Richard; Breiman, Robert F.; Epstein, Jonathan H.; Field, Hume E.; Cunningham, Andrew A.

In this challenging theme, the obvious epidemiological and public health approaches must be integrated with anthropological perspectives that emphasize how prevailing social and cultural values, legal, political and economic factors and organizational norms influence disease classifications and diagnoses [102, 103] . Critical medical anthropology [104] has directed the attention towards the social and political determinants of ill health, disease distribution and access to health care. Recent approaches in health systems research understand health care systems not merely as structures of services, goods and personnel, but as knowledge economies [105] involving health markets that include formal and informal practitioners, with a range of factors influencing people's understandings of illness and health-seeking behaviour. These concepts should underpin the investigation of the extent to which bat virus spillover events are recognized by a range of groups and how diagnosis and public health responses are shaped by institutional factors and health care workers' practices. From socio-epidemiological perspectives, an investigation of how behavioural and socio-demographic factors can predispose people and their domestic animals to spillover infections would be very valuable. Relevant biomedical syndromes must be considered alongside enquiry regarding the extent to which zoonotic disease risk is recognized by local people and features in their concepts of illnesses and perceptions of relevant causes of morbidity and mortality. The detailed laboratory investigation and confirmation of specific infections in humans must follow the same detailed criteria as used for defining the specific infections in bat hosts. Careful quantitative planning and consideration of control selection will be vital for the successful interpretation of data from human patients in epidemiological studies.