What’s in a name?
Last month, the World Health Organization rolled out a best practices memo regarding the naming of new human infectious diseases. Gone are the days of the swine flu, Japanese encephalitis, and Chagas disease; infectious disease names can no longer contain animal species, locations, or names.
The goal of this innovation is to avoid the negative implications that stem from naming a novel human disease something like Middle East Respiratory Syndrome (MERS). To be fair, depending on where you are from and where you are going, the Middle East might not be the most suitable place to vacation at the moment, but the fact that a respiratory disease is named after it does not inspire further confidence in many travelers. In light of MERS last year, Saudi Arabia faced losing a projected $16 billion in tourism trade during Ramadan when religious observers migrate to the region. Just this week, authorities traced a South Korean outbreak of MERS to a man who had been traveling in Bahrain. Since then, stock in South Korean hotels and airlines has decreased due to fear of the MERS outbreak.

The new rules are designed not only to avoid impacting tourism and trade; they are intended to avoid offending cultural or ethnic groups as well as certain occupations. Diseases such as German measles can be offensive to an entire nation. Legionnaire’s disease was named after a group of Legionnaires at a conference in Philadelphia was found at the center of an epidemic caused by a bacterium later named Legionella pneumophila. Prior to being re-named HIV, human immunodeficiency virus was known as “GRID,” or gay-related immune deficiency. The misnomer led to the spread of the anti-gay phrase “the gay plague.”
It is not surprising that the reasoning for developing new regulations has much to do with the widening use of social media and email for dissemination of information.
Nowadays, our resources for learning about new outbreaks worldwide can come as easily from Twitter as they can from a formal newsroom. In fact, news is more likely to come from a journalist’s Twitter in the newsroom. The impact of how people refer to a disease reaches far beyond our computers and into the back of our minds as we search for travel destinations or even our groceries. Such decisions can have an impact on the economy, especially in places that rely on tourism as a major source of revenue.

The avian flu, swine flu, monkey pox, and paralytic shellfish poisoning can give anyone pause, especially the general public that may not understand that eating an animal does not necessarily result in contracting the disease. This can also have economic and animal welfare implications, especially for farmers. In 2009, swine flu, now referred to as H1N1, caused serious problems for pig farmers in the United States. China and Russia even banned some imports of pig meat from the US and Mexico, causing larger pork companies to take a hit on the stock market. Earlier this spring, 3 million birds at a poultry farm in Iowa were destroyed to prevent further spread of an avian flu that does not even pose a threat to humans, costing farms time and money.

In an effort to decrease undue panic from the public, the WHO is also requiring scientists to avoid names that simply sound frightening.
Names that include the words “unknown,” “fatal,” or “epidemic” are to be avoided, for reasons that may seem obvious to the general public but may be lost on some researchers. The unknown is terrifying to many people, especially within the context of medicine. After all, there is a reason why the public is so captivated by films such as Outbreak and Contagion. It would be interesting to chart the increase of Purell sales against the release of movies showing fast-moving infectious diseases.
So which words are acceptable to use in naming a new disease?
Generic terms describing physiological processes or anatomical references are acceptable; these include words such as “respiratory” or “neurologic.” Words describing organs can also be used such as “cardiac” or “pulmonary.” Clinical symptoms of the disease may be used, among them the most pleasant “diarrhea” or more delicately, “fever.”
Specific age groups or patient populations may be referenced as in “juvenile,” “pediatric,” “maternal,” or “senile.” Of course, these are highly specific and should only be used when the pathogen is highly unlikely to change course and suddenly infect those of a different age group. Time course, epidemiological references, or origin can also be stated, so long as they don’t include destination names as origins. Examples of this include “acute,” “progressive,” “contagious,” “congenital” or “zoonotic.”
“Severe” may be used, but only when there is a high initial fatality rate. One might assume the public would find this alarming, but supposedly if they do not understand the meaning behind the severity, or if it is said implicitly, the fear is less likely to cause a Twitter stampede.
The seasons can be mentioned in the name, depending on when the initial outbreak began, and the year can also be used. Environment descriptors may be used, in particular the words “desert,” “coastal,” “river,” and “swamp.” Keeping in mind, of course, that this leaves open the propensity to create a disease that sounds more like a horror film than an illness.

Of course, the pathogen initially causing the disease can and should be mentioned if known, but only the pathogen causing the illness, not the host that has cultivated the organism. Examples of this include “coronavirus,” “salmonella,” “influenza,” or “parasitic.”
The WHO makes one last recommendation — when choosing a long name, scientists should be aware of what a shortened acronym may spell out. Focal Uruguayan Coronaviral Keratitis or Acute Salmonella Syndrome may not be the best choices after all.
And think twice the next time you consider naming your newly discovered virus Deadly Parasitic Texas Rodeo Clown Epidemic, it will be declined no matter how clever you think you are.