Emerging Infectious Diseases: A Threat to Global Public Health and Economic Security Duane J Gubler Professor S. Machado Eco. Health, Kunming, 16 Oct, 2012 Signature Research Program in Emerging Infectious Diseases Duke-NUS Graduate Medical School, Singapore
Emerging Infectious Diseases: A Threat to Global Public Health and Economic Security • • • Background Snapshot of recent epidemics Reasons for emergence and spread Prospects for the future Challenges to reverse the trends
The Global Threat of Infectious Diseases Emerging and re-emerging diseases A/H 1 N 1 Dengue A/H 1 N 1 Chikungunya Dengue Adapted from Morens, Folkers, Fauci 2004 Nature 430; 242 -9 Emerging diseases Re-emerging diseases
Major Infectious Disease Epidemics since 1980 • • • • Dengue/DHF-1970 s, SE Asia, global HIV/AIDS-1980 s-Africa, global Drug resistant TB-1990 s, US, global Cholera-1991 -Americas Plague-1994 -India, global Foot & Mouth disease-1995, 2000 - Taiwan & UK West Nile-1990 s-Mediterranean, Americas BSE-1990 s- UK, Canada, US Swine fever, 1996 - Netherlands H 5 N 1 influenza-1997 - HK-global Nipah encephalitis-1998 -Malaysia, Asia SARS-2002 - Asia, global Chikungunya-2004 -Africa, Asia H 1 N 1 influenza-2009 -Mexico? , global
What did these Epidemic Infectious Diseases have in Common? • All were caused by zoonotic pathogens • All spread by modern transportation • Most had Asian origin • Laboratory and clinical diagnoses were problematic • Poor communication among countries • Major economic impact
Major Infectious Disease Epidemics since 1980 • • • • Dengue/DHF-1970 s, SE Asia, global HIV/AIDS-1980 s-Africa, global Drug resistant TB-1990 s, US, global Cholera-1991 -Americas Plague-1994 -India, global Foot & Mouth disease-1995, 2000 - Taiwan & UK West Nile-1990 s-Mediterranean, Americas BSE-1990 s- UK, Canada, US Swine fever, 1996 - Netherlands H 5 N 1 influenza-1997 - HK-global Nipah encephalitis-1998 -Malaysia, Asia SARS-2002 - Asia, global Chikungunya-2004 -Africa, Asia H 1 N 1 influenza-2009 -Mexico? , global
Plague Pandemics • Justinian’s Plague (mid-6 th Century A. D. ) • Black Death (mid-14 th Century A. D. ) • Modern Pandemic (1894 – mid-1900 s)
Surat
Potential Spread of Pnuemonic Plague out of India, 1994 India Delhi Calcutta Madras Bombay
Pneumonic Plague in India • Indian outbreak was a major surprise – no plague confirmed in India since 1966 • Clinical and lab diagnosis • Media and panic driven epidemic • First epidemic to impact global air transportation • Caused huge economic loss for India (> $3 billion)
Microbial Threats to Health
Chain of transmission among guests at Hotel M—Hong Kong, 2003 2 family members 2 close contacts 4 family members Guangdong Province, China 4 HCWs* Hospital 2 Hong Kong F A A F 156 close contacts of HCWs and patients Hospital 3 Hong Kong H Hospital 1 HK J B C 0 HCWs Hospital 4 Hong Kong 28 HCWs 4 other Hong Kong Hospitals B Vietnam HCW Bangkok Data as of 3/28/03 37 HCWs I E D Ireland L§ United States M§ C B K† I Hotel M Hong Kong J 99 HCWs (includes 17 medical students) K† A H Canada G† G† 3 HCWs 10 HCWs D Singapore E HCW 34 HCWs 37 close contacts Germany HCW 2 family members Unknown number close contacts * Health-care workers; † All guests except G and K stayed on the 9 th floor of the hotel. Guest G stayed on the 14 th floor, and Guest K stayed on the 11 th floor; § Guests L and M (spouses) were not at Hotel M during the same time as index Guest A but were at the hotel during the same times as Guests G, H, and I, who were ill during this period.
Global SARS Cases (Probable) WHO 26 September 2003 Country Cases Deaths Case fatality Canada 251 43 15. 3% China 5327 349 6. 5% Hong Kong 1755 299 16. 9% Singapore 238 33 15. 5% Taiwan 346 37 12. 5% Thailand 9 2 22% U. S. 75 0 0% Vietnam 63 5 7. 9% Other 81 5 6. 2% Total 8098 774 9. 6%
Economic Impact of Selected Infectious Diseases Plague, India $5 -6 bn
Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases? • • Complacency, Lack of Political Will Policy Changes in Public Health Changing Life Styles/Behavior Microbial Adaptation Technology Intent to Harm Climate Change
Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases? Major Drivers • Demographic Changes (Pop Growth) § Environmental Change - Uncontrolled Urbanization - Agricultural/Land Use Practices - Deforestation • • § Animal Husbandry Modern Transportation (Globalization) § Increased Movement of People, Animals, Commodities Lack of Public Health Infrastructure
Urban Growth in Asian(1) and American(2) Cities, 1950 -2010 13 12. 4 12 11 10 Millons of People 9 7. 8 8 7 6 4. 7 5 5. 2 4 3 2 1. 3 1 0 1950 1. 2. 1980 2010 Mean population of Dhaka, Bangkok, Jakarta, Manila and Saigon. Mean population of Rio de Janeiro, Sao Paulo, San Juan, Caracas and Guayaquil.
The global air network
Million of Passenger (Mil) Average annual number of global airline passengers by decade, 1950 -2010 IATA 2010 Decade
Commercial Air Traffic Over a 24 Hour Period
Global distribution of dengue virus serotypes, 1970 DEN 1 DEN 2 DEN 3 DEN 4 DEN 1 DEN 2 Gubler, 1998 DEN 1 DEN 2
Global distribution of dengue virus serotypes, 1970 -2000 1981 1977 1980 1985 1982 1979 1981 1994 1975 1971 DENV – 1; DENV – 2; DENV – 3; DENV – 4
Global distribution of dengue virus serotypes, 2012 DEN 1 DEN 2 DEN 3 DEN 4 DEN 1 DEN 2 DEN 3 DEN 4 Adapted from Gubler, 1998 DEN 1 DEN 2 DEN 3 DEN 4
Exotic Infectious Diseases That Have Recently Been Introduced to the US • • • West Nile Fever Dengue Fever Yellow Fever Mayaro Fever Chikungunya Epidemic Polyarthritis • SARS • Influenza • Lassa Fever • • • Monkeypox CJD/BSE HIV/AIDS Cholera E. coli O 157 E. Coli 0104: H 4 Malaria Leishmaniasis Chagas Disease Cyclospora
Live Animal Importation into the USA - 2002 • 47, 000 mammals § 28 species of rodents • 379, 000 birds • 2 million reptiles & Poisonous snakes • 49 million amphibians • 223 million fish Data from U. S. Fish & Wildlife Service
Exotic Mosquito Species Recently Introduced and Established in the US • • • Aedes (Stegomyia) albopictus Ochlerotatus (Aedes Finlaya) togoi Ochlerotatus (Aedes Finlaya) japonicus Aedes bahamensis Culex biscayensis
Global Threat of Epidemic Infectious Diseases • • • Disease and Trade-interwoven History § 14 th century, Europe discovers exotic goods from Asia Global Trade Flourishes § 18 th, 19, 20 th centuries New Millennium § Integrated global economic system with a transnational flow of knowledge, capital, products, people, animals, and pathogens § Rapid spread of epidemic infectious disease from point of origin
Demographic Changes Global climate change Technology/Globalization Socio-cultural organization H U M A N E C O S Y S T E M Urbanization Agricultural, land use and animal husbandry changes/practices Habitat alteration REGIONAL ENVIRONMENTAL CHANGE Species’ Ecological-evolutionary Dynamics Opportunistic habitat expansion/ecological release Vector (domestication) Vector/reservoir species Wildlife/reservoir transport/encroachment Human encroachment Host-Pathogen Dynamics Emergence Processes of ‘Host-Parasite Biology’ Host switching (host novelty) • Breaching of pathogen persistence thresholds Transmission amplification and genetic change (pathogen novelty) Disease Emergence ecosystem continuum N A T U R A L E C O S Y S T E M
The Global Threat of Epidemic Infectious Diseases Projected Global Trends • Asian countries will lead in economic growth • Asian Cities will lead in population growth § Circular rural to urban migration • Increased globalization § Increased trade § Increased movement of people, animals and commodities § Increased movement of pathogens • Increased probability of epidemic disease • Increased threat to global economic security
Tuesday, Oct 16, 2012 http: //www. dailymail. co. uk/science The Armageddon virus: Why experts fear a disease that leaps from animals to humans could devastate mankind in the next five years • Warning comes after man died from a Sars-like virus that had previously only been seen in bats • Earlier this month a man from Glasgow died from a tick-borne disease that is widespread in domestic and wild animals in Africa and Asia
Pathogens of Tomorrow From Whence They Will Come? From Asia From Animals Mostly Viruses 35
Global Threat of Epidemic Infectious Diseases Challenge to Reverse the Trend • • Prevent movement of pathogens and vectors via modern transportation Improve international cooperation and data sharing Improve effective laboratory-based surveillance Rebuild public health infrastructure to prevent & control vectorborne and zoonotic diseases § Trained personnel § Laboratory and epidemiologic capacity § Tools (vaccines, drugs, insecticides, mosquito control, etc) • § Understanding disease ecology Political will § Economic support § Regional prevention and control programs
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