Emerging Infectious Diseases: The Global Picture · cluster/epidemic/pandemic Ceases/ sporadic ....
Transcript of Emerging Infectious Diseases: The Global Picture · cluster/epidemic/pandemic Ceases/ sporadic ....
February 2017
Emerging Infectious Diseases:
The Global Picture
February 2017
Breaches in species barrier:
emerging infections in humans
Infection Animal linked Year infection to transmission first reported Ebola virus Bats 1976 HIV-1 Primates 1981 E. coli O157:H7 Cattle `1982 Borrelia burgdorferi Rodents 1982 HIV-2 Primate 1986 Hendra virus Bats 1994 BSE/vCJD Cattle 1996 Australian lyssavirus Bats 1996 Influenza A (H5N1 ) Chickens 1997 Nipah virus Bats 1999 SARS coronavirus Palm civets 2003 Influenza A (H1N1) Swine 2009 MERS coronavirus Bat/ Dromedary 2012 Infnuenza A (H7N9) Poultry 2013 Zika virus Monkey 2007
February 2017
Potential transmission pathways, emerging
infectious diseases
Emergence
No further
transmission
February 2017
Rabies transmission to humans: rare
iatrogenic onwards transmission
February 2017
Potential transmission pathways, emerging
infectious diseases
Emergence
No further
transmission
Continues
Transmission
cluster/epidemic/pandemic
Ceases/
sporadic
February 2017
Ebola emergence:
current hypotheses
February 2017
Confirmed Human and Poultry
H5N1 Infections since 2003
February 2017
Genetic Drift: H5N1 virus in human infections
since 2003
February 2017
Potential transmission pathways, emerging
infectious diseases
Emergence
Continues
transmission
Continues/
endemic
No further
transmission
Continues
Transmission
cluster/epidemic/pandemic
Ceases/
sporadic
February 2017
Adults and Children living with AIDS,
2016 worldwide
February 2017
Potential transmission pathways, emerging
infectious diseases
Emergence
Continues
transmission
Continues/
endemic
No further
transmission
Continues
Transmission
cluster/epidemic/pandemic
Ceases/
sporadic
February 2017
Swiss cheese events
in epidemiology and public health
Public health
event
Risk
factor
James Reason: BMJ 2000;320:768-770
Risk
factor
Risk
factor
Risk
factor
February 2017
Animal husbandry, Sudan and trade
associated with religious festivals
February 2017
Routine vaccination of cattle against
Rift Valley Fever, East Africa
February 2017
15
Climate change and health:
extreme weather events
February 2017
El Nino-associated flooding,
East Africa, 1998
February 2017
Rift Valley Fever, human
infection, Sudan, 1998
February 2017
Animal husbandry and
trade, Sudan
February 2017
Rift Valley Fever, Sudan and Arabian
peninsula
Source: WHO
February 2017
Technical/political response
Guidelines for Mitigation Consensus for prevention
February 2017
Emergence from animals in nature:
Eco Challenge, Malaysia, 2000
February 2017
Leptospirosis transmission
February 2017
Leptospirosis (N = 33) among 312
participants, Eco Challenge 2000, Malaysia
Eco Challenge
US: 10
Canada: 4
Brazil: 1
Uruguay: 1 Australia: 4
France: 4 UK: 9
February 2017
Emerging Infections
Occur randomly when risk factors align
Often associated with contact at the animal/human
interface
Spread internationally in humans
February 2017
Dengue in Texas, 2005
Source: CDC
Global recycling
Asian tiger mosquito
Dengue Texas Tiger mosquito
February 2017
Number of countries reporting Dengue,
1965 - 2007
Source: WHO
February 2017
Highly pathogenic H5N1 influenza virus
in smuggled Thai eagles, Belgium, 2005
Source: Van Borm, et al, Emerging Infectious
Diseases Vol. 11, No. 5, May 2005
February 2017
BLOODY DIARRHEA AND HAEMOLYTIC URAEMIC
SYNDROME, SHIGA TOXIN–PRODUCING E. COLI --
CONTAMINATED FENUGREEK SRPOUTS, 2011
February 2017
Emerging Infections
Occur randomly when risk factors align
Often associated with contact at the animal/human
interface
Spread internationally in humans
Spread internationally in animals, insects and food
February 2017
SARS: Clustering of cases, Hong
Kong hotel
Source: CDC/WHO
February 2017
Source:
WHO/CDC
SARS: international spread from Hong Kong,
21 February – 12 March, 2003
Doctor from
Guangdong
Canada
Hotel M Hong Kong
Ireland
USA
New York
Singapore
Viet Nam
Bangkok
B
I
K
F G
E D
C
J H
A
Germany
Hong Kong
February 2017
SARS and the economy:
impact on global travel, April 2003
February 2017
The cost of SARS, Asian Development
Bank, 2003
7 6 5 4 3 2 1 0 US$ billion
Hong Kong
China, mainland
Taiwan
South Korea
Indonesia
Singapore
Thailand
Malaysia
Philippines
US$ billion US$ billion
4%
0.5%
1.9%
0.5%
1.4%
2.3%
1.6%
1.5%
0.8%
% of GDP
As of 30 September, 2003, SARS
had decreased Asia’s combined
GDP by US$18 billion and cost
nearly US$60 billion in lost demand
and revenues
February 2017
Recent infectious disease outbreaks
and their economic impact
February 2017
Emerging Infections
Occur randomly when risk factors align
Often associated with contact at the animal/human
interface
Spread internationally in humans
Spread internationally in animals, insects and food
Cause negative impact on economies
February 2017
Source: WHO/CDC
0
2
4
6
8
10
12
14
16
7-
Mar
13-
Mar
19-
Mar
25-
Mar
31-
Mar
6-
Apr
12-
Apr
18-
Apr
24-
Apr
30-
Apr
6-
May
12-
May
18-
May
24-
May
30-
May
5-
Jun
11-
Jun
17-
Jun
Non health care workers
Health care workers
Ebola Haemorrhagic Fever by mode of
transmission, Kikwit Zaire, 1995
315 cases
250 (80%) deaths
February 2017
SARS Epidemic curve, China,
2002 - 2003
February 2017
SARS, chain of human-to- human
transmission, Singapore 2003
February 2017
SARS risk assessment, late March
2003
Index case
Second generation =
close and direct contact with health
care workers (HCW) or others)
Third generation =
family members of HCW
Fourth generation =
other contacts in
community
February 2017
Emerging Infections
Occur randomly when risk factors align
Often associated with contact at the animal/human interface
Spread internationally in humans
Spread internationally in animals, insects and food
Cause negative impact on economies
Health workers at great risk of infection and unintentionally
serve as conduit to family/community
February 2017
Multidrug-resistant Definitive Type (DT) 104
Salmonella Typhimurium, Europe, 1982-1996
Salmonella Typhimurium isolates from both cattle and humans
%
0
10
20
30
40
50
1982-85 1986-90 1991-94 1995-96
cattle humans
Source: WHO from published data
February 2017
Reservoirs of bacteria causing human
infections
Source: WHO
February 2017
Principal transfer pathways, antibiotic resistance
genes, between humans, animals, food and the
environment
Source: DARC/ARHAI joint report, UKI
February 2017
Antimicrobial use and salmon/trout production,
Norway, after introduction of vaccination
0
100 000
200 000
300 000
400 000
500 000
600 000
700 000
1981 1984 1987 1990 1993 1996 1999 2002
Vo
lum
e(t
on
s w
fe)
0
10 000
20 000
30 000
40 000
50 000
60 000
An
tib
ioti
cs(k
g a
ctiv
e su
bst
ance
)
Volume salmon and trout Consumption antibiotics
Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006
February 2017
Macrolide use and enterococcal
resistance in pigs, Denmark
Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.
February 2017
Cephalosporin resistance after stopping
use in poultry, Quebec, Canada
Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.
February 2017
Emerging Infections
Occur randomly when risk factors align
Often associated with contact at the animal/human interface
Spread internationally in humans
Spread internationally in animals, insects and food
Cause negative impact on economies
Health workers at great risk of infection and unintentionally
serve as conduit to family/community
Involve complex relationships across sectors
February 2017
Human Animal Infections Risk
Assessment Group (HAIRS)
February 2017
Human Animal Infections and
Risk Surveillance Group (HAIRS)
February 2017
Human Animal Infections and Risk
Surveillance Group (HAIRS): newsletter
February 2017
Human – Animal Infections and Risk
Surveillance Group (HAIRS): guidelines
February 2017
Emerging Infections
Occur randomly when risk factors align
Often associated with contact at the animal/human interface
Spread internationally in humans
Spread internationally in animals, insects and food
Cause negative impact on economies
Health workers at great risk of infection and unintentionally serve as
conduit to family/community
Involve complex relationships across sectors
Require a one health approach to risk assessment/management