Epidemiology of Diseases with a Climate Trigger in Dominica Health Info - Epidemiolog… · How is...

Epidemiology of Diseases with a Climate Trigger in Dominica

Health Information Unit Ministry of Health

Trudy Christian, MPH Dr Paul Ricketts, MBBS MSc DLSHTM

Presentation Outline

• How is climate related to health?

• Epidemiological trends of diseases with climate triggers •Communicable diseases

•Non-communicable diseases

• IT approach necessary to analyze climate effects on health

• Conclusions

August 13, 2012 National Consultation on Global Framework for Climate Services 2

Health Impacts of Climate Change


• Affects the social and environmental determinants of health: •Clean air, safe drinking water, sufficient food, secure shelter

• Thermal stress •High temperatures raise levels of ozone and other pollutants that

exacerbate cardiovascular and respiratory disease

•Pollen and aeroallergen levels are high in extreme heat, triggering asthma

• Patterns of infectious disease spread • Lengthening transmission seasons of important vector-borne diseases

•Water-borne disease outbreaks exhibit a positive correlation with excessive precipitation events

Epidemiological Trends

of Communicable

Diseases

Dengue Fever, 2000-2013


0

100

200

300

400

500

600

700

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

No

. o

f C

ase

s

Increasing mosquito

breeding with increasing

temperatures and rainfall

lead to enhanced disease

transmission

Chikungunya, Dec 2013- Aug 2014


0

10

20

30

40

50

6016

.12

.20

13

30.1

2.2

013

13.0

1.2

014

27.

01.

20

14

10.0

2.2

014

24

.02

.20

14

10.0

3.2

014

24

.03.

20

14

07.

04

.20

14

21.

04

.20

14

05

.05

.20

14

19.0

5.2

014

02

.06

.20

14

16.0

6.2

014

30.0

6.2

014

14.0

7.2

014

28

.07.

20

14

Co

un

t

Onset of Symptoms

Climate change coupled

with enhanced

movement of people

and vectors result in the

introduction of new

diseases

Geographic Distribution of Chikungunya Cases

from Dec. 2013 to May 2014

December 2013 January 2014 February 2014 March 2014 April 2014 May 2014

National Consultation on Global Framework for Climate Services August 13, 2014 7

Leptospirosis, 2002-2013


0

5

10

15

20

25

30

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

No

. o

f C

ase

s

Increasing number of cases of

leptospirosis in the last decade may

be due at least in part to increase in

flooding and warmer temperatures

Influenza-Like Illness, 2004-2013


0

50

100

150

200

250

300

350

400

20

04

-01

20

04

-19

20

04

-37

20

05

-03

20

05

-21

20

05

-39

20

06

-05

20

06

-23

20

06

-41

20

07-

07

20

07-

25

20

07-

43

20

08

-09

20

08

-27

20

08

-45

20

09

-10

20

09

-28

20

09

-46

20

10-1

2

20

10-3

0

20

10-4

8

20

11-1

4

20

11-3

2

20

11-5

0

20

12-1

6

20

12-3

4

20

12-5

2

20

13-1

8

20

13-3

6

Nu

mb

er

of

case

s

Year-week

VAT Outbreak,

H3N2

Night landing,

H3N2

Swine, H1N1

Chavez,

H3N2

Blanc Balen,

Inf. B

Respiratory illness like flu

is influenced by what is

being transmitted in other

countries esp. N America,

which in turn is influenced

by climate

Undifferentiated Fever Trends- 2014

Undifferentiated fever in <5 yr olds Undifferentiated fever in >5 yr olds


0

5

10

15

20

25

30

35

40

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

Nu

mb

er

Epiweek

2014 Average Threshold

0

40

80

120

160

200

240

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29

Nu

mb

er

Epiweek

2014 Average Threshold

Gastroenteritis by Age-group, 2004-2013


0

200

400

600

800

1000

1200

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

Co

un

t

Year

GE <5yrs GE ≥5yrs Outbreaks of GE

are often

associated with

climatic conditions

- drought or heavy

rainfall

Epidemiological Trends

of Non-Communicable

Diseases

August 13, 2014 National Consultation on Global Framework for Climate Services

Asthma- incidence, 2004-2013

0

2

4

6

8

10

12

14

16

18

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

No

. o

f ca

ses

Existing data on the

incidence of disease is of

poor quality. Introduction of

electronic medical records

offers the opportunity to

improve data quality and

availability of information to

assess climate impact

National Consultation on Global Framework for Climate Services August 13, 2014 13

Asthma- morbidity – clinic visits, 2003-

2013


0

100

200

300

400

500

600

700

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Nu

mb

er

of

visi

ts

The trend in clinic visits

appears to be downwards but

this may reflect changes in

reporting. Electronic records

offer the opportunity of

improving data accuracy

Cancer- mortality, 2003-2013


0

5

10

15

20

25

30

35

40

45

50

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nu

mb

er

of

De

ath

s

Prostate

Digestive organs and Peritoneum

Stomach

Breast

Trachea, Bronchus and Lung

Colon and rectosigmoid junction

Other genitourinary organs

Carcinoma in situ, benign

neoplasmsLeukemia

Respiratory and Intrathoracic

organs

Important links to changes in the

environment may be found

when the data is available and

analyzed

Cancer- Incidence (Laboratory confirmed),

2004-2013


0102030405060708090

100110120

200

4

200

5

200

6

200

7

200

8

200

9

201

0

201

1

2012

2013

No

. o

f c

as

es

Throat, mouth &accessory glandsStomach

Soft Tissue

Skin

Rectum

Prostate

Metastatic

Lymph Node

Endomentrium

Colon

Cervix

Breast

Increasing diagnosis of cancers

may be linked (at least in part) to

changes in the environment

Cerebrovascular diseases- mortality, 2004-2013


0

20

40

60

80

100

120

140

160

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

Mo

rta

lity

Ra

te

(Pe

r 1

00

,00

0)

Year

Male Female Total

Analyzing

environmental data

with disease trends

may offer

important

information for

disease

management

Heart Disease- mortality, 2004-2014


0

50

100

150

200

250

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

Ra

te p

er

(10

0,0

00

po

pu

lati

on

)

Male Female Total

Is increasing heart

disease mortality in

Dominica linked to

climate change?

Technology

Considerations


Proposed ICT Approach to Develop Climate

Change Surveillance & Response System for

Health • Development of capacity for geospatial analysis

• Layering of health data onto maps produced and maintained by other agencies (e.g. Lands and Surveys, the Meteorology Department, Ministry of Agriculture, Ministry of Finance) • Agreements on information exchange between ministries required

• Potential for geospatial health data collected by Environmental Health and the district health teams to be captured on mobile devices and uploaded to a central database • Relevant data can be extracted and layered onto the maps on the GeoNode server.

• Ability to do accurate geospatial analysis of health data e.g. Chikungunya or dengue, creates a totally new and powerful means of understanding factors contributing to disease and thus the ability to take better preventive actions.

20 National Consultation on Global Framework for Climate Services August 13, 2014

Proposed IT Approach- Resources Needed

• Additional human resources • GIS expert

• Programmer

• Training opportunities for staff (ICT, Environmental Health, District Health Teams)

• Change management strategy • Need to manage the change over from paper-based to electronic systems

• Change management consultant

• GIS relevant equipment

• Software to enable smooth field-to-office workflow • Needs to be integrated with other MoH ICT developments

21 National Consultation on Global Framework for Climate Services August 13, 2014

DIISH Overview

ShareNET Internal Collaboration within the Ministry of Health Staff and other partners

MoH Web Portal Data dissemination for public and external agencies

SComDis Data analysis for communication disaster (Epidemiologist)

OpenMRS (DMedIS) Electronic medical records

Mortbase Mortality database

PACS Medical Imaging

LIS Lab Information System

Components being implemented by HIU

SCom

Dis LIS Mort

base PACS

SIME MOH

Web

Portal

Phar

macy Share

NET Public

Health

Res

Climate

Change DMed

IS


Conclusion


Conclusions/Recommendations • There are clear links to climate change and disease especially vector borne diseases such

as the mosquito borne diseases

• There are important questions to be answered regarding the link between climate change and health that can only be answered by establishing the systems to collect and analyze the data

• To establish the Dominica Climate Change Surveillance System for Health we need • Human resources: appropriately trained professionals in adequate numbers • IT

• Data analysis and interpretation (techniques for longitudinal data are different than used presently for existing data. Disease modelling.)

• Change management

• Equipment and technology • Mobile computer devices, GIS

• Access to data from non-health sector • Central servers, agreements

• Routine intersectoral risk assessments • Information dissemination • Active websites

• International collaborations


References

• Centers for Disease Control and Prevention • http://www.cdc.gov/climateandhealth/effects/

• World Health Organization • http://www.who.int/mediacentre/factsheets/fs266/en/


http://www.cdc.gov/climateandhealth/effects/

http://www.who.int/mediacentre/factsheets/fs266/en/

Acknowledgements

• Dr. Paul Ricketts - National Epidemiologist

• Dr. Shalauddin Ahmed - Communicable Disease Surveillance Officer

• Mrs. Marva Smith - Health Statistical Officer


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