JOHORE HEALTH CONFERENCE 2015 LOKMAN HAKIM S, …jknj.moh.gov.my/jsm/day1/Challenges in Communicable...
Transcript of JOHORE HEALTH CONFERENCE 2015 LOKMAN HAKIM S, …jknj.moh.gov.my/jsm/day1/Challenges in Communicable...
CHALLENGES IN COMMUNICABLE DISEASES
LOKMAN HAKIM S, MD, DAP&E, MScPH, PhD, FA
MM, FAMS, FASc
JOHORE HEALTH CONFERENCE 2015
Ministry of Health
Malaysia
2015-2035: Three Domains of Health Challenges
High rates of avertable infectious, child, and
maternal deaths
Unfinished agenda
Demographic change and shift in GBD
towards NCDs and injuries
Emerging agenda
Impoverishing medical
expenses, unproductive cost increases
Cost agenda
Infectious diseases continue to post great challenges to health
• Profound impact on human history
– Influenced course of wars
– Determined fates of nations
– Affected civilisation
• Economic development and technology advancement leading to demographic transition
• Epidemiologic transition incomplete, unfolding at different rates
• Emerging and re-emerging infections coupled with new challenges
– Hospital acquired infections and the “Super Bug”
– Drug resistance
– Pandemics
– Health security and bioterrorism
Communicable Diseases
• Defined as
– “any condition which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate
animal, host, or vector, or through the inanimate environment.”
• Transmission is facilitated by the following:
– More frequent human contact due to
• Increase in the volume and means of transportation (affordable international air travel),
• globalization (increased trade and contact).
– Microbial adaptation and change.
– Breakdown of public health capacity at various levels.
– Change in human demographics and behavior.
– Economic development and land use patterns.
Source: Morens et al. 2004. The challenge of emerging and re-emerging infectious diseases. Emerg Infect Dis. 430: 242-249
GLOBAL DISTRIBUTION OF EMERGING & RE-EMERGING DISEASES (1996-2004)
• MERS-COV
• EBOLA
• H7N9
• H1N1
Global Burden of Communicable Disease
2005
CD30%
Others70%
Burden of Disease
2015
CD26%
Others74%
Burden of Disease
6
Leading causes of global deaths from infectious diseases (Fauci AS et al, N Engl J Med 2012, 366: 454-461)
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5
Other infectious diseases
Hepatitis B
Measles
Pertussis
Meningitis
Malaria
Tubercolosis
HIV/AIDS
Diarrheal diseases
Respiratory infections
No. of Deaths (millions)
Economic burden
• The epidemic of BSE, UK : USD 30 billion.
• SARS outbreak Hong Kong/Global: range from USD 8 billion to 24 billion,
• Plague in Surat, India (1994), USD 1.5 billion
• Avian influenza outbreak, Hong Kong (1997), estimated to cost hundreds of millions of euros in lost poultry production, commerce and tourism.
• Nipah outbreaks, Malaysia (1998/1999): USD 97 million for direct compensation for the culled 1.1 million pigs (total estimate USD500 million)
Vector-borne disease transmission dynamics and targets for control and elimination
Host Host
Agent (parasite) Agent
(virus)
Vector (Anopheles)
Vector (Aedes)
MALARIA DENGUEEnvironment
Unique characteristics of infectious diseases
• Extraordinary adaptability
– Replication and mutation capacity
• Closely dependent on the nature and complexity of human behavior
– Reflect who we are, what we do, how we live and interact
– Acquired as a result of our lifestyle
• Ease of transportation, ease of spread
• Environmental degradation and climate change
• Explosive potential
0
500
1000
1500
2000
2500
3000
3500
17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
2009 2010
No. of Cases
Epid Week
Number of Lab-Confirmed Influenza A(H1N1) Cases, Malaysia, 2009 - 2010
352
Epid-Curve of the Pandemic A(H1N1) 2009
15 May 2009: 1st confirmed
case
21 June 2009: Communitytransmission
confirmed
10 July 2009: Mitigation
Phase initiated
November 2009: Pandemic vaccination
strategies initiated
MALAYSIA (as of 31/12/2010)
Mid Year Population, 2010
Total no. of confirmed cases
Total no. of death
Mortality Rate(per 100,000 pop)
28,908,800 15,792 95 0.33
3,136
Specific challenges
Migration and Health
Land use changes, Cl
imate Change
and Health
Infectious diseases
and Health Security
But who are these people?
• Challenge: No internationally adopted definition for most terms
• Why do we care about definition?
– To better understand the great diversity among migrants.
– Limit contradictory or misleading information
– Achieve comparability of migration statistics among countries
– Evidence-based , tailor-made policy synthesis
19
Economic Migrants
Legal vs illegal
RefugeesMigrant workers
Foreigners
Formal vs informal
Migration & public health concerns : Communicable Diseases
– Mobile people interact with and potentially affect and adopt the health profile of all communities along their migration route.
•
– The cost to societies:
• Outbreak of disease (Health)
• Trade
• Political relationships
• Financial position in a global economy
• Travel in affected regions.
Climate Change and Communicable Diseases
• Climate may affect:
– Spatial distribution of outbreaks: where?
– Timing of disease outbreaks: when?
– Frequency of disease outbreaks: how often?
– Intensity or severity of outbreaks: how bad?
• Via effects on
– Pathogens: if free-living or outside of host
– Hosts: e.g, immunity
– Vectors: e.g. mosquitoes, ticks etc
– Dynamics: e.g. contact rates
– Indirect effects: effects on other disease drivers
Number of dengue reported cases in the Americas from 2000 to 2007.
Shepard DS et al. (2011). Am. J. Trop. Med. Hyg; 84(2): 200-207.
Annual economic burden of dengue in the Americas from
2000 to 2007 (in 2010 US$).Shepard DS et al. (2011). Am. J. Trop. Med. Hyg; 84(2): 200-207.
Aggregate values of dengue episodes and economic burden by year for 12 countries in SEA (2001–2010).
Shepard DS et al. 2013. PloS Negl Trop Dis; 7(2):e2055. doi:10.1371/journal.pntd.0002055
Use of multiple data sources to estimate the economic cost of dengue illness in Malaysia.
Shepard DS et al (2012). Am. J. Trop. Med. Hyg; 87(5), 796-805
• Adjusted estimate of total dengue cases
• Economic burden of USD56 million per year.
• Overall economic burden would be higher if costs associated with prevention and control, dengue surveillance and long-term sequelae of dengue were included.
Changing human-animal interface: Impact on zoonotic malaria in Malaysia (2014)
Peninsular 2014 Sabah 2014 Sarawak 2014
P. falciparum
P. vivax
P. malariae
Mixed
P. knowlesi
Sarawak 2015
P. falciparum
P. vivax
P. malariae
Mixed
P. knowlesi
Sabah 2015 Penisular 2015
GLOBAL & NATIONAL HEALTH SECURITY:
Mutlidrug resistance malaria
Mutlidrug resistance malaria
Polio
Mutlidrug resistance TB
Mutlidrug resistance TB
Mutlidrug resistance TB
Mutlidrug resistance TB
Cholera
Leishmaniasis
Bancroftian filariasis
Avian influenza H5N1
Exotic zoonoses including avian influenza, H7N9
Managing infectious diseases threats • Epidemiological surveillance through indicator (mandatory &
administrative notification) and syndromic surveillance
• Role of health intelligence
• Real time electronic communication on outbreaks need to be developed
• Networking of laboratories
– National and Regional Public Health Laboratories
– Clinical laboratories – hospitals and private laboratories, IMR
– Others- DVM, Chemistry Labs
• Early warning and response system – CPRC, IHR focal points and WHO & GOARN response structure
• Better integration and cooperation across various government ministries and agencies
Health systems and infectious diseases
• Health systems play an important role.
• Failure to response to emerging challenges may affects communicable disease program delivery system:-
– Constraints not due to lack of technical guidance or expertise but rather the shortcomings of health systems
• Surveillance systems not in place / not monitored / not evaluated thus not detecting ALERT WARNING trends and signals
• Multi sources of information not gathered to make a meaningful and appropriate policy decision
• Current Rabies outbreak a case study
The Threats Continue• Populations grow and move …
Microbes adapt …
Changing climates …
Increasing global interconnectedness …
WHO Briefing Notes: Pandemic (H1N1) 2009
“…. The 2009 influenza pandemic has spread internationally with unprecedented speed. In past
pandemics, influenza viruses have needed more than six months to spread as widely as the new H1N1 virus has
spread in less than six weeks ….”
WHO , Geneva (16 July 2009)