WHO Collaborating Center for TB/HIV co-infection

and TB elimination strategy

Le infezioni emergenti.

Il paradigma di Ebola

Prof. Francesco Castelli

Chair of Infectious Diseases

UNESCO Chair

University of Brescia (Italy)

Società Italiana di Medicina Tropicale e Salute Globale

1st Millenium

Epidemics and Pandemics have shaped

our history…

Middle Ages

20th Century

Aldighieri, PAHO, 2012

… it is time to close the book on

infectious diseases. The war

against pestilence is over…

William Stewart, Surgeon General

in a message to Congress, 1969

Chapers Pages Pages for ID

Part 1. Introduction to clinical medicine 92

Part 2. Cardinal manifestations and presentations of diseases 379 12

Part 3. Genes, the environment and diseases 40

Part 4. Regenerative medicine 20

Part 5. Aging 32

Part 6. Nutrition 58

Part 7. Oncology and hematolgy 361 11

Part 8. Infectious diseases 761 761

Part 9. Terrosism and clinical medicine 30 11

Part 10. Disorders of the cardiovascular system 286

Part 11. Disorders of the respiratory system 112 12

Part 12. Critical care medicine 84 9

Part 13. Disorders of the kidney and urinary tract 122 9

Part 14. Disorders of the gastrointestinal system 248 23

Part 15. Disorders of the joints and adjacent tissues 216 7

Part 16. Endocrinology and metabolism 358

Part 17. Neurologic disorders 342 38

Part 18. Poisoning, drug overdose and evenomations 19

3585 893 (24.9%)

Harr

ison’s

Pri

ncip

les o

f In

tern

al M

edic

ine, 18

e

ditio

n, 2012

People are not just people.

They are an awful lot of microbes, too

90 percent of the cells in the body

are microbial and only the

remaining 10 percent are human

Fattori favorenti l’emergenza di nuove infezioni

• Crescita popolazione, urbanizzazione

• Aumentata produzione animale

• Alterazioni habitat vettori / animali

• Mobilità umana, vettori, germi, reservoir animale

• Modificazioni dell’ecosistema (deforestazione, clima, etc.)

• Comportamento umano

• Pressione farmacologica (uomo e animale)

• Adattamento microbico

• Bioterrorismo ?

Incremento demografico

Urbanizzazione

80% : Latina America, Northern America

73% : Europe

48% : Asia 64% by 2050

40% : Africa 56% by 2050

https://www.google.it/search?q=world+population+and+animal+production&newwindow=1&rlz=1C1GGGE_itIT459IT526&espv=2&tbm=isch&imgil=M_S

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Mobilità umana

Mobilità di merci, vettori, cibo, etc.

World P

opula

tion in b

illions

()

Days t

o C

ircum

navig

ate

()

the G

lobe

Year1850

0

400

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300

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200

150

100

50

2000

0

1900 1950

1

2

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4

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6

Speed of Global Travel in Relation to

World Population Growth

Baseline 2000 2025 2050

Source: Kris Ebi MALARIA IN ZIMBABWE, UNDER CLIMATE CHANGE

Source: Kris Ebi

Baseline 2000 2025 2050

Source: Kris Ebi

Baseline 2000 2025 2050

Maroli et al., TMIH, 2008

Examples of recent emerging diseases

NATURE; Vol 430; July 2004; www.nature.com/nature

2000 : West Nile

2003 : SARS

2004 : H5N1

2009 : H1N1

2011 : MERS-CoV

2013 : H7N9

2014 : allarme poliomielite

2014 : Ebola

… what next?...

Solo nel nuovo millennio…

Non solo virus ….

Batteri

- E. coli 0157/H7

- MRSA

- VRE

Protozoi:

- Resistenza malaria ai nuovi farmaci

- Diffusione areale Leishmania

- Malattia di Chagas e migrazioni

Vettori

- Zecche

- Zanzare

Map of geographic origins of EID events, 1940-2004

(Jones et al, Nature 2008)

Substantiated public health events of potential international

concern by hazard Jan 2001-14 June 2011 (n=2,448; 477 (19%) in AMRO)

85%

Aldighieri, PAHO, 2012

Relative risk of a zoonotic EID event

Hot Spots: global distribution of relative risk of an EID event caused by zoonotic

pathogens from wildlife, (Jones et al, Nature, 2008).

Wildlife

Domestic

Animal Human

Translocation

Human

encroachment

Ex situ contact

Ecological

manipulation

Global travel

Urbanization

Biomedical

manipulation

Technology

And Industry

Agricultural

Intensification

Encroachment

Introduction

“Spill over” &

“Spill back”

EID events have

significantly

increased since

1940, reaching a

peak in 1980-1990

74% of these from

wildlife

Zoonotic EIDs from

wildlife reach

highest proportion in

recent decade

61% of all EID are Zoonoses affecting Humans

Aldighieri, PAHO, 2012

http://healthmap.org/en/

Geosentinel

Bioterrorism

• Possible deliberate release of infectious agents by dissident individuals or terrorist groups

• Biological agents are attractive instruments of terror- easy to produce, mass casualties, difficult to detect, widespread panic & civil disruption

• B. anthracis, C. botulinum toxin, F. tularensis, Y. pestis, Variola virus, Viral haemorrhagic fever viruses

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Outbreak Detection and Response

without Preparedness

Delayed

Response

Day

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Opportunity

for control

Late

Detection

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Case

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Rapid

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Early

Detection

Potential

Cases Prevented

Outbreak Detection and Response

with Preparedness

Il mestiere del guardiabosco …