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The Global Threat of Infectious Diseases
Background
• 20th Century Re-Emergence of Infectious Diseases
- Newly recognized diseases- Known diseases- Geographic spread- Increased epidemic activity
• 26% of Global Mortality – 2003
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Fauci, NIAID/NIH 2005
Dengue
Dengue
H5N1AI
H5N1 AI
Chikungunya
Dengue
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The Global Threat of Infectious Diseases
Global Public Health Emergencies, 1994-2005
• Plague, India/Global, 1994
• Influenza, Hong Kong, 1997
• Nipah Encephalitis, Malaysia/Regional, 1999
• SARS, China/Hong Kong/Global, 2003
• Avian Influenza, Southeast Asia/Global, 2004/2006
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AISA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES
• Global Public Health Emergencies
• Hawaii in Ideal Position to Develop a Center of Excellence
– Geography
– Cultural & Economic Ties
– Training
– East-West Center
– Other partners
Rationale
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Basic ScienceDepartments
Clinical Departments
DeanDeanJohn A. Burns School of MedicineJohn A. Burns School of Medicine
Pacific Center for Pacific Center for Emerging Infectious Emerging Infectious Diseases ResearchDiseases Research
Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
Asia-Pacific Institute of Tropical Medicine and Infectious DiseasesOrganizational Structure
Asia-Pacific Center for Translational
Research
Asia-Pacific Center for Infectious Disease Ecology Research
Asia-Pacific Center for Biosecurity and Conflict Research
Pacific Center for AIDS Research
Asia-Pacific Center for Public Health and
Population Research
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Mission
To develop a global center of excellence in Hawaii for emerging and re-emerging infectious diseases
Emphasis will be placed on infectious diseases of the Asia-Pacific Region, and on developing trans-disciplinary research and development programs that will result in new diagnostics, drugs, vaccines and other treatment and prevention modalities.
Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
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ASIA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES
• Develop a balanced trans-disciplinary research and training program that focuses on basic, field and translational research.
• Develop a laboratory reference and research center
• Develop local and international partnerships.
• To build laboratory and epidemiologic capacity, and research collaborations in selected countries of Asia where diseases with epidemic potential commonly occur.
• Develop a graduate program that will attract highly motivated, research-oriented doctoral candidates.
Goals
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ASIA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES
Disease Priorities
Zoonotic virusesInfluenza
Dengue/dengue hemorrhagic feverWest Nile fever
HIV/AIDSMalaria
Leptospirosis
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Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
• Laboratory Capacity– Biocontainment (BSL-2, BSL-3 , ABSL-3)– Basic research– Diagnostics– Pathogenesis
• Epidemiology• Bioinformatics• Pathogens
– Emerging infectious diseases– Viruses, parasites, bacteria, zoonoses
Scientific Capability
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Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
Progress
Partnerships/Collaboration
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Hawaii’s PRETREAT Alliance
Preventing, Responding, and Treating Emerging Asia-Pacific Disease Threats
Hawaii’s Global Solution for Emerging Infectious Disease ThreatsHawaii’s Global Solution for Emerging Infectious Disease Threats
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Hawaii Biotech•Vaccines and drugs
•Product Development
•FDA approvals
DOD•Surveillance
•Emergency response•Clinical Research
•Clinical trials•MHPCC
NIH• PacRBL• PSWRCE•COBRE• RCMI?
CDC? International• surveillance • response
UH/JABSOM/APITMID
• Center of excellence•Basic & applied research
•Pathogen discovery•Surveillance•Epidemiology
•Asian field sites•Training
Hawaii Pacific HealthQueen’s Hospital
•Clinical Research•Clinical trials•Treatment
PRETREAT Participants and Their PRETREAT Participants and Their CapabilitiesCapabilities
Hawaii DOH•Surveillance
•Emergency response
East WestCenter• Demography• Geography•Climate Change
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PRETREAT Components
• Prevention and treatment
– Early warning surveillance
– Diagnostics
– Drug and vaccine research
– Preclinical development, GLP animal testing
– GMP manufacturing
– Clinical research
– FDA approved products
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PRETREAT Components
• Asian field sites
– Research, clinical & vaccine trials
• Pathogen discovery
– Surveillance, field epidemiology, “pathogens of tomorrow”
• Biocontainment laboratories
– Fixed, mobile
• Basic research
• Training
Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
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International Partnerships
• WHO
• Viet Nam
• Thailand
• Singapore
• Indonesia
• Others
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Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
Progress - Funding
State of Hawaii
University of Hawaii
NIH
DOD
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Microbial Threats to Health
Case in Point: SARS
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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%
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Dengue Hemorrhagic Fever
Social Impact
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DEN-1DEN-2
Global Distribution of Dengue Virus Serotypes, 1970
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Global Distribution of Dengue Virus Serotypes, 2006
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2
DEN-1DEN-2DEN-3DEN-4 DEN-1
DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
DEN-1DEN-2DEN-3DEN-4
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Dengue/dengue hemorrhagic fever, average annual number of cases reported to WHO, 1955-2005
0100000200000300000400000500000600000700000800000900000
1000000
Num
ber
of C
ases
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Source: WHO
Humans & Birds
Birds
Humans
Wave III: Dec 04 - Present
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Source: WHO
Humans & Birds
Birds
Humans
Wave III: Dec 04 - Present
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New York City
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Aedes aegypti
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Aedes aegypti Distribution in the Americas
19701930's 2006
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POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER
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West Nile Virus in the Western HemisphereWest Nile Virus in the Western Hemisphere
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21 66
24482949
62
4,156
9,850
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
Year
# ca
ses
rep
ort
ed
Epidemic West Nile Virus in the United States, 1999-2005
* Reported as of 1/13/2006
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Epidemic/Epizootic West Nile Virus
1937
1950-75
1994 - 2005
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Factors Responsible for Increased Epidemic Infectious Diseases
• Complacency, Lack of Political Will• Policy Changes• Changes in Public Health • Demographic Changes
- Population growth- Urbanization- Agricultural/Land Use Practices- Animal Husbandry
• Modern Transportation- Increased Movement of People, Animals, Commodities
• Changing Life Styles/Behavior• Microbial Adaptation• Technology• Intent to Harm• Climate Change?
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Zoonotic Diseases: Hitching a Ride? Modern Transportation
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Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
Hawaii and the US mainland are highly vulnerable to the importation of exotic pathogens, and at high risk for epidemic disease.
Demographic and cultural factors, along with economic growth and globalization will insure that the Asian region will be important in
producing future epidemic disease.
A center of excellence for research on emerging infectious diseases of Asia and the Pacific in Hawaii will be highly beneficial to the global
efforts to detect, respond and control epidemic disease.
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Pacific Regional Biosafety Laboratory at Kaka’ako
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Pacific Regional Biosafety Laboratory at Kaka’ako