Climate change in the Arctic: Potential emergence or re-emergence of infectious diseases

Transcription

1 Climate change in the Arctic: Potential emergence or re-emergence of infectious diseases Alan J. Parkinson Ph.D. Arctic Investigations Program Centers for Disease Control & Prevention Anchorage, Alaska.

2 Climate Change in the Arctic Environment Where are we going? The Arctic Region Climate Change Effects Health Impacts Infectious Diseases New disease emergence? Existing diseases? Potential emergence? Conclusions Recommendations Public Health & Community Response

3 Mean annual temperature, present day natural vegetation of the Arctic and neighboring regions Barrow Alaska -12C Resolute Bay Canada -16C Mid Arctic Ocean -18C North Greenland-28C Murmansk OC Reykjavik Iceland 4C From Arctic Climate Impact Assessment 2004

4 From Arctic Human Development Report 2004 The Arctic Region

5 Arctic Human Development Report 2004 The Arctic Region

6 Small Remote Communities

7 The US Arctic-Alaska facts US Arctic (Alaska) one fifth the size of the lower 48 states Population 634,180 One sixth (120,494) Alaska Native 42% (266,355) of the population lives in Anchorage; 36,148 are Alaska Native Highest median income 27% live below poverty level One-third of rural Alaska Natives have no in-home water or sewage service

8 Alaska Native Health Care System Alaska Native Medical Center 14 Regional health Centers 7 Regional Hospitals 176 Community Health Aid Clinics

9 Challenges to Health and Wellness Health Disparities Life expectancy 64.9 years vs 76.7 years for US Unintentional injury mortality 3.3 times US rate Suicide 4.2 times rate for US all races Cancer mortality is 1.5 times US all races Infant mortality 8.7/1000 vs 7.2/1000 for US Higher rates of some infectious diseases: Respiratory syncytial virus Invasive bacterial diseases Helicobacter pylori

10 Challenges to Health and Wellness Health impacts of: Environmental contaminants Impact on the traditional food supply Rapid economic change and modernization- the modern diseases Obesity Diabetes Cancer Suicides Cardiovascular diseases Climate change

11 Climate Change in the Arctic Warming to continue 3-5C degrees mean annual increase by 2100 Winters will warm more than summers Mean annual precipitation will increase Continued melting of land and sea ice Greater climate variability, increase in extreme weather events Increasing river discharge and rising sea level The villages of Shishmaref and Kivalina face relocation

12 Climate Change Impact on Arctic Communities Rapid warming results in melting of permafrost Erosion of riverbanks Sinking of ground surface Damage to buildings Disruption to sanitation infrastructure The village of Newtok faces relocation

13 Climate Change Impact on Arctic Communities Rapid warming results in loss of annual sea ice Sea ice protects shorelines from winter storms Supports marine ecosystems Threatens communities, subsistence activities

14 Climate Change Impact on Arctic Communities Increasing marine transportation Oil, gas mineral exploration, industry Fisheries Tourism Reliable less expensive community re-supply Employment Threaten traditional subsistence lifestyles Cultural change

15 Climate Change Human Health Impact Direct impacts Heat stress-low impact Unintentional injuries, mortality will increase Indirect impacts: Threats to the traditional food supply Reduced snow, ice cover, permafrost obstructs travel, access to food supply Retreating and thinning of sea ice stress marine mammal populations, hunting dangerous, unproductive Changes in animal, bird migration patterns Hunting unproductive Increased exposure to environmental contaminants Infectious diseases in subsistence species Change to western diet increase in modern diseases Village relocation -mental/behavioral health effects

16 Climate Change Emergence of infectious diseases New outbreaks of infectious diseases suggesting climate as a factor Infectious diseases already present that may increase in prevalence Infectious diseases not present but that may emerge

17 New outbreaks suggesting climate as a factor in emergence Vibro parahemolyticus Ubiquitous in marine environments Associated with fish/shellfish Causes gastroenteritis Outbreaks associated with farm seawater mean temperatures of >15C Outbreaks increasing since 1997 California Washington British Columbia

18 Mean Daily Farm A Water Temperature by Date, and Number of Farm A -associated Case-patients by Harvest Date of Consumed Oysters July June Date From McLaughlin et al NEJM : Temp. of Cases 6

19 Environmental Investigation Results Farm A July-August Water Temperatures by Year 20 Temperature (ºC) 19 (no data 1999) degree C yearly increase (r² (r²=0.14, P<0.001) Year From McLaughlin et al NEJM :

20 Infectious diseases already present that may increase in prevalence Clostridium botulinum Caused by eating food contaminated with botulinium neurotoxin Common in US, Canadian Arctic and Greenland Associated with fermented foods made in sealed (anaerobic) containers at temperatures above 4C (41F) Incidence may increase as ambient temperatures increase

21 Paralytic Shellfish poisoning (PSP) Shellfish concentrate neurotoxin from algal blooms (red-tides) Follows eating raw shellfish gastroenteritis, paralysis Alaska has one of the highest rates in US Potentially increase by climate-related sea water warming, precipitation, nutrient-laden run-off

22 Echinococcus sp. Endemic regions where Echinococcus sp life cycle has been established Parasitic tape worm disease Human accidental host Cyst-like lesions in liver Vectors are foxes, rodents (voles) Dogs and man accidental hosts Climate-favoring expansion of habitat may result in appearance of disease in new regions.

23 Giardia lamblia Protozoan infection of the GI tract Diarrhea following consumption of contaminated untreated water Beaver common host Range expanding northward in Alaska and Canada Expansion of habitat may result in appearance of disease in new regions.

24 Damage to the sanitation infrastructure Waterborne diseases Giardia sp Cryptosporidium Hepatitis A Water-washed diseases Bacterial Skin infections Methicillin Resistant Staphylococcus aureus Respiratory diseases RSV Pneumonia, influenza

25 Hospitalization Rates for High and Low Water Service Regions, Alaska, *P < * 100 Low Service High Service * * 50 * RS A M Sk in In fe ct io n s R SV 0 Di ar rh ea Pn eu m on ia Rate per 10, Hennessy etal AJPH 2008 in press

26 Infectious diseases not present but may emerge West Nile Virus Surveillance-Dead Birds 2004 West Nile virus Emerged in US 1999outbreak of encphalitis Infects mosquitoes, birds, Humans, horses dead-end hosts Mosquito vectors in Alaska and Canada A. vexans C.pipiens C.resuans Dead bird surveillance conducted Furthest north 57o L North 2004 West Nile Virus Surveillance-Dead Birds 2007

27 What s to be done! Establish surveillance and monitoring networks for climate sensitive events Example International Circumpolar Surveillance Infectious diseases Injuries Research needed on relationship between climate change and individual and community health Investigating outbreaks that may be climate related Identification of key infectious disease indicators Studies of current health effects in local regions where effects are evident Establishing baseline relationships between weather and infectious diseases Establish community-based monitoring networks Identify common set of measures Standardized measurements Within and across regions

28 International Circumpolar Surveillance Network Russian Federation Finland Sweden Norway Latitude 60o North United States Arctic (Alaska) Reference labs Clinical labs Participants shown in dark grey Greenland Iceland Northern Canada Parkinson, AJ., Butler, JC. Emerging Infectious Disease January 2008

29 What s to be done! Establish surveillance and monitoring networks for climate sensitive events Example ICS Infectious diseases Injuries Research needed on relationship between climate change and individual and community health Investigating outbreaks that may be climate related Identification of key infectious disease indicators Studies of current health effects in local regions where effects are evident Establishing baseline relationships between weather and infectious diseases Establish community-based monitoring networks Identify common set of measures Standardized measurements Within and across regions

30 What is being done! Climate Change and Impacts on Human Health in the Arctic: An International Workshop on Emerging Threats and Response of Arctic Communities to Climate Change Anchorage Alaska February 13-15, 2008 CDC working group formed The Public Health Response to Climate Change: Water and Public Health Atlanta October 10-11, 2007 Human Health Challenges from Climate Change and Rapid Urbanization: Excessive Heat Vulnerability. Phoenix Az. November 14-16, 2007 Health Communication and Marketing on Climate Change Workshop January 8-9, 2008 George Mason University, Arlington Va. Workshop on Vulnerable Populations and Climate Change TBA Climate Change and Vector borne Diseases possibly in association with ICEID Atlanta GA March 16-19, 2008 Special issue of AJPM (June 2008) devoted to the public health response to climate change.

31 Conclusions Arctic communities uniquely vulnerable to climate change Small isolated communities Traditional lifestyle and culture important to health and wellbeing Fragile economic support, dependence on subsistence hunting and fishing Public health response and acute care may be marginal, or non-existent in some regions

32 Conclusions Climate change will be a source of illness, injury and mortality in the Arctic Emergence of new climate sensitive infectious diseases Increased prevalence of certain infectious diseases already present Migration northward of infectious diseases not yet present Establish surveillance networks for climate sensitive infectious diseases Conduct research on relationship between climate change infectious diseases Establish community-based monitoring networks

33 Additional Reading.. ACIA Scientific Report. Climate Impact Assessment. Cambridge University Press, New York AHDR (Arctic Human Development Report) Akureyri: Stefansson Institute Iceland

34 Adapting to Climate Change!

35 Rate per 1,000 births Hospitalization rates for children < 3 years old according to water service in village of residence, YK region, * 250 < 10% 10-79% >= 80% Bethel * 200 ** LRTI * P < 0.05 for trend, ** P= 0.08 for trend Pneumonia RSV RSV Pneumonia

36 Rate per 1,000 persons Skin infection rates compared with water service in village of residence, all ages, YK Region, * 15 * * S.aureus Skin Infection * P < for trend MRSA Skin Infection Hospitalized Skin Infection < 10% 10-79% >= 80% Bethel