Risks of Emerging Infectious Diseases in ASEAN. Prasit Palittapongarnpim, M.D. Department of Microbiology, Faculty of Science, Mahidol University

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1 Risks of Emerging Infectious Diseases in ASEAN Prasit Palittapongarnpim, M.D. Department of Microbiology, Faculty of Science, Mahidol University

2 Despite the socio-economic progress of ASEAN and increased importance of NCD, infectious diseases do not go away, actually ASEAN (+China) becomes a hot spot of EID and reemerging diseases. Nipah encephalitis- Sungai Nipah village Malaysia 1998 SARS- Guangdong China 2002 H5N1 influenza-first human cases in Hong Kong 1997 and major outbreaks in 2004 Pandemic influenza H1N H7N9 influenza- China 2013 H10N8 influenza-china Dec 2013 Chikungunya- Tanzania 1962, 2005/6 outbreak on La Réunion Island in the Indian Ocean followed by outbreaks in SE Asia , Streptococcus suis- Denmark 1968 and an outbreak in Sichuan China

3 3 There are also threat of EID from other parts of the world. Ebola (1976) major outbreaks in Africa 2014 Enterohemorrhagic E. coli (104:H4) 2011 MERS (2012) outbreak in Korea 2015 West Nile encephalitis As well as threat from re-emerging endemic diseases. Dengue virus infections Hand-foot-mouth diseases Melioidosis Plague-Surat India 1994 Cholera Leptospirosis Salmonellosis MDR and XDR-TB and other resistant bacteria

4 4 Are there any things else? Many patients with fever are of unknown etiology. No attempts for microbiological diagnosis Limited facility Totally unknown even with aggressive attempts. Possible causes Unknown rickettsial pathogens Unknown viruses, particular zoonotic ones. New variants of known pathogens.

5 5 Risk Factors for New EID More human population Shifting human population profiles. (More aging and immunocompromised population, relatively less children populations, more urbanization) Much more domestic animal populations Chicken, pigs, cow Exotic pets More international and domestic travels Climate changes and changing environments

6 6 Principles in dealing with the urgent situations such infectious diseases outbreak Capacity of personnel Availability of essential equipment Preparedness plan Drilling

Mitigating Biosecurity Threats in Southeast Asia by APEIR (Asia Partnership on Emerging Infectious Diseases Research) MBDS (Mekong Basin Disease Surveillance Network) FETN (Field Epidemiology

7 Mitigating Biosecurity Threats in Southeast Asia by APEIR (Asia Partnership on Emerging Infectious Diseases Research) MBDS (Mekong Basin Disease Surveillance Network) FETN (Field Epidemiology Training Network) and CORDS (Connecting Organizations for Regional Disease Surveillance) Proposal originally prepared by Boonlay Phommasak & Prasit Palittapongarnpim Funded by ASEAN-Canada s GPP and IDRC Updated Research Part for ASEAN East-West Corridor

8 8 Overview 30 month joint project between APEIR, MBDS, and ASEAN+3 FETN Funded by IDRC and GPP Asia Partnership on Emerging Infectious Diseases Research

9 9 specific objectives Develop a greater understanding of the risks of an infectious agents at high-traffic border crossings in Southeast Asia. Strengthen laboratory and field surveillance, diagnostics, prevention and response capacities towards infectious pathogens cross-border outbreak potential. Synergize efforts among partner GPP projects in laboratory capacity strengthening and risk assessment. Build effective and efficient mechanisms for research to directly inform and shape regional policies and practices in surveillance, outbreak investigation and response.

10 10 MBDS (Disease Surveillance) APEIR (Research) OTHERS (Lab, Technical) Strengthen Bio Threat Surveillance Risk Management workshop Develop Biosafety Training manual Capacity building Surveillance equipment & PPE Surveillance app development Policy synthesis workshop Biosafety and Biosecurity web page Collaboration with APEIR Ext Consultant M & E Lead research Data collection Capacity building: lab, researchers, MBDS, border health personnel Early disease detection Risk management workshop (with MBDS) Collaboration Ext consultant M & E Policy synthesis workshop ASEAN WHO EDPLN Bio Diaspora IFBA CORDS

11 11 Research activity and collaboration Activity APEIR MBDS ASEAN +3 FETN CORDS Bio Diaspora WHO EDPLN Research Surveillance Training Technical consultation Others Asia Partnership on Emerging Infectious Diseases Research

12 12 Outline Background APEIR-MBDS-ASEAN+3 FETN-Joint Project Background Objectives Project activities Moving forward Asia Partnership on Emerging Infectious Diseases Research

13 13 Background of APEIR 2006: Initiated as Asia Partnership For Avian Influenza Research (APAIR) 2009: Expanded scope to cover all emerging infectious diseases (EIDs) research Asia Partnership on Emerging Infectious Diseases Research

14 14 Background Regional research network composed of researchers, practitioners, and senior government officials Generates 3M collaborative research and actions on EIDs based on Eco Health/One Health concepts Multi-disciplinary Multi-sector Multi country Asia Partnership on Emerging Infectious Diseases Research

15 15 APEIR Member Countries APEIR Network Missions Research Knowledge translation Policy advocacy Capacity building Asia Partnership on Emerging Infectious Diseases Research

16 16 Background: Vision To be the leading EIDs research network in Asia by 2015 Asia Partnership on Emerging Infectious Diseases Research

17 17 Background ASEAN Community (AC) in 2015 will lead to more travel between ASEAN countries Need to have the knowledge, capacity and policy to mitigate the risks from potentially dangerous infectious diseases that can cross borders. Asia Partnership on Emerging Infectious Diseases Research

19 19 General objective To strengthen regional capacity for understanding, preventing, preparing for, and responding to disease agents with bioterrorism and/or pandemic potential in Southeast Asia Asia Partnership on Emerging Infectious Diseases Research

20 20 Research Objectives Assessing the risk of infectious diseases transmission across borders. Increasing capacity for disease detection

21 21 Studied organisms Influenza Air-borne transmission: endemic, continuously emerging and potential pandemic. Melioidosis Soil transmission: direct impact from increase road traffic and frequently fatal. Salmonellosis Food-borne transmission: spreading of drug resistance genes. Asia Partnership on Emerging Infectious Diseases Research

22 22 Study locations B A C Asia Partnership on Emerging Infectious Diseases Research

23 30 APEIR-MBDS Joint Project Action Plan (September 2014-September 2016) Activities Inception workshop Budget analysis X Ethical/government clearance X X Budget analysis X Evaluation of all facilities X Test running all facilities X Training Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 X Sample collection - processing X X X X X Data sharing and result analysis X X X Interim technical report/financial report X X X X Progress report X X X X Meeting for reviewing research, summarizing data and X synthesize policy X X

24 31 Project activities Activity First preliminary meeting Second preliminary meeting + site visit First International Conference on MBDS Collaboration East-West Corridor Inception Workshop Laboratory Trial Place and date HSRI Thailand: 19 March 2014 Savannakhet and Lao-Vietnam border: April 2014 Mukdahan Grand Hotel, Thailand: 2-3 June 2014 Savannakhet Health Department, Lao PDR: September 2014 Mukdahan-Amnatcharoen, Thailand: 8-20 December 2014

25 As a collateral consequences of an unexpected situation in HSRI, the project budget is suspended since the last quarter of It is expected to resume by the last quarter of This workshop is done as a preparation for resuming the research activities. 32

26 42 Purpose of Today Workshop To build laboratory capacity to handle dangerous pathogens, sharing knowledge on some potential pathogens as well as provide laboratory practicing experiences Face-to-Face Discussion on each subproject Objectives Sampling methods SOP Requirement: authorization, budget, etc. Limitation Opportunity for training and capacity building Action plan and timelines Next step and contact

27 43 THANK YOU VERY MUCH For YOUR ATTENTION Asia Partnership on Emerging Infectious Diseases Research

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