February Emerging Infectious Diseases: The Global Picture

Transcription

1 Emerging Infectious Diseases: The Global Picture

2 Breaches in species barrier: emerging infections in humans Infection Animal linked Year infection to transmission first reported Ebola virus Bats 1976 HIV-1 Primates 1981 E. coli O157:H7 Cattle `1982 Borrelia burgdorferi Rodents 1982 HIV-2 Primate 1986 Hendra virus Bats 1994 BSE/vCJD Cattle 1996 Australian lyssavirus Bats 1996 Influenza A (H5N1 ) Chickens 1997 Nipah virus Bats 1999 SARS coronavirus Palm civets 2003 Influenza A (H1N1) Swine 2009 MERS coronavirus Bat/ Dromedary 2012 Infnuenza A (H7N9) Poultry 2013 Zika virus Monkey 2007

3 Potential transmission pathways, emerging infectious diseases Emergence No further transmission

4 Rabies transmission to humans: rare iatrogenic onwards transmission

5 Potential transmission pathways, emerging infectious diseases Emergence No further transmission Continues Transmission cluster/epidemic/pandemic Ceases/ sporadic

6 Ebola emergence: current hypotheses

7 Confirmed Human and Poultry H5N1 Infections since 2003

8 Genetic Drift: H5N1 virus in human infections since 2003

9 Potential transmission pathways, emerging infectious diseases Emergence No further transmission Continues Transmission cluster/epidemic/pandemic Ceases/ sporadic Continues transmission Continues/ endemic

10 Adults and Children living with AIDS, 2016 worldwide

11 Potential transmission pathways, emerging infectious diseases Emergence No further transmission Continues Transmission cluster/epidemic/pandemic Ceases/ sporadic Continues transmission Continues/ endemic

12 Swiss cheese events in epidemiology and public health Risk factor Risk factor Public health event Risk factor Risk factor James Reason: BMJ 2000;320:

13 Animal husbandry, Sudan and trade associated with religious festivals

14 Routine vaccination of cattle against Rift Valley Fever, East Africa

15 Climate change and health: extreme weather events 15

16 El Nino-associated flooding, East Africa, 1998

17 Rift Valley Fever, human infection, Sudan, 1998

18 Animal husbandry and trade, Sudan

19 Rift Valley Fever, Sudan and Arabian peninsula Source: WHO

20 Technical/political response Guidelines for Mitigation Consensus for prevention

21 Emergence from animals in nature: Eco Challenge, Malaysia, 2000

22 Leptospirosis transmission

23 Leptospirosis (N = 33) among 312 participants, Eco Challenge 2000, Malaysia Canada: 4 US: 10 UK: 9 France: 4 Eco Challenge Brazil: 1 Uruguay: 1 Australia: 4

24 Emerging Infections Occur randomly when risk factors align Often associated with contact at the animal/human interface Spread internationally in humans

25 Dengue in Texas, 2005 Global recycling Asian tiger mosquito Source: CDC Tiger mosquito Dengue Texas

26 Number of countries reporting Dengue, Source: WHO

27 Highly pathogenic H5N1 influenza virus in smuggled Thai eagles, Belgium, 2005 Source: Van Borm, et al, Emerging Infectious Diseases Vol. 11, No. 5, May 2005

28 BLOODY DIARRHEA AND HAEMOLYTIC URAEMIC SYNDROME, SHIGA TOXIN PRODUCING E. COLI -- CONTAMINATED FENUGREEK SRPOUTS, 2011

29 Emerging Infections Occur randomly when risk factors align Often associated with contact at the animal/human interface Spread internationally in humans Spread internationally in animals, insects and food

30 SARS: Clustering of cases, Hong Kong hotel Source: CDC/WHO

31 SARS: international spread from Hong Kong, 21 February 12 March, 2003 Doctor from Guangdong Canada A F G K Ireland Hong Kong H J Hotel M Hong Kong B E D C I USA Viet Nam Singapore Germany Source: WHO/CDC Bangkok New York

32 SARS and the economy: impact on global travel, April 2003

33 The cost of SARS, Asian Development Bank, 2003 % of GDP Hong Kong China, mainland Taiwan South Korea Indonesia Singapore Thailand Malaysia Philippines 1.4% 2.3% 1.6% 1.5% 0.8% 0.5% 1.9% 0.5% 4% As of 30 September, 2003, SARS had decreased Asia s combined GDP by US$18 billion and cost nearly US$60 billion in lost demand and revenues US$ billion

34 Recent infectious disease outbreaks and their economic impact

35 Emerging Infections Occur randomly when risk factors align Often associated with contact at the animal/human interface Spread internationally in humans Spread internationally in animals, insects and food Cause negative impact on economies

36 Ebola Haemorrhagic Fever by mode of transmission, Kikwit Zaire, Non health care workers Health care workers 315 cases 250 (80%) deaths Mar Mar Mar Mar Mar Apr Apr Apr Apr Apr May May May May May Jun Jun Jun Source: WHO/CDC

37 SARS Epidemic curve, China,

38 SARS, chain of human-to- human transmission, Singapore 2003

39 SARS risk assessment, late March 2003 Index case Second generation = close and direct contact with health care workers (HCW) or others) Third generation = family members of HCW Fourth generation = other contacts in community

40 Emerging Infections Occur randomly when risk factors align Often associated with contact at the animal/human interface Spread internationally in humans Spread internationally in animals, insects and food Cause negative impact on economies Health workers at great risk of infection and unintentionally serve as conduit to family/community

41 Multidrug-resistant Definitive Type (DT) 104 Salmonella Typhimurium, Europe, Salmonella Typhimurium isolates from both cattle and humans % cattle humans 0 Source: WHO from published data

42 Reservoirs of bacteria causing human infections Source: WHO

43 Principal transfer pathways, antibiotic resistance genes, between humans, animals, food and the environment Source: DARC/ARHAI joint report, UKI

44 Antimicrobial use and salmon/trout production, Norway, after introduction of vaccination Volume (tons wfe) Antibiotics (kg active substance) Volume salmon and trout Consumption antibiotics 0 Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006

45 Macrolide use and enterococcal resistance in pigs, Denmark Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.

46 Cephalosporin resistance after stopping use in poultry, Quebec, Canada Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.

47 Emerging Infections Occur randomly when risk factors align Often associated with contact at the animal/human interface Spread internationally in humans Spread internationally in animals, insects and food Cause negative impact on economies Health workers at great risk of infection and unintentionally serve as conduit to family/community Involve complex relationships across sectors

48 Human Animal Infections Risk Assessment Group (HAIRS)

49 Human Animal Infections and Risk Surveillance Group (HAIRS)

50 Human Animal Infections and Risk Surveillance Group (HAIRS): newsletter

51 Human Animal Infections and Risk Surveillance Group (HAIRS): guidelines

52 Emerging Infections Occur randomly when risk factors align Often associated with contact at the animal/human interface Spread internationally in humans Spread internationally in animals, insects and food Cause negative impact on economies Health workers at great risk of infection and unintentionally serve as conduit to family/community Involve complex relationships across sectors Require a one health approach to risk assessment/management