Water-related diseases

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1 GLOBAL FORUM ON INNOVATION IN HEALTH PROFESSIONAL EDUCATION A GLOBAL HEALTH WORKFORCE THROUGH A ONE HEALTH FRAMEWORK Workshop: Envisioning the Future of Health Professional Education Environment, Climate, and Human Health: Water Borne Diseases April 24, 2015 Rita R. Colwell, Ph.D., D.Sc. Distinguished University Professor University of Maryland College Park and Johns Hopkins University Bloomberg School of Public Health Water-related diseases Cases per year Deaths per year Amoebiasis Arsenic Diarrhoeal disease, Including cholera Dracunuliasis (guinea worm) Fluorosis Giardiasis Hepatitis A Intestinal helminths Malaria Schistosomiasis Trachoma Typhoid 48,000, m exposed to drinking water with elevated levels 1.5 billion > million (China) 500,000 1,500,00 133,000, ,000, ,000, ,000, , ,000 1,800, Low ,300,000 > 10,000-25,000 West Virginia University Civil and Environmental Engineering 1

2 G. Constantin de Magny What is reported about cholera and macro-scale processes? Cholera outbreaks have been linked to environmental and climate variables precipitation (Hashizume et al. 2008) floods (Koelle et al., 2005) river level (Emch et al., 2008) sea surface temperature (Colwell, 1996; Lobitz et al., 2000) coastal salinity (Miller et al., 1982) dissolved organic material (Worden et al., 2005) fecal contamination (Islam et al., 2006) chlorophyll (Lobitz et al., 2000, Magny et al., 2008) 2

3 5/4/2015 Environmental Signatures Related To Cholera Epidemics Dan Zimble, ESRI Inc. Cholera and SST in the Indian Ocean Six-month SST lead: R2 = 0.72 R

4 Environmental Signatures Related To Cholera Epidemics MATLAB KOLKATA Fitted model Cross-validation model Constantin de Magny et al., 2008, PNAS Results Kolkata: Significant and positive relationship between cholera and CHL(t) and Rain(t). Matlab: Significant and positive relationship between cholera and Chl(t-1). KOLKATA +1 mg.m -3 in CHL(t) => +32.5% in number of cholera cases (95% CI 8.3%-62.0%) +1 mm.day -1 in Rain(t) => +6.5% in number of cholera cases (95% CI 1.6%-11.7%) MATLAB +1 mg.m -3 in CHL(t-1) => +31.4% in number of cholera cases (95% CI 13.0%- 52.7%) Constantin de Magny et al., 2008, PNAS 4

5 Location of areas in the Indus River Basin where cholera outbreaks were reported from

6 Relationship between cholera outbreaks and air temperatures Theoretical framework for predicting cholera outbreaks in epidemic regions Air Temperature Below average for two previous months Above average for two previous months Rainfall Above average Below average Air High Risk Poor or Damaged Low Risk Cholera Outbreak Available and intact Water and Sanitation Access West Virginia University Civil and Environmental Engineering 6

7 Could we have predicted the Haiti Cholera outbreak? Recent cholera outbreak in Haiti indicated the disease remains a global threat. Framework for developing cholera prediction models in cholera endemic (ER) and non-endemic regions (NER) The sharp contrast in mortality rates between ER and NER exists not because we do not know how to treat cholera patients, but because of a persistent knowledge barrier between ER and NER. We propose a pragmatic and adaptive framework which hypothesizes that convergence of three enabling situations - Inception, Environmental Conditions, and Transmission - are necessary for a cholera outbreak to become an epidemic. Antarpreet Jutla, Elizabeth Whitcombe, Nur Hasan, Bradd Haley, Ali Akanda, Anwar Huq, Munir Alam, R. Bradley Sack and Rita Colwell Environmental factors influencing epidemic cholera. Amer J Trop Med Hyg 89(3) Source and Distribution of isolates collected from Haitian outbreak Chansolmes Bassin Bleu Patient Town Arrondissement Department Grande Saline Dessalines Artibonite Gonaïves Gonaïves Artibonite Saint Marc Saint Marc Artibonite Drouin Saint Marc Artibonite Chansolmes Port de Paix Nord Ouest Bassin Bleu Port de Paix Nord Ouest Arcahaie Arcahaie Ouest Cabaret Arcahaie Ouest Croix des Bouquets Croix des Bouquets Ouest En Plein Gonaïves Ouest Plaine Gonaïves Ouest Léogâne Léogâne Ouest Tabarre Port au Prince Ouest Port au Prince Port au Prince Ouest Delmas Port au Prince Ouest Cite Soleil Port au Prince Ouest Petion Ville Port au Prince Ouest Montrouis Ouest Gonaives Drouin Grande Saline Saint Marc Montrouis Arcahaie Carbaret Tabarre Port au Prince Léogâne Petion Ville Jacmel Cite Soleil Delmas En Plein Presumed location of original contamination Croix des Bouquets Cange 7

8 Air temperature in Haiti in 2010 compared with historical air temperature data Monthly rainfall in Haiti in 2010 compared with historical rainfall data The Haitian V. cholerae O1 strains clustered with other 7 th pandemic V. cholerae strains in a single monophyletic clade (a) Phylogenomics th pandemic (c) NCTC8457 BX M66-2 (b) MAK757 HC-51A HC-02C1 V52 HC-1A2 O395 HC-2A1 HC-36A1 RC27 HC-50A1 LMA HC-55B (1) HC-55C2 MZO-3 HC-57A1 AM HC-59A1 HC-59B1 HE-25 HC-60A1 TMA21 HC-61A HC-78A HC-56A1 MZO-2 HC-52A1 HC-55A1 HE-40 HE HE-39 HE-48 HC-44C1 HC-46B1 HC-43B1 HC-1 HC-41B1 HE-45 Amazonia TM HC-2 (b) V51 CT RC385 VL426 HE-09 HE-16 (c) Haitian strains branching separately from South Asian V. cholerae strains RC9 HC41A1 HC7A1 HC80A1 HC43A1 HC23A1 HC06A1 HC46A1 HC17A2 HC22A1 HC32A1 HC68A1 HCUF01 HC48A1 Haiti, HC20A HC61A EL EL1792 HC38A1 HC49A2 HC21A1 HFU EL1798 HC40A1 HC70A1 HC81A1 HC42A1 HC57A2 HC47A1 CP1038Zimbabwe, 2009 CP1048 CP1050Bangladesh, 2010 CIRS 101 Bangladesh, 2002 CP1042 Thailand, 2010 CP1040 CP1041 Zambia, 2004 MO10 MJ-1236 B33 CP1032 Mexico, 1991 CP1033 Mexico, 2000 INDRE 91/ N

9 Principal component analysis: The three dimensional PCA projection plots based on divergence of average nucleotide identity Haitian Cluster Cloud 10 Haitian strains (red) form a cluster cloud, distinct and yet, distant, from CP genomes (concurrent epidemic isolates form different parts of the world) (blue) and others (green). Interestingly, one reference strain CP 1038 (from Zambia) genome falls into the Haitian cluster. Conclusion: Genomic analysis provided evidence that two distinct Vibrio populations, V. cholerae O1 and V. cholerae non O1/O139, contributed to the cholera epidemic in Haiti. Comprehensive genomic analysis showed: V. cholerae O1 populations were clonal, resembling concurrent epidemic isolates from South Asia and Africa. V. cholerae non O1/O139 populations were not clonal but most probably serve as a reservoir for genomic and pathogenicity islands. V. cholerae non O1/O139 populations in Haiti harbor a genomic backbone similar to that of toxigenic V. cholerae O1 circulating in the Western hemisphere. Genomic analysis of Haitian V. cholerae O1 strains has provided evidence of: a distinct VNTR genotype, genetic polymorphisms of rstb and ctxb, nucleotide (GTA) deletions in rstb, an increased number (five) of ToxR binding repeats, mutations in gyra and parc gene, and a genetically similar set of MGE s shared with isolated elsewhere Core gene and SNP derived phylogenies suggest, and PCA findings reinforce, that quite quickly, i.e., within a three week period early in the cholera epidemic, significant genomic diversity accumulated in the circulating population. 9

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11 Cases of Cholera Per 1000 Cases of Cholera Population Per 1000 Population Full Full Study Study Control Sari Nylon Test Group Test Group When one tugs at a single thing in nature, he finds it hitched to the rest of the universe. John Muir ( ) 11

12 Collaborators and Colleagues Anwar Huq, Professor University of Maryland, College Park, MD Antarpreet Jutla, Assistant Professor, West Virginia University Morgantown, WV Dr. Nur Hasan Vice-President, Research and Development CosmosID, Inc. College Park, MD Dr. Seon Young Choi, Bioinformatic Scientist, CosmosID Inc. College Park, MD Courtesy of GB Nair, NICED, Kolkata, India 12

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