February Emerging Infectious Diseases: The Global Picture
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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
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