Looking forward based on past experiences: What s old is new again

Transcription

1 Looking forward based on past experiences: What s old is new again International Conference on (Re-)Emerging Infectious Diseases March 12, 2018 Rebecca Martin, PhD Director of the Center for Global Health US Centers for Disease Control and Prevention 1

2 1. (Re-) emerging infections 2. Defining the factors for (re-)emergence 3. Creating global health security 4. Minding the gaps 5. 2

3 Pandemic flu: Then and now 3

4 Examples of (Re-)Emerging Infectious Diseases 4

5 Zika: Latest in a Series of Unpredicted and Unpredictable Health Threats Zika first discovered in Zika forest, Uganda in 1947 Unprecedented, extraordinary complexity, unique challenges Microcephaly, other serious birth defects, and poor pregnancy outcomes Sexual transmission Associated with Guillain-Barré syndrome Top priority - protect pregnant women The sooner we act, the better we can protect 5

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7 Major CHIKV genotypes in Africa with introductions into Asia. Subsequent importation via travelers to other areas S.C. Weaver, W.K. Reisen / Antiviral Research 85 (2010)

8 Factors for (Re-)Emergence Satellite Image of International Flight Patterns Globalization and movement Rapid mass movement of people, animals, and goods Urbanization/migration to urban areas Demographic and behavior changes Greater human population and density Environmental Social, political, and economic events 8

9 Factors for (Re-)Emergence Ecological Increased contact with animals Habitat encroachment Lifestyle practices Intensification of animal production systems Public health infrastructure Microbial adaptation and change 9

10 Urbanization: Impacts on Cholera Expecting slides 3/8 Increasingly common for cholera to make its way to informal settlements in large cities Outbreaks in cities can be persistent and difficult to control Early detection and a strong, coordinated, multi-sectoral response are key to success 10

11 Youth bulge in Sub-Saharan Africa Projected growth of youth population years of age in Sub-Saharan Africa, China, and India, By 2030, the youth in Sub- Saharan Africa will have doubled from the start of the HIV epidemic (1990) 11

12 Medical tourism Nontuberculous Mycobacteria (NTM) On May 1, 2017, CDC was notified of 3 patients with NTM surgical site infections; all received surgery from a single surgeon at one facility in the Dominican Republic CDC notified Dominican public health authorities Dominican authorities reported the facility closed on 8 July 2017 As of October 12, 2017: 54 patients with a surgical site infection (SSI) after cosmetic surgery in the DR reported to CDC from 9 states, District of Columbia. 34/54 (63%) met CDC s confirmed case definition 12

13 PH: Environmental change Guinea Gueckedou Sierra Leone Liberia 13

14 Zoonotic diseases are a threat to global health security 14

15 Antibiotic resistance: A growing crisis worldwide 15

16 Retrospective analyses show rapid emergence of different C. auris strains worldwide Japan Korea India S. Africa Kenya Kuwait Pakistan Venezuela Israel U.K. United States Colombia At least 4 strains circulating globally Strain sequences pending 16

17 Global Health Security Global health security: 17

18 Detect, Respond, and Prevent is smart spending BY THE NUMBERS $6 Trillion $60 Billion $0.65 Estimated cost of pandemics in the 21 st century Annual expected loss from potential pandemics Annual cost per person for protection against current global health threats Sources: The Neglected Dimension of Global Security. GHFR Commission Gostin et. al., Neglected Dimensions of Global Security. JAMA

19 Acute febrile illness surveillance: India Acute febrile illness (AFI) surveillance captured >30,000 patients from 2014 through the end of February 2018 India tested for 80+ pathogens from 33 sites 50% successfully diagnosed 7 diseases accounted for 90% : malaria, dengue, Scrub Typhus, leptospirosis, Japanese encephalitis, Kyasanur forest disease, influenza India is using this information to appropriately supply health facilities with diagnostics and drugs 19

20 Pre- and post-implementation of enhanced VHF surveillance and diagnostics in Uganda

21 Community involvement in surveillance leads to increased reporting of signals Number of clusters, suspect cases related to clusters, and single suspect cases of measles (left) and yellow fever (right) Kafadougou-Bafing-Folon Health Region, Cote d Ivoire,

22 Importance of government leadership and partner coordination through Emergency Operation Centers 22

23 Importance of Disease Detectives at all levels for an effective response November 2015 June

24 Nigeria quickly contained the 2014 Ebola outbreak by using existing public health infrastructure that had been built over the last decade for diseases like polio 24

25 Building laboratory capacity for current and advanced technologies allows rapid detection and diagnosis 25

26 SLIPTA: A framework to encourage, support and recognize the implementation of QMS in medical laboratories in a stepwise manner 4 Star 5 Star End Point National, Regional or International Accreditation Body 3 Star 2 Star > 95 % 1 Star % 0 Star % % % Score on external evaluation using a checklist 26

27 Regional network developed to create a standard certification model for biosafety and biocontainment in laboratories Thailand Laos Cambodia Myanmar Vietnam 27

28 Preventing vaccine-preventable diseases through a second year of life approach, Ghana Increasing immunization delivery, including MCV2, in the second year of life requires: Raising awareness of vaccination schedule Developing catch-up vaccination policies Removing barriers to opening a vaccine vial for a single child Tracking children who drop out Revising forms to record and report 2YL doses Making vaccination convenient: in daycare and urban community clinics 28

29 Aligning gaps and resources through the JEE process Plan implemented and evaluated over time Joint External Evaluation conducted Costed Plan developed and resources identified National Action Plan developed 29 * Joint: country and external experts

30 Role of Joint External Evaluations in accelerating progress and sustainability JEEs Scheduled for February: Zimbabwe Japan 30 30

31 Decades of civil unrest in all 3 countries A perfect storm for the Ebola outbreak in West Africa Weak public health infrastructure/lack of IPC in health facilities / Unrecognized cases in crowded cities Spotty border control 31

32 The Impact of Ebola 32

33 Ebola and the Economy 33

34 Global safety net and surge capacity are critical Global health security starts at the country level Country action is quicker, more efficient, and more cost-effective Global action must strengthen and work through national systems to the greatest extent possible The international community is also responsible epidemics are the world s problem, not only the problem of individual countries or regions Rapid Response Teams Access to medical countermeasures (PPE, drugs, vaccines, diagnostics) 34

35 Need for research more to learn Accelerating the development of vaccines Discovery research (universities, pharmaceuticals) Development (industry, governments, CEPI) Manufacturing (industry, regulators, governments) Delivery (GAVI, WHO, UNICEF, PAHO, governments) Studies and research during outbreaks Developing of diagnostics Point of care Rapid tests 35

36 Public health advocacy, partnerships, and multi-sectoral interventions to enhance impact and sustainability UN General Assembly Non-communicable disease HIV Ebola Antimicrobial resistance Tuberculosis (2018) WHO and African Union declarations and resolutions Public-private partnerships Multi-sectoral approach 36

37 5 1 2 Health security: Protecting populations from Disease Outbreaks Health System Strengthening: Promoting Stable Societies REASONS TO INVEST IN HEATH GLOBALLY 3 Stable Societies Can Provide Economic Growth Opportunities 4 Share Best Practices in Program Implementation, Research, and Policy 5 Save Lives and Prevent the Spread of Disease 37

38 House on Fire He was shaking as he described himself as just a poor village man. But, he said, when he was growing up, there were things you could depend on. For example, if a house is on fire in a village, no one wastes time putting water on the other houses, just in case the fire spreads Instead they rush to pour water where it will do the most good on the burning house. House on Fire The Fight to Eradicate Smallpox. William H. Foege University of California Press, Berkley CA. 38

39 EMERGING DISEASES Thank you 39