Biosecurity, biobanking and data management during public health crises in Africa. A peer into the future. Akin Abayomi, EU BBMRI ERIC meeting, Brusells, April 2017
Public Health Crises and the era of Emerging Infectious Diseases (EID) in Africa.
What are the precipitating factors leading to EIDs and risk of PHEIC?
Demographics. Population expansion and environmental impacts
Our increasing and expanding urban cities will become fertile ground for disease epidemics
Natural heavy burden of endemic Infectious Diseases.
Human Resources: Quantity and Quality
Number of Persons Served Per Pathologist in sub-saharan Africa THE GAMBIA GUINEA BISSAU SENEGAL SIERRA LEONE MAURITANIA GUINEA LIBERIA COTE DTVOIRE MALI BURKINA GHANA BENIN TOGO NIGER NIGERIA CAMEROON CHAD CENTRAL AFRICAN REPUBLIC SUDAN SOUTH SUDAN ERITREA ETHIOPIA DJIBOUTI No Active Pathologist >5.0 million 2.5-5.0 million 1.0-2.5 million 500,000-1 million 200,000-500,000 Data Not Available EQUATORIAL GUINEA GABON ANGOLA DEMOCRATIC REP. OF REPUBLIC THE OF THE CONGO CONGO (ZAIRE) RWANDA BURUNDI ANGOLA MALAWI UGANDA KENYA TANZANIA SOMALIA Number of Persons Per Pathologist: UK: 15,108 US: 19,232 ZAMBIA NAMIBIA ZIMBABWE MOZAMBIQUE MADAGASCAR SOUTH AFRICA Walvis Bay BOTSWANA LESOTHO SOUTH AFRICA SWAZILAND
Infrastructure. Few well developed facilities are not servicing the populations
Laboratory in Yambuku, DR Congo (Zaire), 1976 Guido van der Groen Photo: Breman
Plasmapheresis in Yambuku, DR Congo, 1976 Margaretha Isaacson (RSA) in Mission Hospital Laboratory Photo: J. Breman
2015 West Africa
Exploitation, strife, corruption and conflict
Diamonds fueling civil strife
Basic Sanitation
Abnormal manipulation of agriculture and the Eco-system
Climate Impact
THE CLIMATE - LAND COVER - POPULATION - WATER RESOURCES CYCLE Climate Land Cover Changes in CO 2, Rainfall and Temperature LU CO 2, T, H 2 O Land Cover Change: Natural Veg. to Crops Need for Energy Water Resources Need for Food Need for Water Population Increase and Development Population Schulze, 2007; Idea: Harding & Kabat, 2007
Estimated Mortality Impacts of Climate Change: Year 2000 Estimated annual deaths due to climate change: malnutrition (~80K), diarrhoea (~50K), malaria (~20K), flooding (~3K) 14 WHO regions scaled according to estimated annual death rates due to the change in climate since c.1970. (Patz, Gibbs et al, 2007: based on McMichael, Campbell-Lendrum, Kovats, et al, 2004)
Climate Change: Multiplier of Conflicts and Regional Tensions Regions afflicted by problems due to environmental stresses: population pressure water shortage climate change affecting crops sea level rise pre-existing hunger armed conflict, current/recent From UK Ministry of Defence [May RM, 2007 Lowy Institute Lecture. Sydney]
EID and risk to National and Global Security. Real case scenarios, happening as we speak.
Minister for Health, Lagos. Dr Jide Idris
Lagos Mega City
Lagos City Metropolis 23 Million inhabitants.
EID currently or imminently in danger of causing public health Lassa Fever EBOLA Dengue Yellow Fever crises in Africa Risk Pandemic flu Enteric outbreak of MDR pathogens MENINGITIS
Lassa Fever (LHF) Has plagued West African countries for decades, perhaps centuries. Contributory to the widespread poverty. 300 000 cases and 5 000 deaths each year, it is one of the priority diseases for urgent research in the WHO blueprint. Control is made complex by the existence of at least 4 lineages of the virus and expansion of multiple small mammals reservoirs.
The West African Ebola Outbreak 28,000 reported cases 2013 to 2016 11,000 reported deaths 14,000 survivors
AMR MDR outbreak in Lagos January 2017 2000 students in an all girls school presented with abdominal pain fever diarrhea and vomiting. 3 deaths so far and several hospitalised Pathogens are a range of enteric bacteria demonstrating MDR super bug features
Profile of Lagos MDR Cases. CDC preliminary report. Patient 1: CULTURE : Campylobacter jejuni O:19 and Campylobacter coli SUSCEPTIBILITY: The Campylobacter identified were sensitive to Erythromycin, moderately sensitive to Imipenem and resistant to all other antimicrobial agents. Patient 2: CULTURE: Salmonella Heidelberg SUSCEPTIBILITY: Salmonella was sensitive to imipenem, resistant to all other antimicrobial agents. Patient X: CULTURE: Escherichia coli 0157:H7 (Shiga toxin producing) SUSCEPTIBILITY: Escherichia coli isolated sensitive to ceftriazone and imipenem, resistant to all other antimicrobial agents. Two remaining samples grew organisms that we are yet to completely identify and classify. Molecular and genetic studies are ongoing and results should be ready within a week.
Meningococcal Meningitis Annual outbreaks across the Sahel of West and central Africa Highly contagious by droplets Very high fatality Currently an outbreak spreading rapidly across Nigeria
Panic, breakdown in security, economic shut down and migration
Activity of Militant and illicit trade routes
Biological Agents and Bioterrorism-2 Biological agents can be used as weapons in: Biocrimes Bioterrorism Biowarfare Definition: North Atlantic Treaty Organization (NATO) defines a biological weapon as the provision of any infectious agent or toxin by any means of delivery in order to cause harm to humans, animals, or plants.
We know that about 12,000 people fly out of Nigeria daily to different corners of the globe, it could have had a devastating effect on the world if not rapidly contained.
A health threat anywhere is a health threat everywhere Global aviation network Source: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/s0140673612611519 Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable