Climate change in the Arctic: Potential emergence or re-emergence of infectious diseases Alan J. Parkinson Ph.D. Arctic Investigations Program Centers for Disease Control & Prevention Anchorage, Alaska.
Climate Change in the Arctic Environment Where are we going? The Arctic Region Climate Change Effects Health Impacts Infectious Diseases New disease emergence? Existing diseases? Potential emergence? Conclusions Recommendations Public Health & Community Response
Mean annual temperature, present day natural vegetation of the Arctic and neighboring regions Barrow Alaska -12C Resolute Bay Canada -16C Mid Arctic Ocean -18C North Greenland-28C Murmansk OC Reykjavik Iceland 4C From Arctic Climate Impact Assessment 2004
From Arctic Human Development Report 2004 The Arctic Region
Arctic Human Development Report 2004 The Arctic Region
Small Remote Communities
The US Arctic-Alaska facts US Arctic (Alaska) one fifth the size of the lower 48 states Population 634,180 One sixth (120,494) Alaska Native 42% (266,355) of the population lives in Anchorage; 36,148 are Alaska Native Highest median income 27% live below poverty level One-third of rural Alaska Natives have no in-home water or sewage service
Alaska Native Health Care System Alaska Native Medical Center 14 Regional health Centers 7 Regional Hospitals 176 Community Health Aid Clinics
Challenges to Health and Wellness Health Disparities Life expectancy 64.9 years vs 76.7 years for US Unintentional injury mortality 3.3 times US rate Suicide 4.2 times rate for US all races Cancer mortality is 1.5 times US all races Infant mortality 8.7/1000 vs 7.2/1000 for US Higher rates of some infectious diseases: Respiratory syncytial virus Invasive bacterial diseases Helicobacter pylori
Challenges to Health and Wellness Health impacts of: Environmental contaminants Impact on the traditional food supply Rapid economic change and modernization- the modern diseases Obesity Diabetes Cancer Suicides Cardiovascular diseases Climate change
Climate Change in the Arctic Warming to continue 3-5C degrees mean annual increase by 2100 Winters will warm more than summers Mean annual precipitation will increase Continued melting of land and sea ice Greater climate variability, increase in extreme weather events Increasing river discharge and rising sea level The villages of Shishmaref and Kivalina face relocation
Climate Change Impact on Arctic Communities Rapid warming results in melting of permafrost Erosion of riverbanks Sinking of ground surface Damage to buildings Disruption to sanitation infrastructure The village of Newtok faces relocation
Climate Change Impact on Arctic Communities Rapid warming results in loss of annual sea ice Sea ice protects shorelines from winter storms Supports marine ecosystems Threatens communities, subsistence activities
Climate Change Impact on Arctic Communities Increasing marine transportation Oil, gas mineral exploration, industry Fisheries Tourism Reliable less expensive community re-supply Employment Threaten traditional subsistence lifestyles Cultural change
Climate Change Human Health Impact Direct impacts Heat stress-low impact Unintentional injuries, mortality will increase Indirect impacts: Threats to the traditional food supply Reduced snow, ice cover, permafrost obstructs travel, access to food supply Retreating and thinning of sea ice stress marine mammal populations, hunting dangerous, unproductive Changes in animal, bird migration patterns Hunting unproductive Increased exposure to environmental contaminants Infectious diseases in subsistence species Change to western diet increase in modern diseases Village relocation -mental/behavioral health effects
Climate Change Emergence of infectious diseases New outbreaks of infectious diseases suggesting climate as a factor Infectious diseases already present that may increase in prevalence Infectious diseases not present but that may emerge
New outbreaks suggesting climate as a factor in emergence Vibro parahemolyticus Ubiquitous in marine environments Associated with fish/shellfish Causes gastroenteritis Outbreaks associated with farm seawater mean temperatures of >15C Outbreaks increasing since 1997 California Washington British Columbia
Mean Daily Farm A Water Temperature by Date, and Number of Farm A -associated Case-patients by Harvest Date of Consumed Oysters-2004 8 21 19 17 15 4 13 11 2 9 7 0 5 1 6 11 16 21 26 1 6 11 July June Date From McLaughlin et al NEJM 2005 353: 1463-70 16 21 26 31 Temp. of Cases 6
Environmental Investigation Results Farm A July-August Water Temperatures by Year 20 Temperature (ºC) 19 (no data 1999) 18 17 16 15 14 13 12 0.21 degree C yearly increase (r² (r²=0.14, P<0.001) 11 10 1997 1998 2000 2001 2002 Year From McLaughlin et al NEJM 2005 353: 1463-70 2003 2004
Infectious diseases already present that may increase in prevalence Clostridium botulinum Caused by eating food contaminated with botulinium neurotoxin Common in US, Canadian Arctic and Greenland Associated with fermented foods made in sealed (anaerobic) containers at temperatures above 4C (41F) Incidence may increase as ambient temperatures increase
Paralytic Shellfish poisoning (PSP) Shellfish concentrate neurotoxin from algal blooms (red-tides) Follows eating raw shellfish gastroenteritis, paralysis Alaska has one of the highest rates in US Potentially increase by climate-related sea water warming, precipitation, nutrient-laden run-off
Echinococcus sp. Endemic regions where Echinococcus sp life cycle has been established Parasitic tape worm disease Human accidental host Cyst-like lesions in liver Vectors are foxes, rodents (voles) Dogs and man accidental hosts Climate-favoring expansion of habitat may result in appearance of disease in new regions.
Giardia lamblia Protozoan infection of the GI tract Diarrhea following consumption of contaminated untreated water Beaver common host Range expanding northward in Alaska and Canada Expansion of habitat may result in appearance of disease in new regions.
Damage to the sanitation infrastructure Waterborne diseases Giardia sp Cryptosporidium Hepatitis A Water-washed diseases Bacterial Skin infections Methicillin Resistant Staphylococcus aureus Respiratory diseases RSV Pneumonia, influenza
Hospitalization Rates for High and Low Water Service Regions, Alaska, 2000-2004 *P < 0.05 250 200 150 * 100 Low Service High Service * * 50 * RS A M Sk in In fe ct io n s R SV 0 Di ar rh ea Pn eu m on ia Rate per 10,000 300 Hennessy etal AJPH 2008 in press
Infectious diseases not present but may emerge West Nile Virus Surveillance-Dead Birds 2004 West Nile virus Emerged in US 1999outbreak of encphalitis Infects mosquitoes, birds, Humans, horses dead-end hosts Mosquito vectors in Alaska and Canada A. vexans C.pipiens C.resuans Dead bird surveillance conducted 2000-2006 Furthest north 57o L North 2004 West Nile Virus Surveillance-Dead Birds 2007
What s to be done! Establish surveillance and monitoring networks for climate sensitive events Example International Circumpolar Surveillance Infectious diseases Injuries Research needed on relationship between climate change and individual and community health Investigating outbreaks that may be climate related Identification of key infectious disease indicators Studies of current health effects in local regions where effects are evident Establishing baseline relationships between weather and infectious diseases Establish community-based monitoring networks Identify common set of measures Standardized measurements Within and across regions
International Circumpolar Surveillance Network Russian Federation Finland Sweden Norway Latitude 60o North United States Arctic (Alaska) Reference labs Clinical labs Participants shown in dark grey Greenland Iceland Northern Canada Parkinson, AJ., Butler, JC. Emerging Infectious Disease January 2008
What s to be done! Establish surveillance and monitoring networks for climate sensitive events Example ICS Infectious diseases Injuries Research needed on relationship between climate change and individual and community health Investigating outbreaks that may be climate related Identification of key infectious disease indicators Studies of current health effects in local regions where effects are evident Establishing baseline relationships between weather and infectious diseases Establish community-based monitoring networks Identify common set of measures Standardized measurements Within and across regions
What is being done! Climate Change and Impacts on Human Health in the Arctic: An International Workshop on Emerging Threats and Response of Arctic Communities to Climate Change Anchorage Alaska February 13-15, 2008 CDC working group formed The Public Health Response to Climate Change: Water and Public Health Atlanta October 10-11, 2007 Human Health Challenges from Climate Change and Rapid Urbanization: Excessive Heat Vulnerability. Phoenix Az. November 14-16, 2007 Health Communication and Marketing on Climate Change Workshop January 8-9, 2008 George Mason University, Arlington Va. Workshop on Vulnerable Populations and Climate Change TBA Climate Change and Vector borne Diseases possibly in association with ICEID Atlanta GA March 16-19, 2008 Special issue of AJPM (June 2008) devoted to the public health response to climate change.
Conclusions Arctic communities uniquely vulnerable to climate change Small isolated communities Traditional lifestyle and culture important to health and wellbeing Fragile economic support, dependence on subsistence hunting and fishing Public health response and acute care may be marginal, or non-existent in some regions
Conclusions Climate change will be a source of illness, injury and mortality in the Arctic Emergence of new climate sensitive infectious diseases Increased prevalence of certain infectious diseases already present Migration northward of infectious diseases not yet present Establish surveillance networks for climate sensitive infectious diseases Conduct research on relationship between climate change infectious diseases Establish community-based monitoring networks
Additional Reading.. ACIA Scientific Report. Climate Impact Assessment. Cambridge University Press, New York 2005 www.acia.uaf.edu AHDR (Arctic Human Development Report) 2004. Akureyri: Stefansson Institute Iceland www.svs.is/ahdr www.arcticcouncil.org www.amap.no
Adapting to Climate Change!
Rate per 1,000 births Hospitalization rates for children < 3 years old according to water service in village of residence, YK region, 1999400 2004 350 300 * 250 < 10% 10-79% >= 80% Bethel * 200 ** 150 100 50 0 LRTI * P < 0.05 for trend, ** P= 0.08 for trend Pneumonia RSV RSV Pneumonia
Rate per 1,000 persons Skin infection rates compared with water service in village of residence, all ages, YK Region, 1999-2000 30 25 20 * 15 * * 10 5 0 S.aureus Skin Infection * P < 0.001 for trend MRSA Skin Infection Hospitalized Skin Infection < 10% 10-79% >= 80% Bethel