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Infectious disease early warning systems: experience from ECDC

Jan C. Semenza

European Centre for Disease Prevention and Control

Countries reporting climate change risk for food and waterborne diseases

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0.72007 2009/2010

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Missing data for 2007

Semenza JC, et al., Environ Health Perspect. 2012;120(3):385-92.

Effectiveness of institutions, health services and surveillance in relation to climate change

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Weak

Could usesignificantimprovement

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Very effective

Semenza JC. et al., Environ Health Perspect. 2012 ;120(3):385-92

Weighted risk analysis of climate change impacts on infectious disease risks in Europe IDs for suggested changes to disease-specific surveillance are in bold. Asterisks indicate diseases currently notifiable in some EU Member States

Lindgren E et al., Science. 2012;336(6080):418-9.

Different clinical manifestation of vibriosis

1. Wound infections. Caused by a range of different Vibrio

spp. including V. vulnificus, V. alginolyticus, V. cholerae –

normally caused by exposure of cut, wound or abrasion to

contaminated seawater. Seriousness of infection is partly

determined by species in question – V. vulnificus probably

the worst ~25% mortality rate (Oliver 2005).

2. Gastroenteritis. Nausea, vomiting, diarrhoea - again,

caused by a range of different Vibrio spp. – most commonly

V. vulnificus, V. parahaemolyticus and V. cholerae – normally

caused by consumption of raw/undercooked seafood and/or

exposure to contaminated water sources.

3. Septicaemia (blood poisoning). Most serious clinical

manifestation associated with vibriosis. Often fatal,

depending on pathogen involved (V. vulnificus > 50% of

cases). 100 Vibrio fatalities a year in the USA, mostly

septicaemia-associated, numerous recent cases in Europe.

Slide courtesy of Jaime Martinez-Urtaza

Pathogenic vibrios present in the marine environment

V. vulnificus

V. parahaemolyticus

V. alginolyticus

V. cholerae

Gram negative bacteria – common in marine and estuarine environments.

All these species proliferate in warm (>15 °C) and low salinity (<30 ppt NaCl) seawater.

Complex life cycle: planktonic and attached to marine organisms

Slide courtesy of Jaime Martinez-Urtaza

Environmental precursors of disease

time

Health outcomes

Environmental consequences

Climate change

CO2

Socio- economic impacts

(homelessness, refugees…)

Indirect exposures

(vector-borne diseases, other infectious diseases)

Surveillance

Direct exposures

(heat stroke, drowning…)

Semenza JC. Int. J. Environ. Res. Public Health. 2015;12(6):6333-51

Global SST exceeding 15 0 C (days, 1982-2011)

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Global overview of the percentage of regions where sea surface temperatures (SST) are above 15 0 C (1982-2011). Large areas over which temperature is suitable for Vibrio growth - around 70% of ocean surface.

Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

Vibrio: adaptation to different ecosystems

Source: http://sungminubc.wikispaces.com/vibrios

Temporal and spatial distribution patterns of potentially pathogenic Vibrio spp. at recreational beaches of the German north sea

Boer, et al., Microb Ecol. 2013; 65(4)1052-67

Disproportionate warming in Northern and Southern latitudes

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Difference in the number of days above 18ºC between 2004-2011 and 1982-1989. Indicates potential areas of Vibrio expansion in response to ocean warming, focussed in many temperate regions (~N40º, ~S40º).

Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

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Environmental suitability for Vibrio spp.

Warming of the Baltic Sea

Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

Sea surface salinity (SSS) in Europe

15 Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

Vibrio model

16 Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

Vibrio model: Baltic Sea

17 Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

Environmental suitability for vibrio ssp.

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Temperature (SST)

Salinity (SSS)

Tem

pera

ture

(o C

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Salinity (NaCl ppt)

Risk algorithm

Baker-Austin et al., 2013, Nature Climate Change. 2013(30): 73-77

Semenza JC, et al., PLOS Neglected Tropical Diseases. 2013; 7(7): e2323

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Validation study: Case-crossover Clinical and laboratory confirmed vibrio case data were

obtained from the mandatory notification system at the Swedish Public Health Agency: 2006-2014

The SST exposure status of the vibrio infection at the time of the vibriosis onset was compared to the distribution of SST in earlier/later periods

Conditional logistic regression model was used to derive an exposure-response curve for the relationship between the odds ratio of vibrio infection and SST

Climate change projections of SST were derived from a CMIP5 model ensemble (r1i1p1) for the Swedish coast line aggregated to county

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Annual frequency of total vibrio infections notified in Sweden from 2006-2014

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Proportion of notified cases with vibrio detected in ear, blood, wound, and feces/ mouth/urine, Sweden, 2006-2014

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Age distribution of notified vibrio infections, Sweden 2006-2014

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Exposure-response relationship of vibrio infections in response to sea surface temperature, Sweden 2006-2014

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Change in relative risk (%) of vibrio infections associated with climate change scenario RCP 4.5, 21th century

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Change in relative risk (%) of vibrio infections associated with climate change scenario RCP 8.5, 21th century

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Months with risk of transmission (%) of vibrio infections associated with climate change scenario RCP 4.5, 21th century

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Months with risk of transmission (%) of vibrio infections associated with climate change scenario RCP 8.5, 21th century

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Conclusions

In July 2014, the ECDC Vibrio Map Viewer detected highly suitable conditions for vibrio infections in the Baltic Sea

The mandatory notification system reported a historic peak of vibriosis cases for 2014

Exposure-response relationship between vibrio infections and SST: reported vibrio infections are related to these favorable environmental conditions

Risk for further vibrio infections will increase in the 21st century

Transmission season will expand

The E3 network can bolster early warnings for climate-related ID events by providing data and tools for epidemiologic analysis

Acknowledgements

J. Rocklöv

M.B. Quam

W. Lohr

B. Sudre

J. Martinez-Urtaza

http://E3geoportal.ecdc.europa.eu Thank you!

Jan.semenza@ecdc.europa.eu

IJERPH Special Issue: Climate Change and Human Health