Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases?
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Why Have we Seen Such a Dramatic Increase in Epidemic Infectious
Diseases?
• Complacency, Lack of Political Will
• Policy Changes
• Changes in Public Health
• Changing Life Styles/Behavior
• Microbial Adaptation
• Technology
• Intent to Harm
• Climate Change?
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Dengue f
ever
outbreak kills
dozens
in Bra
zil
Deadly by the Dozen: 12
Diseases Climate Change
May Worsen
Another death in
Tonga from
dengue fever
Paraguay: Dengue and yellow
fever outbreak DREF
Operation No. MDRPY003
Update No.1
Dengue fever warning for Thailand
An exotic blend
Dengue Fever is ready to
spread across the country
Health alert -
Dengue fever risk
Dengue fears
Climate change will fuel
dengue - WHO exec
Climate change to hit coastal
pregnancies
Warming Increases Malaria, Dengue Fever Threat,SOUTH AMERICA: Climate Change
Fuels Spread of Dengue Fever
Scientists Predict Global Warming Will Lead to Spread of Disease
As Earth Warms Up, Tropical Virus Moves to Italy“ nytimes.com/2007/12/23
Chikungunya disease in NYC? Warming could make it happen Virus causes severe joint pain, is spread by two mosquito species; NBC News
Asian mosquito 'could bring
tropical diseases to Britain‘, The
Independent, 2013
Climate change, globalization, and otherdrivers have made Europe a “hot spot” foremerging infectious diseases, which callsfor changes in monitoring systems27 APRIL 2012 VOL 336 SCIENCE.
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“Fueled by climate change, dengue fever is on the rise again throughout the developing world,
particularly in Latin America”.
Reference: Dengue fever: a deadly scourge. The Economist, April 19, 2007.
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Dengue/Dengue Hemorrhagic Fever, Average Annual Number of Cases Reported to WHO, 1955-2003
0100000200000300000400000500000600000700000800000900000
1000000
1955
-195
9
1960
-196
9
1970
-197
9
1980
-198
9
1990
-199
9
2000
-200
3
Num
ber
of C
ases
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There is no solid scientific evidence to date that global warming has been a major driving force of the 20th century re-emergence of vector-borne infectious diseases!
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Why Have we Seen Such a Dramatic Increase in Epidemic Infectious
Diseases?
• Demographic Changes (Pop Growth) Environmental Change
- Uncontrolled Urbanization
- Agricultural/Land Use Practices
- Deforestation
- Climate change
Animal Husbandry
• Modern Transportation (Globalization) Increased Movement of People, Animals,
Commodities
• Lack of Public Health Infrastructure
Major Drivers
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Global population- 1950-2050Global population- 1950-2050
Evaluation of urban and rural population between 1950 and 2050Evaluation of urban and rural population between 1950 and 2050
Pop
ulat
ion
(Mill
ions
)P
opul
atio
n (M
illio
ns)
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Urban Growth in Asian(1) and American(2) Cities, 1950-2010
1. Mean population of Dhaka, Bangkok, Jakarta, Manila and Saigon.
2. Mean population of Rio de Janeiro, Sao Paulo, San Juan, Caracas and Guayaquil.
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The global air networkThe global air network
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Average annual number of global airline passengers by decade, 1950-2010
IATA 2010IATA 2010
Mill
ion
of P
ass
enge
r (M
il)M
illio
n o
f Pa
ssen
ger
(Mil)
DecadeDecade
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Commercial Air Traffic Over a 24 Hour Period
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Global distribution of dengue virus serotypes, 1970Global distribution of dengue virus serotypes, 1970
Gubler, 1998
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Global distribution of dengue virus serotypes, 2013Global distribution of dengue virus serotypes, 2013
Adapted from Gubler, 1998
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Exotic Infectious Diseases That HaveRecently Been Introduced to the US
• West Nile Fever• Dengue Fever• Yellow Fever• Mayaro Fever• Chikungunya• Epidemic Polyarthritis• SARS• Influenza• Lassa Fever
• Monkeypox• CJD/BSE• HIV/AIDS• Cholera• E. coli O157• Malaria• Leishmaniasis• Chagas Disease• Cyclospora
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Live Animal Importation into the USA - 2002
• 47,000 mammals 28 species of rodents
• 379,000 birds
• 2 million reptiles& Poisonous snakes
• 49 million amphibians
• 223 million fish
Data from U.S. Fish & Wildlife Service
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Exotic Mosquito Species Recently Introduced and Established in the US
• Aedes (Stegomyia) albopictus
• Ochlerotatus (Aedes Finlaya) togoi
• Ochlerotatus (Aedes Finlaya) japonicus
• Aedes bahamensis
• Culex biscayensis
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Urbanization Agricultural, land use and animal husbandry
changes/practices
Habitat alteration
Species’ Ecological-evolutionary DynamicsOpportunistic habitat expansion/ecological release
Vector (domestication) Domestic vector/reservoir species Wildlife/reservoir transport/encroachment Human encroachment
Host-Pathogen DynamicsEmergence Processes of ‘Host-Parasite Biology’
Host switching (host novelty) • Breaching of pathogen persistence thresholdsTransmission amplification and genetic change (pathogen novelty)
Disease Emergenceecosystem continuum
HUMAN
ECOSYSTEM
NATURAL
ECOSYSTEM
Global climate change
Demographic ChangesTechnology/Globalization
Socio-cultural organization
REGIONAL ENVIRONMENTAL CHANGE
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New York City
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Aedes aegyptiAedes aegypti
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POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER
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Global Threat of Epidemic Infectious Diseases
• Disease and Trade-interwoven History 14th century, Europe discovers exotic goods from
Asia
• Global Trade Flourishes 18th, 19, 20th centuries
• New Millennium Integrated global economic system with a
transnational flow of knowledge, capital, products, people, animals, and pathogens
Rapid spread of epidemic infectious disease from point of origin
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Global Threat of Epidemic Infectious Diseases
• Dawn of 21st century, we have come full circle
• Expect the unexpected
• New diseases will emerge
• Old diseases will re-emerge
• Modern transportation and globalization will disseminate
• Unlikely that a zoonotic disease can be eradicated
Lessons Learned
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Global Threat of Epidemic Infectious Diseases
Lessons Learned
• Disease detection and identification systems must be improved and maintained
• International communication and cooperation are critical
• Rapid response plans must be developed and implemented appropriately
• More emphasis must be placed on prevention as opposed to emergency response
• Outbreaks should be contained as local public health events if possible
• Public and Press need reliable information to prevent panic and overreaction
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The Global Threat of Infectious Diseases
Global Trends, 2012-20025
• Most of global economic growth in Asian countries
Increased trade
Increased movement of people, animals and commodities from Asia to rest of world
• Most of global population growth in cities of Asia Rural to urban circular migration
• Globalization
• Increased movement of pathogens
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Global Threat of Epidemic Infectious Diseases
Challenge to Reverse the Trend
• Movement of Pathogens and Vectors via Modern Transportation
• International cooperation and data sharing
• Lack of Effective Laboratory-based Surveillance
• Lack of Public Health Infrastructure to Prevent & control Vector-borne and Zoonotic Diseases
Trained personnel
Laboratory capacity
Tools (vaccines, drugs, insecticides, vector control tools)
Understanding disease ecology
• Political Will
Economic support
Regional prevention and control programs