The Global Threat of Epidemic Emergent- Re-Emergent Infectious Diseases: Lessons Learned and Prospects for the Future S. Machado Duane J Gubler Professor.

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Presentation transcript:

The Global Threat of Epidemic Emergent- Re-Emergent Infectious Diseases: Lessons Learned and Prospects for the Future S. Machado Duane J Gubler Professor Duke Global Health Inst, 3 Sept, 2013 Signature Research Program in Emerging Infectious Diseases Duke-NUS Graduate Medical School, Singapore

The Global Threat of Epidemic Emergent/ Re-Emergent Infectious Diseases Background Case studies of selected epidemic IDs Reasons for emergence Lessons learned Prospects for the future How do we reverse the trend?

The Global Threat of Infectious Diseases Emerging and re-emerging diseases A/H1N1 H7N9 A/H1N1 Dengue MERS Chikungunya Dengue MERS Emerging diseases Adapted from Morens, Folkers, Fauci 2004 Nature 430; 242-9 Re-emerging diseases

The Global Threat of Emerging Zoonotic Diseases Natural Hosts Rodents Bats Birds Others Modes of Transmission Direct contact Respiratory Vector-borne Usually silent Type of Pathogen Viruses Bacteria Parasites

Major Infectious Disease Epidemics since 1980 Dengue/DHF-1970s, SE Asia, global HIV/AIDS-1980s-Africa,global Drug resistant TB-1990s, US, global Cholera-1991-Americas Plague-1994-India, global Foot & Mouth disease-1995,2000- Taiwan & UK West Nile-1990s-Mediterranean, Americas BSE-1990s- UK, Canada, US Swine fever, 1996- Netherlands Avian influenza-1997- HK-global Nipah encephalitis-1998-Malaysia,Asia SARS-2002- Asia, global Chikungunya-2004-Africa, Asia H1N1 influenza-2009-Mexico?,global Hand, foot and mouth disease, Asia MERS and H7N9 ?

Public health impact Social impact Economic impact Dengue Hemorrhagic Fever

The changing epidemiology of dengue Expanding geographic distribution Hyperendemicity Increased epidemic activity Emergence of DHF No of Cases Source: DengueNet

West Nile Virus in the Western Hemisphere

Epidemic West Nile Virus in the United States

1999 4 States 62 Cases

2000 12 States 21 Cases

2001 27 States 66 Cases

2002 44 States 4156 Cases

2003 46 States 9862 Cases

2004 47 States 2535 Cases

2005 48 States 2819 Cases

Persistent Epidemic Transmission Foci Have Developed 2006 48 States 4219 Cases

Epidemic/Epizootic West Nile Virus 1937 1950-75 1994 - 1999 Adapted from Gubler, 2007

Epidemic/Epizootic West Nile Virus 1937 1950-93 1994 - 2007

Phylogenetic Tree of West Nile Viruses Molecular Evolution of WN Virus Strains Egypt 1951 France 1965 South Africa Phylogenetic Tree of West Nile Viruses Israel 1952 Romania 1996 M Kenya 1998 Senegal 1993 Morocco 1996 Italy 1998 Volgograd 1999 New York 1999 Israel 1998 NY2000 3282 US/ NY2000 3356 NY 1999 equine LIN-1 NY 1999 hum Israel Conn 1999 MD 2000 NJ 2000 Israel 1999 H C.Afr.Rep 1989 Senegal 1979 Algeria 1968 C.Afr.Rep 1967 Iv.Coast 1981 1 Kunjin 1960 Kunjin 1973 Kunjin Kunjin 1984b Kunjin 1991 Kunjin 1984a Kunjin 1966 Kunjin 1994 ALL OF THE US STRAINS ARE VERY CLOSELY RELATED TO ONE ANOTHER AND MOST CLOSELY RELATED TO STRAINS WHICH CIRCULATED IN ISRAEL IN 1998 & 1999. SIDE COMMENT ABOUT HOW THE VIRUS GOT HERE. WE DON’T KNOW CONCLUSIVELY BUT I DOUBT THAT IT WAS AN INFECTED HUMAN-VIREMIAS ARE TOO LOW. India India 1955a India 1980 India 1958 India 1955b Kenya 2 Uganda Senegal 1990 Uganda 1937 C.Afr.Rep 1972a LIN-2 C.Afr.Rep 1983 Uganda 1959 C.Afr.Rep 1972b Madagascar 1988 Madagascar 1986 Madagascar 1978 JE SA 14

Plague Pandemics Justinian’s Plague (mid-6th Century A.D.) Black Death (mid-14th Century A.D.) Modern Pandemic (1894 – mid-1900s)

Surat

Potential Spread of Pnuemonic Plague out of India, 1994 Delhi Calcutta Madras Bombay Potential Spread of Pnuemonic Plague out of India, 1994

Pneumonic Plague in India Indian outbreak was a complete surprise – no plague confirmed in India since 1966 Clinical and lab diagnosis were confused Media and panic driven epidemic First epidemic to impact globalization Caused huge economic loss for India (> $3 billion)