1. 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?

2. Climate change to hit coastal pregnancies
         
Scientists Predict Global Warming Will Lead to Spread of Disease
As Earth Warms Up, Tropical Virus Moves to Italy“ nytimes.com/2007/12/23
Dengue fever warning for Thailand
Deadly by the Dozen: 12 Diseases Climate Change May Worsen
Dengue fever outbreak kills dozens in Brazil
Climate change to hit coastal pregnancies
Dengue fears
Warming Increases Malaria,
Dengue Fever Threat,
Paraguay: Dengue and yellow fever outbreak DREF Operation No. MDRPY003 Update No.1
An exotic blend Dengue Fever is ready to spread across the country
SOUTH AMERICA: Climate Change
Fuels Spread of Dengue Fever
Climate change will fuel dengue - WHO exec
Health alert - Dengue fever risk
Climate change, globalization, and other
drivers have made Europe a “hot spot” for
emerging infectious diseases, which calls
for changes in monitoring systems
27 APRIL 2012 VOL 336 SCIENCE.
Asian mosquito 'could bring tropical diseases to Britain‘, The Independent, 2013
Another death in Tonga from dengue fever
Chikungunya disease in NYC? Warming could make it happen
Virus causes severe joint pain, is spread by two mosquito species; NBC News

3. Reference: Dengue fever: a deadly scourge.
“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.

4. Dengue/Dengue Hemorrhagic Fever, Average Annual Number of Cases Reported to WHO, 1955-2003

5. 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!

6. Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases?
Major Drivers
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

7. Global population
Population (Millions)
Evaluation of urban and rural population between 1950 and 2050

8. Urban Growth in Asian(1) and American(2) Cities, 1950-2010
Mean population of Dhaka, Bangkok, Jakarta, Manila and Saigon.
Mean population of Rio de Janeiro, Sao Paulo, San Juan, Caracas and Guayaquil.

10. The global air network

11. Average annual number of global airline passengers by decade, 1950-2010
Million of Passenger (Mil)
IATA 2010
Decade

12. Commercial Air Traffic Over a 24 Hour Period

13. Global distribution of dengue virus serotypes, 1970
DEN 1 DEN 2
DEN 3
DEN 4
Gubler, 1998

14. Global distribution of dengue virus serotypes, 2013
DEN 1 DEN 2
DEN 3
DEN 4
Adapted from Gubler, 1998

15. Exotic Infectious Diseases That Have Recently 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

16. 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

17. 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

18. Demographic Changes Disease Emergence
Technology/Globalization
Socio-cultural organization
Global climate change
Urbanization
Agricultural, land use and animal husbandry changes/practices
Habitat alteration
NATURAL
ECOSYSTEM
HUMAN
ECOSYSTEM
REGIONAL ENVIRONMENTAL CHANGE
Species’ Ecological-evolutionary Dynamics
Opportunistic habitat expansion/ecological release
Vector (domestication) Domestic vector/reservoir species
Wildlife/reservoir transport/encroachment Human encroachment
Host-Pathogen Dynamics
Emergence Processes of ‘Host-Parasite Biology’
Host switching (host novelty) • Breaching of pathogen persistence thresholds
Transmission amplification and genetic change (pathogen novelty)
Disease Emergence
ecosystem continuum

20. New York City

21. Aedes aegypti

22. POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER

23. 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

24. Global Threat of Epidemic Infectious Diseases
Lessons Learned
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

25. 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

26. The Global Threat of Infectious Diseases
Global Trends,
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

27. 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