1. 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

2. 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?

3. 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

4. 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

5. 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, Netherlands
Avian influenza HK-global
Nipah encephalitis-1998-Malaysia,Asia
SARS Asia, global
Chikungunya-2004-Africa, Asia
H1N1 influenza-2009-Mexico?,global
Hand, foot and mouth disease, Asia
MERS and H7N9 ?

6. Public health impact Social impact Economic impact
Dengue Hemorrhagic Fever

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

8. West Nile Virus in the Western Hemisphere

9. Epidemic West Nile Virus in the United States

10. 1999
4 States
62 Cases

11. 2000
12 States
21 Cases

12. 2001
27 States
66 Cases

13. 2002
44 States
4156 Cases

14. 2003
46 States
9862 Cases

15. 2004
47 States
2535 Cases

16. 2005
48 States
2819 Cases

17. Persistent Epidemic Transmission Foci
Have Developed
2006
48 States
4219 Cases

18. Epidemic/Epizootic West Nile Virus
1937
Adapted from Gubler, 2007

19. Epidemic/Epizootic West Nile Virus
1937

20. 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 NY
US/ NY
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

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

23. Surat

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

25. 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)