1. Bats, Rats, Monkeys... Oh My! How Animals Impact Human Health Andrew Clements, Ph.D. USAID/Bureau for Global Health, Avian Influenza and Other Emerging Threats Unit October 8, 2010 USAID Global Health Mini-University

2. Examples of Common “Human” Pathogens with Evolutionary Origins in Animals DiseasePathogenOriginal Host AIDSHIV-1, HIV-2Monkeys/apes Dengue fever Dengue fever viruses Primates Diphtheria Corynebacterium diphtheriae bacteria Probably domestic herbivores Hepatitis Hepatitis B virus Apes Influenza Influenza A viruses Wildfowl Malaria Plasmodium parasites Birds and/or monkeys Measles Measles virus Sheep/goats Plague Yersina pestis bacteria Rodents Sleeping sickness Trypanosoma brucei parasite Wild ruminants Small pox* Variola virus Ruminants (possibly camels) Typhus Rickettsia prowazeckii Rodents Yellow fever Yellow fever virus Primates Source: Wolfe et al. 2007. Nature 447(7142):279-283. * Eradicated in 1980.

3. Examples of Other Animal Diseases that Periodically Affect Human Populations Sources: Wolfe et al. 2007. Nature 447(7142):279-283; WHO DiseasePathogenOriginal Host Avian InfluenzaH5N1 influenza A virusBirds Ebola Hemorrhagic Fever Ebolavirus Bats? Marburg Hemorrhagic Fever Marburgvirus Bats? Monkey pox Orthopox virus Squirrels/rodents? Nipah Nipah virus Bats Rift Valley FeverRVF virus Livestock Severe Acute Respiratory SyndromeSARS coronavirus Bats/palm civets West Nile Fever West Nile virus Birds

4. Emerging Infectious Diseases (EID) Global trends in emerging infectious diseases, K. Jones et al, 2008, Nature, Vol 451.21 Global distribution of relative risk of an event caused by zoonotic pathogens from wildlife Retrospective analysis of 335 EID events (1940-2004) Global distribution of relative risk of an event caused by zoonotic pathogens from domestic animals EID events have risen significantly over time ~60% of EIDs originated in animals  ~70% of these from wildlife  bats, rodents, non-human primates most often associated with EIDs from wildlife EID origins significantly correlate with socio-economic, environmental and ecological factors  limited detection/reporting capacity in geographic “hot spots” for EID emergence

5. Current Public Health Systems Often use “vertical” programs focused on specific infectious diseases that commonly affect humans Weak linkages with wildlife and domestic animal health Emerging infectious diseases in animal populations often not detected until there is an unusual cluster of human cases Limited ability to adapt to detecting and containing new diseases in human population Slow response to new diseases that efficiently spread from person to person can result in regional epidemics or pandemics (e.g. SARS, 2009 H1N1 flu)

6. Human Pandemics of the 20 th and 21 st Century DiseaseTime Period Original HostImpact H1N1 influenza A1918-1919Birds?~50 million deaths HIV/AIDS~1930-2010 Monkeys>25 million deaths H2N2 influenza A1957-1958 Birds and mammals?~1-2 million deaths H3N2 influenza A 1968-1969 Birds and mammals?~1-2 million deaths SARS 2003 Bats/palm civets~800 deaths; >$80 billion in economic losses H1N1 influenza A 2009-2010 SwineTBD Pandemic*: worldwide epidemic of a disease that may occur when a new pathogen appears against which the human population has no immunity * WHO

7. domestic animal outbreak Cross- species transmission Animal Health Surveillance/Response TIME Shifting from Public Health to “One Health” human cases CASESCASES Public Health Surveillance/Response wild animal outbreak Cross- species transmission Cross- species transmission wild animal outbreak Wildlife Health Surveillance/Response

8. domestic animal outbreak Animal Health Surveillance/Response Cross- species transmission TIME Public Health Benefits of Earlier Detection CASESCASES wild animal outbreak Wildlife Health Surveillance/Response Cross- species transmission human cases Public Health Surveillance/Response

9. H5N1 Avian Influenza: “Chasing Chickens for Public Health” Sources: OIE, FAO, and WHO reports through 8/3/10. Year Worldwide H5N1 poultry outbreaks Worldwide H5N1 human cases USAID programmed ~$550 million between 2005 and 2010 Key outcomes: 1. Faster confirmation times for poultry and wild bird outbreaks  decreased outbreak size  fewer subsequent outbreaks  fewer people exposed to virus 2. Cross-sectoral collaboration improved  Animal outbreaks often used to trigger search for possible human cases Public health impact: fewer human cases and better treatment/containment, decreases chances of virus acquiring ability to efficiently move from person to person

10. USAID: Expanding Beyond Avian Influenza AI and Other Emerging Threats Programs managed by USAID/GH’s Avian Influenza and Other Emerging Threats Unit. Pandemic Prevention Avian Influenza (2005-2010+) mostly Asia; some Africa and E. Europe poultry and human surveillance and response, communications, commodities for containment Emerging Pandemic Threats (2009-2014) C. Africa, Amazon, SE Asia, So. Asia wildlife and human surveillance and response, risk determination and reduction Pandemic Preparedness Pandemic Response (2007-2010+) mostly Africa, Asia pandemic planning for civil society and military; linked to disaster preparedness (2009) mostly Africa, Asia planning & provision of equipment needed for delivery of donated H1N1 pandemic vaccine ~$350-400 million over 5 years

11. Risk-Based Focusing of USAID Emerging Pandemic Threats (EPT) Program All countries All animals All pathogens EPT Focus: 4 regional “hot spots” diseases from bats, rodents, non-human primates pathogens TBD

12. USAID EPT Program Objective: pre-empt or contain diseases that could spark future pandemics Key Areas of Emphasis: Wildlife pathogen detection * : Identification of target pathogens in wildlife that threaten humans Risk Determination * : Characterization of potential risk and method of transmission for specific diseases of animal origin Routine Surveillance and Outbreak Response**: Support for sustainable country-level response for control of “normative” diseases Risk Reduction ** : Promotion of actions that minimize or eliminate the potential for the emergence and spread of new disease threats * Represent activities related to wildlife that have generally been missing or underfunded ** Normative functions associated with animal and public health systems

13. Summary 1.Over time, a variety of infectious diseases new to humans have been “crossing over” from animal populations  trend expected to continue  some animal diseases cause deadly and/or disruptive human pandemics 2. In order to adapt to emerging threats, public health systems need to take a more-proactive approach to surveillance and response which includes improving linkages to wildlife and animal health sectors 3.Promoting a “One Health” approach with USAID’s Emerging Pandemic Threats program will contribute to improving: –detection and response to emerging threats –overall public health functions including detection and response to common diseases