1. CLIMATE CHANGE AND PANDEMIC INFLUENZA: THRESHOLDS AND ADAPTATION Kirsty Duncan PhD FSAScot Health Studies, University of Toronto at Scarborough ©

4. H5N1 IN HUMANS: SYMPTOMS fever abdominal pain, bleeding from the gums and nose, chest pain, diarrhoea, vomiting pneumonia multi-organ dysfunction

5. H5N1 IN HUMANS: TREATMENT some anti-viral drugs (e.g. Tamiflu) -improve chance of survival older antivirals antibiotics the disease currently kills over 60% of its victims [357 cases, 225 deaths (31/01/08)]

6. H5N1: THE CONCERN is affecting new animal hosts is increasing its geographic range is highly pathogenic is mutating rapidly several instances of limited human-to-human transmission have occurred causes severe disease in humans has many genetic similarities to the 1918 virus

8. PANDEMICS global epidemic due to a newly-emerged strain of flu few, if any, people have any immunity three pandemics in the last century –1918 (H1N1) –1957 (H2N2) –1968 (H3N2)

9. EPIDEMIOLOGY the principal vectors are: –the migration of wild birds harboring the virus Bar-headed geese Brown-headed gulls Great black-headed gulls, etc. –trade in domestic poultry crew egg flats trucks

11. WEATHER AND MIGRATION weather can directly and indirectly affect breeding success and migration –chilling or starving young –foraging conditions –temperature affects pre-migratory preparation –fronts signal when to migrate –high pressures signal when to feed –wind conditions affect flying

12. CLIMATE CHANGE AND MIGRATION global temperature is expected to increase 1.1-6.4 C over the coming century –this warming is likely to be without precedent during the last 10,000 years if springs become warmer, birds will nest earlier –in North America, Tree Swallows breed 9 days earlier than 30 y.a.

13. SUMMER AND FALL 2006 sixth-warmest year on record since 1850 Europe experienced its warmest fall in 500 years –Central England experienced warmest, July, September, and autumn temperatures –Switzerland experienced November and early- December temperatures 10C above normal –anecdotally, in North America: New York City experienced no snowfall in November and December for the first time since 1877; in Maryland, buds appeared in apple trees, and crocuses pushed up from the ground in New Jersey; and frogs re-emerged from winter hibernation

14. FUTURE

15. CAN A PANDEMIC BE AVERTED? the answer is unknown Adaptation the best way to prevent a pandemic would be to eliminate the influenza virus from birds antiviral medications to treat early cases

16. ADAPTATION global problem global responsibility national responsibility organizational responsibility –U.S. officials asked business, health, and religious groups in June, 2007 to urge Americans to prepare for a possible pandemic personal responsibility