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David Banks Oration. Biosecurity in North Queensland: Challenges and opportunities. Rick Speare Anton Breinl Centre for Public Health and Tropical Medicine James Cook University Richard.speare@jcu.edu.au 13 May 2010. Questions.
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David Banks Oration Biosecurity in North Queensland: Challenges and opportunities Rick Speare Anton Breinl Centre for Public Health and Tropical Medicine James Cook University Richard.speare@jcu.edu.au 13 May 2010
Questions • Are the biosecurity risks in North Queensland different from other areas in Australia? • Do these special risks make Australia more vulnerable? • How are they being addressed? • What are the opportunities to use new approaches to reduce the risks?
What makes North Queensland special? • Receptivity to dengue • Porous PNG-Australian border • in Torres Strait
Receptivity is a Qld problem… at present Slide from Scott Ritchie (JCU)
Control of Dengue • Dengue Control Strategy • Continual enhanced surveillance under National Notifiable Disease Surveillance Scheme (NNDSS) • Dengue Alert and Response Team • State of Emergency declared to control 2008-2009 Cairns outbreak
Constant vigilence, but dengue is under control • Lethal ovitraps • Biodegradable • Research on novel control strategies using a symbiotic bacterium (Wolbachia wMelPop) • Reduces longevity • Reduces feeding ability • Inhibits dengue virus multiplication in mosquito
Pacific Island Countries & Territories (PICTs) PNG 22 countries spread over millions of km2 of Pacific Ocean PICTs are doing badly!
Southeast Asia PICTs Indonesia
Indo-Papuan Conduit Qld’s special link to Asia and the Pacific
PNG Australia
Major outcomes of the Torres Strait Treaty Act 1984 • “each Party shall apply immigration, customs, quarantine and health procedures in such a way as not to prevent or hinder free movement or the performance of traditional activities” (article 16) • Refers to residents of protected zone (PZ) and 13 coastal villages in PNG (article 10)
What are the current offshore biosecurity challenges? • Failed health systems pushing diseased PNG residents towards Torres Strait • Emerging infectious diseases (known and unknown) in Australia’s near neighbours • Poor control of livestock diseases in PICTs and Indonesia • Importation of food products carrying pathogens • Climate change, especially in PICTs, generating environmental refugees
Tuvulu Climate Change will have major impacts in PICTs!
Traditional PNG visitors • Annually 30,000-53,000 59% 2% 3% 29% 2% 4% 0.6% 0.2% 0.1% 0.5% 0.3% 0.2% Estimated 4% come specifically for health care 0.1% House Reps SC Hlth Aging Mar 2010
Contrasts in services Torres Strait • Well functioning Qld Health system staffed by doctors, nurse practitioners and remote area nurses • Specialists visit and referral - Cairns • Basic laboratory services in TS • Veterinary services intermittent in PZ Western Province • Minimal or no health service staffed by health extension officers • Very low vaccination rates • Specialist referral – Port Moresby, but inadequate • Minimal lab services • No veterinary service
Humanitarian emergencies: Entry into Cairns … and points south Saibai Thursday Is Cairns
What about movement of animals and animal products? • AQIS Quarantine offices = 15 Northern Australian Quarantine Strategy (NAQS)
Incursions that have occurred and are under control • Malaria (surveillance - NNDSS) • Dengue (enhanced surveillance - NNDSS) • Japanese encephalitis 1995 (NNDSS, vaccination of all TS residents) • TB (NNDSS) • Leprosy (NNDSS) Merritt et al 1998
Incursions that are not under control • Asian tiger mosquito (Aedes albopictus) found in 10/17 inhabited islands in 2005 Current Distribution Predicted Distribution Russell et al (2005)
Current Emerging Infectious Disease Threats • Multidrug resistant TB, particularly in PNG • Cholera now moved to south coast PNG • Arboviral diseases (Dengue, Japanese encephalitis, West Nile, Chickungunya) • Asian tiger mosquito (A. albopictus) in Torres Strait • Rabies moving east in Indonesia • Highly pathogenic avian influenza and other avian viruses • Nipah virus and other bat-borne viruses • New pathogens emerging from wildlife
Pulmonary TB(Mycobacterium tuberculosis) • Chronic cough (2 wks) • Productive • Haemoptysis (blood in sputum) • Weight loss • Night sweating
Multidrug Resistant TB (MDRTB) • TB is a serious disease • TB prevalence • Aust 5/100,000 • Western Province 552/100,000 (DoH WestProv 2009) • MDRTB is resistant to two of the first line drugs (rifampacin & isoniazid) • Harder to treat & more expensive • 30% of Australia’s MDRTB comes through Torres Strait from Western Province of PNG • Rate of MDRTB in PNG patients in Torres Strait • 25-39% (DHA 2009 dha_171209)
Bad enough!But wait there’s more… • Inadequate treatment drives MDRTB • Evolution to extensively drug resistent TB (XDRTB) is a possibility
Challenges in PNG • DOTS system to treat TB not implemented • No reliable routine TB culture • Inadequate treatment generates multidrug resistance • Partial treatment of TB in Australia may generate MDRTB • No strategy in Western Province to treat MDRTB • HIV is increasing in PNG
Risk of MDRTB to North Queensland? • Manageable since TB control is good in Torres Strait and socio-economic conditions are protective • For local residents risk is not high • Risk highest to health professionals in Torres Strait caring for PNG cases
Management of risk of MDRTB • In Torres Strait • Maintain Aust TB control system • Enhanced surveillance for suspect TB cases • Protect health care workers • In Western Province • Adequately treat PNG patients that present in TS • Cross-border collaboration (Communications officers) • Subsidised boat trips to complete treatment • Assist PNG to improve TB control in Western Province • Assist PNG to establish TB culture facilities at Daru or Balimo
Facilitated cross-border movement • TS Health Issues Committee (HIC) “Package of measures” • Allow travel directly from Saibai and Boigu to treaty villages for nominated health professionals • Agreed to by both sides • Implementation date?
Cholera • PNG cholera epidemic began in Lae in Oct 2009 • Spread to Madang Oct 2009 • Nov 2009 west along north coast, and inland to highlands • May 2010 first cases in Port Moresby • When will it reach the Western Province? How will Australia respond?
JE Other arboviruses? Dengue
Arboviruses • Dengue virus (DEV) • Japanese encephalitis virus • Chickunguna virus • West Nile virus • Unknown and undiscovered viruses Only dengue virus is host specific: 1) humans, 2) Aedes aegypti or A. albopictus
Aedes albopictus Receptivity is a Qld problem, but rain water tank installation will expand the range of the vectors south
Unknown arboviruses in PNG? • Madang encephalitis • Not JEV? • Death in children and severe disability
Rabies is moving east in Indonesia • Susetya et al. Virus Res 2008;135:144-9. Not if, but when? 1997 2008
Strategies to defend against rabies from Indonesia • Assist PNG to monitor dogs with neurological signs (no functional vet service) • Surveillance • Laboratory capacity • Assist in control of rabies in Indonesia • AQIS officers monitoring dogs in Torres Strait • AMRRIC improving dog health in Indigenous communities • Control in wild dogs & dingoes is a problem • Vaccinate against rabies by baiting
HPAI? Other EID? Other arboviruses? JE Bat viruses? Dengue MDRTB
Wildlife Diseases: EID risks • Two higher risk flying reservoirs • Bats: Henipaviruses, lyssaviruses, filoviruses, coronaviruses, rheoviruses, herpesviruses, other viruses • Birds: Avian influenza and other avian diseases Wildlife EIDs are driven by habitat destruction, humans using resources, climate change
Flying foxes are hosts to a range of RNA viruses that cause EIDs • Halpin et al. CID 2007;44:711-717 Dobsonia magna
Highly Pathogenic Avian Influenza • Pandemic (for birds) • H5N1 is here to stay
H5N1 in Indonesia • H5N1 HPAI is widespread • 165 human cases with 136 fatal (82%)
H5N1 Indo-Papuan Conduit Will H5N1 use this route? Ongoing monitoring of poultry & wild birds in PNG & Torres Strait for AI?
Wildlife Disease Surveillance is essential "Our findings highlight the critical need for health monitoring and identification of new, potentially zoonotic pathogens in wildlife populations, as a forecast measure for EIDs” (Jones et al. Nature 2008) We must be looking for • mortality and morbidity in wildlife, esp bats and birds • Marine animals – reptiles, mammals, fish? • Monitoring regularly for particular diseases • Avian influenza • Newcastle disease • West Nile virus (in birds) • Bat henipaviruses
Australian Wildlife Health Network • Largely voluntary surveillance • Should be a parallel system equivalent to human communicable disease surveillance system and veterinary surveillance system • Not functioning in Torres Strait or Cape York • Poorly funded • Major deficiency in biosecurity surveillance in North Queensland
Opportunities in PNG • Assist PNG to establish communicable disease surveillance in Western Province • Syndromic surveillance for outbreak diseases may be best model • Consider a joint human, livestock, and wildlife surveillance system (true “One Health”) • Initially provide expert support from Torres Strait • Initially provide lab support from Australia • Utilise the facilitated cross-border movement approach