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Infezioni e Globalizzazione

Infezioni e Globalizzazione. Massimo Galli Infectious Disease Unit DIBIC L.Sacco, University ofMilano. Timeline of new and emerging infections since 1997. Vettori, clima ed infezioni emergenti. The most important event in mankind history. World population (in millions).

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Infezioni e Globalizzazione

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  1. Infezioni e Globalizzazione Massimo Galli Infectious Disease Unit DIBIC L.Sacco, University ofMilano

  2. Timelineofnew and emerginginfectionssince 1997

  3. Vettori, clima ed infezioni emergenti

  4. The most important event in mankind history World population (in millions) • It was estimated that from the earliest H.sapiens to 2002 they lived on the planet 106 billion human beings. Of these, 6% were living in 2002

  5. Air transport passenger carried per year Source: World Bank 2017

  6. Whatisbetterforaninfectiousagent? • WNV landed for the first time in America in 1999 and then quickly spread to much of North America • CHICKV has been adapting to a new carrier in just a few years, has caused epidemics in geographic areas that have never been touched before and has been steadily rooted in the Americas • ZIKV, another African virus, has caused epidemics in Polynesia and then in the Americas, assuming the connotations of a global emergency • In recent years, various tick-borne infections have increased incidence, extended their spatial area, or emerged for the first time

  7. Vector-borne infectious diseases that may be affected by climate changes in Europe. Vonesch et al.Ann Ist Super Sanita 2016; 52: 397-405

  8. Aedeskoreicus - current known distribution - January 2018 Found in Belluno during 2011. Recently reported in Lombardy and Genova,is a possible efficient transmitter of Dirofilaria immitis to dogs

  9. Aedesalbopictus - current known distribution - January 2018 Punge più frequentemente all’aperto, ma può adattarsi anche al chiuso e nelle ore di luce del mattino e del pomeriggio. Ad ogni pasto ematico assume meno sangue di quanto le necessita per deporre le uova e pertanto tende a pungere più volte e persone diverse-

  10. Chikungunya in Italia, 2017 • Attiva da marzo a settembre. • In opportune condizioni di temperatura ed umidità, la femmina adulta vive 30-40 giorni. • Nelle aree con inverni freddi le uova che entrano in diapausa, bloccano cioè la loro maturazione nei mesi invernali per riattivarsi poi in primavera • Al 6 ottobre 2017, 282 notifiche (156 confermati e 126 probabili) in Lazio (Anzio, Roma e Latina-242 casi probabili e confermati) e Calabria (Guardavalle Marina-33 casi probabili e confermati). • Casi ‘importati’ in Emilia-Romagna (4 casi di malattia 3 probabili da Guardavalle Marina e uno confermato ad Anzio), Marche (un caso da Anzio), Francia (1 caso confermato da Anzio) e Germania (un caso probabile con storia di viaggio a Roma).

  11. Geographic distribution of H7N9 casesand the number of live poultry markets (LPM). The background represents the number of LPM. The 3D bars are for the collective cases of H7N9 from 2013 to 2017 for individual provinces Liu Q et al Front.Med.2018; 12: 3–22

  12. Animals’ travels: monkeypox in USA nel 2003 • Dati del US Fish and Wildlife Service indicanochedal 2000 al 2004 piùdi un 1 trilionedianimalidivariotipo (invertebratiinclusi) sonostatiimportatinegli USA. • Traquesti quasi 900 milionidipesci, 26 milionidianfibi, 9 milionidirettili, 2 milionidiuccelli e piùdi 200 000 mammiferi. Cricetomys gambianus

  13. TX-2GR NJRS, BPTS, SM TX-3RS, SMDM TX-6TS, SMDM WI Human cases:17 confirmed22 probable/suspect IL‡ Human cases:8 confirmed4 probable/suspect 42 PDs traced 14 PDs traced IN Human cases:7 confirmed9 probable/suspect IL-1§GR, DM IA†GR, DM 24 PDs traced IL-2DM TX-9DM TX-7DM TX-8DM TX-10DM TX-5DM TX-4DM JapanDM WIDM MNDM 200 prairie dogs (PDs) at facility 1 PD traced MO Human cases:2 confirmed 1 PD traced SCNo human cases 11 PDs traced KS Human cases:1 confirmed MINo human cases Monkeypox Outbreak 2003 Rodent Shipment Ghana Texas 50 Gambian giant rats (GR)53 rope squirrels (RS) 2 brushtail porcupines (BP) 47 tree squirrels (TS)100 striped mice (SM)~510 dormice (DM) ML Washington, 2009 Adapted from G. Gerberding

  14. MERS vs SARS 9.6% 34.99% 8098 2.143* • La SARS è stata fermata in pochi mesi nel corso del 2003, nonostante avesse interessato più continenti e causato un elevato numero di casi, tra cui 1707 (21.1%) in HCW. • La MERS è in circolazione da più di tre anni e colpisce prevalentemente persone con comorbosità, il che spiega la più elevata letalità. Deve essere ancora chiarito se la malattia sia mantenuta successive immissioni dal reservoir animale o dalla trasmissione inter-umana. • MERS-CoV R0pari a 0·60 (95% CI 0·42–0·80) nello scenario ottimistico e a 0·69 (95% CI 0·50–0·92) in quellopessimistico. • R0di SARS-CoVprepandemico era 0·80 (0·54–1·13). • Brebanetal.Lancet 2013; 382: 694–699 * Al 17.1.2018

  15. In Corea 185 casiconfermati (33 decessi, letalità 17,8%) tra HCW, pazientiricoverati e familiari. • Piùdi 16,000 contattiidentificati e monitorizzati. • Evidenzaditrasmissioneterziaria

  16. Population increase and infectious agents • The current distribution of genotypes and subtypes of many pathogens genotypes and subtypes follows the pathways of recent human dispersion • The demographic explosion has probably favored their evolutionary speed and geographical differentiation • The Yarawa paradox: can the same virus exhibits a much lower evolution rate in a small and isolated population in which is predominantly vertically transmitted than in a large, rapidly growing in which the transmission is predominantly horizontal ? • The Iarawa, an Andamanese tribe of about 275 individuals remaining in absolute and hostile isolation until 1997, has a HBV (65.6%) hyperendemia caused by a HBV-C2 closely related to strains circulating on the Indochinese peninsula. How was it possible?

  17. Ninety-six studies included Published online Oct 2017

  18. Prevalence estimates of the infectious diseases of importance in the refugee and asylum seeker population in Europe in the 2010s Eiset and Wejse. Public Health Reviews 2017; 38:22

  19. Schistosomahaematobiumin Corsica, France Bulinus truncatus snails were found at sites 1, 2, 3, 5, and 6 • Of 11 French native bornmembers of the 3 families, 6 had positive resultsforS.haematobiumby urine examination. • In addition, 2 family members who had a negative result by urine examination had a positive serologicresult. • The 3 families spent summer vacations in Sainte-Luciede Porto-Vecchio in 2011 and 2013, where had bathed at least once per holiday period in the Cavu River. • Following a national screening campaign in France,≈100 additional schistosomiasis cases were described over 2 years among Corsica residents and visitors from other partsof France. Berry et al EID 2014; 20: 1595-7

  20. Prevalence was 1% among migrants from endemic areas and 10% in those fromMali and Senegal.

  21. Estimates of migrants resident in nine studied European countries, legal and undocumented, originating from countries endemic for Chagas disease, and births to mothers from endemic countries, 2009 Basile et al. Euro Surveill. 2011;16:pii=19968

  22. Chagas disease knocks on our door: A cross-sectional study among latinamerican immigrants in Milan, Italy. • Twenty-nine of the subjects with CD (60.4%) underwent disease staging, ten of whom (35.7%) showed cardiac and/or digestive involvement. • Benznidazole treatment was associated with high frequency of adverse reactions (19/27, 70.4%) and permanent discontinuation (8/27, 29.6%) • Forty-eight (9.6%) of the 501 tested subjects were conclusively diagnosed as having CD. • The highest prevalence of CD was among those from Bolivia (43/169, 25.4%) and El Salvador (4/68, 5.9%). • Older age (aOR 1.05, p=0.004), a Bolivian origin (aOR 8.80; p=0.003), being born in the department of Santa Cruz (aOR 3.72, p=0.047), having lived in mud houses (aOR 2.68; p=0.019), and having an affected relative (aOR 12.77, p=0.001) were independently associated with CD. Antinori S. et al. Clin Microbiol Infect. 2018 Mar 16

  23. Grazie per l’attenzione

  24. Infezioni ed estinzioni

  25. Number of animals imported to the United States in 2002: over 38,000 mammals, 365,000 birds, 2 million reptiles, 49 million amphibians, and 216 million fish. • Number of primates legally imported into the United States as pets or research animals between 1995 and 2002: 99,939

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