CERMES Centre de Recherches Médicales et Sanitaires

1. CERMESCentre de Recherches Médicales et Sanitaires Associated Institute of Pasteur Institute International network

2. Missions of CERMESJO 01/09/02 Medical Biology Médicale- Public health 1. Applied fondamental research, operationnal 2. National institutions support (or state else) 3. Risk expertise and evaluation of control programmes against endemic diseases 4. Training of national or stranger sanitary managers

3. Health and Climate in intertropical areasSome links and needs I. JEANNE1, A. DIEDHIOU2, JB DUCHEMIN1, P. BOISIER1, K. KIARI3 1CERMES/RIIP, 2IRD-Niger, 3DSCE (MoH Niger) 21 janvier 2004 - NOORDWIJCK

4. Vector borne diseases Malaria Trypanosomiasis Filariasis Leishmaniasis Plague Rift Valley Fever West Nile virus Yellow fever Tick borne haemorragic fever etc. Others Cholera Other epidemic diarrhea Meningitis … Health ClimateInter-tropical areas Extreme events ++ Climate variability +++ seasonal intraseasonal

5. Direct on agent/reservoir/vector/host : Effects on disease epidemiology elements Onset or cessation of epidemics Indirect: By influence on agricultural output  food security  nutritional status  vulnerability to disease By influence on economic output affects abilities to prevent, to care.. By influence on migrations  exposition change Direct and indirect impacts More important if poor socio-economic status Climate Vulnerability to diseases Socio economic Land use Food security Migrations

6. Climate Agriculture Land use Water resource Water Cycle Impact on Health The possible links Rainfall Humidity Temperature Dust Availability Quality

7. Needs: 2 ways of research • Practical, district level • Sahel  where needs are important • Broad thresholds above or under which no more epidemic occur • To predict where and when epidemics may occur (or put out) and to integrate climatic forecast products into early warning system policies • Theoritical, up to cellular level • Sahel  where climatic factors are most important where balances are fragile • Fine trends between thresholds according to bioclimatic areas • To understand why and how epidemic can occur

8. But as… • Epidemiological data « emerged iceberg » • Links climate/diseases not so simple, lots of others variable factors • Ex: malaria-morbidity, meningitis-immunity • Several scales  spatial interpolation, temporal extrapolation… we need to go forward…

9. Improve epidemiological data collection and diffusion Improve t/s transmission data knowledge (ex: malaria) Improve bacteriological diagnosis(ex: meningitis) Understanding what climatic parameters are pertinent for studies, how much back in time What products are easily available for use in public health What specialists to work with Health community needs Multidisciplinary collaborations

10. Two exemples Malaria Meningitis

11. Malaria Parasite cycle

12. Agent: 4 species of parasite Plasmodium Pl. falciparum Pl. vivax Pl. malariae Pl. ovale Vector: mosquito genus Anopheles An. funestus An. arabiensis An. gambiae … World 300-500 millions cases per year 1.5 - 2.7 millions deaths per year 40% of world population under risk Niger 2003 (10 Millions inhts) First cause of mortality and morbidity Nb cases declared: 768 342 Nb deaths declared: 1 883 (0,25%) Malaria

14. Temperature and Humidity Effects on parasite development and mosquito survival > 18°C < 35°C Sporogonic development stopped Plasmodium falciparum • In insectarium: • Relative Humidity of 80% • < 5% + or - jeopardize anophele survival

15. Some particular questions • What are the impacts of climate variability on mosquito behaviour and population dynamics according to species and location • How anopheles seasonal cycle perpetuate in spite of so disadvantageous climatic conditions? • Estivation anopheles? • Passive transportation by air? • What is the importance of nutriments for larvae brought by deposit areosols in soils/pounds • What are the specific links between climate  pounds dynamic  anopheles aboundance ? According time and space

16. CLIMPAL-NIGER Malaria transmission modelling CLIMATE Environment Water disponibility Quality Parasite development Survival Abundance Malaria risk Morbidity

17. Agent: bacterium Neisseria meningitidis Serogroup A predominant Emergence serogroup W135 Reservoir Asymptomatic carriage Clinically infected cases Spread human to human Direct contact (respiratory droplets) Co-infection World Meningitis belt Cases reported to WHO: 750 000 (10 years), 7% FR Niger 2003 8 135 reported cases 659 deaths, 8.10% FR Meningitis Belt Lapeyssonnie L. La méningite cérébro-spinale en Afrique. Bulletin OMS 1963: 28(S1); 3-114 Epidemic Meningitis

18. 0.0 - (lower) 0.4 - (medium) 0.6 - (high) 0.8 - (very high) THE SPATIAL DISTRIBUTION OF EPIDEMICS RESULTS: EPIDEMIC RISK MAPPING Risk factors Land cover type Seasonal absolute humidity profile Seasonal dust profile* Population density* Soil type* * Significant but not included in final model Molesworth AM, Thomson MC, Connor SJ, Cresswell MP, Morse AP, Shears P, Hart CA, Cuevas LE. Where is the Meningitis Belt? Defining an area at risk of epidemic meningitis in Africa. (Transactions of the Royal Society of Tropical Medicine and Hygiene 2003)

19. Peak rainfall – Aerosols + Rainfall +/ – Seasonal Meningitis • Hypothesis invasiveness increase

20. Some particular questions • Understand mechanism of invasiveness for respiratory communicable diseases • Safe carriers bacteria became invasive or new bacteria takes place? • What are the exact climatic parameters which induce that respiratory mucous membrane becomes more fragile? • What are the exact climatic parameters which induce cessation of epidemic spread? • Humidity rate? only or not? • Dust grain size ? • Aerosols composition? (Iron hypothesis, others..) • Aerosol abundance?

21. PNLP-DSCE Université IRD Niamey DMM – Min. Hydraulique CNAM Mali Centre Muraz, IRSS, CNLP, BF ACMAD – AGHRYMET- ICRISAT RIIP PAL+ Africa Anopheles network (IRD – CNLP) WHO IRI New York - LSTM IPP - IRD – UMLV – ESA – MEDES – CNES – S2E CERMEScollaborations NIGER MALI BURKINA FASO Inter-états International North Nord

24. Collecte des informations 1. External box Centre de Calcul de CLS Balises Argos 4. screen à cristaux liquides INTERNET Stockage de l’information CERMESS IRSS Diffusion de l’information Base de données (MEDIAS) et Serveur Web sécurisé Mail sécurisé Partenaires extérieurs 3. Protection door 5. Clavier 2. Panneau frontal

25. Cerebrospinal Fluid collect

26. PCR: diagnostic policy Type Hi Multiplex  espèce Sérogroupe Nm Collect equipment Data gestion Data analysis Feedback information Questionnaire form

27. CLIMPAL-NIGER

28. ESA EPIDEMIO-Project • End users needs • Remote sensing : final products ESA • OMS, CERMES, IPM, CIRMF, UMLV, MSF, TALA, ProdiG

29. AMMAAfrican Monsoon Multidisciplinary Analysis • LOP: historical data + 10 ans • EOP: 3 years (2005/06/07) • SOP : janv, 15 may to 15 septembre 2006

30. Health & Climate, Workshop 25th, 26th March 2003 CERMES

31. Climate observations and health needs in West Africa • Little is known on changes in health status as a function of climate change, compared with other thematics • More automatic observing stations in poorly served areas • Ground observations should be used to callibrate satellite data • Integrated products need to be made available routinely to health services at local, national and regional level. • Catalogue of available data and specific climate product for health Conclusions Mutual awareness Networks are taking place Need to focus on the needs of the health community – for climate variability and climate change.

32. Climate & health multidisciplinary objectives Improve links (experimental process) Objectives definition Tools definition Scale change validation Modelling Exhanges and Collaborations

33. Thank you for your attention…