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Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases?

Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases?. Complacency, Lack of Political Will Policy Changes Changes in Public Health Changing Life Styles/Behavior Microbial Adaptation Technology Intent to Harm Climate Change?.

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Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases?

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  1. Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases? • Complacency, Lack of Political Will • Policy Changes • Changes in Public Health • Changing Life Styles/Behavior • Microbial Adaptation • Technology • Intent to Harm • Climate Change?

  2. As Earth Warms Up, Tropical Virus Moves to Italy“ nytimes.com/2007/12/23 Dengue fever warning for Thailand Deadly by the Dozen: 12 Diseases Climate Change May Worsen Dengue fever outbreak kills dozens in Brazil Climate change to hit coastal pregnancies Dengue fears Warming Increases Malaria, Dengue Fever Threat, Paraguay: Dengue and yellow fever outbreak DREF Operation No. MDRPY003 Update No.1 An exotic blendDengue Fever is ready to spread across the country SOUTH AMERICA: Climate Change Fuels Spread of Dengue Fever Climate change will fuel dengue - WHO exec Health alert - Dengue fever risk Climate change, globalization, and other drivers have made Europe a “hot spot” for emerging infectious diseases, which calls for changes in monitoring systems 27 APRIL 2012 VOL 336 SCIENCE. Asian mosquito 'could bring tropical diseases to Britain‘, The Independent, 2013 Another death in Tonga from dengue fever Chikungunya disease in NYC? Warming could make it happen Virus causes severe joint pain, is spread by two mosquito species; NBC News

  3. “Fueled by climate change, dengue fever is on the rise again throughout the developing world, particularly in Latin America”. Reference: Dengue fever: a deadly scourge. The Economist, April 19, 2007.

  4. Dengue/Dengue Hemorrhagic Fever, Average Annual Number of Cases Reported to WHO, 1955-2003 Number of Cases

  5. There is no solid scientific evidence to date that global warming has been a major driving force of the 20th century re-emergence of vector-borne infectious diseases!

  6. Why Have we Seen Such a Dramatic Increase in Epidemic Infectious Diseases? Major Drivers • Demographic Changes (Pop Growth) • Environmental Change • Uncontrolled Urbanization • Agricultural/Land Use Practices • Deforestation • Climate change • Animal Husbandry • Modern Transportation (Globalization) • Increased Movement of People, Animals, Commodities • Lack of Public Health Infrastructure

  7. Global population- 1950-2050 Population (Millions) Evaluation of urban and rural population between 1950 and 2050

  8. Urban Growth in Asian(1) and American(2) Cities, 1950-2010 • Mean population of Dhaka, Bangkok, Jakarta, Manila and Saigon. • Mean population of Rio de Janeiro, Sao Paulo, San Juan, Caracas and Guayaquil.

  9. The global air network

  10. Average annual number of global airline passengers by decade, 1950-2010 Million of Passenger (Mil) IATA 2010 Decade

  11. Commercial Air Traffic Over a 24 Hour Period

  12. Global distribution of dengue virus serotypes, 1970 Gubler, 1998

  13. Global distribution of dengue virus serotypes, 2013 Adapted from Gubler, 1998

  14. West Nile Fever Dengue Fever Yellow Fever Mayaro Fever Chikungunya Epidemic Polyarthritis SARS Influenza Lassa Fever Monkeypox CJD/BSE HIV/AIDS Cholera E. coli O157 Malaria Leishmaniasis Chagas Disease Cyclospora Exotic Infectious Diseases That HaveRecently Been Introduced to the US

  15. Live Animal Importation into the USA - 2002 • 47,000 mammals • 28 species of rodents • 379,000 birds • 2 million reptiles & Poisonous snakes • 49 million amphibians • 223 million fish Data from U.S. Fish & Wildlife Service

  16. Exotic Mosquito Species Recently Introduced and Established in the US • Aedes (Stegomyia) albopictus • Ochlerotatus (Aedes Finlaya) togoi • Ochlerotatus (Aedes Finlaya) japonicus • Aedesbahamensis • Culex biscayensis

  17. Demographic Changes Technology/Globalization Socio-cultural organization Global climate change Agricultural, land use and animal husbandry changes/practices Habitat alteration Urbanization NATURAL ECOSYSTEM HUMAN ECOSYSTEM REGIONAL ENVIRONMENTAL CHANGE Species’ Ecological-evolutionary Dynamics Opportunistic habitat expansion/ecological release Vector (domestication) Domestic vector/reservoir species Wildlife/reservoir transport/encroachment Human encroachment Host-Pathogen Dynamics Emergence Processes of ‘Host-Parasite Biology’ Host switching (host novelty) • Breaching of pathogen persistence thresholds Transmission amplification and genetic change (pathogen novelty) Disease Emergence ecosystem continuum

  18. New York City

  19. Aedesaegypti

  20. POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER

  21. Global Threat of Epidemic Infectious Diseases • Disease and Trade-interwoven History • 14th century, Europe discovers exotic goods from Asia • Global Trade Flourishes • 18th, 19, 20th centuries • New Millennium • Integrated global economic system with a transnational flow of knowledge, capital, products, people, animals, and pathogens • Rapid spread of epidemic infectious disease from point of origin

  22. Global Threat of Epidemic Infectious Diseases Lessons Learned • Dawn of 21st century, we have come full circle • Expect the unexpected • New diseases will emerge • Old diseases will re-emerge • Modern transportation and globalization will disseminate • Unlikely that a zoonotic disease can be eradicated

  23. Global Threat of Epidemic Infectious DiseasesLessons Learned • Disease detection and identification systems must be improved and maintained • International communication and cooperation are critical • Rapid response plans must be developed and implemented appropriately • More emphasis must be placed on prevention as opposed to emergency response • Outbreaks should be contained as local public health events if possible • Public and Press need reliable information to prevent panic and overreaction

  24. The Global Threat of Infectious Diseases • Global Trends, 2012-20025 • Most of global economic growth in Asian countries • Increased trade • Increased movement of people, animals and commodities from Asia to rest of world • Most of global population growth in cities of Asia • Rural to urban circular migration • Globalization • Increased movement of pathogens

  25. Global Threat of Epidemic Infectious DiseasesChallenge to Reverse the Trend • Movement of Pathogens and Vectors via Modern Transportation • International cooperation and data sharing • Lack of Effective Laboratory-based Surveillance • Lack of Public Health Infrastructure to Prevent & control Vector-borne and Zoonotic Diseases • Trained personnel • Laboratory capacity • Tools (vaccines, drugs, insecticides, vector control tools) • Understanding disease ecology • Political Will • Economic support • Regional prevention and control programs

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