International Conference on Science and Technology for SustainabInternational Conference on Science and Technology for Sustainability 2007ility 2007International Cooperation for DevelopmentInternational Cooperation for Development

Infectious Diseases: Surveillance and ControlInfectious Diseases: Surveillance and ControlEmerging and ReEmerging and Re--emerging Infectious Diseasesemerging Infectious Diseases

Nobuhiko OKABE, MD, PhDNobuhiko OKABE, MD, PhDInfectious Disease Surveillance Infectious Disease Surveillance CenterCenter

National Institute of Infectious Diseases, JapanNational Institute of Infectious Diseases, Japan

Sept Sept 1515,, 20072007,, TokyoTokyo

Infectious disease is caused by transmission of microInfectious disease is caused by transmission of micro--organisms. organisms. It is spread widely among human, if nothing taken. It is spread widely among human, if nothing taken.

Prevention of Infectious DiseasesPrevention of Infectious Diseasesnot contact with infected patients (isolation)to clean materials contaminated (disinfection)to keep healthy and clean conditionto give immunity (vaccination), if available

disinfectiondisinfection

isolationisolation

Immunization was introduced at 1796.Immunization was introduced at 1796.

Small pox (variolla)

鍋島邸（佐賀藩）におけるわが国初めての種痘1849

Ｉｎｔｒｏｄｕｃｅｄ Ｉｍｍｕｎｉｚａｔｉｏｎ first in Japan (Saga Han, Kyushu) at 1849

Measles in Japan Measles in Japan at 1800`sat 1800`s

Every 20Every 20--40 years, big 40 years, big outbreak of measles outbreak of measles occurred occurred Many people both young Many people both young children and adults were children and adults were suffered by this fatal suffered by this fatal diseasediseaseThe could only prayed The could only prayed not to be suffered by not to be suffered by measlesmeasles

0

2000

4000

6000

Number of Reported Polio by Year in Japan (1947Number of Reported Polio by Year in Japan (1947--2006)2006)

Urgent introduction of OPV imported from USSR and Canada

Legal use of OPV as a routine immunization with 2 doseswith 2 doses 1964-

1950 1960 1970 1980 1990

Last case of wildLast case of wild--polio in the Regionpolio in the Region

Americas RegionLuis Fermin TenorioPeru 1991

European RegionMelik MinasTurkey 1998

Polio Eradication

Western Pacific RegionMum Chanty

Cambodia 1997

A region where no children suffer from……Polio

MeaslesHepatitis B Neonatal

Tetanus

and diphtheria, pertussis & infant tuberculosis

WHO Regional MeaslesWHO Regional MeaslesElimination TargetsElimination Targets

20002000

20072007

2010201020122012

June 4, 2003 World Health OrganizationJune 4, 2003 World Health Organization

Microbes are unpredictable!

WHOWHO--facilitated outbreak responses facilitated outbreak responses in the field, 1998in the field, 1998––20032003

World Health OrganizationWorld Health Organization

Emerging Infectious DiseasesEID are those due to newly identified and

previously unknown infections which cause public health problems either locally or Internationally.

Re-emerging Infectious DiseasesREID are those due to the reappearance and

increase of infections which are known, but had formerly fallen to levels so low that they were no longer considered a public health problem.

The HIV/AIDS pandemic

A new virus recognized in the early 1980sJuly 2007• 39.5 M HIV infected• 2.9 M deaths in 2006• Drug-Resistance• No vaccine

A new virus recognized in the early 1980sJuly 2007• 39.5 M HIV infected• 2.9 M deaths in 2006• Drug-Resistance• No vaccine

Index case:from Guandon, China

Hotel M

Canada

USA

Irland

GermanyHanoi

Bangkok

Singapore

ＳＡＲＳ ｉｎ ２００３

2005. Marburg diseaseIn Angola374（ death 328: FTR 88%)

The malaria challengeThe malaria challenge

(R.Carter,1999)

Annu

al de

aths

from

mala

ria (m

illion

s)

0

1.0

2.0

Africa

World

1950 1970 1990 2000

AntiAnti--malarial drug resistance to malarial drug resistance to treatment worldwide, 2001treatment worldwide, 2001

ChloroquineChloroquine resistanceresistance

S/P resistanceS/P resistance

MultiMulti--drug resistancedrug resistance

MultidrugMultidrug--resistant TB (MDRresistant TB (MDR--TB), 2001TB), 2001

hyperendemicoutbreaks

Cost of treating multidrug-resistant TB:US$ 250 000 per patient in industrialized countries,US$ 1 000 –$ 10 000 in developing countries

Dengue/Dengue feverDengue/Dengue feverDengue/Dengue fever

0

200,000

400,000

600,000

800,000

1,000,000

1950s 1960s 1970s 1980s 1990s 2000s*

Average annual number of DF/DHF cases reported to WHO

454 15,547 122,174

295,591

492,820

877,888

* 2000-2003, provisional data

DF/DHFDF/DHFDF/DHF

1970-19791950-1969

2004 reported

2000>

2005 reported

1980-1999

1999 reported

1996 reported

1998 reported

Leading causes of mortality, 2001Leading causes of mortality, 2001

48%

18%

19%

10%3% 2%

Infectious InjuriesNon-communicablePerinatal Maternal Nutritional

45%

35%

11%6% 1%2%

Low-income nations(South-East Asia & Africa)

Premature mortality(worldwide, 0–44 years)

Total = 53.9 millionTotal = 53.9 million

Leading infectious causes of Leading infectious causes of mortality, 2001 estimatesmortality, 2001 estimates3.5

Dea

ths (

mill

ions

)

< 5 years old > 5 years old

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

ARI AIDS Diarrhoea TB Malaria Measles

2.3 2.2

1.5

1.1 0.9

Why infectious disease, again.Why infectious disease, again.A Changing World !A Changing World !

Collapse of public health Collapse of public health infrastructure infrastructure

Poverty, urbanisation and Poverty, urbanisation and population displacementpopulation displacement

Environmental exploitation Environmental exploitation and degradation and degradation

Complex and natural Complex and natural disastersdisasters

A Changing World ! A Changing World !

Development of antimicrobial Development of antimicrobial resistanceresistanceAnimal diseases crossing into Animal diseases crossing into human populations human populations Globalisation of travel and trade Globalisation of travel and trade (great benefits but new threats !) (great benefits but new threats !) Inappropriate social, political and Inappropriate social, political and economic responses to economic responses to outbreaksoutbreaks

Ricketsial infectionsTyphus

Rocky Mountain spotted fever

Virus infectionsArbovirusFiloviruwsSmall pox

Bacterial infectionsPlagueAnthraxTularaemia

Fungal infectionsCoccidioidomycosis

Additoinal Situation on Infectious Diseases: Bioterolism

Infectious Diseases ControlInfectious Diseases ControlPrevention

Hygiene (personal, public)Immunization

DiagnosisClinical DiagnosisMicrobiological Diagnosis

Treatment

Surveillance

0

10

20

30

40

50

60

70

80

90

1 3 5 7 9

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

Delayed Response

DAY

CASES Opportunity for control

Late Detection

First Case

0

10

20

30

40

50

60

70

80

90

1 3 5 7 9

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

Rapid Response

CASES

Early Detection

Opportunity for Control

DAY

Backbone of SurveillanceBackbone of SurveillanceTo collect information

To analysis information

To disseminate information - regularly, timely and rapidly

Infectious diseases do not respect international borders.

Global and regional partnerships and the rapid sharing of data and other information enhance preparedness and evidence-based control strategies.

Strengthening surveillance system and networks is recognized as one of the most important tool to dissolve these issues. It is necessary to improve and to strengthen surveillance with regard to health crises.

It is necessary to keep track of outbreak trends of basic infectious diseases on a daily basis, and to detect any abnormalities as early as possible.

Furthermore, it is necessary to pass on this information in an appropriate and easy-to-understand manner and to enhance provision of information.

Sometimes crises caused by false rumors and misinformation result in more direct damage．

Fair disclosure of information and easy-to-understand explanations provided to public from a scientific standpoint are increasingly required as measures to manage health crises.

Response to Outbreak of Infectious Diseases through Information Network

Pr e f . De p . He a l t h

Pu b l i c He a l t h I n s t .

Pu b l i c He a l t h Ct r .

Lo c a l Me d . A s s .

N I I D

Lo c a l Co m m i t t e e

Ce n t r a l Co m m i t t e e

Ja p . Me d . A s s .

Cl i n i c / Ho s p i t a l

Qu a r a n t i n e S t .

W HO, CDC, PHLS , e t c

Co m m u n i t y

F i e l d E p i d e m i o l o g i s t

MHW

Global health protection Global health protection --the challengesthe challenges

Ｌｅｔ｀ｓＬｅｔ｀ｓ ｓｔｒｕｇｇｌｅｓｔｒｕｇｇｌｅ ａｇａｉｎｓｔａｇａｉｎｓｔ ｉｎｆｅｃｔｉｏｕｓｉｎｆｅｃｔｉｏｕｓ ｄｉｓｅａｓｅｓｄｉｓｅａｓｅｓｗｉｔｈｗｉｔｈ ＳｃｉｅｎｃｅＳｃｉｅｎｃｅ, , ＴｅｃｈｎｏｌｏｇｙＴｅｃｈｎｏｌｏｇｙ and and International Cooperation.International Cooperation.

Thank you !Thank you !ＡｒｉｇａｔｏｕＡｒｉｇａｔｏｕ gozaigozai mashitamashita

ありがとうございましたありがとうございました

Leading Causes of Death in JapanLeading Causes of Death in Japan

19501.TB2.Brain vascular disease3.Pneumonia4.Gastro-enteritis5. Malignant diseases

20011. Malignant diseases2. Brain vascular disease3. Cardiovascular diseases4. Pneumonia5. Accident

Sakai Sakai outbreak outbreak July,1996 July,1996

The The Education Education Minister Minister visited sick visited sick childrenchildren

Nipah virus infection

1999 Malaysia

Human encephalitis↑

Pig pneumonia, encephalitis↑

Fruit Bat no illness

2005 Bangladesh2007 India

Treatment of Poliomyelitis: 1940’s USA

TB trends in Eastern Europe and Africa

1980 1985 1990 1995 20000

50

100

150

200

250 (cases per 100 000)Africa

Eastern Europe

Spread of wild polio virus 2004Spread of wild polio virus 2004--20052005

In HQ as of 4 May 2005Case or outbreak following importation

Endemic countries

Wild virus type 1Wild virus type 3

Re-established transmission countries

16 polio-free countries had importations from Nigeria.Polio was 're-established' in 5 of these polio-free countries.