s. machado
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S. Machado. The Global Threat of Epidemic Emergent- Re-Emergent Infectious Diseases: Lessons Learned and Prospects for the Future. Duane J Gubler Professor. Duke Global Health Inst, 3 Sept, 2013. Signature Research Program in Emerging Infectious Diseases - PowerPoint PPT PresentationTRANSCRIPT
S. Machado
The Global Threat of Epidemic Emergent-Re-Emergent Infectious Diseases: Lessons Learned
and Prospects for the Future
Duane J Gubler Professor
Signature Research Program in Emerging Infectious Diseases Duke-NUS Graduate Medical School, Singapore
Duke Global Health Inst, 3 Sept, 2013
The Global Threat of Epidemic Emergent/ Re-Emergent Infectious Diseases
• Background• Case studies of selected epidemic IDs• Reasons for emergence• Lessons learned• Prospects for the future • How do we reverse the trend?
The Global Threat of Infectious Diseases
Emerging and re-emerging diseases
Adapted from Morens, Folkers, Fauci 2004 Nature 430; 242-9
Emerging diseasesRe-emerging diseases
Chikungunya
Dengue
Dengue
A/H1N1
A/H1N1H7N9
MERS
MERS
The Global Threat of Emerging Zoonotic Diseases
• Natural Hosts Rodents Bats Birds Others
• Modes of Transmission Direct contact Respiratory Vector-borne Usually silent
• Type of Pathogen Viruses Bacteria Parasites
Major Infectious Disease Epidemics since 1980• Dengue/DHF-1970s, SE Asia, global
• HIV/AIDS-1980s-Africa,global
• Drug resistant TB-1990s, US, global
• Cholera-1991-Americas
• Plague-1994-India, global
• Foot & Mouth disease-1995,2000- Taiwan & UK
• West Nile-1990s-Mediterranean, Americas
• BSE-1990s- UK, Canada, US
• Swine fever, 1996- Netherlands
• Avian influenza-1997- HK-global
• Nipah encephalitis-1998-Malaysia,Asia
• SARS-2002- Asia, global
• Chikungunya-2004-Africa, Asia
• H1N1 influenza-2009-Mexico?,global
• Hand, foot and mouth disease, Asia
• MERS and H7N9 ?
Public health impact Social impact
Economic impact
Dengue Hemorrhagic FeverDengue Hemorrhagic Fever
The changing epidemiology of dengueThe changing epidemiology of dengue
Source: DengueNetSource: DengueNet
No
of
Cas
esN
o o
f C
ases
Expanding geographic distribution
Increased epidemic activity
Hyperendemicity
Emergence of DHF
West Nile Virus in the Western HemisphereWest Nile Virus in the Western Hemisphere
0
2000
4000
6000
8000
10000
12000
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
total cases reported to CDC WNND cases reported
Epidemic West Nile Virus in the United States
4 States
62 Cases
1999
12 States
21 Cases
2000
27 States
66 Cases
2001
44 States
4156 Cases
2002
46 States
9862 Cases
2003
2004
47 States
2535 Cases
2005
48 States
2819 Cases
2006
48 States
4219 Cases
Persistent Epidemic Transmission FociHave Developed
Epidemic/Epizootic West Nile Virus
1937
1950-75
1994 - 1999 Adapted from Gubler, 2007
1937
1950-93
1994 - 2007
Epidemic/Epizootic West Nile Virus
Egypt 1951France 1965
South AfricaIsrael 1952
Romania 1996 MKenya 1998Senegal 1993Morocco 1996Italy 1998Volgograd 1999New York 1999Israel 1998NY2000 3282NY2000 3356NY 1999 equineNY 1999 humConn 1999MD 2000NJ 2000Israel 1999 HC.Afr.Rep 1989
Senegal 1979Algeria 1968
C.Afr.Rep 1967Iv.Coast 1981
Kunjin 1960Kunjin 1973Kunjin 1984bKunjin 1991Kunjin 1984aKunjin 1966Kunjin 1994
India 1955aIndia 1980India 1958India 1955bKenyaUgandaSenegal 1990Uganda 1937
C.Afr.Rep 1972aC.Afr.Rep 1983
Uganda 1959C.Afr.Rep 1972b
Madagascar 1988Madagascar 1986Madagascar 1978JE SA 14
India
Kunjin
US/Israel
Phylogenetic Tree of West Nile Viruses
LIN-1
LIN-22
1
Molecular Evolution of WN Virus Strains
Plague Pandemics
• Justinian’s Plague (mid-6th Century A.D.)• Black Death (mid-14th Century A.D.)• Modern Pandemic (1894 – mid-1900s)
Global Distribution of Plague
Countries reporting plague, 1970-2000
Probable Sylvatic foci
Compiled from WHO, CDC, and country sources
Surat
Potential Spread of Pnuemonic Plague out of India, 1994
India
Delhi
Calcutta
MadrasBombay
Pneumonic Plague in India
• Indian outbreak was a complete surprise – no plague confirmed in India since 1966
• Clinical and lab diagnosis were confused
• Media and panic driven epidemic
• First epidemic to impact globalization
• Caused huge economic loss for India (> $3 billion)