The Global Threat of Infectious Diseases

Background

• 20th Century Re-Emergence of Infectious Diseases

- Newly recognized diseases- Known diseases- Geographic spread- Increased epidemic activity

• 26% of Global Mortality – 2003

Fauci, NIAID/NIH 2005

Dengue

Dengue

H5N1AI

H5N1 AI

Chikungunya

Dengue

The Global Threat of Infectious Diseases

Global Public Health Emergencies, 1994-2005

• Plague, India/Global, 1994

• Influenza, Hong Kong, 1997

• Nipah Encephalitis, Malaysia/Regional, 1999

• SARS, China/Hong Kong/Global, 2003

• Avian Influenza, Southeast Asia/Global, 2004/2006

AISA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES

• Global Public Health Emergencies

• Hawaii in Ideal Position to Develop a Center of Excellence

– Geography

– Cultural & Economic Ties

– Training

– East-West Center

– Other partners

Rationale

Basic ScienceDepartments

Clinical Departments

DeanDeanJohn A. Burns School of MedicineJohn A. Burns School of Medicine

Pacific Center for Pacific Center for Emerging Infectious Emerging Infectious Diseases ResearchDiseases Research

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

Asia-Pacific Institute of Tropical Medicine and Infectious DiseasesOrganizational Structure

Asia-Pacific Center for Translational

Research

Asia-Pacific Center for Infectious Disease Ecology Research

Asia-Pacific Center for Biosecurity and Conflict Research

Pacific Center for AIDS Research

Asia-Pacific Center for Public Health and

Population Research

Mission

To develop a global center of excellence in Hawaii for emerging and re-emerging infectious diseases

Emphasis will be placed on infectious diseases of the Asia-Pacific Region, and on developing trans-disciplinary research and development programs that will result in new diagnostics, drugs, vaccines and other treatment and prevention modalities.

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

ASIA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES

• Develop a balanced trans-disciplinary research and training program that focuses on basic, field and translational research.

• Develop a laboratory reference and research center

• Develop local and international partnerships.

• To build laboratory and epidemiologic capacity, and research collaborations in selected countries of Asia where diseases with epidemic potential commonly occur.

• Develop a graduate program that will attract highly motivated, research-oriented doctoral candidates.

Goals

ASIA-PACIFIC INSTITUTE OF TROPICAL MEDICINE AND INFECTIOUS DISEASES

Disease Priorities

Zoonotic virusesInfluenza

Dengue/dengue hemorrhagic feverWest Nile fever

HIV/AIDSMalaria

Leptospirosis

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

• Laboratory Capacity– Biocontainment (BSL-2, BSL-3 , ABSL-3)– Basic research– Diagnostics– Pathogenesis

• Epidemiology• Bioinformatics• Pathogens

– Emerging infectious diseases– Viruses, parasites, bacteria, zoonoses

Scientific Capability

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

Progress

Partnerships/Collaboration

Hawaii’s PRETREAT Alliance

Preventing, Responding, and Treating Emerging Asia-Pacific Disease Threats

Hawaii’s Global Solution for Emerging Infectious Disease ThreatsHawaii’s Global Solution for Emerging Infectious Disease Threats

Hawaii Biotech•Vaccines and drugs

•Product Development

•FDA approvals

DOD•Surveillance

•Emergency response•Clinical Research

•Clinical trials•MHPCC

NIH• PacRBL• PSWRCE•COBRE• RCMI?

CDC? International• surveillance • response

UH/JABSOM/APITMID

• Center of excellence•Basic & applied research

•Pathogen discovery•Surveillance•Epidemiology

•Asian field sites•Training

Hawaii Pacific HealthQueen’s Hospital

•Clinical Research•Clinical trials•Treatment

PRETREAT Participants and Their PRETREAT Participants and Their CapabilitiesCapabilities

Hawaii DOH•Surveillance

•Emergency response

East WestCenter• Demography• Geography•Climate Change

PRETREAT Components

• Prevention and treatment

– Early warning surveillance

– Diagnostics

– Drug and vaccine research

– Preclinical development, GLP animal testing

– GMP manufacturing

– Clinical research

– FDA approved products

PRETREAT Components

• Asian field sites

– Research, clinical & vaccine trials

• Pathogen discovery

– Surveillance, field epidemiology, “pathogens of tomorrow”

• Biocontainment laboratories

– Fixed, mobile

• Basic research

• Training

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

International Partnerships

• WHO

• Viet Nam

• Thailand

• Singapore

• Indonesia

• Others

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

Progress - Funding

State of Hawaii

University of Hawaii

NIH

DOD

Microbial Threats to Health

Case in Point: SARS

Global SARS Cases (Probable)WHO 26 September 2003

Country Cases Deaths Case fatality

Canada 251 43 15.3%

China 5327 349 6.5%

Hong Kong 1755 299 16.9%

Singapore 238 33 15.5%

Taiwan 346 37 12.5%

Thailand 9 2 22%

U.S. 75 0 0%

Vietnam 63 5 7.9%

Other 81 5 6.2%

Total 8098 774 9.6%

Dengue Hemorrhagic Fever

Social Impact

DEN-1DEN-2

Global Distribution of Dengue Virus Serotypes, 1970

Global Distribution of Dengue Virus Serotypes, 2006

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2

DEN-1DEN-2DEN-3DEN-4 DEN-1

DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

DEN-1DEN-2DEN-3DEN-4

Dengue/dengue hemorrhagic fever, average annual number of cases reported to WHO, 1955-2005

0100000200000300000400000500000600000700000800000900000

1000000

Num

ber

of C

ases

Source: WHO

Humans & Birds

Birds

Humans

Wave III: Dec 04 - Present

Source: WHO

Humans & Birds

Birds

Humans

Wave III: Dec 04 - Present

New York City

Aedes aegypti

Aedes aegypti Distribution in the Americas

19701930's 2006

POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER

West Nile Virus in the Western HemisphereWest Nile Virus in the Western Hemisphere

21 66

24482949

62

4,156

9,850

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Year

# ca

ses

rep

ort

ed

Epidemic West Nile Virus in the United States, 1999-2005

* Reported as of 1/13/2006

Epidemic/Epizootic West Nile Virus

1937

1950-75

1994 - 2005

Factors Responsible for Increased Epidemic Infectious Diseases

• Complacency, Lack of Political Will• Policy Changes• Changes in Public Health • Demographic Changes

- Population growth- Urbanization- Agricultural/Land Use Practices- Animal Husbandry

• Modern Transportation- Increased Movement of People, Animals, Commodities

• Changing Life Styles/Behavior• Microbial Adaptation• Technology• Intent to Harm• Climate Change?

Zoonotic Diseases: Hitching a Ride? Modern Transportation

Asia-Pacific Institute of Tropical Medicine and Infectious Diseases

Hawaii and the US mainland are highly vulnerable to the importation of exotic pathogens, and at high risk for epidemic disease.

Demographic and cultural factors, along with economic growth and globalization will insure that the Asian region will be important in

producing future epidemic disease.

A center of excellence for research on emerging infectious diseases of Asia and the Pacific in Hawaii will be highly beneficial to the global

efforts to detect, respond and control epidemic disease.

Pacific Regional Biosafety Laboratory at Kaka’ako

Pacific Regional Biosafety Laboratory at Kaka’ako