update on regional zoonotic disease status 2015 · urban leptospirosis in brazil unrecognized...
TRANSCRIPT
Update on Regional Zoonotic Disease Status
2015
Dr Frank KoningsWHO/WPRO Emerging Disease Surveillance and Response
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaborationfor the Prevention and Control of Zoonoses
Sapporo, Japan | 28 - 30 October 2015
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Global emerging viral diseases
Source: Marston: Emerging Viral Diseases: Confronting Threats with New Technologies. Sci Transl Med. 2014 Sep 10;6(253)
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Learning from history…
• Health security threats - especially emerging diseases - are inevitable (SARS, H5N1, H7N9, MERS…)
• Investing in preparedness during peace-time enables a rapid response during emergencies
• APSED serves as a regional tool to comply with IHR core capacities, thus collectively managing health security threats
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
1. Surveillance, Risk Assessment and Response
2. Laboratory
3. Zoonoses
4. Infection Prevention and Control
5. Risk Communication
6. Public Health Emergency Preparedness
7. Regional Preparedness, Alert and Response
8. Monitoring and Evaluation
Asia Pacific Strategy for Emerging Diseases (APSED) 2010
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Regional efforts: APSED
Generic platform for preparedness, alert and response
Step-wise approach to capacity development
Connects stakeholders at national and regional levels
Emphasizes value of learning from real world events
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
2015 Joint APSED Evaluation
Joint Member States-WHO review of 9 years of APSED
• Re-confirmed the relevance of APSED
• Demonstrated achievements through country stories
• While we are better prepared, we are not safe from more severe health security threats
• Need further investments in health security to sustain and upgrade the system
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
MERS: An ongoing health security threat
• Since 2012, 26 countries have been affected by MERS, including the recent significant outbreak in the Republic of Korea
• Globally, more than 1500 cases, including at least 550 deaths have been reported
7
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015 8
Ebola Virus Disease (EVD)
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 20159
Nature of health security threat…
• Vulnerability is universal• Emerging disease travels faster than ever before• Public fear spreads quicker than disease itself• Impacts are far beyond “cases & deaths”
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Keeping flu in the spotlight
10
• Significant morbidity and mortality of seasonal influenza: importance of GISRS vaccine strain selection
• Variety of strains circulating among birds in the Asia Pacific• Human infections with “HxNy” continue to be detected• Excellent network of countries and experts built over the
years or “flu family”
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
SEAR: Number of specimens positive for influenza by subtype
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Country-wise positive influenza specimens in SEAR
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
India: Number of specimens positive for influenza by subtype, 2015
Data source: FluNet ( www.who.int/flunet ), GISRS
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
WPR: Number of specimens positivefor influenza by subtype
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Epidemiological curve of human infection withavian influenza A(H7N9)
N=679 cases, 271 deaths as of 20 October 2015
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Geographical distribution of human cases of infection with Avian Influenza A(H7N9) virus
(date of onset 19 Feb 2013 - 20 October 2015)China CasesAnhui 31Beijing 6Fujian 63Guangdong 180Guangxi 4Guizhou 2Hebei 1Henan 4Hong Kong (China) 13Hubei 1Hunan 26Jiangsu 77Jiangxi 11Jilin 2Shandong 7Shanghai 48Taiwan 4Xinjiang 10Zhejiang 186Other CountryMalaysia 1Canada 2Total 679
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Crimean Congo Haemorrhagic Fever outbreak in India
Serological evidence of CCHF in camel,sheep and goats was reported (NIV, 2010)
Overall, 5.43 per cent bovine samples and10.99 per cent sheep/goat samples werefound to be positive for anti-CCHF virusantibodies in Himachal Pradesh, Odisha,Rajasthan and Gujarat states of India (NIV,2015)
Nosocomial infection has been reported in2011 and 2015
CCHF outbreaks constitute a threat topublic health because of its epidemicpotential, high case fatality, potential fornosocomial outbreaks, and difficulties intreatment and prevention
CCHF outbreaks in India, 2011-2015
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Leptospirosis: Endemic and emerging disease in the Asia-Pacific Region
• Endemic Inter-epidemic periods in South and SE Asia
• Endemic with pronounced seasonality New Caledonia Urban leptospirosis in Brazil Unrecognized seasonal transmission?
• Large isolated outbreaks Usually associated with extreme climactic
events Fiji (2015), Mumbai (2005), Philippines (2009)
• Sustained epidemics over broad geographical regions Thai epidemic in late 1990s Sri Lanka outbreak in 2008-2009
Source: LERG report 2014
>100
20-25
7-10
0-3
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Nipah outbreaks in Bangladesh
• Each year, Nipah outbreaks are reported during winter time in Bangladesh
• In 2015, 9 Nipah cases were reported, of them 6 (67%) died.
• These cases are from 6 different districts namely Nilphamari, Ponchoghor, Faridpur, Magura, Naugaon, Rajbari.
• Median age of the Nipah cases in last 13 years (Range: 2 to 45 years).
• Average case fatality rate is 75% in last 15 yearsSource: IEDCR Bangladesh
• Risk factors– Drinking of raw date palm sap (kancha
khejurer rosh) contaminated with NiV– Close physical contact with Nipah
infected patients
Nipah virus outbreaks in South Asia
Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015
Conclusions
• Health security threats are inevitable and we need to invest in preparedness.
• Health security threats do not recognize national borders, and the consequences go far beyond health impacts.
• We have good frameworks and tools to act – but these need to be strengthened.
• Multi-sectoral collaboration at the interface of human and animal health is of key importance to address zoonotic threats.