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S. Machado

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

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S. Machado

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  1. 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 Duke-NUS Graduate Medical School, Singapore

  2. 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?

  3. The Global Threat of Infectious DiseasesEmerging and re-emerging diseases A/H1N1 H7N9 Dengue A/H1N1 MERS Chikungunya MERS Dengue Emerging diseases Re-emerging diseases Adapted from Morens, Folkers, Fauci 2004 Nature 430; 242-9

  4. 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

  5. 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 ?

  6. Public health impact Social impact Economic impact Dengue Hemorrhagic Fever

  7. The changing epidemiology of dengue Expanding geographic distribution Hyperendemicity Increased epidemic activity Emergence of DHF No of Cases Source: DengueNet

  8. West Nile Virus in the Western Hemisphere

  9. Epidemic West Nile Virus in the United States

  10. 1999 4 States 62 Cases

  11. 2000 12 States 21 Cases

  12. 2001 27 States 66 Cases

  13. 2002 44 States 4156 Cases

  14. 2003 46 States 9862 Cases

  15. 2004 47 States 2535 Cases

  16. 2005 48 States 2819 Cases

  17. Persistent Epidemic Transmission Foci Have Developed 2006 48 States 4219 Cases

  18. Epidemic/Epizootic West Nile Virus 1937 1950-75 1994 - 1999 Adapted from Gubler, 2007

  19. Epidemic/Epizootic West Nile Virus 1937 1950-93 1994 - 2007

  20. Molecular Evolution of WN Virus Strains Egypt 1951 France 1965 South Africa Phylogenetic Tree of West Nile Viruses Israel 1952 Romania 1996 M Kenya 1998 Senegal 1993 Morocco 1996 Italy 1998 Volgograd 1999 New York 1999 Israel 1998 NY2000 3282 US/ NY2000 3356 LIN-1 NY 1999 equine NY 1999 hum Israel Conn 1999 MD 2000 NJ 2000 Israel 1999 H C.Afr.Rep 1989 Senegal 1979 Algeria 1968 C.Afr.Rep 1967 Iv.Coast 1981 Kunjin 1960 1 Kunjin 1973 Kunjin 1984b Kunjin Kunjin 1991 Kunjin 1984a Kunjin 1966 Kunjin 1994 India India 1955a India 1980 India 1958 India 1955b Kenya Uganda 2 Senegal 1990 Uganda 1937 LIN-2 C.Afr.Rep 1972a C.Afr.Rep 1983 Uganda 1959 C.Afr.Rep 1972b Madagascar 1988 Madagascar 1986 Madagascar 1978 JE SA 14

  21. Plague Pandemics • Justinian’s Plague (mid-6th Century A.D.) • Black Death (mid-14th Century A.D.) • Modern Pandemic (1894 – mid-1900s)

  22. Surat

  23. India Delhi Calcutta Madras Bombay Potential Spread of Pnuemonic Plague out of India, 1994

  24. 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)

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