February 2017

Emerging Infectious Diseases:

The Global Picture

February 2017

Breaches in species barrier:

emerging infections in humans

Infection Animal linked Year infection to transmission first reported Ebola virus Bats 1976 HIV-1 Primates 1981 E. coli O157:H7 Cattle `1982 Borrelia burgdorferi Rodents 1982 HIV-2 Primate 1986 Hendra virus Bats 1994 BSE/vCJD Cattle 1996 Australian lyssavirus Bats 1996 Influenza A (H5N1 ) Chickens 1997 Nipah virus Bats 1999 SARS coronavirus Palm civets 2003 Influenza A (H1N1) Swine 2009 MERS coronavirus Bat/ Dromedary 2012 Infnuenza A (H7N9) Poultry 2013 Zika virus Monkey 2007

February 2017

Potential transmission pathways, emerging

infectious diseases

Emergence

No further

transmission

February 2017

Rabies transmission to humans: rare

iatrogenic onwards transmission

February 2017

Potential transmission pathways, emerging

infectious diseases

Emergence

No further

transmission

Continues

Transmission

cluster/epidemic/pandemic

Ceases/

sporadic

February 2017

Ebola emergence:

current hypotheses

February 2017

Confirmed Human and Poultry

H5N1 Infections since 2003

February 2017

Genetic Drift: H5N1 virus in human infections

since 2003

February 2017

Potential transmission pathways, emerging

infectious diseases

Emergence

Continues

transmission

Continues/

endemic

No further

transmission

Continues

Transmission

cluster/epidemic/pandemic

Ceases/

sporadic

February 2017

Adults and Children living with AIDS,

2016 worldwide

February 2017

Potential transmission pathways, emerging

infectious diseases

Emergence

Continues

transmission

Continues/

endemic

No further

transmission

Continues

Transmission

cluster/epidemic/pandemic

Ceases/

sporadic

February 2017

Swiss cheese events

in epidemiology and public health

Public health

event

Risk

factor

James Reason: BMJ 2000;320:768-770

Risk

factor

Risk

factor

Risk

factor

February 2017

Animal husbandry, Sudan and trade

associated with religious festivals

February 2017

Routine vaccination of cattle against

Rift Valley Fever, East Africa

February 2017

15

Climate change and health:

extreme weather events

February 2017

El Nino-associated flooding,

East Africa, 1998

February 2017

Rift Valley Fever, human

infection, Sudan, 1998

February 2017

Animal husbandry and

trade, Sudan

February 2017

Rift Valley Fever, Sudan and Arabian

peninsula

Source: WHO

February 2017

Technical/political response

Guidelines for Mitigation Consensus for prevention

February 2017

Emergence from animals in nature:

Eco Challenge, Malaysia, 2000

February 2017

Leptospirosis transmission

February 2017

Leptospirosis (N = 33) among 312

participants, Eco Challenge 2000, Malaysia

Eco Challenge

US: 10

Canada: 4

Brazil: 1

Uruguay: 1 Australia: 4

France: 4 UK: 9

February 2017

Emerging Infections

Occur randomly when risk factors align

Often associated with contact at the animal/human

interface

Spread internationally in humans

February 2017

Dengue in Texas, 2005

Source: CDC

Global recycling

Asian tiger mosquito

Dengue Texas Tiger mosquito

February 2017

Number of countries reporting Dengue,

1965 - 2007

Source: WHO

February 2017

Highly pathogenic H5N1 influenza virus

in smuggled Thai eagles, Belgium, 2005

Source: Van Borm, et al, Emerging Infectious

Diseases Vol. 11, No. 5, May 2005

February 2017

BLOODY DIARRHEA AND HAEMOLYTIC URAEMIC

SYNDROME, SHIGA TOXIN–PRODUCING E. COLI --

CONTAMINATED FENUGREEK SRPOUTS, 2011

February 2017

Emerging Infections

Occur randomly when risk factors align

Often associated with contact at the animal/human

interface

Spread internationally in humans

Spread internationally in animals, insects and food

February 2017

SARS: Clustering of cases, Hong

Kong hotel

Source: CDC/WHO

February 2017

Source:

WHO/CDC

SARS: international spread from Hong Kong,

21 February – 12 March, 2003

Doctor from

Guangdong

Canada

Hotel M Hong Kong

Ireland

USA

New York

Singapore

Viet Nam

Bangkok

B

I

K

F G

E D

C

J H

A

Germany

Hong Kong

February 2017

SARS and the economy:

impact on global travel, April 2003

February 2017

The cost of SARS, Asian Development

Bank, 2003

7 6 5 4 3 2 1 0 US$ billion

Hong Kong

China, mainland

Taiwan

South Korea

Indonesia

Singapore

Thailand

Malaysia

Philippines

US$ billion US$ billion

4%

0.5%

1.9%

0.5%

1.4%

2.3%

1.6%

1.5%

0.8%

% of GDP

As of 30 September, 2003, SARS

had decreased Asia’s combined

GDP by US$18 billion and cost

nearly US$60 billion in lost demand

and revenues

February 2017

Recent infectious disease outbreaks

and their economic impact

February 2017

Emerging Infections

Occur randomly when risk factors align

Often associated with contact at the animal/human

interface

Spread internationally in humans

Spread internationally in animals, insects and food

Cause negative impact on economies

February 2017

Source: WHO/CDC

0

2

4

6

8

10

12

14

16

7-

Mar

13-

Mar

19-

Mar

25-

Mar

31-

Mar

6-

Apr

12-

Apr

18-

Apr

24-

Apr

30-

Apr

6-

May

12-

May

18-

May

24-

May

30-

May

5-

Jun

11-

Jun

17-

Jun

Non health care workers

Health care workers

Ebola Haemorrhagic Fever by mode of

transmission, Kikwit Zaire, 1995

315 cases

250 (80%) deaths

February 2017

SARS Epidemic curve, China,

2002 - 2003

February 2017

SARS, chain of human-to- human

transmission, Singapore 2003

February 2017

SARS risk assessment, late March

2003

Index case

Second generation =

close and direct contact with health

care workers (HCW) or others)

Third generation =

family members of HCW

Fourth generation =

other contacts in

community

February 2017

Emerging Infections

Occur randomly when risk factors align

Often associated with contact at the animal/human interface

Spread internationally in humans

Spread internationally in animals, insects and food

Cause negative impact on economies

Health workers at great risk of infection and unintentionally

serve as conduit to family/community

February 2017

Multidrug-resistant Definitive Type (DT) 104

Salmonella Typhimurium, Europe, 1982-1996

Salmonella Typhimurium isolates from both cattle and humans

%

0

10

20

30

40

50

1982-85 1986-90 1991-94 1995-96

cattle humans

Source: WHO from published data

February 2017

Reservoirs of bacteria causing human

infections

Source: WHO

February 2017

Principal transfer pathways, antibiotic resistance

genes, between humans, animals, food and the

environment

Source: DARC/ARHAI joint report, UKI

February 2017

Antimicrobial use and salmon/trout production,

Norway, after introduction of vaccination

0

100 000

200 000

300 000

400 000

500 000

600 000

700 000

1981 1984 1987 1990 1993 1996 1999 2002

Vo

lum

e(t

on

s w

fe)

0

10 000

20 000

30 000

40 000

50 000

60 000

An

tib

ioti

cs(k

g a

ctiv

e su

bst

ance

)

Volume salmon and trout Consumption antibiotics

Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006

February 2017

Macrolide use and enterococcal

resistance in pigs, Denmark

Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.

February 2017

Cephalosporin resistance after stopping

use in poultry, Quebec, Canada

Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.

February 2017

Emerging Infections

Occur randomly when risk factors align

Often associated with contact at the animal/human interface

Spread internationally in humans

Spread internationally in animals, insects and food

Cause negative impact on economies

Health workers at great risk of infection and unintentionally

serve as conduit to family/community

Involve complex relationships across sectors

February 2017

Human Animal Infections Risk

Assessment Group (HAIRS)

February 2017

Human Animal Infections and

Risk Surveillance Group (HAIRS)

February 2017

Human Animal Infections and Risk

Surveillance Group (HAIRS): newsletter

February 2017

Human – Animal Infections and Risk

Surveillance Group (HAIRS): guidelines

February 2017

Emerging Infections

Occur randomly when risk factors align

Often associated with contact at the animal/human interface

Spread internationally in humans

Spread internationally in animals, insects and food

Cause negative impact on economies

Health workers at great risk of infection and unintentionally serve as

conduit to family/community

Involve complex relationships across sectors

Require a one health approach to risk assessment/management