From Forecasting to Control of Zoonotic Diseases: Linking Animal and Human Systems Bernadette Abela-Ridder, Food Safety and Zoonoses Pierre Formenty, Global Alert and Response Health Security and Environment Cluster Paris, France, 24 February 2011 On behalf of Pierre Formenty Global Alert and Response Department -1 Photo credits: A. Epelboin, A. Casanova, P. Formenty
Epidemics and Pandemics have shaped our history On behalf of Pierre Formenty Global Alert and Response Department -2
Our World is changing The way we live 2025: 5 Billion in urban centres Microbes evolve New threats emerge On behalf of Pierre Formenty Global Alert and Response Department -3
Countries with a critical shortage of health service providers (doctors/nurse/midwives) Data source WHO 2009. Global Atlas of Health workforce Los Angeles Mexico Chicago Bogota Lima Selected major wilderness areas Selected terrestrial biodiversity hotspots New York Belo Horizonte Rio de Janeiro Sao Paulo Buenos Aires London Paris Lagos Kinshasa Moscow 15>29.9 millions habitants Country with critical shortage On behalf of Pierre Formenty Global Alert and Response Department -410 >14.9 millions habitants Country without critical shortage 7 >9.9 millions habitants Beijing Tokyo Tianjin Istanbul Lahore Tehran Shanghai Osaka, Kobe Delhi Wuhan Baghdad Karachi Calcutta Hong Kong Cairo Riyadh Dhaka Ahmadabad Surat Chittagong Hyderabad Metro Manila Mumbai Chennai Bangkok Pune Bangalore 30 millions habitants and more Jakarta Seoul
61% of Emerging Infectious Diseases (EID) are Zoonoses affecting Humans Encroachment Introduction Spill over & Spill back Agricultural Intensification Daszak P. et.al. Science 2000 287:443 Domestic Animal Translocation Wildlife Technology And Industry Human Human encroachment Ex situ contact Ecological manipulation Global travel Urbanization Biomedical manipulation Frequency of all EID events has significantly increased since 1940, reaching a peak in 1980-1990 61% of EID events are caused by the transmission from animals (zoonoses) 74% of these from wildlife. Zoonotic EIDs from wildlife reach highest proportion in recent decade On behalf of Pierre Formenty Global Alert and Response Department -5
Infectious Diseases at the Human Animal interface: from forecasting to outbreak response On behalf of Pierre Formenty Global Alert and Response Department -6
Emerging Infectious Disease outbreak alert and response Wildlife Domestic Animal Human outbreak 90 80 Number of Cases 70 60 50 40 30 Climate Vegetation Environment Animal Amplification Human Amplification 20 10 0-20 -15-10 -5 0 5 10 15 20 25 30 35 40 TIME On behalf of Pierre Formenty Global Alert and Response Department -7
Number of Cases 90 80 70 60 50 40 30 20 10 0 Wildlife Domestic Animal Human outbreak Emerging Infectious Disease outbreak alert and response First cases In Animals Climate Vegetation Environment Animal Amplification Late Detection Human Amplification Delayed Response NB: Yellow areas represent cases that can be prevented with control operations Control Opportunity -20-15 -10-5 0 5 10 15 20 25 30 35 40 TIME On behalf of Pierre Formenty Global Alert and Response Department -8
Emerging Infectious Disease coordinated outbreak alert and response 1. Mitigate 2. Alert 3. Control 4. Learn On behalf of Pierre Formenty Global Alert and Response Department -9
PANDEMIC EPIDEMIC Global spread Amplification Global travel and trade Human to human transmission Amplification Drivers of epidemics Globalization Global travel: people, animals, vectors Global trade: animal and their products, vaccines, medical products, etc. Amplification Urbanization Population density Agricultural Intensification Technology And Industry Vector distribution and densities Transmission in health care centers Successful A2H, V2H and H2H transmission OUTBREAK Emergence Human Animal interface Emergence Human encroachment, Ex situ contact, At-risk behaviour Ecological pressure Exploitation Translocation of wildlife Climate variability, vector density & distribution On behalf of Pierre Formenty Global Alert and Response Department -10
Infectious Diseases at the Human Animal interface: Risk mapping and Forecasting Some examples On behalf of Pierre Formenty Global Alert and Response Department -11
Modeling EID events: Relative risk of an EID Hot Spots: global distribution of relative risk of an EID event caused by zoonotic pathogens from wildlife, (Jones et al. Nature, 2008). On behalf of Pierre Formenty Global Alert and Response Department -12
Modeling EID events: CCHF risk map Courtesy David Roger, Oxford University, Department of Zoology, Oxford, UK On behalf of Pierre Formenty Global Alert and Response Department -13
Forecasting EID emergences Ebola surveillance in Central Africa Collaborators: WCS, CIRMF, IRD, ECOFAC, MoH, National Park Boards, MSF, WHO. On behalf of Pierre Formenty Global Alert and Response Department - 14
Climatic and Ecological Conditions for RVF Risk during November 2006 El Niño effect, October 2006 NDVI anomalies, November 2006 On behalf of Pierre Formenty Global Alert and Response Department -15
East Africa climatic and ecological conditions and RVF outbreak sites Sept 2006 to May 2007 Mapping of the RVF human case locations shows that 64% of the cases were reported in areas at risk within the RVF potential epizootic area, 36% were reported in areas not thought to be at risk of RVF activity 4 0-4 -8-12 On behalf of Pierre Formenty Global Alert and Response Department -16
Risk mapping and forecasting Enhance collaboration with MoH, MoA, Vet services, NGOs working in conservation for surveillance of animal outbreaks that precede human cases (CCHF, RVF, Ebola, Yellow Fever, Nipah Hendra, Hantavirus..) Generating more accurate risk map to improve forecasting models. WHO, FAO OIE and partners to develop spatial & temporal database of emerging sites Developing more specific and less sensitive forecasting models improved with soil type data, elevation data, vector ecology maps, domestic ruminant maps, geolocation of major RVF outbreaks Future: couple models to buy time (6 month) and precision (IOD, SST, NDVI, flood-based risk maps, ) On behalf of Pierre Formenty Global Alert and Response Department -17
Infectious Diseases at the Human Animal interface: detection and assessment On behalf of Pierre Formenty Global Alert and Response Department -18
The International Health Regulations Strengthened national capacity for surveillance and control, including in travel and transport Prevention, alert and response to international public health emergencies Global partnership and international collaboration Rights, obligations and procedures, and progress monitoring On behalf of Pierre Formenty Global Alert and Response Department -19
WHO Alert and Response Department 24 hours / 7days a week. 900 events of potential international importance verified, in all countries, in last 5 years. >400 advice/assistance provided. More than 50 international outbreak response coordinated through the Global Outbreak Alert & Response Network (GOARN). Numerous Outbreak News update on WHO website. On behalf of Pierre Formenty Global Alert and Response Department -20
Formal WHO laboratory networks, (sub-)regional networks, WROs & MoH, UNOs Official Sources e.g. WRO, MoH Epidemic Intelligence Verification Informal Global Public Health Intelligence Network (media), NGOs GLEWS FAO, OIE, WHO Global Early Warning System GOARN Risk Assessment Response strategy and Operations Social Mobilization Health Education Medical Anthropology Logistic Security Communications Coordination Technical & Operational Medias - Information Finances Epidemiological Investigation Surveillance Laboratory Case management Funerals Infection Control On behalf of Pierre Formenty Global Alert and Response Department -21
On behalf of Pierre Formenty Global Alert and Response Department -22 EMS current events 2010-06-09 Current events 23 February 2011
On behalf of Pierre Formenty Global Alert and Response Department -23
Global Alert and Surveillance: perspectives Surveillance of infectious diseases is improving Coordinated assessment of events is key Intensified collaboration with animal disease sector: domestic and wildlife GLEWS with FAO and OIE Formal collaboration with wildlife disease experts Support vector borne network (bats, rodents, birds, primates, ticks, entomology) Connect the human and animal lab networks On behalf of Pierre Formenty Global Alert and Response Department -24
Infectious Diseases at the Human Animal interface: response On behalf of Pierre Formenty Global Alert and Response Department -25
General strategy for controlling outbreak (* COMBI = communication for behavior change) Social Mobilization Health Education COMBI Case Management Death audits Infection control Media Information Coordination Environment Vector control Logistics Security Communications Epidemiological investigation Surveillance Laboratory Human-animal-ecosystems interface partners On behalf of Pierre Formenty Global Alert and Response Department -26
GOARN: Global Outbreak Alert and Response Network Assist countries with disease control efforts by ensuring rapid appropriate technical support to affected populations. Investigate and characterize events and assess risks of rapidly emerging epidemic disease threats Support national outbreak preparedness by ensuring that responses contribute to sustained containment of epidemic threats On behalf of Pierre Formenty Global Alert and Response Department -27
GOARN: Global Outbreak Alert and Response Network On behalf of Pierre Formenty Global Alert and Response Department - 28
Outbreak control : Emerging and Dangerous Pathogens Laboratory Network A network of high security diagnostic laboratories able and willing to collaborate and share their knowledge, biological materials and experimental research results in a real time framework to detect, diagnose and control novel disease threats. Human and Animal High Security Laboratories BSL-4 and selected BSL-3 AMRO AFRO EURO EMRO SEARO EDPLN member EDPLN future member WPRO On behalf of Pierre Formenty Global Alert and Response Department -29
Outbreak control : Ecological studies Wildlife knowledge is crucial to understand the epidemiology of Zoonoses West Nile Monkeypox SARS Avian Influenza Nipah On behalf of Pierre Formenty Global Alert and Response Department -30
Infectious Diseases at the Human Animal interface: conclusion On behalf of Pierre Formenty Global Alert and Response Department -31
Conclusion (1) Globalization is a fact! Benefits Risks Our Weaknesses can be our strengths! Inter-connectedness Inter-dependance Risks are Manageable! All Hazards All Sectors We need Systems/Tools/Networks/People! On behalf of Pierre Formenty Global Alert and Response Department -32
Conclusion (2) Outbreak detection: better than in the past but could be improved To intensify collaboration between wildlife, domestic animals and human health sectors To improve forecasting models Outbreak response: improve quality to ensure acceptance by the affected populations (relational behavior with the patients, respect of the local culture and beliefs, respect of funeral customs, etc ). On behalf of Pierre Formenty Global Alert and Response Department -33
Conclusion (3) Today's technologies can help to better detect, manage and contain the international spread of emerging diseases NOT Enough Key points remain high level governments commitment and international collaboration. On behalf of Pierre Formenty Global Alert and Response Department -34
From forecasting to control of zoonotic diseases. Bernadette Abela-Ridder, Food Safety and Zoonoses Pierre Formenty, Global Alert and Response Health Security and Environment Cluster World Health Organization Thanks! outbreak@who.int On behalf of Pierre Formenty Global Alert and Response Department -35