Transcript Seasons_InfectDis_Feb18_S.Porcelainx - Seasonality

Seasons & Infectious Disease
Sherri L. Porcelain- Seasons & Life on Earth
February 18, 2016
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Epidemiology
Epi (upon)
Demos (the people)
Logos ( to study)
• THE SCIENCE OF PUBLIC HEALTH
•
… Global public health challenges suggest we need
more comprehensive approaches in 21st C
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History of Infectious Disease :
Time & Space
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Miasma (Middle Ages
(5th C)- Middle of the
1800s
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Bad air that causes disease
(poisonous vapor)
Contagion
Pathogenic theory of
disease
 Seed like organisms cause
disease (1540s)
 Microorganisms cause
disease (Germ Theory,
1860s)

Do certain times of the year pose
greater threats- then & now?
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Seasonality & Infectious Disease
• Many of major killers in
• Temperature,
developing countries
humidity & weather
– diarrheal diseases,
patterns influence
malnutrition, malaria
the infectious
other vector-borne
diseases
diseases are highly
– Spread
climate-sensitive &
expected to worsen
– Distribution
with climate changes
– Frequency &
– Intensity
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Infectious Diseases
• Contagious
– levels of how infectious
(communicable)
• Virulence
– levels of how virulent
• Ebola high virulence &
highly contagious versus
low levels of contagious
& virulence
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Changing patterns infectious diseases
www.nature.com
Accessed, Facui A, (2006)Emerging & Re-emerging Infectious
Diseases: The Perpetual challenge
http://www.milbank.org/uploads/documents/0601fauci/0601f
auci.html
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Seasonal Patterns of Infectious Disease
• Western Africa reoccurring seasonal patterns of
meningococcal meningitis
– Epidemics beginning February-May
• Can we explain “patterns on seasonally varying
environmental factor facilitating disease transmission.”
– Suggest meningococcal meningitis related to the air
dryness generated by forceful dust winds
• Pascual M, Dobson A (2005) Seasonal Patterns of Infectious Diseases. PLoS
Med 2(1): e5. doi:10.1371/journal.pmed.0020005
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Number of Case-reports of Primary Amebic Meningoencephalitis, by Month of Illness
Onset and Probable Water Exposure — United States, 1962–2014
http://www.cdc.gov/parasites/naegleria/graphs.html
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Kaleidoscopic vs. Microscopic Approaches…
First identified 1590s
1625 confirmed
Invented circa 1815
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Field Epidemiology Survey Team (F.E.S.T)
• Understanding
science + world
affairs
– Seasonal variations
& threats to health
& safety
Microbes
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Bacteria
Viruses
Fungi
Protozoa
Helminths
Prions
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Developing Countries
Garbage Collection?
20-50% of domestic solid waste uncollected
seasonal outbreaks of vector borne diseases associated
Peru , 2008
Ecuador, 2010
Garbage pickers
PAHO, 2006
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Vectors, Seasons & Infectious Disease
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Rainfall
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Temperature &
Humidity
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Altitude
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Latitude/longitude
• Rising temperatures give vectors
(e.g. insects) ability to survive at
higher elevations
– Vectors cross mountain ranges,
resulting in new outbreaks
– Changes in the spatial &
temporal shifts of pests &
pathogens presenting new
global challenges across
different seasons
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FIELD EPIDEMIOLOGY SURVEY TEAM (F.E.S.T.)
Hot humid months – seasonal- or not?
Barrancabermeja, Colombia1980
Fungi
Hyphae- Spores
Casabe, Colombia- 1982
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Scabies
Controlling the mite
.
Multi-disciplinay approach
Vector control + more comprehensive
strategies
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Infections – Infestations
• Scabies & Pyoderma
–
Incidence of scabies highest during cold, dry season (MayNovember in Malawi)
– Incidence of pyoderma skin infection was highest during the
hot, rainy season (December-April)
• Scabies
– winter= close body contact & overcrowding
• Pyoderma
– researchers suggest rainy season “deficiencies in hygienic
precautions. “
• ( Malawi, Scabies & Pyoderma)
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Is it Head Lice Season?
• September is pediculosis prevention
month
– Pediculosis capitis
• Summer fun kids return to school
with more than happy smiles…
– 6- 12 M per/yr. in U.S.
• Young children
– Girls more than boys
• Data unreliable due to lack of
reporting
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– Vector- borne transmitted by
Aedes mosquito
– Highly sensitive to climate
conditions
– Studies suggest climate change
could impact dengue
transmission significantly with
projections of more than 2
billion people to become
infected by 2080s
– Hales S et al. Potential effect of population and
climate changes on global distribution of dengue
fever: an empirical model. The Lancet, 2002,
360:830–834.
• TODAY NEW THREATS OF
CHIKUNGUNYA & ZIKA + REEMERGENCE OF YELLOW FEVER
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Dengue
http://www.cdc.gov/dengue/dengue_upd/index.h
tml (accessed Oct 15, 2011)
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Seasonal Drought
Mosquitoes
• Use containers to store water associated with…
– Rise in Aedes Aegypti mosquito
– Leading to outbreaks of dengue fever in Caribbean
– Chikungunya in East Africa & Indian Ocean islands
• Epstein (2007)Chikungunya fever resurgence and global warming.
American Journal of Tropical Medicine and Hygiene 76(3)
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Drought in the Americas (2015)
• Seasonal events
– extend beyond
expected
• Worst drought hit Americas
– especially central
America & Caribbean
• Extended dry season
– as seen in southern
Brazil Amazon
• Worst to hit the Caribbean
• Global warming may
not cause droughts
• May expect droughts to
arrive faster & become
more intense
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Trenberth KE, A Dal, et al. (2014)
Global warming and changes in
drought, Nature Climate Change 4,
17-22
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West Nile Fever
• Long spring drought +
heat wave in July
– outbreak of West Nile
Fever ( NYC), August 1999
• West Nile is established
– wildlife & warm wet
conditions conducive to
outbreaks
– Epstein, P. (2010) The ecology of
climate change and infectious
diseases: comment. Ecology, 91(3),
925-8
• Seasonal changes in
weather
– Early start to mosquito
season with an extended
seasons (NW Italy)
– Warmer temps.
– Rain later in the year
– Rosàet al. Parasites &
Vectors (2014), 7:269
http://www.parasitesand
vectors.com/content/7/1
/269
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Changing Seasons- Changing Paradigm
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Public – Planetary health
Globalization
Diplomacy
Securitization of infectious diseases
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Planetary Health
• Planetary health incorporates
– “the interdependencies of human and natural
systems, while also recognising preserving the
integrity of natural systems is an essential
precondition for human health, survival, and
prosperity.”
• Horton R, Beaglehole R, Bonita R, et al. (2014) From public to
planetary health: a manifesto, Vol 383, No 9929, p847, 8 March
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Infectious Diseases & Seasons
• Want to travel?
– Remote areas?
– Possibly humans may never intended to inhabit
– Interactions with humans, animals & plants
– Summer, Winter, Spring & Fall
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Influenza
• Causation confusion until
– 20th C
– disease assoc. with
meteorological
conditions
– Viral strains
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Seasonal Influenza (Flu)
• Seasonal Flu less severe than pandemic strains
- Partial immunity exists
• CDC issued severe influenza illness in US ( Feb 1,2016)
– Seasonal vaccine often prevents circulating strains
– Rise compared to last season
– Peak in February 2016 ( may be later than usual), call caution this
month!
• 2014-2015
– 19M influenza associated medical visits
- 970,000 influenza associated hospitalizations
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Weekly US Influenza Surveillance Report
(CDC, 2016)
http://www.cdc.gov/flu/weekly/index.htm#OISmap
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Pandemic Flu- 1918-1919 (Spanish Flu)
• H1N1- influenza
• 1st wave
Pandemic Influenza Threat
– Spring 1918 Northern
Hemisphere
• 2nd wave
– Fall 1918 spreading
throughout North
America, Europe & Africa
• 3rd wave-
Admiral Benson, CNO, Annual Report to Congress, 1919
– Winter 1919-spread to
new global reach
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Biggerstaff et al. BMC Infectious Diseases
2014, 14:480
http://www.biomedcentral.com/14712334/14/480
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Pandemic flu- 1957- Hong Kong flu 1968
• H2N1 (February 1957,
Southern China)
• 1st wave
– April 1957- spread to Hong
Kong & Singapore
• 2nd wave
– June 1957- Identified in
U.S.
– Peak of pandemic in US &
Canada in Oct 1957
• 3rd wave
– Jan 1958
• H3N2- (July 1968- Hong
Kong)
• September- 1968- April
1969
– Northern Hemisphere
• Spikes in December &
January 1968-69
– Northern Hemisphere
• Spikes in June- September
1969
– Southern Hemisphere
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Influenza 1997
• H5N1- Avian/Bird Flu- Hong Kong
• May 1997
• Different because it was directly transmitted
from chickens – humans
– previous outbreaks from chickens- pigs before
transmittal to people.
• Culling of 1.5 M chickens by end of Dec 1997
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Influenza Pandemic – 2009- 2010
• H1N1 (Swine Flu)
– Late winter – early spring 2009- Mexico
• 1st wave
– Spring 2009- US & England
• 2nd wave– Fall 2009 – many cases not severe
• Why so many cases?
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Seasonal Flu
• We see most fall to early spring months peaks
in winter months
• In tropical climates you see such epidemics
– in rainy seasons
– while in non-tropical areas throughout the globe
late fall & early spring
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What we must consider…
• Seasons/weather
– the transmissibility of influenza has not been fully
explored according to researchers
• What has been studied
– humidity as inversely correlated with influenza
transmission
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Health risks at the Hajj
Millions arrive ( approx. 3M)
Risk of quick spread
Increasing temperatures
e.g. Influenza & MERS
Sept 22-27, 2015
Sept 9-, 2016
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Since the Hajj follow the lunar calendar ( shorter than the Gregorian calendar) time of year varies
– Ahmed QA, Arabi YM & Z A Memish, Health risks at the Hajj, Lancet Vol 367, No9515 1008-1015,
25 March 2006
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Distribution cases of Middle East Respiratory Syndrome
(MERS) (2014)
wwwnc.cdc.gov
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Convergence Infectious Disease &
International Studies
• Seasons – travel- exchange- possible diseases
– Summer travel to new destinations
– Winter home visits family & friends for holidays
– Spring outdoors – shed coats & new interactions
– Fall change of season & changing behaviors
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Rationale:
Planetary health & seasonal transitions
• Globalization
– Temporal, spatial and cognitive
• Health Diplomacy
– Transparency reporting
• Health Security
– Detect, protect & secure
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Globalization
• Travel
– Quicker, further & new interactions
– < 20 hours travel Miami - Sydney, Australia
• Trade
– Seasonal goods not available in U.S.
– During winter months, up to 70% of certain fresh
fruits & vegetables may come from developing
countries
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Globalization & Health
– Diseases can emerge
anywhere on planet
• Global hitchhikers
– Spread quickly to
regions via trade &
travel
– Boundaries of human
interactions
changing….
Processes changing interactions
Interactions
Seasons
How does seasonal travel & trade impact the
spread of infectious diseases in the 21st C
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International tourism arrivals +4 = 1.2B (2015)
Holiday Travel
NOTE: The number of trips shown represents departing trips plus return trips for
each day.
SOURCES: U.S. Department of Transportation, Bureau of Transportation Statistics,
Federal Highway Administration, National Household Travel Survey (Washington
DC: 2003).
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Health Diplomacy
• Seasonal outbreaks & official reporting
• High seasonal tourism
– deny spread of diseases
• Desired locations for seasonal visits may limit a country’s
coming forward with health issues
• “Epidemiologic silence”
– Cholera, dengue- Cuba
– Zika- Venezuela
• While some threats minor others could escalate quickly
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Health Diplomacy
• Office of Global Health Diplomacy (July 3, 2012)
– Diplomatic support through ambassadors
– Disease surveillance & timely sharing of information
– Improve diplomatic cooperation
• Elucidates how global health issues important to US
foreign policy strategies
– Engaging diplomatic approaches
• promote trans-border cooperation to prevent, control
and treat diseases before they become
– Understand changing dynamic of globalization & new
disease challenges
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Security & Seasonal Health Issues
• Seasonal to epidemic to pandemic flu
• Indonesia’s decision to withhold sharing viral
strains … claiming viral sovereignty has caused
great concern
– Denial in sharing viral strains for H5N1 in
Indonesia (2007)
– Importance of influenza strains for each season!
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Need viral samples each season!
• U.S. est. each year 5% - 20% of pop. gets flu
• Flu seasons unpredictable & can be severe
(CDC)
• In U.S., flu season occurs in fall & winter
• http://www.cdc.gov/flu/about/qa/disease.htm
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Health Security
• Global Health Security Agenda ( Feb 13, 2014)
– Prevent, detect, & respond
– Prevent epidemics whether they occur naturally,
intentionally, or by human error
– Protect & secure health within/across borders
• requires a more rational approach to address the
intersection of health + security demands today.
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Translating science – seasonal health
• Requires research, practice & policy implementation
– More rigorous study of seasonal health & globalization
• Study short - longer term impact on public health
• Understand new challenges
– Applied actions for health diplomacy in 21st C
• Promote transparency in reporting to protect
• Seek better cooperation & coordination for infectious disease
– Willingness to embrace health security
• Prevent, detect & respond to unintentional & intentional and human
error spread of diseases – time of year preparation
• Develop strategy to reduce threats
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Seasonal health challenges
• Emerging & re-emerging diseases
• Previously seasonal now annual or protracted
seasonal threats?
• Science + public policy actions
– Prevent, protect, secure health
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Global Health Emergencies (2014-2016)
High rates of the Zika virus in Recife, Brazil reported highest
temperatures on record from September-November 2015.
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Movement of microbes
…seasons converge to understand…
• New framework of analysis
– Public Health- Planetary health
– Globalization
– Diplomacy
– Security
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Analytical & Practical Tool: Seasonal - Annual Infectious Disease Threats (Porcelain)
PERSPECTIVES
------------------
PUBLIC HEALTH
GLOBALIZATION
DIPLOMACY
SECURITY ( levels of analysis)
(Planetary Health)
Individual/community/state/regional/
Epidemiology
global
GLOBAL –LOCAL
CROSS BORDER THREAT
ROLE OF TRADE,
TOURISM
(STUDY & SERVICE
ABROAD)
STATE & NON STATE
ACTORS
(CIVIL SOCIETY)
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THANK YOU!
I WELCOME YOUR FEEDBACK!
Prof. Sherri Porcelain
Department of International Studies
Department of Public Health Sciences
[email protected]
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