Atmosphere and Health, some links and needs

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Transcript Atmosphere and Health, some links and needs

CERMES
Centre de Recherches Médicales et Sanitaires
Associated Institute of
Pasteur Institute International network
Missions of CERMES
JO 01/09/02
Medical Biology Médicale- Public health
1. Applied fondamental research, operationnal
2. National institutions support (or state else)
3. Risk expertise and evaluation of control
programmes against endemic diseases
4. Training of national or stranger sanitary managers
Health and Climate in
intertropical areas
Some links and needs
21 janvier 2004 - NOORDWIJCK
I. JEANNE1, A. DIEDHIOU2, JB DUCHEMIN1, P. BOISIER1, K. KIARI3
1CERMES/RIIP, 2IRD-Niger, 3DSCE
(MoH Niger)
Health Climate
Inter-tropical areas
• Vector borne diseases
• Others
– Malaria
–
Trypanosomiasis
–
Filariasis
–
Leishmaniasis
–
Plague
Rift Valley Fever
West Nile virus
Yellow fever
Tick borne haemorragic
fever
– etc.
–
–
–
–
–
–
–
–
Cholera
Other epidemic diarrhea
Meningitis
…
Extreme events ++
Climate variability +++
seasonal
intraseasonal
Direct and indirect impacts
More important if poor socio-economic status
• Direct on agent/reservoir/vector/host :
Effects on disease epidemiology elements
Onset or cessation of epidemics
• Indirect:
By influence on agricultural output  food security  nutritional status
 vulnerability to disease
By influence on economic output affects abilities to prevent, to care..
By influence on migrations  exposition change
Vulnerability
to diseases
Climate
Socio economic
Land use
Food security
Migrations
The possible links
Climate
Water
resource
Availability
Quality
Water Cycle
Rainfall
Humidity
Temperature
Impact on Health
Agriculture
Land use
Dust
Needs: 2 ways of research
1. Practical, district level
•
•
•
Sahel  where needs are important
Broad thresholds above or under which no more
epidemic occur
To predict where and when epidemics may occur (or
put out) and to integrate climatic forecast products
into early warning system policies
2. Theoritical, up to cellular level
•
•
•
Sahel  where climatic factors are most important
where balances are fragile
Fine trends between thresholds according to
bioclimatic areas
To understand why and how epidemic can occur
But as…
• Epidemiological data « emerged iceberg »
• Links climate/diseases not so simple, lots
of others variable factors
– Ex: malaria-morbidity, meningitis-immunity
• Several scales
 spatial interpolation, temporal extrapolation…
we need to go forward…
Health community needs
• Understanding
• Improve epidemiological
data collection and
diffusion
• Improve t/s transmission
data knowledge
(ex: malaria)
• Improve bacteriological
diagnosis
(ex: meningitis)
– what climatic parameters are
pertinent for studies, how
much back in time
– What products are easily
available for use in public
health
– What specialists to work with
Multidisciplinary
collaborations
Two exemples
Malaria
Meningitis
Malaria Parasite cycle
Malaria
• Agent: 4 species of
parasite
Plasmodium
–
–
–
–
Pl. falciparum
Pl. vivax
Pl. malariae
Pl. ovale
• Vector: mosquito genus
Anopheles
–
–
–
–
An. funestus
An. arabiensis
An. gambiae
…
• World
– 300-500 millions cases per year
– 1.5 - 2.7 millions deaths per
year
– 40% of world population under
risk
• Niger 2003 (10 Millions inhts)
– First cause of mortality and
morbidity
– Nb cases declared: 768 342
– Nb deaths declared: 1 883
(0,25%)
Temperature and Humidity
Effects on parasite development and mosquito survival
> 18°C
< 35°C
Sporogonic development stopped
Plasmodium falciparum
Pl. falciparum
Pl. vivax
20°C
20 days
16 days
24°C
11 days
9 days
30°C
9 days
7 days
An. gambiae
An.
funestus
25°C
10 days
20 days
30°C
5 days
?
•In insectarium:
–Relative Humidity of 80%
–< 5% + or - jeopardize anophele survival
Some particular questions
•
What are the impacts of climate variability on mosquito
behaviour and population dynamics according to
species and location
How anopheles seasonal cycle perpetuate in spite of so
disadvantageous climatic conditions?
•
–
–
•
•
Estivation anopheles?
Passive transportation by air?
What is the importance of nutriments for larvae brought
by deposit areosols in soils/pounds
What are the specific links between climate  pounds
dynamic  anopheles aboundance ?
According time and space
Malaria transmission modelling
CLIMATE
r disponibility
Environment
Quality
Survival
Abundance
Parasite
development
Malaria risk
Morbidity
Epidemic Meningitis
• Agent: bacterium
– Neisseria meningitidis
– Serogroup A predominant
– Emergence serogroup W135
• Reservoir
– Asymptomatic carriage
– Clinically infected cases
• Spread human to human
– Direct contact (respiratory
droplets)
– Co-infection
Meningitis Belt
Lapeyssonnie L. La méningite
cérébro-spinale en Afrique.
Bulletin OMS 1963: 28(S1); 3-114
• World
– Meningitis belt
– Cases reported to WHO:
750 000 (10 years), 7% FR
• Niger 2003
– 8 135 reported cases
– 659 deaths, 8.10% FR
THE SPATIAL DISTRIBUTION OF EPIDEMICS
RESULTS: EPIDEMIC RISK MAPPING
Risk factors
Land cover type
Seasonal absolute humidity
profile
Seasonal dust profile*
Population density*
Soil type*
* Significant but not included in final model
0.0 - (lower)
0.4 - (medium)
0.6 - (high)
0.8 - (very high)
Molesworth AM, Thomson MC, Connor SJ, Cresswell MP, Morse AP, Shears P, Hart CA,
Cuevas LE. Where is the Meningitis Belt? Defining an area at risk of epidemic meningitis in
Africa. (Transactions of the Royal Society of Tropical Medicine and Hygiene 2003)
Seasonal Meningitis
Peak
60
40
rainfall –
Aerosols +
20
Rainfall +/ –
500
AGADEZ
DIFFA
DOSSO
MARADI
TILLABERI
400
0
S
O N D
J
F M A M
J
J
A
Nombre de cas
Incidence
• Hypothesis
invasiveness increase
TAHOUA
ZINDER
NIAMEY
300
200
100
0
S1
S3
S5
S7
S9
S11
S13
Semaine
S15
S17
S19
S21
S23
Some particular questions
• Understand mechanism of invasiveness for
respiratory communicable diseases
• Safe carriers bacteria became invasive or new
bacteria takes place?
• What are the exact climatic parameters which
induce that respiratory mucous membrane
becomes more fragile?
• What are the exact climatic parameters which
induce cessation of epidemic spread?
–Humidity rate? only or not?
–Dust grain size ?
–Aerosols composition? (Iron hypothesis, others..)
–Aerosol abundance?
CERMES
collaborations
•
•
•
•
•
•
•
•
•
•
•
•
•
PNLP-DSCE
Université
IRD Niamey
DMM – Min. Hydraulique
CNAM Mali
Centre Muraz, IRSS, CNLP, BF
ACMAD – AGHRYMET- ICRISAT
RIIP
PAL+
Africa Anopheles network (IRD – CNLP)
WHO
IRI New York - LSTM
IPP - IRD – UMLV – ESA – MEDES – CNES – S2E
NIGER
MALI
BURKINA FASO
Inter-états
International
North
Nord
Health community
requirement
CERMES and collaborators
Improve data collection
Improve data diffusion
S2E ARGOS
MDSC, GREMEN, RF
Improve biological diagnostic
PCR monthly collected
Dipsticks
Improve spatial an temporal
malaria transmission data
CLIMPAL-Niger
Exhange with environmental
communities
Hydrological, weather forecast,
climatologist
 Workshop March 2003 Niamey
 AMMA, ESA-EPIDEMIO
 others projects (RF, GICC, NSF)
1. External box
4. screen à
cristaux
liquides
3. Protection door
5. Clavier
2. Panneau frontal
Collecte des informations
Centre de
Calcul de CLS
Stockage
de
l’informati
on
Balises
Argos
INTERNET
Diffusion de l’information
Base de données (MEDIAS) et Serveur Web sécurisé
CERME
SS
IRS
S
Mail
sécurisé
Partenaires
extérieurs
Cerebrospinal Fluid collect
PCR: diagnostic policy
Multiplex
N. meningitidis
S. pneumoniae
H. influenzae
Prédiction de sérogroupe
Recherche sérotype b
Type Hi
Nm A
Nm B
Nm C
Nm Y/W135
Nm ind
Hi b
Hi non b
Multiplex  espèce
Distinction Y/W135
Nm Y
Nm W135
Sérogroupe Nm
Collect equipment
Questionnaire form
Data gestion
Data analysis
Feedback information
ESA EPIDEMIO-Project
• End users needs
•
• Remote sensing : final products ESA
• OMS, CERMES, IPM, CIRMF,
UMLV, MSF, TALA, ProdiG
AMMA
African Monsoon Multidisciplinary Analysis
 LOP: historical data + 10 ans
 EOP: 3 years (2005/06/07)
 SOP : janv, 15 may to 15 septembre 2006
Health & Climate, Workshop
25th, 26th March 2003
CERMES
Climate observations and health needs in West Africa
– Little is known on changes in health status as a function of climate
change, compared with other thematics
– More automatic observing stations in poorly served areas
– Ground observations should be used to callibrate satellite data
– Integrated products need to be made available routinely to health
services at local, national and regional level.
– Catalogue of available data and specific climate product for health
Conclusions
Mutual awareness
Networks are taking place
Need to focus on the needs of the health community – for climate
variability and climate change.
Climate & health multidisciplinary
objectives
Improve links (experimental process)
Objectives definition
Tools definition
Scale change validation
Modelling
Exhanges and Collaborations
Thank you for your attention…