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Emerging Infectious DiseasesAustralia is not an Island
Bart Currie
Global and Tropical Health DivisionMenzies School of Health Research, Darwin
Infectious Diseases Department, Royal Darwin Hospital
Lom
bok
Wallace’s LineWeber’s Line
Jakarta
Darwin
Timika
Borneo
Papua
Sulawesi
Bal
i
Java
Timor
Northern
Territory
Lom
bok
Wallace’s LineWeber’s Line
Jakarta
Darwin
Timika
Borneo
Papua
Sulawesi
Bal
i
Java
Timor
Northern
Territory
Which infections for our region?
• Tuberculosis (incl MDR XDR)
• HIV• Influenza; H1N1 (swine)
& H5N1 (avian)• Malaria• Dengue• Hepatitis B• MRSA• Other bacterial sepsis• Multi-resistant Gm -ves
• Melioidosis• Leptospirosis• Rickettsial diseases – scrub
typhus, other• JE• Chikungunya• Zika & other arboviruses• Nipah; other bat-associated• Ebola?• The next SARS?
Which infections for our region?
• Tuberculosis (incl MDR XDR)
• HIV• Influenza; H1N1 (swine)
& H5N1 (avian)• Malaria• Dengue• Hepatitis B• MRSA• Other bacterial sepsis• Multi-resistant Gm -ves
• Melioidosis• Leptospirosis• Rickettsial diseases – scrub
typhus, other• JE• Chikungunya• Zika & other arboviruses• Nipah; other bat-associated• Ebola?• The next SARS?
Which infections for our region?
• Tuberculosis (incl MDR XDR)
• HIV• Influenza; H1N1 (swine) &
H5N1 (avian)
• Malaria• Dengue• Hepatitis B• MRSA• Other bacterial sepsis• Multi-resistant Gm -ves
• Melioidosis• Leptospirosis• Rickettsial diseases – scrub
typhus, other• JE• Chikungunya• Zika & other arboviruses• Nipah; other bat-associated• Ebola?• The next SARS?
“The Red Plague”
• Refers to emerging resistance in Gram negative organisms (E. coli, Klebsiella spp.)
• Cause common infections e.g. UTI in community
• High rates of resistance in Asia-Pacific region
• Some strains pan-drug resistant
Resistance (%ESBL) in the Asia Pacific region
AustraliaECOL: 12%KPNE: 15% New Zealand
ECOL: 11%KPNE: 10%
Hong KongECOL: 46%KPNE: 23%India
ECOL: 78%KPNE: 64%
IndonesiaECOL: 71%KPNE: 64%
Japan†ECOL: 17%KPNE: 11%
KoreaECOL: 37%KPNE: 40%
MalaysiaECOL: 36%KPNE: 45%
PhilippinesECOL: 47%KPNE: 23%
SingaporeECOL: 21%KPNE: 32%
TaiwanECOL: 91%KPNE: 75%
China*ECOL: 54%KPNE: 41%
Thailand*ECOL: 55%KPNE: 50%
Courtesy John TurnidgeACSQHC
Resistance (%ESBL) in the Asia Pacific region
AustraliaECOL: 12%KPNE: 15% New Zealand
ECOL: 11%KPNE: 10%
Hong KongECOL: 46%KPNE: 23%India
ECOL: 78%KPNE: 64%
IndonesiaECOL: 71%KPNE: 64%
Japan†ECOL: 17%KPNE: 11%
KoreaECOL: 37%KPNE: 40%
MalaysiaECOL: 36%KPNE: 45%
PhilippinesECOL: 47%KPNE: 23%
SingaporeECOL: 21%KPNE: 32%
TaiwanECOL: 91%KPNE: 75%
China*ECOL: 54%KPNE: 41%
Thailand*ECOL: 55%KPNE: 50%
Courtesy John TurnidgeACSQHC
Multi-resistant organisms post 2002 Bali bombings
• 35 patients with severe burns transferred to Royal Perth– 19 Multi-resistant Acinetobacter baumannii (MRAB)
– 15 Extended-spectrum B- lactamase producing Gm-negs (ESBL)
– 9 Vancomycin-resistant enterococci (VRE)
– 6 Multi-resistant Pseudomonas aeruginosa (MRPA - 2 fatal)
– 3 MRSA
• Transmission of MROs to 41 non-Bali pts in RPH– 11 bacteremias
– 4 deaths with MRPA
Heath C et al. Aust Infect Control 2003;8:43-54
In 2010, a multi-drug carbapenem-resistant K. pneumoniaewas introduced into the ICU of a Sydney Metropolitan
Hospital by a patient recently returned from Egypt. Three additional patients acquired the organism over several months before
termination of the outbreak. All four patients who developed an infection with this organism died.
Then introduction and spread of carbapenem-resistant bacteria
There have been previous documented cases of infection with imported blaNDM-1-containing bacteria in Australia.
We hypothesise that this carbapenem-resistant Enterobacteriaceae isolate was acquired after transmission from an unidentified carrier of blaNDM-1, possibly
during previous hospital admissions or receipt of home nursing care.
Now community spread of carbapenem-resistant bacteria
Tal et al. Med J Aust 2015;202:270
Resistance in Australia: public attention & funding
Which infections for our region?
• Tuberculosis (incl MDR XDR)
• HIV• Influenza; H1N1 (swine)
& H5N1 (avian)• Malaria• Dengue• Hepatitis B• MRSA• Other bacterial sepsis• Multi-resistant Gm -ves
• Melioidosis• Leptospirosis• Rickettsial diseases – scrub
typhus, other• JE• Chikungunya• Zika & other arboviruses• Nipah; other bat-
associated• Ebola?• The next SARS?
Bats and emerging human viral diseases
Australian bat rabies(lyssavirus)
Nipah & Hendra virusSARS & MERS
EbolaWhat next??
Bat-filled tree may have been ground zero for the West African Ebola epidemic
"I would not say that the future is necessarily less predictable than the past - I think the past was not
predictable when it started." Donald Rumsfeld
So what else is out there?
So what else is out there?
“Prediction is very difficult, especially about the future."
Niels Bohr
Which infections for our region?
• Tuberculosis (incl MDR XDR)
• HIV• Influenza; H1N1 (swine)
& H5N1 (avian)• Malaria• Dengue• Hepatitis B• MRSA• Other bacterial sepsis• Multi-resistant Gm -ves
• Melioidosis• Leptospirosis• Rickettsial diseases – scrub
typhus, other• JE• Chikungunya• Zika & other arboviruses• Nipah; other bat-associated• Ebola?• The next SARS?
198 million cases globally 584,000 deaths (78% <5yo)24 million Southeast Asia 41,000 deaths (29% <5yo)(44% P. vivax)1 million Western Pacific 3,300 deaths (49% <5yo)
Malaria globally and regionally
But Its Worse Than We Thought: February 2015
• 17 Member Countries (from the initial 11 in 2009)– Bangladesh, Bhutan, Cambodia, China, India, Indonesia, DPR Korea, Republic of Korea, Laos,
Malaysia, Nepal, Philippines, Solomon Islands, Sri Lanka, Thailand, Vanuatu, Vietnam
• 18 Research and Service Partners
Vivax Working Group– Identify key research priorities– Build local capacity– Workshops:
• Genotyping, G6PD, Clinical Trials
– Technical grants
Clinical TrialsGenotypingG6PD deficiency testingParasite Prevalence
Asia Pacific Malaria Elimination Network
Asia Pacific Malaria Elimination Network
Successful elimination of malaria inSolomon Islands and neighbouring
countries would be a historicachievement for the health of the
peoples of our region, and it wouldalso pay a dividend for Australia’sown public health and biosecurity.
Harin Karunajeewa et al. MJA 202 (7) · 20 April 2015
Asia Pacific Leaders Malaria Alliance
Created at 2013 East Asia Summit in BruneiSecretariat formally commenced operations January 2014
Asia Pacific Leaders Malaria Alliance
East Asia leaders commit to eliminate malaria from Asia Pacific by 203013th November 2014
198 million cases globally 584,000 deaths (78% <5yo)24 million Southeast Asia 41,000 deaths (29% <5yo)(44% P. vivax)1 million Western Pacific 3,300 deaths (49% <5yo)
Papua New Guinea: our forgotten friends & colleagues?
198 million cases globally 584,000 deaths (78% <5yo)24 million Southeast Asia 41,000 deaths (29% <5yo)(44% P. vivax)1 million Western Pacific 3,300 deaths (49% <5yo)
Papua New Guinea: our forgotten friends & colleagues?
Which infections for our region?
• Tuberculosis (incl MDR XDR)
• HIV• Influenza; H1N1 (swine) &
H5N1 (avian)• Malaria• Dengue• Hepatitis B• MRSA• Other bacterial sepsis• Multi-resistant Gm -ves
• Melioidosis• Leptospirosis• Rickettsial diseases – scrub
typhus, other• JE• Chikungunya• Zika & other arboviruses• Nipah; other bat-associated• Ebola?• The next SARS?
MDR TB: PNG… TSI…Where next??
The 32-year-old Torres Strait Islander died on 29/09/14
“Close connection" with another TSI woman who died from MDR TB in 2013
Contact with at least 50 people
October 14, 2014Amy Remeikis
Papua New Guinea: our forgotten friends & colleagues?
The 32-year-old Torres Strait Islander died on 29/09/14
“Close connection" with another TSI woman who died from MDR TB in 2013
Contact with at least 50 people
October 14, 2014Amy Remeikis Adult wards at PMGH
Mortality 10% 1989Mortality 32% 2013TB 25% of deaths
HIV/AIDS 24% of deathsVincent Pyakalyia
M Med Thesis UPNG 2013
World TB Day March 24 2007
= LTBI active TB
= LTBI (Mx +ve)
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