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David Banks Oration. Biosecurity in North Queensland: Challenges and opportunities. Rick Speare Anton Breinl Centre for Public Health and Tropical Medicine James Cook University [email protected] 13 May 2010. Questions. - PowerPoint PPT Presentation
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Biosecurity in North Queensland:
Challenges and opportunitiesRick Speare
Anton Breinl Centre for Public Health and Tropical Medicine
James Cook [email protected]
13 May 2010
David Banks Oration
Questions
• Are the biosecurity risks in North Queensland different from other areas in Australia?
• Do these special risks make Australia more vulnerable?
• How are they being addressed?
• What are the opportunities to use new approaches to reduce the risks?
What makes North Queensland special?
• Receptivity to dengue• Porous PNG-Australian border in Torres Strait
Slide from Scott Ritchie (JCU)
Receptivity is a Qld problem… at present
Slide from Scott Ritchie (JCU)
North Queensland dengue outbreakscases per month
0
100
200
300
400
North Queensland dengue outbreakscases per month
0
100
200
300
400
Graph from Dr Scott Ritchie, JCU/QH
Control of Dengue
• Dengue Control Strategy
• Continual enhanced surveillance under National Notifiable Disease Surveillance Scheme (NNDSS)
• Dengue Alert and Response Team
• State of Emergency declared to control 2008-2009 Cairns outbreak
Constant vigilence, but dengue is under control
• Lethal ovitraps
• Biodegradable
• Research on novel control strategies using a symbiotic bacterium (Wolbachia wMelPop)– Reduces longevity– Reduces feeding ability– Inhibits dengue virus
multiplication in mosquito
Pacific Island Countries & Territories (PICTs)
PNG
PICTs are doing badly!
22 countries spread over millions
of km2 of Pacific Ocean
Southeast Asia
Indonesia
PICTs
Indo-Papuan Conduit
Qld’s special link to Asia and the Pacific
PNG
Australia
Joh Rescues Torres Strait Islands
Torres Strait Treaty 1978
Major outcomes of the Torres Strait Treaty Act 1984
• “each Party shall apply immigration, customs, quarantine and health procedures in such a way as not to prevent or hinder free movement or the performance of traditional activities” (article 16)
• Refers to residents of protected zone (PZ) and 13 coastal villages in PNG (article 10)
What are the current offshore biosecurity challenges?
• Failed health systems pushing diseased PNG residents towards Torres Strait
• Emerging infectious diseases (known and unknown) in Australia’s near neighbours
• Poor control of livestock diseases in PICTs and Indonesia
• Importation of food products carrying pathogens
• Climate change, especially in PICTs, generating environmental refugees
Comparing ICUs: Lake Murray vs Townsville Mater
POVERTY!
Tuvulu
Climate Change willhave major impacts
in PICTs!
Traditional PNG visitors
• Annually 30,000-53,000 59%
3%
2%4%
29%
2%
0.6%
0.5%0.3%
0.2%
0.2%
0.1%
0.1%
House Reps SC Hlth Aging Mar 2010
Estimated 4% come
specifically for health care
Contrasts in services
Torres Strait• Well functioning Qld
Health system staffed by doctors, nurse practitioners and remote area nurses
• Specialists visit and referral - Cairns
• Basic laboratory services in TS
• Veterinary services intermittent in PZ
Western Province• Minimal or no health
service staffed by health extension officers
• Very low vaccination rates
• Specialist referral – Port Moresby, but inadequate
• Minimal lab services• No veterinary service
Humanitarian emergencies: Entry into Cairns … and points south
Saibai
Thursday Is
Cairns
What about movement of animals and animal products?
• AQIS Quarantine offices = 15
Northern Australian Quarantine Strategy
(NAQS)
Incursions that have occurred and are under control
• Malaria (surveillance - NNDSS)
• Dengue (enhanced surveillance - NNDSS)
• Japanese encephalitis 1995 (NNDSS, vaccination of all TS residents)
• TB (NNDSS)
• Leprosy (NNDSS)
Merritt et al 1998
Incursions that are not under control• Asian tiger mosquito (Aedes albopictus) found in 10/17 inhabited islands
in 2005
Russell et al (2005)
Predicted Distribution
Current Distribution
Current Emerging Infectious Disease Threats
• Multidrug resistant TB, particularly in PNG• Cholera now moved to south coast PNG• Arboviral diseases (Dengue, Japanese
encephalitis, West Nile, Chickungunya)• Asian tiger mosquito (A. albopictus) in Torres
Strait• Rabies moving east in Indonesia• Highly pathogenic avian influenza and other
avian viruses• Nipah virus and other bat-borne viruses• New pathogens emerging from wildlife
MDRTB
Pulmonary TB(Mycobacterium tuberculosis)• Chronic cough
(2 wks)• Productive• Haemoptysis
(blood in sputum)
• Weight loss• Night sweating
Multidrug Resistant TB (MDRTB)
• TB is a serious disease• TB prevalence
– Aust 5/100,000– Western Province 552/100,000 (DoH WestProv 2009)
• MDRTB is resistant to two of the first line drugs (rifampacin & isoniazid)
• Harder to treat & more expensive• 30% of Australia’s MDRTB comes through
Torres Strait from Western Province of PNG• Rate of MDRTB in PNG patients in Torres Strait
– 25-39% (DHA 2009 dha_171209)
Bad enough!But wait there’s more…
• Inadequate treatment drives MDRTB
• Evolution to extensively drug resistent TB (XDRTB) is a possibility
Challenges in PNG
• DOTS system to treat TB not implemented
• No reliable routine TB culture
• Inadequate treatment generates multidrug resistance
• Partial treatment of TB in Australia may generate MDRTB
• No strategy in Western Province to treat MDRTB
• HIV is increasing in PNG
Risk of MDRTB to North Queensland?
• Manageable since TB control is good in Torres Strait and socio-economic conditions are protective
• For local residents risk is not high
• Risk highest to health professionals in Torres Strait caring for PNG cases
Management of risk of MDRTB
• In Torres Strait– Maintain Aust TB control system– Enhanced surveillance for suspect TB cases– Protect health care workers
• In Western Province– Adequately treat PNG patients that present in TS
• Cross-border collaboration (Communications officers)
• Subsidised boat trips to complete treatment– Assist PNG to improve TB control in Western
Province– Assist PNG to establish TB culture facilities at Daru
or Balimo
Facilitated cross-border movement
• TS Health Issues Committee (HIC) “Package of measures”
• Allow travel directly from Saibai and Boigu to treaty villages for nominated health professionals
• Agreed to by both sides• Implementation date?
Cholera
• PNG cholera epidemic began in Lae in Oct 2009
• Spread to Madang Oct 2009• Nov 2009 west along north
coast, and inland to highlands
• May 2010 first cases in Port Moresby
• When will it reach the Western Province?
How will Australia respond?
JE
Dengue
Other arboviruses?
Arboviruses
• Dengue virus (DEV)
• Japanese encephalitis virus
• Chickunguna virus
• West Nile virus
• Unknown and undiscovered viruses
Only dengue virus is host specific: 1) humans, 2) Aedes aegypti or A. albopictus
Receptivity is a Qld problem, but rain water tank installation
will expand the range of the vectors south
Aedesalbopictus
Unknown arboviruses in PNG?
• Madang encephalitis
• Not JEV?
• Death in children and severe disability
Rabies is moving east in Indonesia
• Susetya et al. Virus Res 2008;135:144-9.
1997
2008
Not if, but when?
Indo-Papuan Conduit
Strategies to defend against rabies from Indonesia
• Assist PNG to monitor dogs with neurological signs (no functional vet service)– Surveillance– Laboratory capacity
• Assist in control of rabies in Indonesia• AQIS officers monitoring dogs in Torres
Strait• AMRRIC improving dog health in Indigenous
communities • Control in wild dogs & dingoes is a problem
– Vaccinate against rabies by baiting
MDRTB
Bat viruses?
Other arboviruses?Other EID?HPAI?JE
Dengue
Wildlife Diseases: EID risks• Two higher risk flying reservoirs
• Bats: Henipaviruses, lyssaviruses, filoviruses, coronaviruses, rheoviruses, herpesviruses, other viruses
• Birds: Avian influenza and other avian diseases
Wildlife EIDs are driven by habitat destruction,
humans using resources,climate change
• Halpin et al. CID 2007;44:711-717
Flying foxes are hosts to a range of RNA virusesthat cause EIDs
Dobsonia magna
Highly Pathogenic Avian Influenza
• Pandemic (for birds)• H5N1 is here to stay
H5N1 in Indonesia
• H5N1 HPAI is widespread
• 165 human cases with 136 fatal (82%)
Indo-Papuan Conduit
Will H5N1 use this route?
H5N1
Ongoing monitoring of poultry & wild birds in PNG & Torres Strait
for AI?
Wildlife Disease Surveillance is essential
We must be looking for • mortality and morbidity in wildlife, esp bats and birds • Marine animals – reptiles, mammals, fish?• Monitoring regularly for particular diseases
– Avian influenza– Newcastle disease– West Nile virus (in birds)– Bat henipaviruses
"Our findings highlight the critical need for health monitoring and identification of new, potentially zoonotic pathogens in wildlife populations, as a forecast measure for EIDs”
(Jones et al. Nature 2008)
Australian Wildlife Health Network
• Largely voluntary surveillance• Should be a parallel system equivalent to
human communicable disease surveillance system and veterinary surveillance system
• Not functioning in Torres Strait or Cape York
• Poorly funded• Major deficiency in biosecurity surveillance
in North Queensland
Opportunities in PNG• Assist PNG to establish communicable disease
surveillance in Western Province• Syndromic surveillance for outbreak diseases
may be best model• Consider a joint human, livestock, and wildlife
surveillance system (true “One Health”)• Initially provide expert support from Torres Strait• Initially provide lab support from Australia• Utilise the facilitated cross-border movement
approach
Syndromic surveillance in resource poor environments
• Frontline health workers trained to recognise signs and symptoms of diseases of outbreak potential (eyes of the system)
• Supported by a hub of communicable disease control specialists (brain of the system)
• Backed up by laboratory support to confirm diagnoses• Used to control human diseases in Mpumulanga
Province (South Africa), Tuvalu, now other PICTs• Western Province is “virgin soil”• Why not implement a syndromic surveillance One Health
system that looks for outbreak diseases in humans, livestock, and wildlife?
Speare et al (2003), Nelesone et al (2006)
Opportunities in Torres Strait
• Establish a functional wildlife disease surveillance system with good response capacity
• Improve formal collaboration in outbreak investigation and response across all three arms (human, livestock, wildlife)
• Provide cross-border support to surveillance in PNG, particularly for diseases with outbreak potential
Way forward• Political will at all levels in Australia• Money to demonstrate commitment• Coordinated planning• Strengthening of the Torres Strait surveillance and
response activities to detect and control disease and pest incursions in a timely manner
• Collaborative partnership with PNG national and Western Province leaders
• Focus on decreasing the EID risks liable to enter via the IndoPapuan conduit
• Protect Australia by protecting PNG
Thank you!
Difficult, long-term, but essential
Images• Aedes aegypti -
http://www.health.gov.bz/www/images/stories/aedes_aegypti_seitlich.jpg• Black-striped wallaby -
http://www.fauna.com.au/web_pages/animals/marsupials/black_striped_wallaby.html• Leaving on a jet plane - www.thegoodsplace.org/2007/06/boo-hoo-hoo.html• Pasteur & swan neck flasks -
http://www.daviddarling.info/encyclopedia/P/Pasteur.html• Rabid dog - http://www.jack-russell-terrier.co.uk/advice/vaccinations.html• Port Douglas - http://www.flickr.com/photos/blackdiamondimages/3874757902/• Scott O’Neill - www.uq.edu.au/news/?article=18458• Rain water tank from Scott Ritchie• Scott Ritchie - http://www.jcu.edu.au/phtmrs/staff/academic/JCUDEV_015744.html• Dobsonia magna -
http://www.henipavirus.org/virus_and_host_info/bats/dobsonia_magna.htm
Literature cited
• Hufnagel L. et.al. PNAS 2004;101:15124-15129• Jones KE, Patel NG, Levy MA, Storeygard A, Balk D, Gittleman JL,
Daszak P. Global trends in emerging infectious diseases. Nature 2008;451(7181):990-3.
• Nelesone T, Durrheim DN, Speare R, Kiedrzynski T, Melrose WD. Strengthening sub-national communicable disease surveillance in a remote Pacific Island Country by adapting a successful African outbreak surveillance model. Tropical Medicine and International Health 2006;11(1):17-21.
• Speare R, Durheim DN, Ogunbanjo GA, Edginton ME, Harris BN. An effective training strategy for communicable disease control nurses. African Journal of Nursing and Midwifery. 2003;5(1):50-56.
• Susetya H, Sugiyama M, Inagaki A, Ito N, Mudiarto G, Minamoto N. Molecular epidemiology of rabies in Indonesia. Virus Research 2008;135:144-9.