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On behalf of Pierre Formenty – Global Alert and Response Department - 1
Bernadette Abela-Ridder, Food Safety and Zoonoses Pierre Formenty, Global Alert and Response
Health Security and Environment Cluster
Paris, France, 24 February 2011
From Forecasting to Control of Zoonotic Diseases: Linking Animal and Human Systems
Photo credits: A. Epelboin, A. Casanova, P. Formenty
On behalf of Pierre Formenty – Global Alert and Response Department - 2
Epidemics and Pandemics have shaped our history…
On behalf of Pierre Formenty – Global Alert and Response Department - 3
Our World is changingOur World is changing
● The way we live
● 2025: 5 Billion in urban centres
● Microbes evolve
● New threats emerge
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Countries with a critical shortage of health service providers (doctors/nurse/midwives)
Data source WHO 2009. Global Atlas of Health workforce
Country with critical shortage
Country without critical shortage
Selected major wilderness areasSelected terrestrial biodiversity hotspots
Tokyo
Mexico
New York
Sao Paulo
Delhi
Mumbai
Los Angeles
Rio de Janeiro
Buenos Aires
Lagos
Cairo
Istanbul
Moscow
Beijing
Osaka, KobeShanghai
Metro Manila
Jakarta
DhakaCalcuttaKarachi
ParisLondon
Chicago
Bogota
Lima
Seoul
Tianjin
Hong Kong
Chennai
Tehran
Kinshasa
Wuhan
Lahore
Bangalore
HyderabadAhmadabad Surat
BangkokPune
Belo Horizonte
Baghdad
Riyadh Chittagong
15>29.9 millions habitants
10 >14.9 millions habitants7 >9.9 millions habitants
30 millions habitants and more
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61% of Emerging Infectious Diseases (EID) are Zoonoses affecting Humans
Wildlife
DomesticAnimal Human
Translocation
Human encroachmentEx situ contactEcological manipulation
Global travelUrbanizationBiomedicalmanipulation
Technology And Industry
AgriculturalIntensification
EncroachmentIntroduction“Spill over” &“Spill back”
● Frequency of all EID events has significantly increasedsince 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 wildlifereach highest proportion in recent decade
Daszak P. et.al.Science 2000 287:443
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Infectious Diseases at the Human Animal interface:from forecasting to outbreak response
Infectious Diseases at the Human Animal interface:from forecasting to outbreak response
On behalf of Pierre Formenty – Global Alert and Response Department - 7TIME
Emerging Infectious Disease outbreak alert and response
Num
ber o
f Cas
es
ClimateVegetation
Environment
0102030405060708090
-20 -15 -10 -5 0 5 10 15 20 25 30 35 40
HumanAmplification
Domestic Animal
Human outbreak
Wildlife
AnimalAmplification
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Domestic Animal
Human outbreak
Wildlife
0102030405060708090
-20 -15 -10 -5 0 5 10 15 20 25 30 35 40
Num
ber o
f Cas
es
TIME
Emerging Infectious Disease outbreak alert and response
AnimalAmplification
ClimateVegetation
Environment HumanAmplification
First casesIn Animals
LateDetection
DelayedResponse
Control Opportunity
NB: Yellow areas represent cases that can be prevented with control operations
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1. Mitigate 3. Control 4. Learn
Emerging Infectious Disease coordinated outbreak alert and response
2. Alert
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Drivers of epidemicsPANDEMIC Global spread
EPIDEMIC Amplification
OUTBREAK Emergence
Amplification
Global travel and trade
Human Animal
interface
Human to human transmission
Emergence• Human encroachment, Ex situ contact,• At-risk behaviour• Ecological pressure• Exploitation• Translocation of wildlife• Climate variability, vector density & distribution
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
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Some examplesSome examples
Infectious Diseases at the Human Animal interface:Risk mapping and Forecasting
Infectious Diseases at the Human Animal interface:Risk mapping and Forecasting
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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).
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Modeling EID events: CCHF risk map
Courtesy David Roger, Oxford University, Department of Zoology, Oxford, UK
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Forecasting EID emergences
Ebola surveillance in Central Africa
Collaborators: WCS, CIRMF, IRD, ECOFAC, MoH, National Park Boards, MSF, WHO.
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Climatic and Ecological Conditions for RVF Risk during November 2006
El Niño effect, October 2006
NDVI anomalies, November 2006
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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
-4
0
-8
-12
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● 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,…)
Risk mapping and forecasting
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Infectious Diseases at the Human Animal interface:detection and assessment
Infectious Diseases at the Human Animal interface:detection and assessment
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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
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● 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.
WHO Alert and Response Department
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Response strategy and Operations
FormalWHO laboratory networks, (sub-)regional networks,
WROs & MoH, UNOs
Finances
Official Sourcese.g. WRO, MoH
InformalGlobal Public Health Intelligence
Network (media), NGOs
Risk Assessment
Verification
EpidemicIntelligence
Coordination Technical & Operational Case management
FuneralsInfection Control
Epidemiological Investigation SurveillanceLaboratory
Social Mobilization Health Education
Medical Anthropology
LogisticSecurity
Communications Medias - Information
GOARNGLEWS
FAO, OIE, WHOGlobal Early Warning System
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EMS current events 2010-06-09Current events 23 February 2011
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On behalf of Pierre Formenty – Global Alert and Response Department - 24
● 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
Global Alert and Surveillance: perspectives
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Infectious Diseases at the Human Animal interface:response
Infectious Diseases at the Human Animal interface:response
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General strategy for controlling outbreak
Social Mobilization
Epidemiologicalinvestigation Surveillance Laboratory
Logistics Security
Communications
EnvironmentVector control
Health EducationCase Management
Death auditsInfection control
CoordinationMedia
Information
COMBI
(* COMBI = communication for behavior change)
Human-animal-ecosystems interface partners
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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
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GOARN: Global Outbreak Alert and Response Network
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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
EDPLN memberEDPLN future member
AMROAFRO
WPRO
SEARO
EURO
EMRO
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Outbreak control : Ecological studiesWildlife knowledge is crucial to understand the epidemiology of Zoonoses
Monkeypox
Avian Influenza
SARS
West Nile
Nipah
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Infectious Diseases at the Human Animal interface: conclusion
Infectious Diseases at the Human Animal interface: conclusion
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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 !
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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…).
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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.
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From forecasting to control of zoonotic diseases….
Bernadette Abela-Ridder, Food Safety and Zoonoses Pierre Formenty, Global Alert and ResponseHealth Security and Environment ClusterWorld Health Organization
Thanks!
From forecasting to control of zoonotic diseases….
Bernadette Abela-Ridder, Food Safety and Zoonoses Pierre Formenty, Global Alert and ResponseHealth Security and Environment ClusterWorld Health Organization
Thanks!
