Update on Regional Zoonotic Disease Status 2015 · Urban leptospirosis in Brazil Unrecognized seasonal transmission? ... – Drinking of raw date palm sap (kancha khejurer rosh) contaminated

Update on Regional Zoonotic Disease Status

2015

Dr Frank KoningsWHO/WPRO Emerging Disease Surveillance and Response

Sixth Asia-Pacific Workshop on Multi-Sectoral Collaborationfor the Prevention and Control of Zoonoses

Sapporo, Japan | 28 - 30 October 2015

Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015

Global emerging viral diseases

Source: Marston: Emerging Viral Diseases: Confronting Threats with New Technologies. Sci Transl Med. 2014 Sep 10;6(253)


Learning from history…

• Health security threats - especially emerging diseases - are inevitable (SARS, H5N1, H7N9, MERS…)

• Investing in preparedness during peace-time enables a rapid response during emergencies

• APSED serves as a regional tool to comply with IHR core capacities, thus collectively managing health security threats


1. Surveillance, Risk Assessment and Response

2. Laboratory

3. Zoonoses

4. Infection Prevention and Control

5. Risk Communication

6. Public Health Emergency Preparedness

7. Regional Preparedness, Alert and Response

8. Monitoring and Evaluation

Asia Pacific Strategy for Emerging Diseases (APSED) 2010


Regional efforts: APSED

Generic platform for preparedness, alert and response

Step-wise approach to capacity development

Connects stakeholders at national and regional levels

Emphasizes value of learning from real world events


2015 Joint APSED Evaluation

Joint Member States-WHO review of 9 years of APSED

• Re-confirmed the relevance of APSED

• Demonstrated achievements through country stories

• While we are better prepared, we are not safe from more severe health security threats

• Need further investments in health security to sustain and upgrade the system


MERS: An ongoing health security threat

• Since 2012, 26 countries have been affected by MERS, including the recent significant outbreak in the Republic of Korea

• Globally, more than 1500 cases, including at least 550 deaths have been reported

7

Sixth Asia-Pacific Workshop on Multi-Sectoral Collaboration for the Prevention and Control of ZoonosesSapporo, Japan | 28 - 30 October 2015 8

Ebola Virus Disease (EVD)


Nature of health security threat…

• Vulnerability is universal• Emerging disease travels faster than ever before• Public fear spreads quicker than disease itself• Impacts are far beyond “cases & deaths”


Keeping flu in the spotlight

10

• Significant morbidity and mortality of seasonal influenza: importance of GISRS vaccine strain selection

• Variety of strains circulating among birds in the Asia Pacific• Human infections with “HxNy” continue to be detected• Excellent network of countries and experts built over the

years or “flu family”


SEAR: Number of specimens positive for influenza by subtype


Country-wise positive influenza specimens in SEAR


India: Number of specimens positive for influenza by subtype, 2015

Data source: FluNet ( www.who.int/flunet ), GISRS


WPR: Number of specimens positivefor influenza by subtype


Epidemiological curve of human infection withavian influenza A(H7N9)

N=679 cases, 271 deaths as of 20 October 2015


Geographical distribution of human cases of infection with Avian Influenza A(H7N9) virus

(date of onset 19 Feb 2013 - 20 October 2015)China CasesAnhui 31Beijing 6Fujian 63Guangdong 180Guangxi 4Guizhou 2Hebei 1Henan 4Hong Kong (China) 13Hubei 1Hunan 26Jiangsu 77Jiangxi 11Jilin 2Shandong 7Shanghai 48Taiwan 4Xinjiang 10Zhejiang 186Other CountryMalaysia 1Canada 2Total 679


Crimean Congo Haemorrhagic Fever outbreak in India

Serological evidence of CCHF in camel,sheep and goats was reported (NIV, 2010)

Overall, 5.43 per cent bovine samples and10.99 per cent sheep/goat samples werefound to be positive for anti-CCHF virusantibodies in Himachal Pradesh, Odisha,Rajasthan and Gujarat states of India (NIV,2015)

Nosocomial infection has been reported in2011 and 2015

CCHF outbreaks constitute a threat topublic health because of its epidemicpotential, high case fatality, potential fornosocomial outbreaks, and difficulties intreatment and prevention

CCHF outbreaks in India, 2011-2015


Leptospirosis: Endemic and emerging disease in the Asia-Pacific Region

• Endemic Inter-epidemic periods in South and SE Asia

• Endemic with pronounced seasonality New Caledonia Urban leptospirosis in Brazil Unrecognized seasonal transmission?

• Large isolated outbreaks Usually associated with extreme climactic

events Fiji (2015), Mumbai (2005), Philippines (2009)

• Sustained epidemics over broad geographical regions Thai epidemic in late 1990s Sri Lanka outbreak in 2008-2009

Source: LERG report 2014

>100

20-25

7-10

0-3


Nipah outbreaks in Bangladesh

• Each year, Nipah outbreaks are reported during winter time in Bangladesh

• In 2015, 9 Nipah cases were reported, of them 6 (67%) died.

• These cases are from 6 different districts namely Nilphamari, Ponchoghor, Faridpur, Magura, Naugaon, Rajbari.

• Median age of the Nipah cases in last 13 years (Range: 2 to 45 years).

• Average case fatality rate is 75% in last 15 yearsSource: IEDCR Bangladesh

• Risk factors– Drinking of raw date palm sap (kancha

khejurer rosh) contaminated with NiV– Close physical contact with Nipah

infected patients

Nipah virus outbreaks in South Asia


Conclusions

• Health security threats are inevitable and we need to invest in preparedness.

• Health security threats do not recognize national borders, and the consequences go far beyond health impacts.

• We have good frameworks and tools to act – but these need to be strengthened.

• Multi-sectoral collaboration at the interface of human and animal health is of key importance to address zoonotic threats.


International partnership

Documents

Update on Regional Zoonotic Disease Status 2015 · Urban leptospirosis in Brazil Unrecognized seasonal transmission? ... – Drinking of raw date palm sap (kancha khejurer rosh) contaminated