Global burden of melioidosis was predicted - What's next ?

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  1. 1. Global burden of melioidosis was predicted, Whats next? Direk Limmathurotsakul, MD MSc PhD Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Thailand Presented at WMC 9th, Cebu, 8 August 2016
  2. 2. Problems How many die of melioidosis each year ? - It is the main question that policy makers such as World Health Organization (WHO) and Ministry of Health in each country want to know the answer
  3. 3. Predicted global distribution of B. pseudomallei and burden of melioidosis (Nature Microbiology, 2016) Main Result: We estimate there to be 165,000 (95%CI 68,000-412,000) human melioidosis cases per year worldwide, of which 89,000 (95%CI 36,000-227,000) die. Cartogram of the incidence as a proportion of national geographical area in 2015; 44% is in South Asia
  4. 4. Predicted mortality of melioidosis worldwide Disease Predicted incidence Predicted mortality Predicted case fatality rate Source of data Tuberculosis 8,600,000 1,300,000 15% WHO website Malaria 219,000,000 660,000 0.3% WHO website 2009 Pandemic Influenza A H1N1 N/A 284,000 N/A LID 2012, 12(9)687-695 Melioidosis 165,000 89,000 54% Nature Microbiology 2016 Leptospirosis 1,000,000 59,000 6% PLoS NTD 2015 Severe Dengue 500,000 12,500 2.5% WHO website
  5. 5. Predicted mortality of melioidosis worldwide Countries (selected) Predicted Incidence Predicted Mortality Predicted Mortality Rate India 52,506 31,245 60% Indonesia 20,038 10,224 51% Bangladesh 16,931 7,056 56% Nigeria 13,481 8,324 62% Vietnam 10,430 4,703 45% Philiipines 9,116 4,510 50% Thailand 7,572 2,838 38% Myanmar 6,247 3,687 59% Cambodia 2,038 1,149 56% Lao PDR 420 260 62%
  6. 6. IS THIS ENOUGH ? WHATS MORE THAN CITATION
  7. 7. LESSON & LEARN: MEDIA
  8. 8. LESSON & LEARN: MEDIA BE PREPARED: It takes a lot of time and energy You are not alone (Thanks to David, Bart, Eric, etc.) You need a strong support team (Faculty, Institution, Public Relationship team, etc.) Press-release, Embargo, Rules to check Media skill training (Please ask around)
  9. 9. Now, its in your THUMBDRIVE Please use it only for personal uses Dont put it on YOUTUBE, ANY WEBSITE or ANY MEDIA
  10. 10. IS THIS ENOUGH ?
  11. 11. IS MELIOIDOSIS AN IMPORTANT DISEASE ? [ ] YES [ ] NO
  12. 12. AT PRE- CONGRESS WORKSHOP: IS MELIOIDOSIS AN IMPORTANT DISEASE ? YES NO
  13. 13. http://www.melioidosis.info
  14. 14. http://www.melioidosis.info
  15. 15. http://www.melioidosis.info
  16. 16. WHAT DO WE NEED TO CONVINCE POLICY MAKERS ?
  17. 17. What I said 3 years ago We need to do more for melioidosis prevention Policy change is important Keep pushing is important Networking is important Strategy that fits local need is important If you would like it to be changed, change it
  18. 18. You are wrong, I am right can never be right Researchers, > 700 died of melioidosis in NE Thailand in 2007 Melioidosis has caused six deaths this year, Public Health Minister
  19. 19. IDENTIFY THE UNDERLYING PROBLEM ?
  20. 20. Examples of Thailand Main problem is the notifiable disease system (Report 506) http://www.boe.moph.go.th/boedb/surdata/506wk/y56/en/d72_5256_en.pdf
  21. 21. TRY TO SOLVE IT, TOGETHER AS A NETWORK
  22. 22. Since 2012, Thailand Melioidosis Network kept pushing the accurate data from research into MoPH system Since 2012, Thailand Melioidosis Network kept pushing the accurate data from research into MoPH system Up to 2014, we still failed [Totally, 11 deaths reported] Examples of Thailand Main problem is the notifiable disease system (Report 506) http://www.boe.moph.go.th/boedb/surdata/506wk/y57/en/d72_5257_en.pdf
  23. 23. KEEP PUSHING
  24. 24. In 2015, we succeeded in pushing data of Ubon Ratchathani into the system, and we are having a formal attachment to annual report of MoPH 2015 (expect to release in Nov 2016; Thanks to everyone in the Network, including CDC Thailand) Examples of Thailand
  25. 25. In Thailand, 120 died of Dengue per year 40 died of Leptospirosis per year 6 died of Melioidosis per year Examples of Thailand [PAST under reported] http://www.khaosod.co.th/view_newsonline.php?newsid=1453033649 http://health.kapook.com/view1 33876.html
  26. 26. In Thailand, 120 died of Dengue per year 40 died of Leptospirosis per year 107 died of Melioidosis per year Examples of Thailand [PRESENT 1st step]
  27. 27. In Thailand, 120 died of Dengue per year 40 died of Leptospirosis per year 2,000 died of Melioidosis per year Examples of Thailand [FUTURE MUST BE RIGHT]
  28. 28. IDENTIFY THE UNDERLYING PROBLEM (AGAIN AND AGAIN) ?
  29. 29. Examples of Thailand Main problem is the notifiable disease system (Report 506) Hospitals dont report melioidosis cases because 1) Melioidosis is never in the top priority list 2) Patients die before culture result came back 3) Final diagnosis is not written; A24.1 4) Staffs are too busy to report 5) Staffs dont know that they have to report 6) Epidemiologists Clinicians Microbiologists in the hospitals do not talk to each other
  30. 30. MAKE USE OF AN OPPORTUNITY, & CONNECT THE DOTS
  31. 31. Examples of Thailand New Communicable Disease Act 2015 http://www.ddc.moph.go.th/file/law/008.pdf
  32. 32. Examples of Thailand New Communicable Disease Act 2015 We put melioidosis as an example in the campaign of MOPH to educate healthcare officers about new communicable disease Act 2015 1) Propose a model to put Epidemiologists Clinicians Microbiologists to attend the workshop and talk to each other 2) Inform them that its compulsory to report melioidosis, its A24.1, and it can improve hospital income with the right final diagnosis
  33. 33. LOCAL ADVOCATES ARE NEEDED
  34. 34. Doctors should do . MoPH should do. Thats not my duty . I dont have the authority to . THOSE ARE WRONG, EVERYONE IS NEEDED
  35. 35. ALSO, STRATEGY IS NEEDED
  36. 36. Conclusion We need to do more for melioidosis awareness (Dx, Tx, and Prevention) Policy change is important Keep pushing is important Everyone is important !!! Networking is important !!! Strategy that fits local need is important Have you done enough ?
  37. 37. Update of PRE-MEL study A Single-blind Stepped Wedge Cluster Randomized Controlled BCT to Determine Effectiveness of Prevention Programme of Melioidosis in Diabetics in Ubon Ratchathani, NE Thailand, NCT02089152 Jan 15 Jan 16 Jan 17 Jan 18 Jan 19
  38. 38. Preliminary Result data of enrolled patient 9,068 diabetic patients were enrolled into the study Up to 31st March 2016 (1 y 4 mo : without intervention) - 856 patients admitted to hospitals at least once - 67 died 5 died of melioidosis 5 culture-confirmed melioidosis 0 clinical-suspected melioidosis - 26 had melioidosis (including 5 who died of melioidosis) 18 culture-confirmed melioidosis 8 clinical-suspected melioidosis (comparable to the sample size calculation) - 2 withdraw from the study
  39. 39. YOU MIGHT NOT WANT TO MISS PORNPANS ORAL PRESENTATION
  40. 40. Acknowledgement David Dance LOWMRU Vanaporn Wuthiekanun MORU, Thailand Dr Eric Bertherat WHO, Geneva Prof Sharon Peacock, Cambridge Every network and YOU !!!
  41. 41. Pseudomallei CP999 Super Strong Can kill human Kills >80,000 humans worldwide yearly Needs better awareness diagnosis, treatment and prevention worldwide