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Health Effect of Climatic Change: Malaysian Senarios Dr Rozlan Ishak Environmental Health Unit Disease Control Division Ministry of Health Malaysia Situations 50 years ago Malaria was rampant in Malaysia 460,000 cases a year High mortality and morbidity Every parts of the country were under malaria Even the Island of Penang has malaria Some urban areas were free from malaria Health problems Water supply was inadequate. Hygiene and sanitation was poor Latrines were lacking in most parts of the country. Bucket latrines was the style of the day. Infectious disease such as cholera, typhoid, dysentery, worms infestation were very common. Dengue is not a problem! Mosquito borne diseases 50 years later Malaria Malaria in Malaysia from 1961 to 2006 600,000 400,000 300,000 malaria 200,000 100,000 0 19 61 19 70 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 Number cases 500,000 Years Dengue Fever Dengue Fever In Malaysia from 1980 to 2006 45000 40000 30000 25000 Dengue Fever 20000 15000 10000 5000 0 19 75 19 81 19 83 19 85 19 87 19 89 19 91 19 93 19 95 19 97 19 99 20 01 20 03 20 05 Number of Cases 35000 Years Viral Encephalitis Viral Encephalitis in Malaysia from 1980 to 2006 350 250 200 150 100 50 Years Viral Encephalitis 20 06 20 04 20 02 20 00 19 98 19 96 19 94 19 92 19 90 19 88 19 86 19 84 19 82 0 19 80 Number of Cases 300 Water Borne Diseases 50 years later Cholera Cholera incidence in Malaysia from 1980 to 2006 2500 1500 Cholera 1000 500 Years 20 06 20 04 20 02 20 00 19 98 19 96 19 94 19 92 19 90 19 88 19 86 19 84 19 82 0 19 80 Number of Cases 2000 Dysentery Dysentery Incidence in Malaysia from 1980 to 2006 1800 1600 1200 1000 Dysentery 800 600 400 200 0 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 Number of Cases 1400 Years Food Poisoning Food Poisoning incidence in Malaysia from 1980 to 2006 10000 9000 7000 6000 5000 4000 3000 2000 1000 Years Food Poisoning 20 06 20 04 20 02 20 00 19 98 19 96 19 94 19 92 19 90 19 88 19 86 19 84 19 82 0 19 80 Number of Cases 8000 Typhoid Typhoid incidence in Malaysia from 1980 to 2006 3500 2500 2000 Typhoid 1500 1000 500 0 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 Number of Cases 3000 Years Hepatitis (all forms) Hepatitis (all form) reported in Malaysia from 1980 to 2006 8000 7000 5000 4000 Hepatitis (all form) 3000 2000 1000 0 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 19 98 20 00 20 02 20 04 20 06 Number of Cases 6000 Years Climate Change Facts ! Global Warming 2100 Climate Change Pathways Climate change and health: pathway from driving forces, through exposures to potential health impact. Modulating influences Adaptive capacity Regional weather changes Population dynamics Unsustainable economic development Heatwaves Mitigation measures Extreme Greenhouse gases (GHG) emissions Temperature-related illness and death Extreme weatherrelated health effects Mitigative capacity Driving forces Health effects CLIMATE CHANGE weather Temperature Precipitation Natural causes Microbial contamination pathways Air pollution-related health effects Transmission dynamics Water and food-borne diseases Agroecosystems, hydrology Socioeconomics, demographics Vector-borne and rodent-borne diseases Effects of food and water shortages Mental, nutritional, infectious and other health effects Health-specific adaptation measures Research needs Evaluation of adaptation Source: Climate Change and Human Health – Risks and Reponses. Summary (WHO, 2003) Biological Factors Biologic response to changes in climate Global warming and wider fluctuation in weather help to spread diseases Temperatures – affect growth, development and survival of microbes and the vectors Weather affects the timing and intensity of disease outbreaks (McMichael et al, 2003) Biologic response to changes in climate: Infectious diseases Warmer environment and mosquitoes Boost rate of reproduction Increase the number of blood meal Prolongs their breeding season Shorten the maturation period of microbes they carry Heavy downpours Drive rodents from burrows: risk of zoonotic diseases Create mosquito breeding sites Faster fungal growth in houses Flush pathogens and chemicals into waterways Milwaukee’s cryptosporidiosis outbreak in 1993 Katrina’s flood 2005: water-borne pathogens and toxins spread. Johor flood 2007 and leptospirosis Common communicabale diseases sensitive to climate (WHO, 2004) Climate is the primary factor in epidemic Cholera, Malaria Climate plays significant role Meningococcal meningitis, leishmaniasis, dengue, Japanese encephalitis, Rift valley fever, Ross river virus, St. Louis encephalitis, Murray valley fever Infection & Climate: Potential impact on endemic diseases in Malaysia Disease Trans-mission Evidence for inter-annual variability Climateepidemic link Strength of climate sensitivity Climateepidemic relationship quantified Cholera Food & waterborne ***** Increase in sea & air temp. Sanitation ***** Malaria Mosquito ***** Temp. & rainfall. Many others ***** √ Dengue Mosquito **** Temp., humidity & rainfall *** √ √ Temperature, vectorial capacity of Ann. maculatus and projected number of malaria cases (Ambu et al. 2003) Temp (oC) Esti. Ma Esti. A Esti. N C VC 27 20 0.043 10 0.069 28 21 0.043 9.9 0.075 29 22 0.043 9.8 0.081 16000 0.25 30 25 0.050 9.7 0.096 31 27 0.050 9.6 0.12 No. Malaria cases 14000 0.2 12000 10000 0.15 8000 0.1 6000 4000 0.05 2000 32 30 0.050 9.5 0.14 33 35 0.050 9.4 0.17 34 40 0.050 9.3 0.20 0 0 27 28 29 30 31 32 33 34 Temp (oC) No. of cases Vectorial Capacity (VC) Rainfall and dengue outbreak in Malaysia No. days examined for 1990 rain Modification of Mogi et al. model Study the threshold of rainfall actually required to trigger an outbreak Dengue incidence and rainfall data in 1986-1997 Model indicated relatively fewer raining days are required for high transmission Heavy rain flushes off breeding habitats Low transmission: no. raining days required for an outbreak High transmission: no. raining days required for an outbreak 30 2.89 0.47 60 4.57 2.15 90 6.25 3.83 120 7.93 5.51 150 9.61 7.19 180 11.29 8.87 210 12.97 10.55 240 14.65 12.33 270 16.33 13.91 300 18.01 15.59 330 19.69 17.27 360 21.37 18.95 Potential Health Effects from Global Warming Year 2100 Malaria Year 2100 Possible Pattern of Malaria in Worst Cases Senario in Malaysia from Year 1960 to 2100 600,000 400,000 300,000 200,000 100,000 80 20 60 20 45 20 35 20 25 20 15 20 06 20 00 20 90 19 80 19 70 19 61 0 19 Number of Malaria Cases 500,000 Year Malaria With Control measures Without Control measures Dengue Fever Year 2100 Dengue Fever In Malaysia from Year 1980 to 2100 700000 500000 400000 300000 200000 100000 Years Dengue Fever with Control Measures Without Control Measures 00 21 80 20 70 20 60 20 50 20 45 20 40 20 35 20 30 20 25 20 20 20 15 20 10 20 06 20 05 20 00 20 95 19 90 19 85 19 80 0 19 Number of Cases 600000 What is our plans? 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