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Global connections and disease Laura C. Harrington, PhD Department of Entomology Goals for today •Understand the underlying factors and connections that lead to global emergence of new infections •Recognize what types of pathogens are most likely to emerge Which of the following general classes of human pathogens are most likely to emerge rapidly with globalization? a. b. c. d. e. Bacteria Protozoa Viruses Fungi Worms Red represents newly emerging diseases; blue, re-emerging/resurging diseases; black, a 'deliberately emerging' disease. Morens et al. 2004. Nature 430, 242-249. What factors lead to emerging/re-emerging pathogens? Mutation of existing pathogens Ex: Y. pseudotuberculosis - inserting mutations in lab increases virulence Host shifting Influenza virus H5N1 Highly diverse infecting both humans and animals Can acquire genes readily from other animal viruses Re-assortment of viral pathogens Stevens et al. Nature Reviews Microbiology 4, 857-864 (November 2006) | doi:10.1038/nrmicro1530 Changing weather patterns and climate Range expansion of vectors and disease Changes in land use and agricultural practices Rice paddy irrigation Banana plantations Dams Clear cutting forests Logging Road building unplanned urbanization and poor sanitation Waste Poverty Breakdown of health care infrastructure War and conflict Increasing contact between humans and animals rapid global travel over 760 million international arrivals annually Changes in human behavior/society Drug abuse – HIV and other infections among intravenous drug users in USA Use of tampons - Toxic shock syndrome and Staphylococcus aureus infection Changes in technology Use of new technology- air conditioning and water cooling- Legionnaires’ disease (Legionella pneomophila) Food processing technology – food borne illness Chikungunya Global spread of the Asian Tiger mosquito Pathogens transmitted by Ae. albopictus Chikungunya virus DEN 1-4 virus Dog heartworm virus Eastern Equine Encephalitis Jamestown Canyon virus Keystone virus LaCrosse virus Mayaro virus Orapouch virus Potosi virus Rift Valley Fever virus Ross River virus Sinbis virus Trivittatus virus West Nile virus Venezuelan Equine Encephalitis Dog heartworm CNN: Thousands hit by Brazil outbreak of dengue (4/3/08) Dengue vector Aedes aegypti •50-100 million dengue fever cases/year •500,000 cases of DHF •2/3 of world’s population at risk An 11-year-old boy is seen by a military doctor last weekend at a field hospital west of Rio de Janeiro, Brazil. •among top global neglected diseases No vaccine and no treatment for dengue Cases per thousand Increasing incidence of Dengue Infections Globally 1000 900 800 884 700 600 500 400 300 200 100 0 482 296 122 1 15 1955-59 1960-69 1970-79 1980-89 Years 1990-99 2000-05 WHO: Dengue Net 2006 Review – factors giving rise to global emergence of human pathogens •Mutation, re-assortment and host shifting •Changing weather patterns and climate •Changes in land use •Unplanned urbanization and poor sanitation •Poverty, war and breakdown of public health infrastructure •Changes in human behavior and technology •Increasing contact between humans and animals