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Epidemics in a Changing World
Presentation
to PMSEIC
Parliamentary
Library Lecture
24 June 2009
Epidemics in a Changing World:
Parliamentary Library lecture
Epidemics
• Professor Anne Kelso AO
– Director, WHO Collaborating Centre
for Reference and Research on
Influenza
– Member: Expert Working Group on
Epidemics in a Changing World
24 June 2009
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The first 21st century pandemic
Dr Margaret Chan and Dr Keiji Fukuda at the press conference
to announce the start of the 2009 influenza pandemic, 11 June 2009
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A devastating disease eradicated
Frank Fenner announcing the eradication
of smallpox to the World Health Assembly
on 8 May 1980
http://epress.anu.edu.au/
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A changing world
• Disease agents constantly evolve
• New agents emerge
• Our environment is changing more
rapidly than ever before
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Members of the Expert Working Group
Professor Brian Kay AM
Chair
Australian Centre for International & Tropical
Health, QIMR
Professor Stephen Prowse
Deputy Chair
CEO, Australian Biosecurity CRC for
Emerging Infectious Disease
Professor John Horvath AO
Principal Consultant, Department of Health
and Ageing
Professor Anne Kelso AO
Director, WHO Collaborating Centre for
Reference and Research on Influenza
Professor John Mackenzie AO Australian Biosecurity CRC for Emerging
Infectious Disease
Professor Adrian Sleigh
National Centre for Epidemiology and
Population Health, ANU
Professor Jonathan Carapetis
Director, Menzies School of Health Research
Dr Andy Carroll
Expert Advisor
Chief Veterinary Officer, Department of
Agriculture, Fisheries and Forestry
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Influenza
Dengue
Bluetongue
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The spread of influenza
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Origin of new influenza viruses
Mutation
“Drift”
Reassortment
when two viruses
mix in one animal
“Shift”
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Notified influenza cases
Seasonal influenza in Australia
2003
2004
2005
2006
2007
2008
2009
Australian Influenza Surveillance Report,
Dept Health & Ageing (May 2009)
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% Influenza viruses
Seasonal influenza in Hong Kong
1998
1999
2000
2001
2002
2003
2004
2005
2006
Yang et al, PlosOne (2008)
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Origin of new influenza viruses
Seasonal strains
Tamiflu resistance
1918 pandemic
Equine influenza
Mutation
Reassortment
when two viruses
mix in one animal
24 June 2009
1957 pandemic
1968 pandemic
2009 H1N1 swl
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Origin of new human H1N1 virus
Eurasian
swine H1N1
swine
avian
human
24 June 2009
1998
North
American
swine H1N1
2009
human
H1N1
Epidemics in a Changing World:
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Equine influenza 2007
Narrabri
Maitland
NSW DPI (2007)
Centennial Park
DAFF (2008)
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Equine influenza 2007
• ~80,000 horses infected
• No NSW and QLD racing for 3 months
• Cost to Government: >$350 million
• Cost to industry: ~$1 billion
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Mortality in the 1918 pandemic
Children in a remote
Alaskan village
survived the 1918-19
pandemic while most
of their parents and
grandparents
succumbed.
Ahmed et al,
Nature Immunol. (2007)
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Flinders St Station, Melbourne
The way we live
World Youth Day, Sydney 2008
MCG
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Spread of the new H1N1 influenza
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Spread of H5N1 avian influenza
www.pandemicflu.gov/
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Changes for the better
•
•
•
•
•
•
Knowledge and technology
Vaccines
Antiviral drugs
Global surveillance and cooperation
Communication systems
Pandemic planning and response
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Dengue viruses
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Dengue viruses
• Dengue fever:
50 million infections p.a.
• Dengue haemorrhagic fever:
500,000 p.a.
• No vaccines or drugs
• Transmitted by mosquitoes:
Aedes aegypti
Aedes albopictus
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Control of dengue virus: water storage
www.who.int
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Areas at risk of dengue transmission
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Bluetongue viruses
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Bluetongue viruses
• Mainly affect sheep
• Spread depends on:
- midge vector
Saegerman et al. (2008)
- susceptible animals
- warm weather
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Bluetongue viruses
Saegerman et al. (2008)
Colours represent
different virus types
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Influenza, dengue and bluetongue
• Mobility
• Demographic change
• Animal management and trade
• Climate change
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Epidemics
• Professor Stephen Prowse
– CEO of the Australian Biosecurity
Cooperative Research Centre for
Emerging Infectious Disease
– Deputy Chair: Expert Working Group
on Epidemics in a Changing World
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An emerging disease SARS - 2003
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What is an emerging infectious disease?
A disease that:
Causes more serious illness – bluetongue virus in Europe
Changes geographic region – rabies in Bali
Changes host – Ebola-Reston in Philippines
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Mortality associated with global
influenza outbreaks
WHO (2005)
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Impacts of recent disease events
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Foot and mouth disease - UK
Burning foot and mouth disease infected animals, UK 2001
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Emerging infectious diseases are
increasing
Jones et al. (2008)
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Climate change
Temperature
Rainfall
Water use
Extreme weather events
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Water storage
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Movement of people
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Movement of livestock and commodities
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Prosperity
Shanghai skyline
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Intensive livestock production
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Poverty
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Nipah outbreak in pigs in Malaysia
105
deaths
$US 276
million
Culling pigs
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Urban infrastructure
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Livestock at the urban-rural interface
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Vaccination
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Complex inter-related factors
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Risks to Australia
•Entry through
northern borders
•Entry through ports
and airports
•Disease emerging
within Australia
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Our northern neighbours
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Ports and airports
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“Home grown” diseases
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Summary
Uncertainty and inevitability
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Summary
• We are changing the world
• This is changing the emergence and
spread of human and animal diseases
• We need preparedness and agility to
tackle the “unknown unknowns”
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