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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 Epidemics in a Changing World: Parliamentary Library lecture 1 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 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 2 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/ 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 3 A changing world • Disease agents constantly evolve • New agents emerge • Our environment is changing more rapidly than ever before 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 4 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 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 5 Influenza Dengue Bluetongue 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 6 The spread of influenza 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 7 Origin of new influenza viruses Mutation “Drift” Reassortment when two viruses mix in one animal “Shift” 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 8 Notified influenza cases Seasonal influenza in Australia 2003 2004 2005 2006 2007 2008 2009 Australian Influenza Surveillance Report, Dept Health & Ageing (May 2009) 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 9 % Influenza viruses Seasonal influenza in Hong Kong 1998 1999 2000 2001 2002 2003 2004 2005 2006 Yang et al, PlosOne (2008) 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 10 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 Epidemics in a Changing World: Parliamentary Library lecture 11 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: Parliamentary Library lecture 12 Equine influenza 2007 Narrabri Maitland NSW DPI (2007) Centennial Park DAFF (2008) 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 13 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 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 14 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) 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 15 Flinders St Station, Melbourne The way we live World Youth Day, Sydney 2008 MCG 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 16 Spread of the new H1N1 influenza 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 17 Spread of H5N1 avian influenza www.pandemicflu.gov/ 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 18 Changes for the better • • • • • • Knowledge and technology Vaccines Antiviral drugs Global surveillance and cooperation Communication systems Pandemic planning and response 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 19 Dengue viruses 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 20 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 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 21 Control of dengue virus: water storage www.who.int 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 22 Areas at risk of dengue transmission 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 23 Bluetongue viruses 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 24 Bluetongue viruses • Mainly affect sheep • Spread depends on: - midge vector Saegerman et al. (2008) - susceptible animals - warm weather 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 25 Bluetongue viruses Saegerman et al. (2008) Colours represent different virus types 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 26 Influenza, dengue and bluetongue • Mobility • Demographic change • Animal management and trade • Climate change 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 27 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 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 28 An emerging disease SARS - 2003 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 29 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 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 30 Mortality associated with global influenza outbreaks WHO (2005) 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 31 Impacts of recent disease events 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 32 Foot and mouth disease - UK Burning foot and mouth disease infected animals, UK 2001 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 33 Emerging infectious diseases are increasing Jones et al. (2008) 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 34 Climate change Temperature Rainfall Water use Extreme weather events 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 35 Water storage 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 36 Movement of people 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 37 Movement of livestock and commodities 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 38 Prosperity Shanghai skyline 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 39 Intensive livestock production 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 40 Poverty 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 41 Nipah outbreak in pigs in Malaysia 105 deaths $US 276 million Culling pigs 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 42 Urban infrastructure 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 43 Livestock at the urban-rural interface 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 44 Vaccination 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 45 Complex inter-related factors 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 46 Risks to Australia •Entry through northern borders •Entry through ports and airports •Disease emerging within Australia 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 47 Our northern neighbours 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 48 Ports and airports 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 49 “Home grown” diseases 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 50 Summary Uncertainty and inevitability 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 51 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” 24 June 2009 Epidemics in a Changing World: Parliamentary Library lecture 52