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Emerging infections and Health Protection In Scotland
Looking to the future
Kirsty Roy and Martin Donaghy
Health Protection Scotland
Scottish Government
19th October 2011, Edinburgh
UK definition
An emerging infectious disease can be either
– a newly recognised infectious disease
or
– a known disease
Whose reported incidence within the past 2
decades is increasing (or threatens to increase) in a
specific place, or among a specific population
Human Animal Infections and Risk Surveillance
(HAIRS) Group
Global map of emerging infections
Morgens et al Nature, 2005
The convergence model of emerging
infectious diseases
• Human demographics,
behaviour and vulnerability
• Technology and industry
• Economic development, land
use, climate and changing
ecosystems
• International travel and
commerce
• Microbial adaptation and
change
• Poverty, social inequality and
breakdown of public health
measures
• Intent to harm
(Factors contributing to emerging infections. IoM,
1992 and 2003)
Detection of emerging infections in the UK
Combination of
• Detecting ‘unusual incidents’
• Horizon scanning and surveillance. Detection of
incidents/events of potential threat to public health.
Systematic review of informal and formal reports and
maintenance of a log recording significant incidents which
are then followed up
– National
– Locally international (Europe)
– International (Global)
National Expert Panel for New and
Emerging Infections (NEPNEI)
Indentify key areas for action and to advise on
priorities by
– Identifying emerging and potential infectious threats
to public health both nationally and internationally
– Placing emerging infections to the wider clinical and
public health contexts
– Advising on prevention and control measures
– Prioritising areas for surveillance and for information
– Advising on research, including technological
development needs
UK Horizon scanning for infectious diseases
Human Animal Infections and Risk Surveillance (HAIRS)
Group
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Health Protection Agency
DEFRA
Veterinary Laboratory Agency
Department of Health
Chair of National Expert Panel on New and
Emerging Infections (NEPNEI)
• Food Standards Agency
• NPHS Wales
• Health Protection Scotland
Horizon scanning and hazard identification
UK Foresight ‘Infectious Diseases: preparing for the future’
To use the best available science to evaluate the threats of infectious diseases In humans, animals and
plants over the next 10-25 years; and to produce a vision for their management, specifically
through systems for detection, identification and monitoring.
Future disease risk
•
New pathogen or novel variants of existing pathogens
•
Pathogens acquiring resistance e.g. to microbicides
•
Zoonosis
•
HIV/AIDS, tuberculosis and malaria
•
Epidemic plant disease
•
Acute respiratory infections
•
Sexually transmitted infections included HIV
•
Transboundary animal diseases
Potential moderate and high risk factors
influencing human disease risks, 2030, UK
UK Government’s Foresight project “Infectious Diseases:
preparing for the future
Scottish drivers for emerging
infectious disease
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More susceptible population – older population, increasing
prevalence of chronic infection, greater use of high technology
medicine
Rural Scotland set to grow bigger
Scottish climate 2.5-3.5oC warmer by the turn of the century
Food production to decline (over-reliance on the international
market)
Increased air travel (predominantly through central belt
airports)
Bio- and nanotechnology industry increasing
Horizon scanning for Scotland’s Futures: The next 30 years (and beyond) (Scotland &
N. Ireland Forum for Environmental Research, 2007)
Dealing with emerging infections
Be prepared
develop and strengthen our capacity to detect and rapidly
respond to any kind of health threat
Detection, investigation and management
(DIM) systems
Dealing with emerging infections
• Surveillance and response
detect, investigate and monitor unusual, unexpected, unexplained pathogens, the
diseases they cause and the factors influencing their emergence and respond to
problems as identified
• Applied research
development of predictive models based on epidemiological data, climate change
surveillance and human behaviour
• Infrastructure and training
strengthen infrastructures to support surveillance, response and research and to
implement prevention and control programs. Integrate laboratory and epidemiology to
increase effectiveness of public health practice. Provide the work force with
knowledge and tools it needs
• Prevention and control
Ensure prompt implementation of prevention strategies and enhance communication
of public health information about emerging diseases
Role of Health Protection
• Establish systems for detecting unusual diseases and
drug resistant agents (from medical intelligence,
surveillance and other information sources)
• Assure laboratory capacity to investigate new agents
and confirm known agents
• Promote national and international collaboration
• Develop plans for handling clusters/outbreaks of
unknown agents (case reporting, investigation and
appropriate follow-up)
• Education – physicians, public and policy makers
• Promote a long term flexible approach