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Impact of Climate Change on the Dynamic of Disease
EBV, Cancer, Malaria
and Climate Change : pulling the trigger
Sofia Mubarika HaryanaFaculty of Medicine
Universitas Gadjah Mada
2829 October 2015
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Outline
1. Post MDGs 2015SDGs 2030
2. The effect of climate change to health:
3. Viral related cancerclimate effect4. Future works :joint forces to better world
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United Nations Development Programme
1. Post-2015 SDGs 2030
THE WORLD WE WANT
(status: 20 February 2012)
Equity, accesibility, peace, better life and ecosystem
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Where is health in the SDGs?
SDGs3: Ensure healthy lives and promote
wellbeing for all at all ages: 9 targets that
cover a wide range of health issues, from
maternal and child health to environmental
health
SDG s 7: greater access to energy , increasethe services hospitals and community health
centers
SDGs 13: climate change that change
ecosystems and increase vector bornediseases.
SDGs 16: Peace and stability will impact the
mental and physical health of communities
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Heat & cold waves:5,671
climate
15,000 excess deaths in France, 35,000 elsewhere in Europe, triggered
by two weeks of heatwave. Sixty percent of deaths were >75 years(IPCC, 2007)
2. Climate Change to Health.....
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Climate - Vector-borne threats Europe
Disease Vector Notes
African horse
sickness,bluetongue
Biting midges Europe 1998-2010
Canine
leishmanosis
Sand flies Belgium 2005
(vectors)
Dengue fever Asian tigermosquito
France 2010
Chikungunya
Fever
Asian tiger
mosquito
Italy 2007
West Nile fever Culicidmosquitoes
Mediterranean basin: 1990s to
present
Crimean Congo
haemorrhagic fever
Ticks Spreading in the Balkans
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Vector-borne Disease
What is VBD?
Types of VBD transmission:Human-vector-human
(Anth ropo not ic Infect ions)
Vector
Humans
Humans
Vector
Malaria
Dengue
Yellow fever
Animal-vector-human
(Zoon otic Infect io ns)
Vector Vector
Animals
Animals
Humans Lyme diseaseHantaviral disease
Most arboviral diseases (e.g., WNV)
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Vector-borne Disease Dynamics
Susceptiblepopulation
Migration (forced)
Vector environment
Vector
Survival, lifespan
Reproduction/breeding patterns
Biting behavior
Pathogen
Survival
Transmission
Replication in host
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Direct Effects of Climate Change on Vector-borne Disease
Climate change has the potential to Increase range or abundance of animal reservoirs
and/or arthropod vectors
(e.g., Malaria, Schistosomiasis, Lyme)
Enhance transmission (e.g., West Nile virus and other arboviruses)
Increase importation of vectors or pathogens (e.g., Dengue, Chikungunya, West Nile virus)
Increase animal disease risk and potential humanrisk (e.g., Trypanosomiasis)
Greer et al., 2008
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Case Study I: Malaria
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40% world population at risk
500 million severely ill
Climate sensitive disease1
No transmission where mosquitoes
cannot survive Anopheles: optimal adult
development 28-32C
P falciparum transmission: 16-33C
Highland malaria2
Areas on the edges of endemic
regions
Global warming El Nio3
Outbreaks
Estimated incidence of clinical malaria episodes (WHO)
1 Khasnis and Nettleman 2005; 2 Patz and Olson 2006; 3 Haines and Patz,2004
McDonald et al., 1957
Case Study I: Malaria (cont.)
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WHO, 2008b
Malaria Transmission Map
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Climate change and malariascenario
Hugo Ahlenius, UNEP/GRID-Arendal, 2005
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Summary of Climate ChangeEffects
Climate change has the potential to Increase range or abundance of animal reservoirs
and/or arthropod vectors Lyme, Malaria, Schistosomiasis
Prolong transmission cycle Malaria, West Nile virus, and other arboviruses
Increase importation of vectors or animalreservoirs Dengue, Chikungunya, West Nile virus
Increase animal disease risk and potential humanrisk African trypanosomiasis
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Viral related cancers
1. Epstein Barr Virus (EBV)Nasopharyngeal Cancer,Lymphoma, Non Hodgkinlymphoma, B Cell
Lymphoma, Gastric carcinoma - SALIVA
2. Human Papilloma Virus (HPV) Cervical Cancer - STD
3. HIVsarcoma - STD
4. Hepatitis B virus ( HBV / HCV)Hepatocellular
carcinoma - SALIVA
5. TB / HPV Lung Cancer - STD
http:/www.med.sc.edu:85/virol/herpes.htm
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Globocan 2012Cancer incidence and mortality
HPV
EBV + Helicobacter Pylorii
HPV + EBV
HPV
HPV + EBV
HBV
EBV
EBV
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Cancer FactsGlobocan 2012
> 70% death
International Agency for Research on Cancer
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Epstein Barr VirusNPC
Infect > 90 % population worldwide - Kissingdisease .
DNA virus ( herpes Virus)once infect will
reside the whole life in the infected individu Infect Epithel oropharynx through gp 21 ( also
express on B lymphocytes)IgG and IgA
Screening strategyELISA
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Etiology of NPC
NPC
Epstein-Barr virus
Ethnicity
DietTobacco
(Immuno)genetic
factors
GenderHerbal
Drugs/
oils
Environmental
factors
100%
http://images.google.nl/imgres?imgurl=www.cdc.gov/diabetes/pubs/images/bathroom.gif&imgrefurl=http://www.cdc.gov/diabetes/pubs/tcyd/ktrack.htm&h=163&w=158&prev=/images?q=FEMALE+MALE++SIGN&svnum=10&hl=nl&lr=&ie=UTF-8&oe=UTF-8http://images.google.nl/imgres?imgurl=astronomy.swin.edu.au/~pbourke/texture/flag/china.gif&imgrefurl=http://astronomy.swin.edu.au/~pbourke/texture/flag/&h=217&w=325&prev=/images?q=china&svnum=10&hl=nl&lr=&ie=UTF-8&oe=UTF-8http://www.mobot.org/MOBOT/research/library/kohler/1761_089.jpghttp://images.google.nl/imgres?imgurl=stagnes.dio.org/images/chili%20pepper.gif&imgrefurl=http://stagnes.dio.org/parish_bulletin.htm&h=338&w=481&prev=/images?q=chili+pepper&svnum=10&hl=nl&lr=&ie=UTF-8&oe=UTF-8http://images.google.nl/imgres?imgurl=www.chez.com/frenzy/images/cigarette.jpg&imgrefurl=http://www.chez.com/frenzy/horreur_noire.htm&h=180&w=300&prev=/images?q=cigarette&svnum=10&hl=nl&lr=&ie=UTF-8&oe=UTF-8 -
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EBV - Nasopharyngeal carcinoma (NPC)
Tumor arising from the epithelial cells covering nasopharyngeal
surface.
Remarkable geographical incidence; frequently occurs in a well-defined regions.
Absolut association to Epstein-Barr virus (EBV) infection - > 90%
population infected worldwide
Non specific symptoms
https://reader009.{domain}/reader009/html5/0319/5aaf0dd22083b/5aaf0ddbcc984.jpg; IARC publication; Chang ET & Adami HO. Cancer Epid Biomarkers Prev. 2006.
http://nasopharyngealcancer.com/images/head.jpghttp://nasopharyngealcancer.com/images/head.jpg -
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( C)
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Nasopharyngeal carcinoma (NPC) in Indonesia:
3%
0%
11%
30%
21%
35%
0%
Stage I Stage II A Stage II B Stage III Stage IV A Stage IV B
0
10
20
30
40
50
60
70
01-
10
yrs
11-
20
yrs
21-
30
yrs
31-
40
yrs
41-
50
yrs
51-
60
yrs
61-
70
yrs
71-
80
yrs
>80
yrs
Male
Female
Sardjito hospital Yogyakarta : the 1st cancer in man
Non-specific symptoms at early stage
85% late stage
(III/IV)
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Figure 10-3 part 1 of 3
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The regulation of B cell activation by complement receptor
Binding of complement proteins (C3d) to antigens directly or via attached antibodies leads tocoligation of antigen receptors (Ig) and complement receptors (CR2, CD21) on antigen-specificB cells. This enhances the Ig-mediated signal and the subsequent B cell response.
The complement receptors (CR2/CD21)are the EBV receptors on B cells
The EBV viral envelope protein gp350/200, which shares a regionof sequence similarity with C3d, can interact with CR2/CD21
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Date1: 12-09-20012: 03-12-2001
3: 15-03-2002
4: 17-10-2002
5: 16-12-2002
6: 01-05-2003
7: 02-07-20038: 05-11-2003
9: 19-11-2003*
Days1: 02: 82
3: 184 CR
4: 400
5: 460
6: 596
7: 6588: 784
9: 798* Mx
EBV IgA ELISA
0,0
0,5
1,0
1,5
2,0
2,5
3,0
3,5
1 2 3 4 5 6 7 8 9
Sample number
ELISAO
D4
50valu VCA-p18 peptide
EAd-extract
* Lung metastasis (CT/MRI)
1 2 3 4 5 6 7 8 9*
BFRF3 (18 kD)
BZLF1 (36+38 kD)
BdRF1 (40 kD)
BALF2 (138 kD)
BKRF1 (72 kD)BXLF1 (68 kD)
BMRF1 (47/54 kD)
BGLF5 (58 kD)
Immunoblot
Case: Female caucasian (age 16): T4N1M0Treatment Chemoradiation + IFN- > 2 years follow-up
R.Mertens et al. Cancer. (1997);80(5):951-9.
EBV-serology predictive
at >6 months pre-metastasis
Note: No increased EBV-DNA in circulation
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Best practices ....In Taiwan
In year 2002EBV/ NPC is the highest in
Taiwan and China
In Year 2012EBV /NPC is very low ( 2nd
lowest ) WHY ??
Taiwan : good hygieneclean water , healthy
life style
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IGR KI VUMC AvL UGM
From Basic to Clinic Advocacy
Multidiscipline Integrated
tr nsl tion l ppro ch
From bench to precision medicine
UNHAS USU UNUD UNAIR UI UNPAD UNDIP UB
Best Practices : To be C oE in EBVNasopharyngeal carcinoma
diagnosisi, treatment band prevention in Indonesia
Asia Link (EU ) : 20032006
KWF : 2006 - nowRistek Dikti/ PUPT : 2012 - now
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Future works
EBVcancer - high burden : EBV + Malaria ( Co-
infection? Joint forces muliti and transdiscipiin
Early screening : Dip stickimmunohromatography
based - Early Stage Minimal Invasive : Cancer Biomarkers ( NPC, Breast,
Ovarial, HCC)
Translational reserach From genomic to proteomics
EBV genomeHost genome
Clean water , healthy life style are required :CAMPAIGN
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FM UGM established 5 March 1946
UGM established on 19 December 1949
through synergy to better world..........
Merci ...
Kop kun kap...
Thank you ...
Terima kasih...
Matur nuwun...