the role of globalization in emerging diseases one health

The Role of Globalizationin Emerging Diseases

One Health

Globalization in Emerging Diseases 2

Content Overview

• Global Public Health• Globalization• Emerging / Re-Emerging Diseases• The Role of Globalization in Emerging/Re-

emerging Diseases


Learning Objectives

• Define global public health • Explain the role of globalization in emerging

and re-emerging diseases • Introduce emerging and re-emerging diseases

Shalin

Explore globalization as an important causal factor in emerging diseases


Global Public Health

• Global public health refers to improving the health of all people on the planet, not just those within one nation

• Refers to issues that affect multiple countries

Shalin

It might be good to use whole sentences


Global Public Health

• An area for study, research, and practice• Affected by governmental organizations,

intergovernmental organizations, the media, international foundations, nongovernmental organizations, and transnational corporations


Globalization

• “The increased interconnectedness and interdependence of peoples and countries.”

• Increases importance of Global Public Health• Globalization includes:– Movement of people, products, services, capital,

and ideas between borders– Affected by changes in policy at the international

and national levels


Globalization History

• Dates back 2,000 years to the era of the ancient Silk Road trade route

http://en.wikipedia.org/wiki/File:Silk_route.jpg

Shalin

I corrected the subheading on the slide. For some reason, the master slide name did not show on this slide. Maybe this was added in.


Global Public Health History

• Middle Ages: Plague spread across Europe and Asia

• 16th Century: Smallpox and Measles introduced to the New World by European invaders

• 16th Century: Europeans took tobacco from America back to Europe

• 18th Century: Opium sold to China by Europeans

Shalin

This works fine in the flow. This makes sense to set the context here.


Globalization Today

• Rapidly increasing due to:– Technology– Reduced cost of transactions– Increased mobility of capital– Open economies– International architecture

• United Nations• World Bank • World Health Organization• European Union


EMERGING DISEASES


Emerging Diseases

• Incidence of emerging diseases in humans has increased recently or threatens to increase in near future

• “Zoonotic” diseases – transmitted animals-humans• May be due to – Spread of a new pathogenic agent– Recognition of an agent previously undetected– Identification of infectious cause of a disease– Mutation or recombination allowing “jump” into humans– Changes in human habitation or land use


What Are Emerging Diseases?

• Emerging diseases are outbreaks of previously unknown diseases or known diseases whose incidence in humans increased significantly– Examples: Bartonella henselae, Ehrlichiosis,

Hendra virus, Lyme disease, and Hepatitis C


What Are Re-Emerging Diseases?

• Re-emerging diseases are known diseases that have reappeared after a significant decline in incidence– Examples: Clostridium difficile, Mumps virus,

Streptococcus Group A, and Staphylococcus aureus


Why Are There Emerging Diseases?

• Changes in Ecology– Land use (dams, agriculture, and deforestation), the

design of the built environment, and climate change• Changes in Human Demographics– Population growth and movement from rural areas to

cities, war, and immigration• Changes in Human Behavior– Sexual behavior, drug use, outdoor recreation, eating

habits, and increased use of child care centers


Why Are There Emerging Diseases?

• International Travel and Commerce• Changes in Technology and Industry– Globalization of food supplies, changes in food

processing and packaging, organ/tissue transplants, drug therapy resulting in immunosuppression, and the use of antibiotics

• Microbial Adaptation and Change• Poor Public Health Measures– Reduction of prevention programs, inadequate

sanitation, and inadequate vector control measures


Where are Diseases Emerging?

• Around the world• Typically where there are the most people• Potential hotspots of future disease

emergence:– Central America– Tropical Africa– South Asia


What Types of Diseases are Emerging or Re-emerging?

• 70% are zoonotic or vector-borne• Drug-resistant infections• Types of pathogens– Viruses– Bacteria– Protozoans– Prions


A Recent History of Emerging Diseases

• 29 microbes and infectious diseases recognized since 1973– 1976 Cryptosporidium parvum– 1977 Ebola virus– 1977 Legionella pneumophila– 1981 Toxin-producing Staphylococcus aureus– 1982 Escherichia coli O157:H7– 1982 Borrelia burgdorferi


A Recent History of Emerging Diseases

• --1983 HIV• --1983 Helicobacter pylori• --1989 Hepatitis C virus• --1992 Vibrio cholerae 0139• --1993 Sin nombre virus• --1994 Sabia virus• --1994 Mad Cow disease• --1994 Hendra virus• --1995 Human herpes virus 8• --1999 West Nile virus in US• --1999 Nipah virus• --2003 SARS virus• --???? Next??

Cells Infected with Hepatitis C Virus


Ebola

• Initially seen in 1970’s in various locations in Africa—identified as new virus

• Related to other viruses causing hemorrhagic fevers—uncontrollable bleeding

• Kills >90% of people infected• Subsequent recurrent outbreaks in west and

central Africa


Public Health Failures in Ebola Outbreaks

• Two largest outbreaks, 1976 and 1995, spread by hospitals—reuse of needles; lack of basic supplies such as gloves and masks

• Large number of victims were hospital employees

• War and poverty in developing world helped spread disease—probably isolated cases before; now epidemics


Ebola—The Future

• Natural host still not known but chimpanzees are suspected

• No cure or effective treatment as yet• Vaccine trial (DNA vaccine) is in progress—has

shown some potential in chimps


Hendra and Nipah Viruses

• Hendra isolated 1994; Australia• Nipah isolated 1999; Malaysia• Disease in animals (pigs, horses, dogs, cats)

and humans (spread from infected animals)• Natural host/reservoir – fruit bats• Severe flu-like symptoms with encephalitis

and death in some cases


Rift Valley Fever Virus

• Losses to livestock, including abortions (sheep especially susceptible)

• Primarily affects animals but also humans• Can cause severe disease and death• 1931—Rift Valley of Kenya• Major outbreaks in Africa; has spread to Saudi

Arabia and Yemen


Rift Valley Fever Distribution

• Blue, countries with endemic disease and substantial outbreaks of Rift Valley Fever (RVF); green, countries known to have some cases, periodic isolation of virus, or serologic evidence of RVF.


Transmission of Rift Valley Fever Virus (RVFV) to Humans

• Direct or indirect contact with blood or organs of infected animals

• Herders, farmers, slaughterhouse workers, veterinarians at risk

• Inoculation through broken skin or inhalation of aerosols

• Also via insects (mosquitoes and flies)


Chikungunya

• High fever, disabling joint and muscle pain, some hemorrhagic symptoms; low fatality (<0.5%)

• First isolated 1952 from humans, Aedes and Culex mosquitos in Tanzania

• Zoonotic, cycling through wildlife species via mosquitoes

• 2004-06—major human outbreak in India and islands; many European tourists infected


Chikungunya Virus Distribution

• 2007—detected in S. Europe in human case and in introduced Aedes species; has new mutation in envelope gene that enhances spread


Crimean-Congo Hemorrhagic Fever

• Characterized in Crimea in 1944 andCongo in 1969

• Ticks are reservoir and vector• Wild and domestic animals can be

hosts• Human transmission via infected

animal blood and tick bites• Symptoms: headache, fever, pain,

bleeding; 9-50% fatalities seen


RE-EMERGING DISEASES


Re-Emerging Diseases: Why?

• Social and political changes, changes in agricultural or industrial practices, land use, etc., can cause previously quiescent diseases to re-emerge

• Sometimes these are much more deadly than before• May have acquired resistance to previously effective

drugs• Examples:

-- Dengue: transportation, travel, and urbanization --Yellow fever: drug and insecticide resistance


Dengue

• Viral, insect transmission• Rapidly spreading, no vaccine• WHO calls “most important arboviral disease”• Fever, headache, joint/muscle pain• Up to 5% lethality• Mosquito vector expanding range


Distribution of Aedes Aegypti Mosquitoes and Dengue

Distribution of Aedes aegypti in1970, at the end of the mosquitoeradication program, and in 1997

Confirmed cases of dengue


Distribution of Countries or Areas at Risk of Dengue Transmission Worldwide, 2008


THE ROLE OF GLOBALIZATION IN EMERGING DISEASES


Globalization Factors that Increase Risk of Spread of Disease

• The movement of:– People– Animals / Animal Products– Food


The Movement of People

• In 2009, there were 880 million international tourist arrivals for business, leisure, and other purposes– Includes travel by air, road, rail, and sea

• If a person contracts a disease in one country, they can quickly travel around the world where they can spread the disease to new populations


The Movement of People

• Infected people quickly spread disease around the world

• People may contract a disease in one country and travel to other countries before they are symptomatic

• May result in super spreading events


Travel Medicine

• Preventing infectious diseases during international travel

• Ensuring personal safety of international travelers

• Avoiding environmental risks during travel


Travel Medicine

• Pre-travel– Risk assessment

• Traveler: Existing medical conditions, allergies, etc• Risks of travel country: itinerary, season, planned activities, etc

– Preventive counseling• Preventing illness – vaccines, sources of illness, vectors,

environmental concerns, travel medical kits, etc

– Vaccination• Post-travel– Evaluation of ill


Increased Risk of Zoonotic Diseases During Travel

• Bites/scratches from direct contact with animals• Visits to farms and agricultural areas• Local food/bushmeat/live animal markets– Slaughter, undercooked meat, raw milk, cross-

contamination, raw fish• Wilderness travel – vector-borne disease• Walking barefoot/swimming• Contamination of souvenirs• If pets travel, they can get disease that may spread

to people


Severe Acute Respiratory Syndrome (SARS)

• November 2002—first reports of new respiratory disease in Guangdong, China

• Large outbreaks in Hong Kong, Beijing, Singapore, Taiwan, and Toronto in Spring 2003

• >8000 cases with 774 deaths in 30 countries on 5 continents


Source of SARS?

• Agent is a novel coronaviruses• Connection noticed with wild food markets—

animal source?• Closely related viruses found in civets, raccoon

dogs, and bats• Bat appears to be source; amplified by

transmission in civets; following species jump, transmitted between humans


SARS Super Spreading Events

• Hospitals• Hotel• Airplane flight• Housing complex


Hotel


Spread from Hotel to Multiple Countries


Plane Flight


Movement of Animals: Travel with Pets

• Reasons people travel with pets– Companionship– Reluctance to leave pet at home– Save on cost of boarding animal – Taking animal for breeding or medical care


Movement of Animals: Travel with Pets

• Risks– Pets may contract diseases, including zoonotic

diseases and bring them back home– Exposure to toxins during travel– Physical injuries and stress– Allergies• In pet• In humans traveling near pet (airplanes, trains, etc)


Movement of Animals andAnimal Products

• Global Animal Trade – Legal

• From 2000-2004, there were 37,858,179 live amphibians, birds, mammals, and reptiles legally imported to the U.S. from 163 countries.

• Highest demand for animals in U.S., People’s Republic of China, and the European Union

– Illegal• Estimated to be $5-20 billion annually• U.S. demand for illegal wildlife estimated to be same as legal

demand– $2.8 billion in 2007


Animal Trade

• Primary sources of demand:– Wildlife items for personal use• Souvenirs, exotic pets

– Products for commercial use or related to hunting• Hunting trophies

– Other sources• Zoos, research, conservation programs, scientific

education, food, pets of tourists and immigrants


Animal Trade in the U.S.

• Globalization increases demand for illegal animals– Examples• Sea turtle eggs and meat is in demand by immigrants

from Central America• Increased demand for traditional Asian medicines


Disease Outbreaks from Animal TradeAnthrax

• Anthrax from untreated, imported animal hides for drums– 1974: imported drum from Haiti, cutaneous Anthrax, patient

survives– 2006: drum maker imports hides from Côte d'Ivoire; contracts

inhalation Anthrax while making drums; patient dies– 2007: drum maker and his child get cutaneous Anthrax form

imported hides from Guinea in West Africa; both survive– 2008: drum maker in London contracts inhalation Anthrax

from contaminated animal hides from Africa; dies– 2009: gastrointestinal Anthrax contracted while playing in

drum circle; multiple drums and environment contaminated; patient survives


Anthrax

• Bacteria Bacillus anthracis• Cutaneous – handling products from infected animals• Inhalation – breathing in spores from infected animal products• Gastrointestinal – eating undercooked meat from infected animals• Weaponized – 22 cases in 2001 Anthrax spores sent through the mail• Treat with antibiotics• Vaccine is available• Anthrax does occur naturally in animals in the U.S. but much more

prevalent in Asia, the Middle East, and Africa• Importation of cattle and goat hides regulated by the USDA. Hides

must be treated to reduce risk of Anthrax.


Disease Outbreaks from Animal TradeMonkeypox

• Monkeypox– June 2003—several people in US became infected

through contact with pet prairie dogs infected by legally imported African rats


Monkeypox

• Found in 1958 among monkeys captured for research

• 1970—found in human patients in Africa• Related to smallpox; can kill up to 10% of

infected people• Isolated cases during 1980’s; didn’t seem to be

major problem—not very contagious


Monkeypox Concerns

• Can the virus become more lethal or transmissible????

• Some reports of human-human transmission• Increased host range and geographic spread• HIV infection in Africa makes monkeypox more

difficult to control


The Movement of Food

• In the United States, 15% of food is imported from more than 150 countries

• These numbers have been increasing for past 10 years

• When food is contaminated, it can cause widespread outbreaks due to the movement of food


Food and Drug Administration Globalization Act of 2009

• All facilities operating in the U.S. or importing to the U.S. must register with the FDA

• Food facilities must have plan to identify and mitigate hazards

• FDA inspects all plants on a risk-based schedule• Expanded traceback capabilities• Requires country-of-origin labeling and

disclosure• FDA may issue mandatory recalls



• Illegal bushmeat trade from Africa– $50 million annually sold worldwide– Sold to some communities in U.S.– Diseases associated with bushmeat• Ebola• HIV/AIDS• Monkeypox • SARS



• Legal food imports may also cause disease– 1996: Cyclospora is strawberries from Guatemala– 2000-2002: Salmonella in cantaloupe from

Mexico– 2008: Salmonella in peppers from Mexico– 2011: Salmonella in Papayas from Mexico


The Benefits of Globalization Regarding Disease Outbreaks

• Shared research/medical advances• Global surveillance and disease response• Global Health Initiatives


Shared Research and Medical Advances


Global Surveillance & Disease Response

• Animal Diseases/Zoonotic Diseases– Global Early Warning and Response System

(GLEWS)• Human Diseases– Global Outbreak Alert and Response Network

(GOARN)


Animal Disease Outbreak Alerts

• Global Early Warning and Response System (GLEWS)– For Major animal diseases, including zoonotic diseases– Developed by:

• World Health Organization (WHO)• Food and Agricultural Organization of the United Nations

(FAO)• World Organization for Animal Health (OIE)

– Goals:• Earlier detection• Coordinated response


GLEWS Alerts in 2010

• Rabies in Peru, Trinidad, and Tobago• Nipah Virus in Bangledesh• H5N1 Influenza in Vietnam, Romania, Bulgaria• Highly pathogenic avian influenza in China and Japan• Rift Valley Fever in South Africa, Saudi Arabia• Foot and Mouth Diseases in Republic of Korea• Glanders in Bahrain• Venezuelan Equine Encephalomyelitis in Panama• African Swine Fever in Armenia and Chad• Anthrax in Bangladesh


Human Disease Outbreak Response

• Global Outbreak Alert and Response Network (GOARN)– Combat international spread of outbreaks among

humans– WHO, UNICEF, Red Cross, and others


GOARN Response to SARS

• WHO recognized outbreak in March 2003; declared Global Alert

• Goal was to allow all countries time to prepare for possible global epidemic

• Created network of 13 labs in ten countries– Identified virus associated with SARS in 2 weeks– Genome sequenced in 2 more– (Took 2 years to identify HIV as cause of AIDS in 80’s)


GOARN Alerts in 2010• Avian Influenza in Egypt, Indonesia, China, Cambodia, Vietnam• Cholera in Haiti, Pakistan, Central Africa• Polio in Central Asia, the North Caucasus Federal Region of the

Russian Federation, Congo, Angola, Tajikistan• Crimean-Congo haemorrhagic fever (CCHF) in Pakistan • Dengue in Pakistan• Yellow Fever in Senegal, Congo, Cameroon, Guinea, Côte d'Ivoire• Plague in Peru• Lead poisoning in Nigeria from mining• Acute Haemorrhagic Fever in Congo• Rift Valley Fever in South Africa• Meningococcal disease in Chad


Global Health Initiatives

• Roll Back Malaria– Launched in 1998– More than 500 partners– Vision: World free from Malaria

• Stop TB– Launched in 1998

• Global Alliance for Vaccines and Immunization– Launched in 2000 – Bring vaccines to developing countries

• Hepatitis B, Childhood meningitis, Yellow Fever, and respiratory infections


References

• The WHO Global Health Observatory Map Gallery

• The US Centers for Disease Control and Prevention

• http://www.ispub.com/journal/the_internet_journal_of_biological_anthropology/volume_1_number_1_10/article_printable/how_to_deal_with_emerging_and_re_emerging_infectious_diseases_globally.html

• http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijba/vol1n1/infections.xml

http://gamapserver.who.int/mapLibrary/app/searchResults.aspx

http://www.cdc.gov/

http://www.cdc.gov/

http://www.ispub.com/journal/the_internet_journal_of_biological_anthropology/volume_1_number_1_10/article_printable/how_to_deal_with_emerging_and_re_emerging_infectious_diseases_globally.html





http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijba/vol1n1/infections.xml

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijba/vol1n1/infections.xml

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