international fetp training of trainers · •zika 18 . a health threat anywhere is a health threat...
TRANSCRIPT
Thailand MOPH – US CDC Collaboration
International FETP Training of Trainers
John MacArthur, MD, MPH
Director
Thailand MOPH – US CDC Collaboration
02 July 2018
Emerging Infectious Diseases Why Asia Matters
Driving Forces in Asia
• Population growth, urbanization, environmental changes
• Diverse zoonotic and vector-borne pathogens
• High density, proximity, and mobility of humans and animal reservoirs provide fertile conditions for disease transmission
• Ecologic factors allow rapid pathogen mutation and host adaptation
Asia Population
• Thailand 68m
• Greater Mekong Sub-region 235m • Burma, Cambodia, Laos, Thailand, Vietnam, Yunnan
• ASEAN 625m • ASEAN +3 (+China, Korea, Japan) 2,174m
• WHO:SEARO/WPRO 3,728m
ASIA: 53.3% of world’s population
Global Hotspots for Emerging Diseases Originating in Wildlife
Morse et al., 2012: The Lancet
Nipah Virus
• Isolated and identified in 1999 • Outbreak of encephalitis and
respiratory illness among pig farmers
• 300 human cases with 100 deaths
• Transmission occurs from direct contact with infected bats, pigs, or persons
SARS
• First reported in Asia in 2003 • Outbreak of fever and resp illness
among people with contact with an infected individual
• 8,098 human cases with 774 deaths
• Transmission occurs from airborne contact with infected persons
• Possible origin: bats, palm civets
Influenza A
H5N1 • First reported in humans in 1997
(Hong Kong) • re-emerges in 2003 in HK in patients
with h/o China travel • 846 human cases with 449 deaths
through 2015
• Transmission occurs from direct or close contact with infected poultry; some H2H reported
H1N1 • First reported in mid-April 2009
(USA) • H1N1 picked up as a part of a clinical
study • ~61 million human cases with
>12,000 deaths
• Transmission occurs from person to person (coughing and sneezing)
• Possible origin: reassortment of bird, swine, and human influenza viruses
Keep Calm and … Emerge
H7N9
• First reported in humans in 2013 (China) • Infections found in poultry and
people • >300 human cases with 67 deaths
• Transmission occurs likely from exposure to infected poultry or contaminated environment
• Possible origin: reassortment of H7N1 chicken and duck virus
MERS-CoV
• First identified in 2012 (Saudi Arabia) • Coronavirus family ranging from
common cold to SARS • 1,644 human cases with 590
deaths
• Exact route of transmission still unknown (likely H2H)
• Possible origin: likely bats but transmitted to camels at some point in the past
H5N1 53%
MERS-CoV 36%
Nipah virus 33%
H7N9 22%
SARS 10%
H1N1 0.02%
Case Fatality Rates
Emerging/Re-emerging Infectious Diseases in Asia • Artemisinin-resistant malaria
• Burkholderia pseudomallei
• Chikungunya
• Dengue
• Japanese encephalitis
• Leptospirosis
• MDR/XDR TB
• multidrug-resistant Acinetobacter baumannii, Salmonella enterica, and Enterobacteriaceae
• Rabies
• Streptococcus suis
• Vibrio cholerae O139
• Zika
18
A health threat anywhere is a health threat everywhere Global Aviation Network
Source: The Lancet 380:9857, 1-7 Dec 2012, pp. 1946-55. www.sciencedirect.com/science/article/pii/S0140673612611519 Note: Air traffic to most places in Africa, regions of South America, and parts of central Asia is low. If travel increases in these regions, additional introductions of vector-borne pathogens are probable
MERS-CoV cases by country of residence and travel history
Global transmission patterns of measles viruses from the
Philippines, 1/1/14 to 3/31/14
Diseases can spread as fast as an airplane
MERS-CoV spread across the Arabian peninsula
648
1378
1026
17
3069
482
322
935
6
1745
430 694
422
13
1559
0
500
1000
1500
2000
2500
3000
3500
Guinea Liberia SierraLeone
Nigeria Total
Cases Confirmed Deaths
Ebola Outbreak as of 28 AUG 2014
Figure 1. Geographical distribution of counties involved in live bird market networks originating from southern China in the (A) January, (B) February, (C) March and (D) April.
Soares Magalhães RJ, Zhou X, Jia B, Guo F, et al. (2012) Live Poultry Trade in Southern China Provinces and HPAIV H5N1 Infection in Humans and Poultry: The Role of Chinese New Year Festivities. PLoS ONE 7(11): e49712. doi:10.1371/journal.pone.0049712 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0049712
ASEAN Economic Community
AEC Single Market and Production base
To create a stable, prosperous and highly
competitive ASEAN economic region
Freer flow of capital
Free flow of goods services, investment,
and skilled labor
characteristic
objective
Global Health Risks are Increasing
Emergence and Spread of New Pathogens
Globalization of Travel, Food and Medicines
Rise of Drug Resistance
Intentional Engineering of Microbes
XDR TB
MRSA
Anthrax
Recombinant
Technologies
HIV
Avian Flu
Food Supply
Global Frameworks IHR, APSED, & GHSA
International Health Regulations (IHR) 2005
• International agreement between WHO and its 196 member states
• Framework for identifying, reporting, and responding to public health emergencies of international concern (PHEIC)
Less than 1/3 of the world is prepared
• All 196 countries of the world committed to International Health Regulations
• By 2014 – only 32% fully prepared to detect and respond to pandemics
ASEAN Countries have a head start
Asia Pacific Strategy for Emerging Diseases Five Objectives
1. Reduce the risk of emerging diseases
2. Strengthen early detection
3. Strengthen rapid response
4. Strengthen effective preparedness
5. Build technical partnerships
Source: WHO
Good but still not there
Global Health Security – “...the activities required, both proactive and reactive, to minimize vulnerability to acute public health events that endanger the collective health of populations living across geographical regions and international boundaries” (World Health Assembly Report,
2007)
• In 2003, SARS cost $30 billion in only 4 months • The anthrax attacks of 2001 infected 22 people,
killed 5, and cost more than $1 billion to clean up • The 2009 H1N1 influenza pandemic killed
284,000 people in its first year alone • AIDS spread silently for decades
Global Health Security Agenda A Move to Accelerate Progress
The Problem
The Process
PREVENT Avoidable Catastrophes
DETECT Threats Early
RESPOND Rapidly & Effectively
Action Packages
AMR
Zoonotic
Biosafety/ Biosecurity
Immunization
Nat’l Lab Sys
Surveillance
Reporting
Workforce Dev
EOC
Public Health Law
Medical Counter- measures
Global Health Security Agenda
Goals Objectives
Prevent avoidable epidemics
Prevent the emergence and spread of antimicrobial drug resistant organisms and emerging zoonotic diseases and strengthen international regulatory frameworks governing food safety
Promote national biosafety and biosecurity systems
Reduce the number and magnitude of infectious disease outbreaks
Global Health Security Agenda
Goals Objectives
Detect threats early
Launch, strengthen and link global networks for real-time biosurveillance
Strengthen the global norm of rapid, transparent reporting and sample sharing in the event of health emergencies of international concern
Develop and deploy novel diagnostics and strengthen laboratory systems
Train and deploy an effective biosurveillance workforce
Global Health Security Agenda
Goals Objectives
Respond rapidly and effectively
Develop an interconnected global network of Emergency Operations Centers and multi-sectoral response to biological incidents
Improve global access to medical and non-medical countermeasures during health emergencies
GHSA Participating Countries
Systems strengthening Global Health Security Agenda
FETP Thailand Highlights
• First FETP established outside North America
• More than 85% of the over 190 FETP graduates hold leadership positions at provincial, national and international levels.
• >1,000 outbreak investigations
• >690 publications
Dr. David Brandling-Bennett and 1st FETP Cohort - 1980
Workforce Development
• Strengthen human capacity for disease surveillance, response, and control
• FETP for veterinarians and wildlife workers • Scientific writing
• Mentors – Increase number and quality
• Develop and update curriculum and new training modules
• Strategic planning
• Regional linkages
Building Upon Success: Global Health Security • 1980 – Begin to build epidemiology capacity
• 2003 – SARS: Intensive collaboration on outbreak investigation
• 2004 – H5N1: Built on previous collaboration to mitigate associated risks
• IMPACT: Thailand immediately identified 3 imported cases of MERS-CoV, isolated the patients, introduced infection control practices, and conducted contact tracing with no secondary cases reported • Contrast to South Korea (186 cases & 36 deaths from a single imported case)
FETP in the 21st Century The Many Flavors of Health Security
Economic Development in Asia 1960-2014
Epidemiologic Transition
There are two major components of the transition:
1. changes in population growth trajectories and composition, especially in the
age distribution from younger to older, and
2. changes in patterns of mortality, including increasing life expectancy and reordering of the relative importance of different causes of death.
Thailand Top Causes of Death 2012
0 10 20 30 40 50 60 70 80
Kidney Disease
Resp CA
Liver CA
Diabetes
AIDS
COPD
RTI
LRI
Stroke
Ischemic Heart Disease
Adult Risk Factors
• Raised Blood Glucose • M: 7.3%
• F: 7.1%
• HTN • M: 24.6%
• F: 20.2%
• Obesity • M: 4.9%
• F: 11.8%
• Tobacco Use • M: 46%
• F: 3%
Making a difference in Asia
• Infectious diseases • Still very important and need attention
• Emerging and re-emerging infectious diseases may affect large numbers in a short amount of time
• May have dramatic impact on economies
• Large portion of ministries’ workforce development
• Non-communicable Diseases • Growing importance
• 8 of 10 top causes of mortality in Thailand
• Will have slower yet significant impact on economy
• Small number of epidemiologists with NCD expertise
You are not here merely to make a living. You are here to enable the world to live more amply, with greater vision, and with a finer sense of hope and achievement. You are here to enrich the world, and you impoverish yourself if you forget the errand.
Woodrow Wilson 28th President of the United States