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Microbial Threats – Whats Next? RADM Ali S. Khan, MD MPH Deputy Director National Center for Zoonotic, Vectorborne, and Enteric Diseases (NCZVED) Assistant.

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Presentation on theme: "Microbial Threats – Whats Next? RADM Ali S. Khan, MD MPH Deputy Director National Center for Zoonotic, Vectorborne, and Enteric Diseases (NCZVED) Assistant."— Presentation transcript:

1 Microbial Threats – Whats Next? RADM Ali S. Khan, MD MPH Deputy Director National Center for Zoonotic, Vectorborne, and Enteric Diseases (NCZVED) Assistant Surgeon General, US Public Health Service

2 EBOLA-RESTON PHILIPPINES 2008

3 ARENAVIRUS OUTBREAK ZAMBIA-SOUTH AFRICA 2008

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5 Death Rates for Typhoid Fever in the U.S. Rate per Population Year

6 Examples of Emerging and Re-emerging Infectious Diseases

7 Factors in Emergence Genetic and biological factors –Microbial adaptation and change –Human susceptibility to Infection Physical environmental factors –Climate and weather –Economic development and land use Ecological factors –Changing ecosystems –Human demographics and behavior Social, political, and economic factors –International Travel and commerce –Poverty and Social inequity –War and Famine –Lack of political will –Intent to harm

8 Woesian Tree of Life 3.5 Billion 90% of all life 30 generation in a day Transposons & plasmids The Age of Microbes

9 The Zoonotic Pool* Assume 50,000 vertebrates, each with 20 endemic viruses. There are likely 1 million vertebrate viruses Only 2,000 or so identified, so 99.8% of vertebrate viruses remain to be discovered *Morse, 1993

10 Speed of Global Travel in Relation to World Population Growth W o r l d P o p u l a t i o n i n b i l l i o n s ( ) D a y s t o C i r c u m n a v i g a t e ( ) t h e G l o b e Year

11 Incubation periods Plague days Yellow fever days Cholera daysCholera Influenza daysInfluenza Ebola daysEbola Polio daysPolio Pertussis daysPertussis Measles daysMeasles Smallpox daysSmallpox Chicken pox daysChicken pox Mumps daysMumps Rubella (German measles) daysRubellaGerman measles

12 SARS Clusters Linked to Hotel M Hotel M Hong Kong B B Singapore 34 HCW United States 1 HCW I, L,M Vietnam 37 HCW K Ireland 0 HCW K Guangdong Province, China A A H,J A Hong Kong SAR 95 HCW >100 close contacts F,G Canada 18 HCW F,G C,D,E

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14 West Nile Virus in the Western Hemisphere

15 Incidence per million >=100 Any WNV activity WNV Neuroinvasive Disease Incidence, by County, US, 2000 N=19

16 WNV Neuroinvasive Disease Incidence, by County, US, 2001 N=64 Incidence per million >=100 Any WNV activity

17 WNV Neuroinvasive Disease Incidence, by County, US, 2002 N=2946 Incidence per million >=100 Any WNV activity

18 WNV Neuroinvasive Disease Incidence, by County, US, 2003 N=2866 Incidence per million >=100 Any WNV activity

19 WNV Neuroinvasive Disease Incidence, by County, US, 2004 N=1142 Incidence per million >=100 Any WNV activity

20 WNV Neuroinvasive Disease Incidence, by County, US, 2005 N=1294 Incidence per million >=100 Any WNV activity

21 WNV Neuroinvasive Disease Incidence, by County, US, 2006 N=1339 * Reported as of November 7, 2006 Incidence per million >=100 Any WNV activity

22 WNV Neuroinvasive Disease Incidence, by County, US, 2007* N=1213

23 You said it was ONLY a virus!

24 Nature. February 2008; vol 451(21) Global Distribution of Relative Risk of an EID Event zoonotic pathogens from wildlifezoonotic pathogens from non-wildlife drug-resistant pathogensvectorborne pathogens

25 Physical and Environmental Factors Ecological Factors Humans Wildlife Animals E I D Social, Political, and Economic Factors Genetic and Biological Factors Convergence Model

26 WHO Issues Global Alert 12 March WHO Issues first travel advisory 15 March Adapted from the SARS WHO Epidemic Curves [http://www.who.int/csr/sars/epicurve/epiindex/en/index1.html]

27 African Shipment Arrives April 9 Purchased by Illinois Shop April 21 6

28 Identification of the Etiologic Agent of SARS Spec Isolation studies – unknown (3-18), adenovirus PCR for respiratory viruses- Rhino+ (3-15)+, HMPV+ (3-19) Consensus PCR – herpes+, paramyxovirus+ Antigen detection, PCR for bacterial pathogens Histopathologic studies EM – paramyxovirus-like structures Conference call consultation (3-19) Isolation material to UCSF for multiple array studies (3-22) EM+ A-C+ PCR+ Seq Anti-v New CoV Thu 3-13 Fri 3-14 Sat 3-15 Sun 3-16 Mon 3-17 Tue 3-18 Wed 3-19 Thu 3-20 Fri 3-21 Sat 3-22 Sun 3-23

29 ArboNet: Capturing Human and Animal Data

30 BioPHusion: Information Fusion

31 The compelling message is that sustained global disease surveillance is a basic public health necessity because ongoing interactions among humans, animals, and the environment will inevitably lead to disease emergence or re- emergence and the impact of disease reverberates throughout national and global social, economic, and trade systems. Achieving Sustainable Global Capacity for Surveillance and Response to Emerging Diseases of Zoonotic Origin. Workshop Report

32 Lessons Learned from Recent Outbreaks: Support a Global Strategy Focus on Prevention & Preparedness as Foundation of Response Build New Collaboration between Human and Animal Health Integration of surveillance, diagnostic, and information systems Incorporate pathogen discovery and risk-based focus Adopt a One Health mindset and strategy Infectious Disease Ecology Centers & Distributed Networks Establish R&D prototypes at various interfaces Design scalable strategies for successful prototypes Shift up-stream for earlier detection and intervention Meet local/national needs Multi-disciplinary partners and public-private partnerships Proactive communications Identify political barriers & be transparent

33 Nipah Virus Whats Next?

34 The Perfect Microbial Storm: Chikungunya A report of 270 people infected with Chikungunya in Ravenna, Italy A Virus from Africa (an alphavirus – Chikungunya) A mosquito from Asia (Aedes albopictus: tiger mosquito) A tourist from India (1.25 million human cases in 2006) Whats Next?

35 Thank You ! RADM Ali S. Khan The views and conclusions of this report are those of the authors and do not necessarily represent the views of the CDC.

36 Acknowledgements Dr. Lyle Petersen Dr. Jim Leduc Dr. Thomas Ksiazek Dr. Peter Daszak Dr. Kate Glynn Dr. Robert Swanepoel Sarah Nystrom


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