Adapting to climate change Jonathan Suk 30 June 2010

Source: Woolhouse, M.E.J. & Gowtage-Sequeria, S. Emerging Infectious Diseases 2005, Vol. 11(12): Rank*Driver 1Changes in land use or agricultural practices 2Changes in human demographics and society 3Poor population health, e.g. HIV, malnutrition 4Hospitals and medial procedures 5Pathogen evolution, e.g. antimicrobial drug resistance, increased virulence 6Contamination of food sources or water supplies 7International travel 8Failure of public health programmes 9International trade 10Climate change * Ranked by the number of pathogen species associated with them (most to least). Main categories of drivers associated with emergence and re-emergence of human pathogens Drivers of emerging infectious diseases

Food- and water-borne pathogens with known climate links DiseaseClimate linkage BotulismFood-borne. Temperature link, risk if poorly stored; high temperatures affect risk in fish CampylobacteriosisLinked to heavy rain CholeraLinked to heavy rain CryptosporidiosisLinked to heavy rain GiardiasisLinked to heavy rain VTECLinked to heavy rain Hepatitis ALinked to heavy rain ListeriosisSmall risk if inadequate cold storage. SalmonellosisFood: temperature linkage. Water: linked to heavy rain ShigellosisLinked to heavy rain Typhoid / paratyphoid feverLinked to heavy rain YersiniosisFood: temperature linkage. Water: heavy rain. 3

Vector-borne diseases/pathogens that may be linked to climate change in Europe Tick-borneMosquito-borneOther insect- borne Rodent-borne Lyme diseaseChikungunyaLeishmaniasisHanta viruses Tick-borne encephalitis Dengue*Chandipura virusHemorrhagic fever with renal syndrome (HFRS) Human erlichiosisMalaria*Sicilian virusNefropathia epidemica Crimean-congo hemorrhagic disease* West Nile virusTularaemia Yellow fever*Toscana virusPlague* Sindbis virusPhlebotomus fever (Naples virus) Lymphocytic choriomeningitis virus Tahnya virusCowpox virus Lassa fever* 4 *Disease not currently prevalent in continental EU region

Current distribution of Aedes albopictus in the EU Source: Schaffner, F. Development of Aedes albopictus risk maps. TigerMaps project. ECDC, Stockholm (Forthcoming.)

6 Potential establishment under climate change scenarios

7 Climate change at ECDC Vulnerability and risk assessments International workshop on Environmental Change and Infectious Disease International workshop on Linking Environmental and Epidemiologic Data Risk assessment of vector-borne diseases in the EU (V-borne) Impact of climate change on food- and water-borne (FWB) diseases in Europe Risk maps for Aedes albopictus Risk maps for dengue fever and aedes aegypti Adaptation strategies Chikungunya communication toolkit Adaptation and vulnerability toolkit Response ECDC/WHO risk assessment of chikungunya in northern Italy

1. Vector Surveillance: VBORNET Objectives  To establish a network of expertise in entomology across the EU  To obtain data on vectors of primary concern to health in the EU (mosquitos, ticks)  To promote EU-wide harmonization of standards and methods for vector surveillance 8

2. Environmental monitoring 9 time Health outcomes Environmental consequences Climate change CO 2 Socio- economic impacts (homelessness, refugees…) Indirect exposures (vector-borne diseases, other infectious diseases) Surveillance Direct exposures (heat stroke, drowning…)

3. Adaptation handbook Background  Climate change as a threat multiplier – addressing climate-sensitive diseases should also benefit public health today Objectives  To assist EU Member States to conduct national and regional vulnerability assessments as concerns climate change and communicable diseases  To develop comprehensive advice for ECDC and EU Member States on how to implement regionally targeted adaptation strategies to mitigate against future communicable disease transmission due to climate change. 10

Pragmatic approach  Identify baseline description (epidemiologic, socio-economic, current disease burden), and note it is changing alongside climate  Identify climate-sensitive diseases most relevant for a given region, and then weighing options for action  Identify climatic drivers (rainfall, drought, temperature) most relevant to these diseases  Develop adaptation strategies with future projections in mind, and engage other sectors where possible  Strategy needs to be evidence-based, but does not necessarily need to involve sophisticated modelling 11

Assessment Process 12 Aim, demarcation Quality control Organisational structure: Working group, reference group, etc Base-line description Climate, diseases, vulnerability factors Assessment: Vulnerability and impacts Base-line description Adaptation measures Assessment: Adaptive strategies and measures Follow-up/ monitoring: Impacts and measures Policy decision Iterative process

Identifying priorities for action High Medium Low HighMediumLow Weighted significance of climate change on the transmission of a specific infectious disease in an area High Medium Low Probability of an outbreak/strength of climate change- disease relationship Severity of consequence for society risk group

Thank you. 14