1. Emerging infections and Health Protection In Scotland Looking to the future Kirsty Roy and Martin Donaghy Health Protection Scotland Scottish Government 19 th October 2011, Edinburgh

2. UK definition An emerging infectious disease can be either – a newly recognised infectious disease or – a known disease Whose reported incidence within the past 2 decades is increasing (or threatens to increase) in a specific place, or among a specific population Human Animal Infections and Risk Surveillance (HAIRS) Group

3. Global map of emerging infections Morgens et al Nature, 2005

4. The convergence model of emerging infectious diseases Human demographics, behaviour and vulnerability Technology and industry Economic development, land use, climate and changing ecosystems International travel and commerce Microbial adaptation and change Poverty, social inequality and breakdown of public health measures Intent to harm (Factors contributing to emerging infections. IoM, 1992 and 2003)

5. Detection of emerging infections in the UK Combination of Detecting ‘unusual incidents’ Horizon scanning and surveillance. Detection of incidents/events of potential threat to public health. Systematic review of informal and formal reports and maintenance of a log recording significant incidents which are then followed up –National –Locally international (Europe) –International (Global)

6. National Expert Panel for New and Emerging Infections (NEPNEI) Indentify key areas for action and to advise on priorities by –Identifying emerging and potential infectious threats to public health both nationally and internationally –Placing emerging infections to the wider clinical and public health contexts –Advising on prevention and control measures –Prioritising areas for surveillance and for information –Advising on research, including technological development needs

7. UK Horizon scanning for infectious diseases Human Animal Infections and Risk Surveillance (HAIRS) Group Health Protection Agency DEFRA Veterinary Laboratory Agency Department of Health Chair of National Expert Panel on New and Emerging Infections (NEPNEI) Food Standards Agency NPHS Wales Health Protection Scotland

8. Horizon scanning and hazard identification UK Foresight ‘Infectious Diseases: preparing for the future’ To use the best available science to evaluate the threats of infectious diseases In humans, animals and plants over the next 10-25 years; and to produce a vision for their management, specifically through systems for detection, identification and monitoring. Future disease risk New pathogen or novel variants of existing pathogens Pathogens acquiring resistance e.g. to microbicides Zoonosis HIV/AIDS, tuberculosis and malaria Epidemic plant disease Acute respiratory infections Sexually transmitted infections included HIV Transboundary animal diseases

9. Potential moderate and high risk factors influencing human disease risks, 2030, UK UK Government’s Foresight project “Infectious Diseases: preparing for the future

10. Scottish drivers for emerging infectious disease More susceptible population – older population, increasing prevalence of chronic infection, greater use of high technology medicine Rural Scotland set to grow bigger Scottish climate 2.5-3.5 o C warmer by the turn of the century Food production to decline (over-reliance on the international market) Increased air travel (predominantly through central belt airports) Bio- and nanotechnology industry increasing Horizon scanning for Scotland’s Futures: The next 30 years (and beyond) (Scotland & N. Ireland Forum for Environmental Research, 2007)

11. Dealing with emerging infections Be prepared develop and strengthen our capacity to detect and rapidly respond to any kind of health threat Detection, investigation and management (DIM) systems

12. Dealing with emerging infections Surveillance and response detect, investigate and monitor unusual, unexpected, unexplained pathogens, the diseases they cause and the factors influencing their emergence and respond to problems as identified Applied research development of predictive models based on epidemiological data, climate change surveillance and human behaviour Infrastructure and training strengthen infrastructures to support surveillance, response and research and to implement prevention and control programs. Integrate laboratory and epidemiology to increase effectiveness of public health practice. Provide the work force with knowledge and tools it needs Prevention and control Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases

13. Role of Health Protection Establish systems for detecting unusual diseases and drug resistant agents (from medical intelligence, surveillance and other information sources) Assure laboratory capacity to investigate new agents and confirm known agents Promote national and international collaboration Develop plans for handling clusters/outbreaks of unknown agents (case reporting, investigation and appropriate follow-up) Education – physicians, public and policy makers Promote a long term flexible approach