Transboundry Zoonotic Diseases

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  • 1. TRANSBOUNDARY ZOONOTIC DISEASES: INDIAN PERSPECTIVE Pankaj Dhaka Ph.D Scholar Division of VPH, I.V.R.I, pankaj.dhaka2@mail.com
  • 2. TRANSBOUNDARY ZOONOTIC DISEASES Diseases that are of significant economic, trade and/or food security importance for a considerable number of countries; which can easily spread to other countries & reach epidemic proportions; & where control/management, including exclusion, requires cooperation between several countries. (FAO, 2004) Diseases are the tax on pleasures - John Ray
  • 3. Spanish flu (Misnomer): Mother of all pandemics • Exceptional fatality rate (> 2.5% ) + whooping rate of infectivity • Infected 1/3 of world’s population + deaths toll > 50mn • 17 mn death in India (5% population) (Susan Mayor, 2000) • “W-shaped” curve pattern instead of the normal U-shaped curve Left too many queries to be solved by researchers???
  • 4. Chronology : Homo to Homo sapiens • Pleistocene Epoch 11,000 years ago Human population: Short-lived, immunizing, human-specific infections (Burnet, 1946) • 6mn years ago: Advent of agriculture 1st epidemiological transition Population size and density grew “CROWD DISEASES” (Armelagos et al., 2005)
  • 5.  10,000 years ago domestication of animals • Greatest conduit for zoonotic disease transmission (Wolfe et al., 2007) “Species jump” • Rinderpest virus of sheep & goats Human measles (Weiss, 2001) • Smallpox from camel domestication (Gubser et al., 2004) • Domestication of waterfowl Human influenza (Shortridge, 2003) • Helicobacter pylori ( Nobel Prize, B.J Marshall & J.Warren, 2005) may have 1st been transmitted to humans via sheep’s milk . (Dore et al., 2001)
  • 6. The 2nd Epidemiological Transition: Complacency • Late 19th & early 20th centuries ↓ in infectious disease • U.S. Institute of Medicine report : “era of complacency” (Davis and Lederberg, 2001) • “Conquest of all infectious diseases was imminent” U.S. Secretary of State (1948) (Najera, 1989) • “The war against diseases has been won” Gen. William Stewart (1967) (Morens et al., 2004) • “To write about infectious disease is almost to write of something that has passed into history ” (Burnet, 1962) "Civilization is a limitless multiplication of unnecessary necessities” Mark Twain
  • 7. THE 3rd EPIDEMIOLOGICAL TRANSITION: EID • > 30 newly identified human pathogens in past 30 yrs. • Till back viruses = Species-specific  Now, not only interspecies navigation but plant reservoir for Ebola virus brought more sophisticated concept, i.e., (Monath, 1999) “Superbugs”: Springing up everywhere “Disease is the biggest money maker in our economy” John H. Tobe
  • 8. A World in Transition ? AIDS Avian Influenza Ebola Marburg Cholera Rift Valley Fever E.coli 0157:H7 BSE Nipah virus Hantaan virus SARS Swine flu JE ...............H7N9 DOWN UP Guinea worm Smallpox (Eradicated) Yaws Poliomyelitis Measles Leprosy Neonatal tetanus This listing is not meant to be exhaustive…“there is no way to keep the lid on the Pandora’s box. .What you can’t predict is what’s going to come out…but you can predict is that something will ”
  • 9. IT’S HIGH TIME TO INTROSPECT: (Lederberg, 2006)
  • 10. • Population explosion • Commercialization led to deprivation of traditional stock & influx of new one to food supply. ( New stocks ) ( New environment ) ( New pathogens)  Global trade in exotic wild animals as a pet • International wildlife trade - US $ 6 bn industry (Karesh, 2005) • 3% of world population (215 mn) live outside their native countries (IOM, 2010) TOP THREE HITS IN BULL’S EYE: Best recipe for zoonosis
  • 11. Monkey pox: “Harbinger of things to come” • Recent havoc in U.S • West Africa (endemic for monkey pox) • Gambian giant rat imported to U.S • Close contact with captive prairie dogs and other pets • Outbreak in the Western hemisphere,71 cases (Gross, 2003)
  • 12. “Deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolific source of diseases” Edward Jenner Key players The increasing demand for animal protein, Expansion & intensification of animal agriculture, Long-distance live animal transport, Live animal markets, Bushmeat consumption and habitat destruction (WHO-FAO-OIE, 2004)
  • 13. BSE: “accidental experiment” • Huge setback to the effected economy in terms of food safety & food security (UK DEFRA, 2004) “Accidental experiment on the dietary transmissibility of prion between sheep & cows” (Harrison & Roberts, 1992) • 165 human cases of vCJD (Bruce et al., 1997) • U.K lost approx. $ 6 bn (Davis and Lederberg, 2001) vCJD Only BSE
  • 14. Climate change HUMAN ANIMALS ENVIRONMENT Population Growth VECTORS Mega-cities Migration Pollution Exploitation Vector proliferation Vector resistance Food production Transmission Antibiotics Intensive farming
  • 15. INDIA: One of the “HOTSPOT” for zoonosis? • Area : 32,87,263 sq. km • Coastline -7516.6 km • Sharing border with 7 countries • Tremendous diversity of climate & physical conditions • Great variety of fauna (over 92,037 species) (ZSI, 2007) DEMOGRAPHIC BACKGROUND • 1.21bn population with a density of 382/sq.km • Point of concern: 2.4% of world surface area • Yet it supports and sustains a whopping 17.5% of world population • Agriculture - more than 58% of the population
  • 16. WHO WILL PAY FOR THIS? • 1st in total milk production – 127.3 mMT (DADF, 2012) • 2nd in aquaculture - 82.9 lakh tones of fish production • 3rd in egg production - 63.0 bn • 5th in meat production - 6.3 mn tones • 244.78 mn tones of food grains (FAOSTAT, 2010) IS BURDENSOME POPULATION GROWTH MASKING THESE FIGURE ? ?
  • 17. Tourism industry • 2nd largest sector • Provide employment to low-skilled workers • ‘Pro-poor tourism’ & “Visa-on- arrival”….. Are we following concept of healthy tourism?? Or Just being a industry of exotic diseases????
  • 18. Trade & Commerce • Liberalization process began in the early 1990s • 10 free trade agreements, 9 proposals • 1st developing nation to extend duty free quota free (DFQF) access in LDCs • 1st in Asia to implement EPZ model, then convert it in SEZ • FDI policy by GOI, 2012 C.P. Chandrasekhar2012
  • 19. You cannot prevent the birds of sorrow from flying over your head, but you can prevent them from building nests in your hair
  • 20. TIMELINE OF ENIGMA IN INDIA EVENTS TIME & PLACES Vibrio cholerae O139 1992 (W.B) Plague 1994 (Mah., Guj.), 2002 (H.P), 2004 (U.K) SARS 2003 Nipah 2001, 2007 (W.B) CCHF 2011 (Guj.) Lyme Disease 2013 (Kerala) J.E Endemic
  • 21. PLAGUE: “its victims ate lunch with their friends & dinner with their ancestors in paradise.” Devastation of mighty Roman Empire ? ? ? Statistics never fails to startle:  1st pandemic (541 A.D.) The Justinian Plague - 100mn people (Khan, 2004)  2nd pandemic – (1334) The black death - China to Europe Swept 60% of the population (Benedictow, 2008)  3rd pandemic- (1860s) The modern Plague, China -10mn deaths Spread to port cities around the world by rats (Khan, 2004)  Sub-Saharan Africa & Madagascar account for > 95% cases (Stenseth, 2008) GEOGRAPHICAL SHIFTS: ASIA→AMERICAS→AFRICA
  • 22. Plague in India: A New Warning from an Old Nemesis • 12mn deaths • 1st recorded case in Bombay (1896) (John, 1996) • Bounced back as epidemic in Beed district, Maharashtra (1994) • Migration of 3lakhs people from Surat within 2 days (Godshen Robert, 2009) Major keyholes • Poor sanitary measures + heavy monsoon ═ Rats came out into play • Spread of disease by travelers from these epidemic foci “How could this happen?” • 2002- 16 cases of pneumonic plague in H.P (Gupta and Sharma, 2007) • 2004- 8 cases, 3 of them died in Uttarakand (Mittal et al., 2004)
  • 23. CHOLERA: MADE IN INDIA? • 1817-1823-The first known pandemic- Ganges River delta Colonization & trade Rest of the world • 1829-1849- 2nd pandemic via. India led to 22,000 death in England In 1832, Irish immigrants, fleeing poverty & the potato famine N. America • 1852-1859-3rd pandemic via. India In 1854, 23,000 death in Britain made John Snow to identify transmission source • 1863-1879-4th pandemic- From Bengal region Middle East, Europe, Africa & N. America made 30,000 victims
  • 24. • 1881-1896: 5th pandemic via. Bengal Claimed 2,00,000 lives in Russia & 90,000 in Japan • 1899-1923- 6th pandemic killed > 8,00,000 in India • 1961 to present-7th pandemic originated in Indonesia  Zimbabwe (2008) - 12,000 cases, 500 deaths  Haiti (2010)- 250 deaths Cholera bacteria (O139) Bangladesh (1992) Fear of 8th pandemic ? (CBHI, 2012)
  • 25. H5N1: A VIRUS OF OUR OWN HATCHING • H5N1: Hong Kong (1997) rendered recognition of highly zoonotic potential, with case fatality rate > 60% (WHO, 2007) • “The world is teetering on the edge of a pandemic that could kill a large fraction of the human population” - Robert G.Webster • Since 2003, 566 confirmed human cases with deaths of 332 people (WHO, 2011) • Around US $ 10mn loss • > 200 mn birds have been culled to hold in ugly scenario (BMO Financial Group)
  • 26. In, 2011, out of 603 lab confirmed cases of H1N1, 75 deaths were reported in India (MOHFW/GOI, 2011)
  • 27. Pandemics of influenza 1895 1905 1915 1925 1955 1965 1975 1985 1995 2005 2010 2015 H7 H9* H5 1980 H1N1 1999 1997 Recorded new avian influenzas 2003 1996 2002 1955 1965 1975 1985 1995 2005 H2N2 1889 Russian influenza H2N2 H7N9 1957 Asian influenza H2N2 H3N2 1968 Hong Kong influenza H3N2 H3N8 1900 Old Hong Kong influenza H3N8 1918 Spanish influenza H1N1 2009 Pandemic influenza H1N1 H1N1 Pandemic H1N1 Human influenza B viruses: not subject to pandemics H2N2
  • 28. NIPAH: An Emergent Deadly Paramyxovirus Infection • In 1998, a large Malaysian outbreak – Intensively farmed pigs, sickened by fruit bats – Slash-and-burn deforestation • 1st isolated from Sungai Nipah New Village (Field et al., 2001) Intensive animal agriculture Long-distance animal transport Habitat destruction
  • 29. • In 1997-98, >10 mn acres forest burnt, exacerbated by El Ni˜no drought • The haze and habitat loss Mass exodus of “flying fox” • Unprecedented encroachment on orchards resulted in porcine exposure to flying fox saliva or urine (Chua et al., 2002) • Rapid transportation of infected pigs - 257 human cases, 48% fatality (CDC, 1999) • Culling of > 1 mn pigs minified the catastrophe (Lam, 2003) Pigs Barking Blood
  • 30. Indian scenario: • Siliguri (2001): Important commercial center Population of ≈500,000 borders with China, Bangladesh & Nepal • 66 cases with 74% mortality rate (Chadha et al., 2006) • Nadia District (2007): 50 suspected cases with 5 fatalities Outbreak site borders Bangladesh (ICDDR, 2007)
  • 31. WEST NILE FEVER • 1st reported in Ugandan woman (1937) • Americans got an inkling in 1999, when dead crows started falling out • The cause? Mosquito that hopped a plane from Israel to New York • > 3,100 infected, 1,600 developed neurological symptoms & 130 died (CDC, 2012) • In India, Ab first detected in humans in Mumbai (1952) • Isolation in: – Cx. vishnui in A.P & T.N, – Cx. quinquefasciatus in Mah. & Karnataka (Paramasivan et al., 2003) A result of laxity in zoonotic disease surveillance
  • 32. Lyme disease: "The Great Imitator" • In Connecticut (1975) - “Suburbanization” • ↑ density of nymphal, Ixodes scapularis due to ↑ forest fragmentation, led to ↑ numbers of the white-footed mouse (Peromyscus leucopus) (Allan et al., 2003) • “Edge” habitat effect on P. leucopus density due to ↓ predation & competition in small forest fragments (Nupp et al., 1996)
  • 33. Seroprevalence of B. burgdorferi in N-E India (Praharaj, 2007) • Lyme disease with neuroretinitis from S.India in a 45-year-old lady (Babu and Murthy, 2010) • Recently in WayanadWildlife Sanctuary, claimed the life of a 50-year-old woman while four others have been affected (TOI, Mar 2, 2013) State Total IgG positivity to B. burgdorferi (%) A.P 230 41 (17.8) Meghalaya 88 8 (9.09) Nagaland & Manipur 130 11 (8.46) Assam 52 5 (9.6)
  • 34. SARS: The headline maker in 2003 • Guangdong, birthplace of HPAI & SARS, famous for its intensive commercial bush meat trade (Donnelly et al., 2003) • Entry of wild life to China through Vietnam where bush meat trade is 2nd largest income source (Duck worth et al., 1999) Crowded interspecies mixing + Immunosuppressive effect of stress = Potentiate latent infections to flare up (Padgett and Glaser, 2003)
  • 35. Cultural effects • In China, civets raised for meat, penis is consumed as an aphrodisiac & coffee beans recovered from excreta, flavored with peri-anal gland scent (William, 2003) • The palm civet not only as transitional host & amplifier, but a “favorable incubator” as well (Zhao, 2007) • Economic cost in Asia > $ 10 bn (Lee and Mckibbin, 2003)  In India, April 10, 2003, a marine engineer, just returned from a holiday trip to Hong Kong & Singapore was the 1st case (TOI, 2003) “ Mother Nature is the world’s worst bioterrorist”
  • 36. SPEEDS MATTERS: IT THRILLS BUT KILLS  A worldwide outbreak was seeded from a single person on a single day on a single floor of a Hong Kong hotel (MacKen-zie et al., 2004)  Physician from Guangdong, had attended a wedding. As guests departed, the virus spread to 5 countries within 24 hours (Lee and Krilov, 2005)  With in months, the virus spread to 30 countries on 6 continents, causing 8,096 probable cases & 775 deaths (Mack, 2005; WHO, 2004)
  • 37. Hemorrhagic fevers: An endless episodes……. • Upsurge in field mouse populations led to the surfacing of the Junin virus in the early1950s • 5 mn people at risk for Argentine hemorrhagic fever (Enria, 1998) • Deforestation for agricultural use led to emergence of other BSL-4, rodent-borne, hemorrhagic fever Arenaviruses: Machupo virus in Bolivia, Sabia virus in Brazil Guanarito virus (Charrel and Lamballerie, 2003) Drowning isn't fun; neither is bleeding…. Hemorrhagic fevers find a way to mix the two: as the entire body oozes & bleeds, the lungs can bleed into themselves, causing victims to literally drown in their own blood.
  • 38. Some other doomed sequel of intrusions: • 1st Filo virus discovery not in Africa, but 4,000 miles away in Marburg, Germany, that received monkeys from Uganda (Martini, 1969) • Ebola virus was imported into the U.S in monkeys destined for research (Jahrling et al., 1990) • Holding different populations of captive primates during transport or while housed at or enroute to zoos or lab viral recombination (Chapman et al., 1995)
  • 39. CCHF: An overlooked slayer..??  CCHF : 1st diagnosed in 1944 in Ukraine & continue to cause diligent havoc regularly in different parts of the world • Endemic in Pakistan, first case detected in 1976 • In India 1st case reported in 2011 from Ahmadabad. (Patel et. al., 2011)
  • 40. J.E: ROUND-THE-CLOCK MENACE IN INDIA: Historical glimpse: • 1st reported in T.N in 1955- 65 (Chakravarty, 1975) • W.B (1973) – 325 deaths (Vaughn, 1975) • W.B(1976 –78) - 1500 cases, 700 died • U.P experienced its 1st epidemic in 1979 (Kabhilan, 2004) • A.P (1999) - 178 death (Rao, 2003) • Gorakhpur region (1988)- 875 cases Recent drone attacks YEAR J.E CASES DEATHS 2008 427 70 2009 653 103 2010 555 112 2011 1214 181 2012 745 140 2013 7 0 (NVBDCP, 2013) FACTS OR FARCE ??
  • 41. RECENT ASSAULT: H7N9 • H7 normally circulates amongst avian populations • Centre for Health Protection of Hong Kong received notification on March 31, 2013 concerning 3 confirmed human cases of influenza A (H7N9) • More than 20,000 birds have been killed in a live poultry-trading area in Shanghai • No human to human spread, till now condition under control “In a sense, the earth is mounting an immune response against the human species”-R. Preston
  • 42. GLOBAL REPORTING SYSTEMS:
  • 43. GLOBAL AGENCIES: INTERNATIONAL TASK FORCE FOR DISEASE ERADICATION
  • 44. Govt. efforts to tackle the battle: • National surveillance program for communicable diseases (1997) • National Rural Health Mission (NRHM) - 2005 – National Vector Borne Disease Control Programme – Universal Immunization Programme (UIP) - 1978 – Revised National Tuberculosis Control (RNTC) – 1997 • Integrated Disease Surveillance Project (2004) • Food safety and standard act, (2006) • Roadmap to Combat Zoonoses in India (RCZI) (2008) • Airport Health Organizations / Port Health Organizations What can’t be measured can’t be managed……………..
  • 45. Key tasks - carried out by whom? National Regional Global Synergy
  • 46. “Adopt the pace of nature: her secret is patience” - R. Emerson