Global warming ICAN


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Talk at ICAN 2012 (Cape Town) on Global warming and ID. Based on a Lancet ID publication 2009 and thus geared at Europe.

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Global warming ICAN

  1. 1. Climate  Change  and  ID   November  2012   by  far  the  most  terrible  talk   errifying  film   you  wwill  ver  hear   you   ill  e ever  see   Andreas  Voss   iPrevent   Al  Voss   A   Gore   UMCN  &  CWZ   Nijmegen,  The  Netherlands   ¤ AcceleraKng  economic  acKvity  and  fossil  fuel   ¤ Worldwide  mean  surface  temperature  has   combusKon  over  the  past  century  has   increased  by  0·∙74°C  (SD  0·∙18)  over  the  past  100   years   precipitated  an  environmental  impact  of   ¤ Worldwide  sea  level  has  risen  by  1·∙8  mm  per  year   unprecedented  proporKons:     since  1961  and  oceans  are  becoming  more  acidic   ² Ecosystem  decline   ¤ ArcKc  sea  ice  is  retreaKng  by  2.7%  (SD  0.6)  per   ² Loss  of  biodiversity   decade   ¤ Sea  surface  temperatures  are  warming   ² Stratospheric  ozone  depleKon   ¤ Mountain  glaciers  are  shrinking     ² Climate  change   ¤ Extreme  weather  events  are  increasing  in   frequency  and  intensity.     Hukme  et  al.  Clim  Res  17:  145–168,  2001    Andreas  Voss,  MD,  PhD   1  
  2. 2. Climate  Change  and  ID   November  2012   2020s                        2050s                2080s   Hukme  et  al.  Clim  Res  17:  145–168,  2001     ¤  Heat waves ¤ higher  proliferaKon  and  reproducKon  rates  at   ¤  Storms higher  temperatures   ¤  Floods ¤ extended  transmission  season   ¤  Fires ¤ changes  in  ecological  balances   ¤  Droughts ¤ climate-­‐related  migraKon  of  vectors,  reservoir   hosts,  or  human  populaKons   ¤  Infectious diseasesAndreas  Voss,  MD,  PhD   2  
  3. 3. Climate  Change  and  ID   November  2012   ¤  =  infecKons  transmiged  by  the  bite  of  infected  arthropod  species,          such  as  mosquitoes,  )cks,  sandflies,  and  blackflies.     ¤ Vector-­‐borne  diseases     ¤  Arthropod  vectors  are  cold-­‐blooded  and  thus  especially  sensiKve   ¤ Rodent-­‐borne  diseases   to  climaKc  factors.     ¤ Water-­‐borne  diseases   ¤  Weather  influences:     ¤ Air-­‐borne  diseases   -­‐  survival  and  reproducKon  rates   -­‐  habitat  suitability/distribuKon   ¤ Food-­‐borne  diseases   -­‐  intensity  and  temporal  pagern  of  vector  acKvity          (parKcularly  biKng  rates)  throughout  the  year   -­‐  rates  of  development,  survival  and  reproducKon  of        pathogens   -­‐  changes  in  human  behaviour   Culex  spp  mosquito   ¤  West  Nile  virus,  a  virus  of  the  family  Flaviviridae  that  is   part  of  the  Japanese  encephaliKs  anKgenic  group.     ¤  France  2000  -­‐  Aggressiveness  of  the  vector  (Culex   modestus)  was  posiKvely  correlated  with  temperature  and   ¤  West  Nile  fever  mainly  infects  birds  and  infrequently   humidity,  and  linked  to  rainfall  and  sunshine,  which  were   human  beings  through  the  bite  of  an  infected  Culex   parKcularly  high  during  the  epidemic  period   spp  mosquito.     ¤  Romenia  1996  and  Israel  2000  -­‐  associated  with  a  heat   ¤  In  numerous  European  countries  the  virus  has  been   wave  early  in  the  summer  with  high  minimum   isolated  in  mosquitoes,  wild  rodents,  migraKng  birds,   temperatures   hard  Kcks,  horses,  and  human  beings.     ¤  Clima)c  model  for  West-­‐Nile  virus  with  mild  winters,  dry   ¤  Roughly  80%  of  cases  are  asymptoma)c,  the  rate  of   springs  and  summers,  heat  waves  early  in  the  season,  and   West-­‐Nile  virus  infecKons  in  human  beings  remains   wet  autumns.   largely  unknown  Andreas  Voss,  MD,  PhD   3  
  4. 4. Climate  Change  and  ID   November  2012   ¤  Dengue  is  the  most  important  worldwide  arboviral  human   ¤ Italy:  reported  5  new  cases,  from  the  Veneteo   disease     region  (n=4)  and  Emilia  Romagna  (n=1).  Cases  are   age  62  tot  82,  admiged  to  the  hospital  with   ¤  Due  to  nearly  universal  use  of  piped  water,  the  disease  has   neurological  symptoms.   disappeared  from  Europe.   ¤ France:  reports  a  41-­‐year-­‐old  paKent  in  Var  (South-­‐ ¤  Dengue  is  frequently  introduced  into  Europe  by  travellers   France).  The  last  cases  of  WNF  in  France  was  in   returning  from  dengue-­‐endemic  countries,  but  no  local   2003  (same  region,  7  humans,  4  horses).     transmission  has  been  reported  since  it  would  also  depend  on   the  reintroduc)on  of  its  principal  vector,  the  mosquito  Aedes   ¤ Hungary:  2  paKents  from  central  Hungary.     aegyp*   ¤ All  three  countries  started  control  measures,  WNF-­‐ ¤  However,  over  the  past  15  years  another  competent  vector   surveillance,  public  informa)on  campaigns  and     Aedes  albopictus  (Asian  Kger  mosquito)  has  been  introduced   screening  of  blood  donors.   into  Europe  and  expanded  into  several  countries,  raising  the   possibility  of  dengue  transmission   Weekly  public  health  rapport,  1  October  2009     ¤  Temperature  is  a  factor  in  dengue  transmission  in  urban   areas!   ¤  Climate  change  projecKons  on  the  basis  of  humidity  for   2085  suggests  dengue  transmission  to  shiG  the   la)tudinal  and  al)tudinal  range.   ¤  Climate  change  could  further  increase  the  length  of  the   transmission  season  in  endemic  loca)ons   ¤  Increase  in  mean  temperature  could  result  in  seasonal   dengue  transmission  in  southern  Europe  if  principal   vector  A.  aegyp2  infected  with  the  virus  were  to  become   established.   ¤   IncubaKon  period  2-­‐3  (–7)  days   ¤   Symptoms   ²   fever  up  to  39°C   ²   spot  bleeding  and  rash  (arms  and  legs)   ²   painful  joints     ²   headache,  photophobia,  …   ¤   Mostly  self-­‐limiKng,  someKmes  chronic  joint      pain   Aedes  aegyp2-­‐  en  Aedes  albopictus  mosquito  Andreas  Voss,  MD,  PhD   4  
  5. 5. Climate  Change  and  ID   November  2012   ¤ Vector  surveillance  in  the  vicinity  of  the  cases   ¤   Three  genotypes:  West-­‐African,  Central-­‐East-­‐   idenKfied  large  numbers  of  Aedes  albopictus    African,  and  Asian   mosquitoes  in  traps     ¤   UnKl  2007  only  in  tropical  countries     ¤ IntroducKons  of  A  albopictus  and  Chikungunya   ¤   Sporadic,  mostly  travel-­‐related  cases  (Central-­‐   virus  into  Italy  were  accidental  events    East-­‐African  type)  in  Europe   ¤ SKll,  a  clima)c  model  predicts  establishment  of   ¤   Augustus  2007,  Ravenna  Italy:  first  epidemic  in     A.  albopictus  in  Europe  with  main  variables  such   as  mild  winters,  mean  annual  rainfall  exceeding    Europe   50  cm,  and  mean  summer  temperatures   ¤ In  2009  hundreds  of  cases  in  Italy  and  France   exceeding  20°C.   ¤  Caused  by  Plasmodium  spp  transmiged  by  female   Anopheles  spp  mosquitoes.     ¤  Historically  malaria  was  endemic  in  Europe,  including   Scandinavia,  but  it  was  eventually  eliminated  in  1975   through  a  number  of  factors  related  to  socio-­‐economic   development.   ¤  Any  role  that  climate  played  in  malaria  reduc)on  would   have  been  small.  Nevertheless,  the  potenKal  for  malaria   transmission  is  intricately  connected  to  meteorological   condiKons  such  as  temperature  and  precipitaKon.     ¤  Condi)ons  for  transmission  in  Europe  have  remained   favourable  as  documented  by  sporadic  autochthonous   transmission  of  a  tropical  malaria  strain  by  local  vectors  to   a  suscepKble  person.   ¤  The  potenKal  for  malaria  and  other  tropical  diseases  to   ¤ Thus,  while  climaKc  factors  may  favour   invade  southern  Europe  is  commonly  cited  as  an  example   autochthonous  transmission,  increased  vector   of  the  territorial  expansion  of  risk  due  to  climate  change       density,  and  accelerated  parasite   ¤  Portugal  projected  an  increase  in  the  number  of  days  per   development,  ...   year  suitable  for  malaria  transmission;  however,     transmission  would  depend  on  infected  vectors  being   present   ¤ ...  other  factors  (socio-­‐economic,  building  codes,   ¤  For  the  UK,  an  increase  in  risk  of  local  malaria   land  use,  treatment,  capacity  of  health-­‐care   transmission  based  on  changes  in  temperature  projected   system,  etc)  limit  the  likelyhood  of  climate-­‐ to  occur  by  2050  was  esKmated  to  be  8–14%,  but  malaria   related  re-­‐emergence  of  malaria  in  Europe   re-­‐establishment  is  highly  unlikely.  Andreas  Voss,  MD,  PhD   5  
  6. 6. Climate  Change  and  ID   November  2012   ¤ Protozoan  parasi)c  infecKon  caused  by  Leishmania   infantum  that  is  transmiged  to  human  beings   through  the  bite  of  an  infected  female  sandfly.     ¤ Temperature  influences  the  biKng  acKvity  rates  of   the  vector,  and  maturaKon  of  the  protozoan   parasite  in  the  vector.   ¤ Sandfly  distribuKon  in  Europe  is  south  of  la)tude   45°N  and  less  than  800  m  above  sea  level,  although   it  has  recently  shiGed  to  a  laKtude  of  49°N     45°   49°   ¤  Historically,  sandflies  are  from  the  Mediterranean,  but    more   recently,  have  been  reported  in  northern  Germany.   ¤  The  bi)ng  ac)vity  of  European  sandflies  is  strongly  seasonal,   and  in  most  areas  is  restricted  to  summer  months.     ¤  Once  condiKons  make  transmission  suitable  in  northern   la)tudes,  imported  cases  could  act  as  sources  of  infecKons,   permiong  new  endemic  foci.     ¤  Conversely,  if  climaKc  condiKons  become  too  hot  and  dry  for   vector  survival,  the  disease  may  disappear  in  the  South.  Andreas  Voss,  MD,  PhD   6  
  7. 7. Climate  Change  and  ID   November  2012   ¤ Arbovirus  infecKon,  transmiged  by  Kcks   (predominantly  Ixodes  ricinus)  that  act  both  as   vectors  and  as  reservoirs.   ¤ Temperature  accelerates  the  Kcks’  developmental   cycle,  egg  producKon,  populaKon  density,  and   distribuKon.     ¤ Climate  change  (increased  temperature)  already   led  to  changes  in  the  distribuKon  of  Ixodes  ricinus   populaKons  in  Europe,  expending  into  higher   Ixodes  ricinus   al)tudes  in  the  Czech  Republic  over  the  past  two   decades.   Endemic  in  27  European  countries     ¤ In  Sweden,  since  the  late  1950s  all  cases  of   encephaliKs  admiged  in  Stockholm  County  have   been  serologically  tested  for  TBE.     ¤ 1960–98  =  increase  in  TBE  incidence  since  the   mid-­‐1980s  related  to  milder  and  shorter  winters,   resulKng  in  longer  Kck-­‐acKvity  seasons.     ¤ The  distribuKon-­‐limit  shired  to  higher  laKtude;     ¤ DistribuKon  has  also  shired  in  Norway  and   Germany.   ¤ ClimaKc  changes  alone  are  unlikely  to  explain  the   surge  in  TBE  incidence  over  the  past  three   decades,  ...     ¤ Poten)al  causal  pathways  include:     ² changing  land-­‐use  pagerns   ² increased  density  of  large  hosts  for  Kcks  (eg.  deer)   ² habitat  expansion  of  rodent  hosts   ² alteraKons  in  recreaKonal  and  occupaKonal  human   acKvity  (habitat  encroachment)  Andreas  Voss,  MD,  PhD   7  
  8. 8. Climate  Change  and  ID   November  2012   ¤  InfecKon  with  the  bacterial  spirochete  Borrelia   burgdorferi,  which  is  transmiged  to  human  beings   ¤ A  shir  toward  milder  winter  temperatures  due  to   during  the  blood  feeding  of  hard  )cks  of  the  genus   climate  change  may  enable  expansion  of  Lyme   Ixodes.     borreliosis  into  higher  laKtudes  and  alKtudes,  but   ¤  In  Europe,  the  primary  vector  is  I.  ricinus,  also  known   only  if  all  of  the  vertebrate  host  species  required  by   as  the  deer  )ck,  and  Ixodes  persulcatus  from  Estonia   to  far  eastern  Russia.       Kck  vectors  are  equally  able  to  shiG  their  populaKon   ¤  Lyme  borreliosis  is  the  most  common  )ck-­‐borne   distribu)on.     disease  in  Europe  with  at  least  85  000  cases  yearly   ¤ In  contrast,  droughts  and  severe  floods  will   ¤  Increasing  incidence  in  several  European  countries   nega)vely  affect  the  distribuKon,  at  least   such  as  Finland,  Germany,  The  Netherlands,  Russia,   Scotland,  Slovenia,  Sweden  ….     temporarily.     ¤ Caused  by  an  RNA  virus  of  the  Bunyaviridae  family   and  transmiged  by  Hyalomma  spp  )cks  from   domesKc  and  wild  animals.     ¤ Most  widespread  Kck-­‐borne  arbovirus  and  is  found   in  the  eastern  Mediterranean  where  there  have   been  a  series  of  outbreaks  in  Bulgaria  in  2002  and   2003,  and  in  Albania  and  Kosovo  in  2001.   ¤ Milder  weather  condiKons,  favouring  Kck   reproducKon  may  influence  CCHF  distribuKon:   ² outbreak  in  Turkey  was  linked  to  a  milder  spring  season  Andreas  Voss,  MD,  PhD   8  
  9. 9. Climate  Change  and  ID   November  2012   ¤  Rodents  can  act  as  both  intermediate  infected  hosts   and  as  hosts  for  arthropod  vectors  such  as  fleas  and   Kcks.     ¤  Rodent  populaKons  are  affected  by  weather  condiKons.   In  parKcular,  warm,  wet  winters  and  springs  increase   rodent  popula)ons.   ¤  Under  climate  change  scenarios,  rodent  populaKons   could  be  anKcipated  to  increase  in  temperate  zones,   resulKng  in  greater  interacKon  between  human  beings   and  rodents  and  a  higher  risk  of  disease  transmission,   especially  in  urban  areas.   ¤  In  some  European  countries  breakdown  in  sanita)on   and  inadequate  hygiene  are  contribuKng  to  serious  rat   infestaKons.   ¤  Plague  is  a  zoonosis  caused  by  the  bacterium  Yersinia  pes*s   that  is  spread  by  fleas  feeding  on  black  rats  (Ragus  ragus).     ¤  Since  the  last  major  plague  outbreak  in  1720,  plague  is  no   longer  circulaKng  in  Europe—neither  in  human  beings  nor  in   rodent  populaKons.   ¤  Milder  weather  condiKons  are  favourable  to  rodent   popula)ons,  while  harsh  weather  condiKons  such  as  heat   waves  might  drive  rodents  indoors  in  search  of  water  and  thus   increase  contact  with  human  beings.   ¤  Central  Asia:  a  1°C  increase  in  spring  temperatures  could   result  in  a  50%  increase  in  Y.  pes*s  prevalence  in  its  reservoir   host.   Belgium     –  tree  seeds   ¤ Hantaviruses  are  rodent-­‐borne  viruses  with  four   genotypes  circulaKng  in  Europe,  of  which  at  least   Puumala,  Dobrava,  and  Saaremaa  viruses  are   human  pathogens.   ¤ Human  beings  are  at  risk  of  exposure  through  the   inhala)on  of  virus  aerosols  from  the  excreta  of   infected  rodents.    Andreas  Voss,  MD,  PhD   9  
  10. 10. Climate  Change  and  ID   November  2012   ¤  Excess  prolifera)on  of  rodent  popula)ons  related  to   climaKc  changes  is  of  considerable  internaKonal  public   health  concern.   ¤  Hantavirus  infecKon  is  sensiKve  to  clima)c  condi)ons;   rat  populaKons  in  Belgium  are  linked  to  tree-­‐seed   producKon  that  in  turn  has  been  linked  to  high   summer  and  autumn  temperatures.   ¤  It  is  anKcipated  that  general  warming  of  the  European   climate  will  increase  the  risk  of  infecKon.   ¤ Increased  mean  temperature  of  water  bodies,   ¤ altering  mean  meteorological  measures  but   also  by  increasing  the  frequency  of  extreme   which  can  be  favourable  for  micro-­‐organism   events  such  as  excessive  precipitaKon,  storm   reproducKon  cycles  and  algal  blooms.     surges,  floods,  and  droughts   ¤ For  example,  Vibrio  spp  bacteria  indigenous  to   ¤ two  major  exposure  pathways:  drinking  water   the  Bal)c  and  the  North  Sea,  have  displayed   and  recrea)onal  water  use.   increased  growth  rates  during  unusually  hot   summers  (eg,  2006)  and  infected  open  wounds   that  can  necroKse  and  cause  severe  sepsis.   ¤  Water-­‐borne  outbreaks  have  the  potenKal  to  be  rather   large  and  of  mixed  aeKology,  but  the  actual  disease   ¤  Extreme  precipitaKon  events  can  overwhelm  water   burden  in  Europe  is  difficult  to  approximate  and  most   treatment  plants  and  lead  to  cryptosporidium   likely  underesKmated.   outbreaks  due  to  oocysts  infiltraKng  drinking-­‐water   reservoirs  from  springs  and  lakes     ¤  In  2006,  only  17  water-­‐borne  outbreaks  were  reported   by  five  countries.     ¤  A  study  from  England  and  Wales  found  that  20%  of   ¤  These  outbreaks  involved  3952  pa)ents,  of  whom  181   water-­‐borne  outbreaks  in  the  past  century  were   were  hospitalised,  afflicted  by  a  number  of  causaKve   associated  with  a  sustained  period  of  low  rainfall,   agents  including  campylobacter,  calicivirus,  giardia,   compared  with  10%  associated  with  heavy  rainfall.   and  cryptosporidium    Andreas  Voss,  MD,  PhD   10  
  11. 11. Climate  Change  and  ID   November  2012   ¤   storms  and  floods  can  cause  a  lot  of  other   trouble  resulKng  in  …   Displacement  of  rodents  !   Displacement  of  paKents  à  overcrowded  waiKng  room  at  “open”  hospitals   ¤ The  epidemic  acKvity  of  RSV  infecKon  is  related  to   meteorological  condiKons  and  thus  to  laKtude:   persistently  high  temperature  and  humidity   results  in  epidemic  peaks  in  summer  and  early   autumn,  while  in  temperate  climates  RSV  infec)on   peaks  in  the  winter.   ¤ ClimaKc  factors  such  as  absolute  humidity   have  been  associated  with  the  risk  of  lower   ¤ A  causal  link  with  temperature  seems  inconsistent   respiratory  tract  infecKons.   based  on  these  climaKc  data,  but  the  RSV  infecKon   season  in  England  and  Wales  has  ended  earlier  and   its  dura)on  has  shortened  as  the  climate  has   become  warmer.   ¤ Increased  use  of  cooling  towers  during  heat   waves  might  increase  the  risk  for  exposure  to   Legionella  spp   ¤   Increased  use  of  whirlpools  in  The      Netherlands  ...  Andreas  Voss,  MD,  PhD   11  
  12. 12. Climate  Change  and  ID   November  2012   ¤ ...  most  commonly  reported  GI  bacterial  disease,   ¤ Higher  ambient  temperatures  increase   and  is  caused  by  thermophilic  Campylobacter  spp   bacteria.     replicaKon  cycles  of  food-­‐borne  pathogens,   and  prolonged  seasons  may  augment  the   ¤ In  2007,  the  European  Union  incidence  was  45·∙2   cases  per  100  000  people  (200507  confirmed  cases)   opportunity  for  food  handling  mistakes   and  broiler  meat  and  fresh  poultry  meat  were  the   biggest  idenKfied  sources  of  infecKons.   ¤ In  32%  of  invesKgated  food-­‐borne  outbreaks   ¤ Colonisa)on  of  broiler-­‐chicken  flocks  with   in  Europe  “temperature  misuse”  is  considered   Campylobacter  increases  rapidly  with  rising   a  contribuKng  factor.   temperatures.  The  risk  of  campylobacteriosis  is   posi)vely  associated  with  mean  weekly   temperatures.   ¤ The  second  largest  number  of  human  food-­‐ ¤ Higher  ambient  temperatures  have  been  associated   borne  diseases  is  caused  by  Salmonella  spp.     with  5–10%  higher  salmonellosis  noKficaKons  for   each  degree  increase  in  weekly  temperature,  for   ¤ In  2007,  the  European  Union  incidence  was   ambient  temperatures  above  5°C.   31·∙1  cases  per  100  000  populaKon  (151995   confirmed  cases)  with  eggs  being  the  biggest   ¤ Roughly  one-­‐third  of  the  transmission  of   contributors  to  these  outbreaks  followed  by   salmonellosis  (populaKon  agributable  fracKon)  in   fresh  poultry  and  pig  meat.   England  and  Wales,  Poland,  the  Netherlands,  the   Czech  Republic,  Switzerland,  and  Spain  can  be   agributed  to  temperature  influences.     E³ ¤ Despite  a  considerable  body  of  research  on   ECDC has recognised the need to develop an infrastructure coined the European the  relaKon  between  climate  and  infecKous   Environment Epidemiology (E³) Network diseases,  substan)al  informa)on  gaps   remain,  such  as  the  impact  of  climate  change   on  the  geographical  distribuKon  of  vectors,   vector–host  relaKonships,  new  or  re-­‐emerging   pathogens,  transmission  of  food-­‐borne   pathogens,  or  the  vulnerability  of  drinking   water  supplies.    Andreas  Voss,  MD,  PhD   12  
  13. 13. Climate  Change  and  ID   November  2012   Dutch  North-­‐Sea  coast  2050?   Global  warming:  mistake  of  the  Royal  Dutch   June  25-­‐28,  2013   Meteorological  Ins)tute   Geneva  Switzerland  Andreas  Voss,  MD,  PhD   13  
  14. 14. Climate  Change  and  ID   November  2012   “We  appreciate  you   reading  &  ciKng   ARIC  and  welcome   your  manuscripts”  Andreas  Voss,  MD,  PhD   14