eHealth Resources for Controling AIDS in Brazil
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eHealth Resources for Controling AIDS in Brazil. Bastos F. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

eHealth Resources for Controling AIDS in Brazil. Bastos F. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

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eHealth Resources for Controling AIDS in Brazil Presentation Transcript

  • 1. E-Health and the Surveillance and Management of Infectious Diseases By: Francisco I. Bastos. Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil, at francisco.inacio.bastos@hotmail.com
  • 2. The inter-relationships between e-health and infectious diseases are multifarious and far from linear or unidirectional. 1. Virtual models as tools for better understanding the dynamic of infectious diseases
  • 3. The very understanding of the dynamic of infectious diseases has evolved in recent years from the so-called “vat model” (apud Duncan Watts[1]), according which susceptibles and infected individuals interact in the same haphazard way molecules (for instance, of a gaseous substance) do (i.e. depending on their respective orders of magnitude, but without any underlying structure). [1] Watts D. “Six Degrees: The Science of a Connected Age”
  • 4. Vat model
  • 5. New, interactive, agent-based models assess such interactions taking in account their underlying structure. i.e. the geographic, social and cultural characteristics that shape their networks. In this sense, virtual worlds that emulate the characteristics and dynamics of real world situations became a fundamental tool of such renewed modeling strategies.
  • 6. The now famous plague affecting the game “World of Warcraft”, as described by Ran Balicer (Epidemiology 2007;18:260-261) showed that: “(…) agent-based modeling and similar simulations are limited in their potential to account for changes in human behaviors during epidemics. This has led to searches for novel methods to simulate human daily interactions. One possibility lies in existing Internet role-playing games.” “A serious epidemic of an infectious disease recently erupted among the virtual characters in „World of Warcraft‟”
  • 7. World of Warcraft
  • 8. “The outbreak began on September 2005 when the “World of Warcraft” game administrators introduced a new virtual creature that had the ability to cast a disease (“corrupted blood”) on its opponents.” “In addition to inflicting severe damage on the target character, the disease “infected” close contacts who could spread the disease to others in close proximity. Game administrators presumably believed that the short period of infectivity (several seconds), as well as its highly lethal effect, would render the disease self- limiting. This proved not to be the case.” “Unlike previous “virtual plagues” that had been officially planned, this was a local effect that went out of control - a naturally occurring virtual outbreak.”
  • 9. “(…) the plague ravaged the population. Game administrators were baffled. As they scrambled to quarantine areas of the game world, the disease quickly spread beyond their control. Partially to blame was the game‟s feature that allows players to teleport from one area to another, and which made it possible for the plague to rapidly reach the most distant regions of the map.” … any similarity between teleport properties and Francisco Bastos itinerary to deliver this lecture today?
  • 10. BASTOS/FRANCISCO INACIO -------------- ------------------- --------------------- -------- ------- IBERIA - IB 6024 SAB 13MAR RIO DE JANEIRO RJ BARCELONA ES 2000 1255 INTL AIRPORT 14MAR 1 PARADA TERMINAL 1 TERMINAL 1 DURACION 12:55 INFORMACION A BORDO: DESAYUNO/ALMUERZO RIO DE JANEIRO RJ - MADRID AVION: AIRBUS INDUSTRIE A340-200 IB 6764 MADRID - BARCELONA OPERADO POR IB IBERIA CAMBIO DE AVION : AIRBUS INDUSTRIE A321 IBERIA - IB 6025 MIE 17MAR BARCELONA ES RIO DE JANEIRO RJ 0910 1840 AIRPORT INTL 1 PARADA TERMINAL 1 TERMINAL 1 DURACION 13:30 RESERVA CONFIRMADA- I BUSINESS PARA A BORDO: DESAYUNO INFORMACION IB 6755 BARCELONA - MADRID OPERADO POR IB IBERIA AVION: AIRBUS INDUSTRIE A320-100/200 MADRID - RIO DE JANEIRO RJ CAMBIO DE AVION: AIRBUS INDUSTRIE A340-200
  • 11. “ (…) several epidemiologic attributes enabled this uncontrolled dissemination of the disease. One was the lack of residual immunity following convalescence. This enabled characters to be reinfected and re-enter the transmission cycle.” “The second characteristic was its infectivity to the virtual animals (“pets”). While pets were relatively resistant to the lethal effects of the disease, they were infective to other pets and humans, thus serving as a disease reservoir.”
  • 12. What about our own pets as reservoirs of different zoonosis? “An increasing number of people suffer from immunodeficiencies. Environmental- and climatic conditions cause a change in distribution of vectors in need of special climatic conditions to establish. Exotic species are also to an increasing extent introduced as family pets, which may contribute to a wider panorama of infections.” “However, the traditional zoonotic diseases are still the most important. Vaccination, proper hygiene measurements and knowledge of preventive measures restrict the risk of transmittance of infections from companion animals. The most significant risk of companion animals in Norway are mostly related to dog and cat bites or other physical injuries.”
  • 13. So… why do we have pets? “In total the benefit and pleasure of this type of animal husbandry is more important than the fear of zoonotic diseases.” (J. Grøndalen, B. Sævik, H. Sørum, first published in the Norwegian Veterinary Journal 11/2004).
  • 14. Avalon Bastos
  • 15. “once the plague reached the cities, it did not just infect other players but also the nonplayer characters of the city, providing a large “bystander” population that also spread the disease.” What about our cities?
  • 16. Rio
  • 17. Rio
  • 18. Unger A, Riley LW, 2007 Slum Health: From Understanding to Action. PLoS Med 4(10): e295. “In 2002, the UN operationally defined slums as those communities characterized by: insecure residential status, poor structural quality of housing, overcrowding, and inadequate access to safe water, sanitation, and other infrastructure” “Slum locations may be unused or undesirable because of their hazardous geography, such as landslide- or flood-prone areas, or unsafe or polluted environments. Moreover, their residential status limits their ability to fight for the right to a safe environment.”
  • 19. “Slum housing is densely packed and poorly built with substandard or even flammable materials. Houses built against hillsides are subject to landslides during heavy rain, and inferior building standards cause many thousands of deaths from earthquakes, especially where urbanization and poverty collide” “Slum dwellings have high occupancy rates in all-purpose rooms. Cooking, sleeping, and living with 13.4 people per 45 m2 room (…) places residents at risk of respiratory infections, meningitis, and asthma.” “(…) children living in squatter settlements are nine times more likely than other children to have tuberculosis (TB). Epidemic-prone infections like pertussis cluster in areas of urban poverty, and overcrowding may even fuel potentially emerging epidemic diseases like SARS or influenza.”
  • 20. “Poor water quality is a leading cause of morbidity and mortality worldwide and a defining danger of living in slums. Many life- threatening infectious diseases are associated with contaminated water in slums, such as cholera and hepatitis.” “Lack of access to water also restricts water intake, sources for infant formula or cooking, bathing and personal hygiene. Infrequent bathing is associated with scabies and bacterial skin infections, a subset of which (i.e., group A streptococcus) can lead to acute glomerulonephritis” “The lack of infrastructure affects all aspects of life, including waste collection and sewers, public transportation, policing, education, and electricity supply.”
  • 21. 2. Back to Games: World of Warcraft as a research tool…. “The mixing patterns and behavior observed in the game can be precisely measured and accounted for (without the usual epidemiologic problems of incomplete ascertainment or loss to follow-up). Furthermore, the rules and environment could potentially be adjusted to allow better modeling of specific real-life scenarios.” “The game‟s administrators eventually cured the plague with a “spell” that was distributed rapidly to players en masse. If only real life were that simple.” What kind of spell could we disseminate?
  • 22. 3. The spell is to profit from the connectivity of risk networks as prevention networks, actually the very same networks, just disseminating prevention by the word-of-mouth about prevention, instead of micro-organisms… Such spell helped to curb HIV dissemination in San Francisco: “With no cure and no vaccine for AIDS currently available, the only way we can stop HIV is to prevent its spread. Every community has its own unique prevention needs - in San Francisco we work with populations at greatest risk for infection by focusing on individuals' overall life and health.” “The San Francisco AIDS Foundation operates four programs for gay and bisexual men and also runs one of the nation's largest needle exchange programs” (San Francisco AIDS Foundation)
  • 23. San Francisco AIDS Foundation
  • 24. The big challenge ahead refers to Sub-Saharan Africa: “The Grassroots Alliance for Community Education works with communities in sub- Saharan Africa to mitigate the effects of HIV/AIDS. G.R.A.C.E. helps networks of African community-based organizations (CBOs), people living with AIDs (PLWAs), and youth deliver household-focused prevention and care, early childhood development, nutritional, agricultural, and economic improvements for sustainable communities.”
  • 25. Grassroots Alliance for Community Education
  • 26. Another major challenge: microbial resistance “The Alliance for the Prudent Use of Antibiotics (APUA) was founded as a non-profit global organization in 1981 to contain antibiotic resistance and improve antibiotic effectiveness. APUA‟s mission is to strengthen society‟s defenses against infectious disease by promoting appropriate antimicrobial access and use and controlling antimicrobial resistance on a worldwide basis.” “With affiliated chapters in over 60 countries, many in the developing world, APUA stands as the world‟s leading organization conducting antimicrobial resistance research, education, capacity building and advocacy at the global and grassroots levels.”
  • 27. APUA
  • 28. “Antimicrobials are uniquely societal drugs because each individual patient use can propagate resistant organisms affecting entire health facilities, the environment and the community. Wide-scale antimicrobial misuse and related drug resistance is challenging infectious disease treatment and healthcare budgets worldwide.” 4. E-health tools as key resources in the management of resistance
  • 29. Sites targeting both the general and specialized audience http://www.thepigsite.com/swinenews/22512/co mmission-to-tackle-antimicrobial-resistance http://www.who.int/csr/en/
  • 30. Pig news
  • 31. Information can be disseminated through the use of text messages to mobile phones, wherever access to the internet is rare or non- existent. As of February 2009, Brazil topped over 152 million mobile phones, corresponding to 0.8 phone per inhabitant. Brasil tem mais de 152 milhões de celulares em fevereiro de 2009 Por Redação do IDG Now! Publicada em 20 de março de 2009 às 13h03 Atualizada em 20 de março de 2009 às 13h53 Destaque fica por conta da teledensidade, que cresceu 22,82% em 12 meses. Com isso, Brasil tem quase 0,8 celular por habitante.
  • 32. The bad side of the internet: • Misinformation • Dissemination of racism, prejudice, spam, viruses etc. • Networks and/or communities of pedophiles, warmongers, hooligans etc.
  • 33. The good side of the internet The whole presentation delivered today was composed by material of high quality obtained at no cost from the internet. Including a wonderful rooster by Miró and a mispronounced word in Catalan with the help of an on-line translator!
  • 34. Thank you! Muchas gracias! Grácies! Miró