Strengthen the prevention and outbreak control strategy


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GRF 2nd One Health Summit 2013: Presentation by Eric Bertherat, Pandemic and Epidemic Diseases WHO Geneva

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  • Strengthen the prevention and outbreak control strategy

    1. 1. Global Leptospirosis Environmental Action Network Strengthen the prevention and outbreak control strategy Eric Bertherat, MD, MPH, MSc Pandemic and Epidemic Diseases WHO Geneva Health and Climate Foundation
    2. 2. Leptospirosis: a multifaceted disease Zoonosis + Environmental disease + Occupational disease • • • Complex natural history Complex pathogen agent Non specific clinical presentation + severe forms • • Worldwide distribution. Endemic + seasonal variations / epidemic Ko A, Goarant C, Picardeau M. Nature Reviews Microbiology, 2009, 7: 736-747 1,000,000 cases / 60,000 deaths annually in some areas as high as 975 cases per 100 000
    3. 3. Leptospirosis Outbreaks 1970-2008 (n=239) Outbreak size: mean=465; median=51; range=2-14285. Source: C. Munoz Zanzi
    4. 4. Philippines, 2009 680 cases of leptospirosis /yr with seasonal peak during the rainy season Typhoon Pepeng: 3 October Typhoon Ondoy: 26 September Thousands of people displaced and housed in emergency evacuation centers In the 2 following weeks, 505 suspect ! cases and 15 deaths in Manila alone
    5. 5. Looking for a clear and coherent strategy Detection and confirmation – – – What is a leptospirosis case ? What is an outbreak ? How to confirm the cases ? Control – Case management: • • • – A role for human immunization ? • • • – Vaccine serovar specific. Limited availability. Does not prevent carriage and release Mass chemoprophylaxis ? • • • – – Early diagnosis and treatment. Severe cases Logistic issues Efficacy, Logistic issues High risk groups ? Up to 6 months of flood waters Decontamination of the environment ? Rodent control ? !Better prediction and preparedness are essential but many key questions still pending
    6. 6. The Global Leptospirosis Environmental Action Network (GLEAN) A One Health Approach To reduce the impact that leptospirosis outbreaks have on communities through providing cost-effective, implementable and sustainable solutions Reducing the impact of leptospirosis outbreaks through cost-effective, implementable and sustainable solutions Early warning systems and Improved prevention and control strategies Increasing the knowledge of the relationship between environmental, biological, ecological, economic, demographic factors GLEAN: An international Community of Practice Medical Clinicians, Public health specialists, Veterinarians, Climatologists, Statisticians, Rodent specialists, Biologists, Anthropologists, Ecologists, Water and Sanitation Specialists, Economists...
    7. 7. How to reduce the impact of the outbreaks ?  Retrospective analysis of leptospirosis outbreaks Predict  Determine baseline disease incidence  What are the main drivers? What are their predictive potential ? What type of prediction to inform public health decisions ?  Develop tool / validate on site Prevent Detect Relative importance of potential preventive measures ? Improve lab confirmation (protocols, bank of reference sera, evaluation of rapid tests, reference lab network, training..)  Role of animals /human vaccination? Develop outbreak detection algorithms (case definition, epidemic threshold ?) Intervene  Guidance for outbreak control and investigation  Outbreak preparedness and capacity building
    8. 8. Thank you 3rd GLEAN annual meeting, Brasilia, March 2013