From SARS to the novel
coronavirus: the rise of
new infectious diseases
Thomas Abraham
Today’s class
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The rise of emerging infectious diseasesfrom SARS to H5N1 to the novel coronavirus
Why are new diseases emerging?
Reporting a new disease: the example of the
novel coronavirus
13 June 2012. Dr Soliman Fakeeh Hospital, Jeddah Saudi Arabia
A 60 year old Saudi man was
admitted to the hospital
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Seven day history of fever, cough, shortness of
breath
X rays showed his lungs were cloudy, and
showing signs of an infection
http://www.nejm.org/doi/full/10.1056/NEJMoa
1211721#t=article
Lungs worsened, and next day transferred to
ICU and intubated
Died on day 11 after admission of respiratory and
renal failure
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Sputum and blood samples were tested by Dr Ali
Zaki at the hospital in Jeddah;
Negative for common viruses, but tested positive
for coronavirus
Sent specimens to the Erasmus Centre in
Netherlands, which published the sequence of
the genome (genetic sequence): a new
coronavirus
From the same large coronavirus family to which
SARS virus belongs, but no direct link
In September- patient no. 2
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49-year old Qatari man who had travelled to
Saudi Arabia is admitted to hospital in Doha
with respiratory illness
Transferred by air ambulance to London
Samples show he is infected with the same
new virus
Since then: 13 cases, including seven deaths;
cases in Saudi Arabia, Jordan and the UK
Virus related to coronavirus in bats
The emergence of new
diseases
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At least 20 new infectious diseases have
emerged since the 1970s including
HIV/AIDS, SARS, Ebola, Nipah, Marburg
All of them caused by viruses which passed
from animals to humans
Re-emergence of infectious
diseases
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Penicillin and other antibiotics proved miraculously
effective against a range of common infections and
diseases -scarlet fever, diphtheria, meningitis,
tuberculosis
Development of anti-viral drugs
In the 1950s and 1960’s, plans made to eradicate
malaria, polio, tuberculosis and smallpox globally
US Surgeon General in 1969 “ We can now close the
book on infectious diseases.”
Old diseases persist
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Malaria kills one child every 30 seconds, and
one million people a year
One third of the world’s population is
infected with TB
Polio has not yet been eradicated
Smallpox the only successful eradication
programme
The microbes fight back
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Drug resistant forms of disease causing
agents developed
Increasingly TB does not respond to the
earlier, cheaper antibiotic: MDR and XDR TB
The case of malaria- both parasite and vector
became resistant to control methods
A few newly emerged diseases
Malaysian flying fox- Pteropus vampyrus
Copyright Adam Fink
1998 Malaysia
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An unusual disease breaks out among people
working in pig farms
High fever, muscle pain, convulsions and
possible death
Pigs were first affected, and transmitted the
disease to humans
265 human cases, 105 deaths
Eventually traced to a previously unknown
virus: Nipah
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Malaysian flying foxes had been noticed
eating fruit from trees near the farm
Their droppings and saliva could have
contained the virus which could have infected
the pigs
Ebola Reston in the
Philippines,2008/09
Photo credit: R. Dolan
Rift Valley Fever, East Africa
HIV
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Nearly 30 years ago, HIV/AIDS was first
identified and has since spread across the
world
HIV= Human immunodeficiency virus
AIDS= Acquired Immune Deficiency
Syndrome ( the advanced stages of HIV
infection)
Adults and children estimated to be living with HIV,
2008
Western & Eastern Europe
Central Europe & Central Asia
850 000
North America
1.4 million
[1.2 – 1.6 million]
Caribbean
240 000
[710 000 – 970 000]
1.5 million
[1.4 – 1.7 million] East Asia
Middle East & North
Africa
[220 000 – 260 000]
310 000
[250 000 – 380 000]
Sub-Saharan Africa
Latin America
2.0 million
[1.8 – 2.2 million]
22.4 million
[20.8 – 24.1 million]
850 000
[700 000 – 1.0 million]
South & South-East
Asia
3.8 million
[3.4Oceania
– 4.3 million]
59 000
[51 000 – 68 000]
Total: 33.4 million (31.1 – 35.8 million)
December
2009
Estimated number of adults and children
newly infected with HIV, 2008
Western & Eastern Europe
Central Europe & Central Asia
30 000
North America
55 000
[36 000 – 61 000]
Caribbean
20 000
[23 000 – 35 000]
110 000
[100 000 – 130 000] East Asia
Middle East & North
Africa
[16 000 – 24 000]
35 000
[24 000 – 46 000]
Sub-Saharan Africa
Latin America
170 000
[150 000 – 200 000]
1.9 million
[1.6 – 2.2 million]
75 000
[58 000 – 88 000]
South & South-East
Asia
280 000
[240 000
– 320 000]
Oceania
3900
[2900 – 5100]
Total: 2.7 million (2.4 – 3.0 million)
December
2009
Global estimates for adults and children, 2008
• People living with HIV
33.4 million [31.1 – 35.8
million]
• New HIV infections in 2008
2.7 million [ 2.4 – 3.0
million]
• Deaths due to AIDS in 2008
million]
December
2009
2.0 million [1.7 – 2.4
Estimated adult and child deaths due to AIDS, 2008
Western & Eastern Europe
Central Europe & Central Asia
13 000
North America
25 000
[20 000 – 31 000]
Caribbean
12 000
[10 000 – 15 000]
87 000
[72 000 – 110 000] East Asia
Middle East & North
Africa
[9300 – 14 000]
20 000
[15 000 – 25 000]
Sub-Saharan Africa
Latin America
77 000
[66 000 – 89 000]
1.4 million
[1.1 – 1.7 million]
59 000
[46 000 – 71 000]
South & South-East
Asia
270 000
[220 000
– 310 000]
Oceania
2000
[1100 – 3100]
Total: 2.0 million (1.7 – 2.4 million)
December
2009
Estimated number of children (<15 years)
newly infected with HIV, 2008
Western & Eastern Europe
Central Europe & Central Asia
<100
North America
<100
[<100 – <200]
Caribbean
2300
[<100 – <200]
3700
[1700 – 6000]
Middle East & North
Africa
[1400 – 3400]
4600
[2300 – 7500]
Sub-Saharan Africa
Latin America
6900
[4200 – 9700]
390 000
[210 000 – 570 000]
East Asia
3200
[2100 – 4500]
South & South-East
Asia
18 000
[11Oceania
000 – 25 000]
<500
[<500 – <1000]
Total: 430 000 (240 000 – 610 000)
December
2009
Estimated deaths of children (<15 years) due to AIDS,
2008
Western & Eastern Europe
Central Europe & Central Asia
<100
North America
<100
[<100 – <200]
Caribbean
1300
[<100 – <200]
1400
[<500 – 2700]
Middle East & North
Africa
[<1000 – 2100]
3300
[1600 – 5300]
Sub-Saharan Africa
Latin America
3900
[2100 – 5700]
230 000
[120 000 – 350 000]
East Asia
1500
[<1000 – 2300]
South & South-East
Asia
11 000
[4900
– 17 000]
Oceania
<100
[<100 – <500]
Total: 280 000 (150 000 – 410 000)
December
2009
Over 7400 new HIV infections a day in 2008
•
More than 97% are in low- and middle-income
countries
•
About 1200 are in children under 15 years of age
•
About 6200 are in adults aged 15 years and older,
of whom:
— almost 48% are among women
— about 40% are among young people (15–24)
December
2009
2008 global HIV and AIDS estimates
Children (<15 years)
• Children living with HIV
2.1 million [1.2 – 2.9
million]
• New HIV infections in 2008
430 000 [240 000 – 610
000]
• Deaths due to AIDS in 2008
000]
December
2009
280 000 [150 000 – 410
How did this all happen?
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HIV virus related to a group of viruses simian
immunodeficiency viruses (SIV)
Closest relative an SIV virus found among
chimpanzees in Gabon and Zaire
Could have been present in humans as early
as the 1930s
Had probably begun to spread outside Africa
in isolated cases by the 1960s
Social and cultural conditions
required for an epidemic
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HIV infection spread through bodily fluids:
blood and sexual fluids primarily
Changes in social and sexual practices
Great increase in numbers of injection drug
users
Professional donors donating blood to blood
banks
Spread in Africa
In Africa:
 Armed conflicts in the 1970s and 80s
disrupted societies
 Movement of soldiers and combatants
 Men going to work in urban areas away from
their families
 Women looking for ways to support their
families become commercial sex workers
 Mother to child transmission
Issues in HIV/AIDS
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Meeting the challenge of HIV/AIDs has two
aspects: Prevention, and Treatment
Prevention
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An average of over 7,000 new people get
infected every day
New infections are outpacing people getting
treatment by a 5:2 ratio; the AIDS pandemic
cannot be stopped without effective
prevention
More than 80% of transmission is sexual
Behavioral changes in sexual
behaviour
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Empowering women
Decriminalising homosexuality and
encouraging access to treatment and
prevention services
Encouraging drug users to use needle
exchanges etc
Encouraging condom use/Male circumcision
HIV/AIDS as a human rights issue
Prevention through medical
interventions
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Research on vaccines showing some promise
Microbicides to use after exposure
Treatment
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Getting people access to anti-retroviral
therapy
33 million people living with HIV/AIDS. Only
14.6 million have access to treatment
Funding: costs US$ 143/person/year
Ensuring the treatment is adhered to
More infor: UNAIDS
(http://www.unaids.org)
Environmental change and
disease
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How did the Nipah get to Malaysia
In 1997, giant forest fires broke out in
Kalimantan and Borneo in Indonesia
1997 forest fires in Kalimantan and
Borneo
Haze reaches Malaysia, Singapore
and Thailand
Globalisation and disease: The
speed at which disease travelled
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In 1827, a cholera outbreak in north India
1830, carried by traders to Moscow
1831, reaches other European cities
1832 reaches North America
The speed at which it travels
now
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The SARS outbreak showed us, that a disease
that is in Hong Kong today, can be in South
east Asia in 3-4 hours, Europe in 12 hours,
and North America in 18 hours
Summing up
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Population growth has led humans to expand
to new environments and come in contact
with new pathogens
Social and cultural factors have contributed
to the spread of new diseases
Reporting the novel
coronavirus
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Dr Ali Zaki posts his findings on pro-med mail:
http://www.promedmail.org/direct.php?id=201
20920.1302733
Saudi press release:
http://www.bna.bh/portal/en/news/525747
A few days later, a case in the UK. WHO reports
http://www.who.int/csr/don/2012_09_23/en/i
ndex.html
UK HPA news release:
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NEJM article:
http://www.nejm.org/doi/pdf/10.1056/NEJ
Moa1211721
Questions to ask
http://www.reuters.com/article/2013/02/27/u
s-coronavirus-idUSBRE91Q0MD20130227