1
A Time Line of Emerging Zoonoses
and Epidemics of the 21st Century
A Global Perspective on the Epidemics of Foot-and-Mouth Disease, BSE,
West Nile Encephalitis, SARS, Monkey Pox, and Avian Influenza.
FMD
Avian Influenza
West Nile Virus Infections
Human cases
2003… 9862
(~44% encephalitis)
Human deaths
2003… 264
Human cases
2004… 2535
Human deaths
2004… 98
Equine deaths 1999-2004 15,000
Monkeypox
2
Bursting Bubbles
of the 21st
Century Clash of
Civilizations
Y2K Computer
Crisis
Right of Pre-emptive
Action and War in Iraq
Florida
Hurricanes
With acknowledgement for the idea to
Thomas Friedman
New York Times April 24 2003
Bioterrorism
Naturally Occurring Emerging Diseases
and Epidemics
3
What are the Driving Forces of Epidemics?
• Accelerated global trading
patterns of the late 20th Century
(brought about in part by
democracy and major trading
blocks)
• Technical sophistication in food
processing masking true origins
• Exposure to new pathogens
through ecosystem disruption
(human population pressures)
Major trading Blocks
NAFTA
Andean Pact
Mecosur
Caricom
EFTA
EU
Europe's Associates
ASEAN
4
Driving Forces of Epidemics contd.
• Evolutionary pressures through
overpopulation and change in
tropism
• Speed of transportation
• Unique combination of factors
that we truly do not understand
(i.e. akin to the Hurricanes in
Florida in 2004)
We need to shift our focus from
economy to ecology!
5
6
5
300
(
Days to Circumnavigate (
the Globe
350
)
400
4
250
200
3
150
2
100
50
1
0
0
1850
1900
Year
1950
2000
“No city on the earth is now more than 24 hours away from any other”.
Economist 2003
“Annually, the world's airlines carry a staggering total approaching some two billion passengers.
At any one moment, about half a million people world-wide are flying in commercial aircraft “
Select Committee on Science and Technology Fifth Report UK Parliament 2000
World Population in billions
)
Speed of Global Travel in Relation to
World Population Growth
6
A Time Line for Zoonoses & Epidemics of
the 21st Century
Year Event
Comment
1999 West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in
Asia
Some human cases and deaths. Fear of
pandemic human influenza rises
2005
H5N1 Avian Influenza spreads to
more countries in Asia
Virus adapts to village poultry, ducks and
wild birds. More human cases.
Fear of human pandemic persists
2003
7
Recent Events Have Emphasized the
Importance of Wildlife Species in
Understanding the Epidemiology of Zoonoses
West Nile
Monkeypox
SARS
Avian Influenza
8
A Time Line for Zoonoses & Epidemics of the 21st Century
Year Event
Comment
1999 West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in
Asia
Some human cases and deaths. Fear of
pandemic human influenza rises
2005
H5N1 Avian Influenza spreads to
more countries in Asia
Virus adapts to village poultry, ducks and
wild birds. More human cases.
Fear of human pandemic persists
2003
9
Video of FMD in UK 2001
10
FMD Progress of an Epidemic
What happened February 20 (first recognition in Essex) to
April 11 (the turning point of the epidemic) and thereafter
April 11
21 cases
Netherlands
2 cases in
France
1 case in Ireland
June 4
http://www.guardian.co.uk/footandmouth
http://news.bbc.co.uk/hi/english/in_depth
/uk/2001/foot_and_mouth/default.stm
11
Welfare : The Cost in Animals
&
The Psychological Trauma on Society
September 30
Total outbreaks
2030
Slaughtered 3,940,000
But animals were also
slaughtered on 7,549 premises
because they were either
Contiguous Premises/
Dangerous Contacts (7,294 ) or
Slaughtered on Suspicion (255)
12
Late Summer 2001
The Future and FMD
Where will the road take us?
13
A Time Line for Zoonoses & Epidemics of the 21st Century
Year Event
Comment
1999 West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in
Asia
Some human cases and deaths. Fear of
pandemic human influenza rises
2005
H5N1 Avian Influenza spreads to
more countries in Asia
Virus adapts to village poultry, ducks and
wild birds. More human cases.
Fear of human pandemic persists
2003
14
Bioterrorism emerges in the USA
“If that hideousness (FMD) came here, it
wouldn't be any more hideous for the
animals Smallpox
- they are all bound for a ghastly death
anyway. But it would wake up consumers...I
openly hope that it comes here.
Ingrid Newkirk President of People for the Ethical
Treatment of Animals (PETA) Talking on FMD April 2001
Anthrax Oct 2001
Economist November 2002
15
A Time Line for Zoonoses & Epidemics of the 21st Century
Year Event
Comment
1999 West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in
Asia
Some human cases and deaths. Fear of
pandemic human influenza rises
2005
H5N1 Avian Influenza spreads to
more countries in Asia
Virus adapts to village poultry, ducks and
wild birds. More human cases.
Fear of human pandemic persists
2003
16
Severe Acute Respiratory Syndrome
SARS
A new disease; a new virus!
SARS map courtesy of WebMD
17
SARS Outbreak, Worldwide
Cases by Country (June 3, 2003)
Germany: 10
Sweden: 3
Finland: 1
Russian Federation: 1
Canada: 198
United States: 66
Romania: 1
United Kingdom: 4
Ireland: 1
France: 7
Spain: 1
Mongolia: 9
Rep. Of Korea: 3
China: 5,328
Taiwan: 684
Switzerland: 1
Italy: 9
India: 3
Kuwait: 1
Colombia: 1
Thailand: 8
Hong Kong: 1,746
Macao: 1
Philippines: 12
Vietnam: 63
Indonesia: 2
Singapore: 206
Brazil: 2
Malaysia: 5
Australia: 5
South Africa: 1
According to the World Health Organization (WHO),
during the SARS outbreak of 2003, a total of 8,098 people
worldwide became sick with SARS; of these, 774 died.
New Zealand: 1
18
The first clues that
SARS may be a
zoonotic disease
• Food handlers with
likely animal contact
were over represented
in early cases (9/23,
39%)
• People living near
markets were over
represented in early
cases
Video
Masked Palm
Civets
Courtesy AP
19
12,500 Km
2000 Km
Guangzhou
3200 Km
4900 Km
The International Trade in Wildlife
Slide Courtesy of Dr Billy Karesh Wildlife Conservation Organization
20
A Time Line for Zoonoses & Epidemics of the 21st Century
Year Event
Comment
1999 West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in
Asia
Some human cases and deaths. Fear of
pandemic human influenza rises
2005
H5N1 Avian Influenza spreads to
more countries in Asia
Virus adapts to village poultry, ducks and
wild birds. More human cases.
Fear of human pandemic persists
2003
21
Did Smallpox hit the USA
in May 2003?
Fortunately not! It was
Monkeypox.
Dr Kurt Zaeske, DVM
Wauwatosa, WI
22
Monkeypox in monkeys and humans
in West and Central Africa
Smallpox
WHO / AFIP
http://www.cdc.gov/ncidod/monkeypox/index.htm
23
Monkeypox and the reservoir host
WHO / AFIP
http://www.cdc.gov/ncidod/monkeypox/index.htm
24
Human cases (71) of monkeypox in USA 2003
by date of onset MMWR July 11, 2003 / 52(27);642-646
25
How did this happen?
Prairie dogs
26
Movement of
Imported
African
Rodents
MMWR July 11,
2003 / 52(27);642646
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5227a5.htm
27
Is there any precedent?
Human, Cow and
Cat Infections
with Cowpox
Virus in Europe
Bank Vole
Clethrionomys glareolus
28
A Time Line for Zoonoses & Epidemics of the 21st Century
Year Event
Comment
1999 West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in
Asia
Some human cases and deaths. Fear of
pandemic human influenza rises
2005
H5N1 Avian Influenza spreads to
more countries in Asia
Virus adapts to village poultry, ducks and
wild birds. More human cases.
Fear of human pandemic persists
2003
29
Avian Influenza H5N1 in Asia
“Enemy at the gate”
Pandemic threat
of human
influenza
With thanks to V. Martin, L. Sims, J. Lubroth,
S. Kahn, J. Domenech, C. Benigno
and Wantanee Kalpravidh of FAO
30
H5N1 Influenza virus in Poultry
and Humans in Asia
• New virus, which, if it mutates to easily infect
humans, could infect entire human population.
• If were to occur in the USA, 15-35% of the
population might be affected, at a cost between
$71 and $167 billion
31
The agricultural landscape of Vietnam is based
on rice production
32
Interactions on the farm and the market
33
Influenza A
A promiscuous virus!
• Orthomyxovirus
HA
– Envelope
– Surface spikes
• Hemagglutinin protein
(HA) (16 types)
• Neuraminidase protein
(NA) (9 types)
– SS(-) RNA
– 8 segmented genes
NA
12
78
6
5
34
34
Why H5N1 is of particular concern
Traditional belief of antigenic shift
leading to pandemics of human
influenza
The pig is the
“Mixing Vessel”
H5NI influenza is able to infect
humans directly
?
35
DPRK
H7
Philippines
H5
Malaysia
H5N1
Situation in July, but
constantly changing!
H5-affected
H5-affected
H7-affected
H5-affected
countries with cases in the last 3 months
countries without cases in the last 3 months
countries
countries with reported human clinical cases/seropositive
36
Recent Spread of H5N1and the
Questioned Role of Migratory Birds
17 August
The East AsianAustralasian Flyway
Bar-headed goose
http://www.tasweb.com.au/awsg/eafw.htm
http://www.scz.org/animals/g/bhgoose2.html
37
History and Evolution of H5N1 HPAI viruses
Key epidemiological findings
•Nomadic or free-range ducks
•Contact wild waterbirds
•Virus shedding and spreading
• Reservoir of infection
•Live bird markets
•Cultural practices
38
Conclusions & an Agenda for Action
Zoonoses & Emerging Diseases of the 21st Century
What have we learned and how are we adapting?
Avian Influenza
FMD
Monkeypox
39
A Time Line for Zoonoses & Epidemics of the 21st Century
Year
Event
Comment
1999
West Nile virus arrives in New York
Poor state of preparedness of National Public
Health Services in USA realized
2001
Foot-and-mouth disease hits UK
Reality check! Is USA equally unprepared?
West Nile hits Florida
Surprise at the ferocity of the epidemic
9-11
War on terrorism begins
Anthrax bioterrorism
The nation feels vulnerable
SARS pandemic
Canada is hit hard, but we are lucky
Monkeypox
Could it have been smallpox?
Mad Cow Disease
Did we say we would never get it?
West Nile impacts the Mid West
Truly an epidemic now!
2004
H5N1 Avian Influenza explodes in Asia
Some human cases and deaths. Fear of pandemic
human influenza rises
2005
H5N1 Avian Influenza spreads to more
countries in Asia
Virus adapts to village poultry, ducks and wild
birds. More human cases.
Fear of human pandemic persists
2003
But do not forget Eastern Equine Encephalitis, Lassa,
Ebola, Nipah, Hendra, and Rift Valley Fever! All of
which threatened during the same time span.
40
Risk Assessment for Viral Zoonoses
Minor zoonotic
potential
(Social impact of
control may be
significant)
Significant zoonotic
potential, but
technology available
for control and
prevention
Epidemic, even
pandemic, potential
with limitations in
technology for control
and prevention
Orf in sheep
Rabies
Avian Influenza H5 and H7
subtypes
Newcastle Disease
Mad Cow Disease (Prion)
SARS
Foot-and-mouth disease
West Nile
Ebola
Nipah and Hendra
Rift Valley Fever
The unknown agent
41
Today we have
“Microbial Club Med”
(concept courtesy of Lonnie King)
• 75% of emerging
diseases are zoonotic
• viruses most common
• 60% of pathogens are
zoonotic
(Taylor et al., Proc. Roy. Soc. 2001)
More than 99% of viruses remain to be discovered.
Huge potential for future zoonotic emergence
Daszak, 2003
42
A Time Line for Zoonoses & Epidemics of the 21st Century
Year
Event
Lessons Learned/Actions Initiated by event
1999
West Nile virus arrives in
New York
Greater coordination of Public Health Services,
improved research and diagnostics
2001
Foot-and-mouth disease hits
UK
USA biosecurity is seen as important and food
supply seen as vulnerable to bioterrorism. The
power of the media
9/11 & Anthrax bioterrorism Preparedness for bioterrorism accelerates
2003
2004/5
SARS pandemic
Global surveillance and international cooperation
needs improvement. Increasing awareness of
wildlife importance in zoonoses
Monkeypox in the USA
Jurisdiction and concerted action clarified for
international trade in wildlife
Mad Cow Disease in the
USA
Awareness of international sensitivity and trade. The
interface of complex biology and complex trade
H5N1 Avian Influenza
explodes in Asia
All of the above. Need for $ support for developing
countries. The importance of WHO and FAO
Risk assessment is a great approach, but preparedness is all important!
43
Society’s role in
meeting the challenge
of emerging diseases
and zoonoses
“I know of no safe depository of the ultimate posers
of society but the people themselves, and if we think
them not enlightened enough to exercise control with
a wholesome discretion, the remedy is not to take it
from them, but to inform their discretion.”
Thomas Jefferson
We must educate!