The Global Threat of Infectious Diseases
Background
•
20th Century Re-Emergence of Infectious Diseases
- Newly recognized diseases
- Known diseases
- Geographic spread
- Increased epidemic activity
•
26% of Global Mortality – 2003
H5N1 AI
Dengue
Dengue
H5N1AI
Dengue
Chikungunya
Fauci, NIAID/NIH 2005
The Global Threat of Infectious Diseases
Global Public Health Emergencies, 1994-2005
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•
•
•
•
Plague, India/Global, 1994
Influenza, Hong Kong, 1997
Nipah Encephalitis, Malaysia/Regional, 1999
SARS, China/Hong Kong/Global, 2003
Avian Influenza, Southeast Asia/Global, 2004/2006
AISA-PACIFIC INSTITUTE OF
TROPICAL MEDICINE AND INFECTIOUS DISEASES
Rationale
•
Global Public Health Emergencies
•
Hawaii in Ideal Position to Develop a Center of Excellence
– Geography
– Cultural & Economic Ties
– Training
– East-West Center
– Other partners
Asia-Pacific Institute of Tropical Medicine and Infectious Diseases
Organizational Structure
Dean
John A. Burns School of Medicine
Clinical
Departments
Pacific Center for
AIDS Research
Asia-Pacific Institute of
Tropical Medicine and Infectious Diseases
Asia-Pacific Center
for Biosecurity and
Conflict Research
Pacific Center for
Emerging Infectious
Diseases Research
Asia-Pacific Center for
Infectious Disease
Ecology Research
Basic Science
Departments
Asia-Pacific Center
for Translational
Research
Asia-Pacific Center for
Public Health and
Population Research
Asia-Pacific Institute of
Tropical Medicine and Infectious Diseases
Mission
To develop a global center of excellence in Hawaii for emerging
and re-emerging infectious diseases
Emphasis will be placed on infectious diseases of the Asia-Pacific
Region, and on developing trans-disciplinary research and
development programs that will result in new diagnostics, drugs,
vaccines and other treatment and prevention modalities.
ASIA-PACIFIC INSTITUTE OF
TROPICAL MEDICINE AND INFECTIOUS DISEASES
Goals
•
Develop a balanced trans-disciplinary research and training
program that focuses on basic, field and translational research.
•
Develop a laboratory reference and research center
•
Develop local and international partnerships.
•
•
To build laboratory and epidemiologic capacity, and research
collaborations in selected countries of Asia where diseases with
epidemic potential commonly occur.
Develop a graduate program that will attract highly motivated,
research-oriented doctoral candidates.
ASIA-PACIFIC INSTITUTE OF
TROPICAL MEDICINE AND INFECTIOUS DISEASES
Disease Priorities
Zoonotic viruses
Influenza
Dengue/dengue hemorrhagic fever
West Nile fever
HIV/AIDS
Malaria
Leptospirosis
Asia-Pacific Institute of Tropical Medicine
and Infectious Diseases
Scientific Capability
• Laboratory Capacity
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–
–
–
Biocontainment (BSL-2, BSL-3 , ABSL-3)
Basic research
Diagnostics
Pathogenesis
• Epidemiology
• Bioinformatics
• Pathogens
– Emerging infectious diseases
– Viruses, parasites, bacteria, zoonoses
Asia-Pacific Institute of
Tropical Medicine and Infectious Diseases
Progress
Partnerships/Collaboration
Hawaii’s PRETREAT Alliance
Preventing, Responding, and Treating Emerging
Asia-Pacific Disease Threats
Hawaii’s Global Solution for Emerging Infectious Disease Threats
PRETREAT Participants and Their Capabilities
UH/JABSOM/
APITMID
DOD
•Surveillance
•Emergency response
•Clinical Research
•Clinical trials
•MHPCC
• Center of excellence
•Basic & applied research
•Pathogen discovery
•Surveillance
•Epidemiology
•Asian field sites
•Training
•Vaccines and drugs
•Product
Development
•FDA approvals
East West
Center
• Demography
• Geography
•Climate Change
Hawaii Biotech
Hawaii DOH
NIH
• PacRBL
• PSWRCE
•COBRE
• RCMI?
CDC?
International
• surveillance
• response
•Surveillance
•Emergency response
Hawaii Pacific Health
Queen’s Hospital
•Clinical Research
•Clinical trials
•Treatment
PRETREAT Components
• Prevention and treatment
– Early warning surveillance
– Diagnostics
– Drug and vaccine research
– Preclinical development, GLP animal testing
– GMP manufacturing
– Clinical research
– FDA approved products
Asia-Pacific Institute of
Tropical Medicine and Infectious Diseases
PRETREAT Components
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Asian field sites
– Research, clinical & vaccine trials
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Pathogen discovery
– Surveillance, field epidemiology, “pathogens of tomorrow”
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Biocontainment laboratories
– Fixed, mobile
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Basic research
•
Training
International Partnerships
• WHO
• Viet Nam
• Thailand
• Singapore
• Indonesia
• Others
Asia-Pacific Institute of
Tropical Medicine and Infectious Diseases
Progress - Funding
State of Hawaii
University of Hawaii
NIH
DOD
Microbial Threats to Health
Case in Point: SARS
Global SARS Cases (Probable)
WHO 26 September 2003
Country
Cases
Deaths
Case fatality
Canada
251
43
15.3%
China
5327
349
6.5%
Hong Kong
1755
299
16.9%
Singapore
238
33
15.5%
Taiwan
346
37
12.5%
Thailand
9
2
22%
U.S.
75
0
0%
Vietnam
63
5
7.9%
Other
81
5
6.2%
Total
8098
774
9.6%
Social Impact
Dengue Hemorrhagic Fever
Global Distribution of Dengue Virus Serotypes, 1970
DEN-1
DEN-2
Global Distribution of Dengue Virus Serotypes, 2006
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-3
DEN-4
DEN-1
DEN-2
DEN-3
DEN-4
Number of Cases
Dengue/dengue hemorrhagic fever, average annual
number of cases reported to WHO, 1955-2005
1000000
900000
800000
700000
600000
500000
400000
300000
200000
100000
0
9
95
1
55
19
9
96
1
06
19
9
97
1
07
19
9
98
1
08
19
9
99
1
09
19
5
00
2
00
20
Wave III: Dec 04 - Present
Humans & Birds
Humans
Birds
Source: WHO
Wave III: Dec 04 - Present
Humans & Birds
Humans
Birds
Source: WHO
Aedes aegypti
Aedes aegypti Distribution in the Americas
1930's
1970
2006
POTENTIAL GLOBAL SPREAD OF URBAN YELLOW FEVER
West Nile Virus in the Western Hemisphere
Epidemic West Nile Virus in the United States,
1999-2005
10000
9,850
8000
7000
6000
5000
4,156
4000
2448
3000
2949
2000
1000
62
66
21
* Reported as of 1/13/2006
Year
05
20
04
20
03
20
02
20
01
20
00
20
99
0
19
# cases reported
9000
Epidemic/Epizootic West Nile Virus
1937
1950-75
1994 - 2005
Factors Responsible for Increased Epidemic
Infectious Diseases
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Complacency, Lack of Political Will
Policy Changes
Changes in Public Health
Demographic Changes
- Population growth
- Urbanization
- Agricultural/Land Use Practices
- Animal Husbandry
Modern Transportation
- Increased Movement of People, Animals, Commodities
Changing Life Styles/Behavior
Microbial Adaptation
Technology
Intent to Harm
Climate Change?
Zoonotic Diseases: Hitching a Ride?
Modern Transportation
Asia-Pacific Institute of
Tropical Medicine and Infectious Diseases
Hawaii and the US mainland are highly vulnerable to the importation of
exotic pathogens, and at high risk for epidemic disease.
Demographic and cultural factors, along with economic growth and
globalization will insure that the Asian region will be important in
producing future epidemic disease.
A center of excellence for research on emerging infectious diseases of
Asia and the Pacific in Hawaii will be highly beneficial to the global
efforts to detect, respond and control epidemic disease.
Pacific Regional Biosafety Laboratory at
Kaka’ako
Pacific Regional Biosafety Laboratory at
Kaka’ako