Bats, Rats, Monkeys... Oh My! How Animals Impact Human Health Andrew Clements, Ph.D. USAID/Bureau for Global Health, Avian Influenza and Other Emerging Threats Unit October 8, 2010 USAID Global Health Mini-University Examples of Common “Human” Pathogens with Evolutionary Origins in Animals Disease AIDS Dengue fever Diphtheria Hepatitis Influenza Pathogen Original Host HIV-1, HIV-2 Monkeys/apes Primates Dengue fever viruses Corynebacterium diphtheriae bacteria Probably domestic herbivores Apes Hepatitis B virus Influenza A viruses Wildfowl Malaria Plasmodium parasites Birds and/or monkeys Measles Measles virus Sheep/goats Plague Yersina pestis bacteria Rodents Trypanosoma brucei parasite Wild ruminants Variola virus Ruminants (possibly camels) Rickettsia prowazeckii Rodents Yellow fever virus Primates Sleeping sickness Small pox* Typhus Yellow fever Source: Wolfe et al. 2007. Nature 447(7142):279-283. * Eradicated in 1980. Examples of Other Animal Diseases that Periodically Affect Human Populations Disease Avian Influenza Pathogen Original Host H5N1 influenza A virus Ebola Hemorrhagic Fever Marburg Hemorrhagic Fever Ebolavirus Birds Bats? Marburgvirus Bats? Monkey pox Orthopox virus Squirrels/rodents? Nipah Nipah virus Bats Rift Valley Fever RVF virus Livestock SARS coronavirus Bats/palm civets West Nile virus Birds Severe Acute Respiratory Syndrome West Nile Fever Sources: Wolfe et al. 2007. Nature 447(7142):279-283; WHO Emerging Infectious Diseases (EID) Retrospective analysis of 335 EID events (1940-2004) • EID events have risen significantly over time • ~60% of EIDs originated in animals Global distribution of relative risk of an event caused by zoonotic pathogens from wildlife ~70% of these from wildlife bats, rodents, non-human primates most often associated with EIDs from wildlife • EID origins significantly correlate with socio-economic, environmental and ecological factors Global distribution of relative risk of an event caused by zoonotic pathogens from domestic animals limited detection/reporting capacity in geographic “hot spots” for EID emergence Global trends in emerging infectious diseases, K. Jones et al, 2008, Nature, Vol 451.21 Current Public Health Systems • Often use “vertical” programs focused on specific infectious diseases that commonly affect humans • Weak linkages with wildlife and domestic animal health • Emerging infectious diseases in animal populations often not detected until there is an unusual cluster of human cases • Limited ability to adapt to detecting and containing new diseases in human population • Slow response to new diseases that efficiently spread from person to person can result in regional epidemics or pandemics (e.g. SARS, 2009 H1N1 flu) Human Pandemics of the 20th and 21st Century Pandemic*: worldwide epidemic of a disease that may occur when a new pathogen appears against which the human population has no immunity Disease Time Period Original Host Impact H1N1 influenza A 1918-1919 HIV/AIDS ~1930-2010 Birds? Monkeys ~50 million deaths >25 million deaths H2N2 influenza A H3N2 influenza A 1957-1958 Birds and mammals? ~1-2 million deaths 1968-1969 Birds and mammals? ~1-2 million deaths 2003 Bats/palm civets 2009-2010 Swine ~800 deaths; >$80 billion in economic losses TBD SARS H1N1 influenza A * WHO Shifting from Public Health to “One Health” Animal Health Public Health Surveillance/Response Surveillance/Response Wildlife Health Surveillance/Response domestic animal outbreak C A S E S Crossspecies transmission wild animal outbreak wild animal outbreak TIME Crossspecies transmission Crossspecies transmission wild animal outbreak wild animal outbreak human cases Public Health Benefits of Earlier Detection Animal Health Public Health Surveillance/Response Surveillance/Response Wildlife Health Surveillance/Response C A S E S Crossspecies transmission wild animal outbreak wild animal outbreak TIME wild animal outbreak domestic animal outbreak wild animal outbreak Crossspecies transmission human cases H5N1 Avian Influenza: “Chasing Chickens for Public Health” USAID programmed ~$550 million between 2005 and 2010 10000 Worldwide H5N1 poultry outbreaks Key outcomes: 1. Faster confirmation times for poultry and wild bird outbreaks decreased outbreak size fewer subsequent outbreaks fewer people exposed to virus 1000 100 Worldwide H5N1 human cases 2. Cross-sectoral collaboration improved Animal outbreaks often used to trigger search for possible human cases Public health impact: fewer human cases and better treatment/containment, decreases chances of virus acquiring ability to efficiently move from person to person 10 2003/ 2005 2006 2007 2008 2009 2010 2004 Year Sources: OIE, FAO, and WHO reports through 8/3/10. USAID: Expanding Beyond Avian Influenza Pandemic Prevention Pandemic Preparedness Pandemic Response (2007-2010+) (2009) (2005-2010+) Emerging Pandemic Threats (2009-2014) mostly Asia; some Africa and E. Europe C. Africa, Amazon, SE Asia, So. Asia mostly Africa, Asia mostly Africa, Asia poultry and human surveillance and response, communications, commodities for containment wildlife and human surveillance and response, risk determination and reduction pandemic planning for civil society and military; linked to disaster preparedness planning & provision of equipment needed for delivery of donated H1N1 pandemic vaccine Avian Influenza ~$350-400 million over 5 years AI and Other Emerging Threats Programs managed by USAID/GH’s Avian Influenza and Other Emerging Threats Unit. Risk-Based Focusing of USAID Emerging Pandemic Threats (EPT) Program EPT Focus: All countries All pathogens All animals • 4 regional “hot spots” • diseases from bats, rodents, non-human primates • pathogens TBD USAID EPT Program Objective: • pre-empt or contain diseases that could spark future pandemics Key Areas of Emphasis: • Wildlife pathogen detection*: Identification of target pathogens in wildlife that threaten humans • Risk Determination*: Characterization of potential risk and method of transmission for specific diseases of animal origin • Routine Surveillance and Outbreak Response**: Support for sustainable country-level response for control of “normative” diseases • Risk Reduction**: Promotion of actions that minimize or eliminate the potential for the emergence and spread of new disease threats * Represent activities related to wildlife that have generally been missing or underfunded ** Normative functions associated with animal and public health systems Summary 1. Over time, a variety of infectious diseases new to humans have been “crossing over” from animal populations trend expected to continue some animal diseases cause deadly and/or disruptive human pandemics 2. In order to adapt to emerging threats, public health systems need to take a more-proactive approach to surveillance and response which includes improving linkages to wildlife and animal health sectors 3. Promoting a “One Health” approach with USAID’s Emerging Pandemic Threats program will contribute to improving: – – detection and response to emerging threats overall public health functions including detection and response to common diseases