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Looking forward based on past experiences:
What’s old is new againInternational Conference on (Re-)Emerging Infectious Diseases
March 12, 2018
Rebecca Martin, PhDDirector of the Center for Global Health
US Centers for Disease Control and Prevention
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1. (Re-) emerging infections2. Defining the factors for (re-)emergence3. Creating global health security4. Minding the gaps5. Moving forward
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Pandemic flu: Then and now
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Examples of (Re-)Emerging Infectious Diseases
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Zika: Latest in a Series of Unpredicted and Unpredictable Health Threats
Zika first discovered in Zika forest, Uganda in 1947
Unprecedented, extraordinary complexity, unique challenges• Microcephaly, other serious birth defects, and poor pregnancy
outcomes• Sexual transmission• Associated with Guillain-Barré syndrome
Top priority - protect pregnant women
The sooner we act, the better we can protect
5Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Major CHIKV genotypes in Africa with introductions into Asia. Subsequent importation via travelers to other areas
7S.C. Weaver, W.K. Reisen / Antiviral Research 85 (2010) 328–345
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Factors for (Re-)EmergenceGlobalization and movement
• Rapid mass movement of people, animals, and goods
• Urbanization/migration to urban areas
Demographic and behavior changes
• Greater human population and density
Environmental Social, political, and economic
events8Satellite Image of International Flight Patterns
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Ecological • Increased contact with animals
Habitat encroachment Lifestyle practices
• Intensification of animal production systems
Public health infrastructure
Microbial adaptation and change
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Factors for (Re-)Emergence
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Urbanization: Impacts on Cholera
• Expecting slides 3/8
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Increasingly common for cholera to make its way to informal settlements in large cities
Outbreaks in cities can be persistent and difficult to control
Early detection and a strong, coordinated, multi-sectoral response are key to success
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
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Youth bulge in Sub-Saharan Africa
By 2030, the youth in Sub-Saharan Africa will have
doubled from the start of the HIV epidemic (1990)
Projected growth of youth population 15-24 years of age in Sub-Saharan Africa, China, and India, 1950-2050
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Medical tourism
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Nontuberculous Mycobacteria (NTM) On May 1, 2017, CDC was notified of 3 patients with NTM surgical site
infections; all received surgery from a single surgeon at one facility in the Dominican Republic
CDC notified Dominican public health authorities
Dominican authorities reported the facility closed on 8 July 2017
As of October 12, 2017: 54 patients with a surgical site infection (SSI) after cosmetic surgery in the DR reported to CDC from 9 states, District of Columbia. 34/54 (63%) met CDC’s confirmed case definition
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
PH: Environmental change
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Guinea
Sierra Leone Liberia
Gueckedou
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Zoonotic diseases are a threat to global health security
14www.oie.int/onehealth
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Antibiotic resistance: A growing crisis worldwide
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Retrospective analyses show rapid emergence of different C. auris strains worldwide
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At least 4 strains circulating globally
Strain sequences pending
PakistanVenezuela
IsraelU.K.
S. AfricaKenyaKuwait
United StatesColombiaJapan
2009 2010 20122011 20142013 2015 2016
Korea India
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Global Health Security
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Global health security: Prevent, Detect, Respond
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
“Detect, Respond, and Prevent” is smart spending
18Sources: The Neglected Dimension of Global Security. GHFR Commission 2016.Gostin et. al., Neglected Dimensions of Global Security. JAMA 2016
BY THE NUMBERS
Estimated cost of pandemics in the 21st
century
Annual cost per person for protection against current
global health threats
$6 Trillion $0.65
Annual expected loss from potential
pandemics
$60 Billion
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Acute febrile illness surveillance: India
Acute febrile illness (AFI) surveillance captured >30,000 patients from 2014 through the end of February 2018
India tested for 80+ pathogens from 33 sites • 50% successfully diagnosed
7 diseases accounted for 90% : malaria, dengue, Scrub Typhus, leptospirosis, Japanese encephalitis, Kyasanur forest disease, influenza
India is using this information to appropriately supply health facilities with diagnostics and drugs
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Pre- and post-implementation of enhanced VHF surveillance and
diagnostics in Uganda 2000-2017
Community involvement in surveillance leads to increased reporting of signals
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Number of clusters, suspect cases related to clusters, and single suspect cases of measles (left) and yellow fever (right)
Kafadougou-Bafing-Folon Health Region, Cote d’Ivoire, 2014-201721
Importance of government
leadership and partner
coordination through
Emergency Operation Centers
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Importance of Disease Detectives at all levels for an effective response
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
November 2015 June 2017
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Nigeria quickly contained the 2014 Ebola outbreak by using existing public health infrastructure that had been built
over the last decade for diseases like polio
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Building laboratory capacity for current and advanced technologies allows
rapid detection and diagnosis
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
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SLIPTA: A framework to encourage, support and recognize the implementation of QMS in medical laboratories in a stepwise manner
1 Star
5 Star
2 Star
3 Star
4 Star
55-64 %
65-74 %
75-84 %
85-94 %
> 95 %
↑ Score on external evaluation using a checklist
0 Star
End Point
National, Regional or International Accreditation Body
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Regional network developed to create a standard certification model for biosafety and
biocontainment in laboratories
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Thailand Laos CambodiaMyanmar Vietnam
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Preventing vaccine-preventable diseases through a second year of life approach, Ghana
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Increasing immunization delivery, including MCV2, in the second year of life requires:• Raising awareness of vaccination schedule
• Developing catch-up vaccination policies
• Removing barriers to opening a vaccine vial for a single child
• Tracking children who “drop out”
• Revising forms to record and report 2YL doses
• Making vaccination convenient: in daycare and urban community clinics
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Joint External Evaluation conducted
National Action Plan developed
Costed Plan developed and resources identified
Plan implemented and evaluated over time
*Joint: country and external experts
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Aligning gaps and resources through the JEE process
JEEs Scheduled for February:ZimbabweJapan
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Role of Joint External Evaluations in accelerating progress and sustainability
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Decades of civil unrest in all 3countries
Weak public healthinfrastructure/Lack of IPCin health facilities / Unrecognized cases incrowded cities
Spotty border control
Aperfect stormfor the Ebola
outbreak in West Africa
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
The Impact of Ebola
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Ebola and the Economy
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Global safety net and surge capacity are critical
Global health security starts at the country level• Country action is quicker, more efficient, and more cost-effective• Global action must strengthen and work through national systems to the
greatest extent possible
The international community is also responsible – epidemics are the world’s problem, not only the problem of individual countries or regions• Rapid Response Teams• Access to medical countermeasures (PPE, drugs, vaccines, diagnostics)
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Need for research – more to learn Accelerating the development of vaccines
• Discovery research (universities, pharmaceuticals)• Development (industry, governments, CEPI) • Manufacturing (industry, regulators, governments)• Delivery (GAVI, WHO, UNICEF, PAHO, governments)
Studies and research during outbreaks
Developing of diagnostics• Point of care • Rapid tests
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
Public health advocacy, partnerships, and multi-sectoral interventions to enhance impact and sustainability UN General Assembly
• Non-communicable disease• HIV• Ebola• Antimicrobial resistance • Tuberculosis (2018)
WHO and African Union declarations and resolutions Public-private partnerships Multi-sectoral approach
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Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
1 2
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Health security: Protecting populations from Disease Outbreaks
Health System Strengthening: Promoting Stable Societies
Share Best Practices in Program Implementation, Research, and Policy
Stable Societies Can Provide Economic Growth Opportunities
Save Lives and Prevent the Spread of Disease
REASONS TO INVEST IN HEATH GLOBALLY
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37Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
House on Fire
“He was shaking as he described himself as just a poor village man. But, he said, when he was growing up,
there were things you could depend on. For example, if a house is on fire in a village, no one wastes time
putting water on the other houses, just in case the fire spreads…Instead…they rush to pour water where it will
do the most good – on the burning house.”
38House on Fire – The Fight to Eradicate Smallpox. William H. Foege. 2011. University of California Press, Berkley CA.
Emerging Infections Factors of Emergence Global Health Security:Prevent, Detect, Respond Minding the Gaps Moving forward
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