Early Warning System for

Emerging Infectious Diseases

in South-western Amazonia:

technological innovation

aiming at adaptation to

the negative impacts of

Global Climate Change

on Human Health

Professor Manuel CesarioMD, PhD, FLS

UNIFRAN

PFPMCG Workshop

11-12 MAY 2011

EARLY WARNING SYSTEM FOR EMERGING INFECTIOUS DISEASES

IN SOUTH-WESTERN AMAZONIA:

ADAPTATION TO THE NEGATIVE IMPACTS OF GLOBAL CLIMATE CHANGE

ON HUMAN HEALTH

PI:

Prof. Dr. Manuel Cesario – UNIFRAN (Franca-SP)

Co-PIs:

Prof. Dr. Luis Marcelo Aranha Camargo – ICB5USP (Monte Negro-RO)

Prof. Dr. Maria Emília Bavia – UFBA (Salvador-BA)

Prof. Dr. Antônio Sérgio Ferraudo – UNESP (Jaboticabal-SP)

Prof. Dr. Mônica Andrade-Morraye – UNIFRAN (Franca-SP)

Associated Researchers:

Raquel Rangel Cesario, MSc; PhD Proponent on Health Promotion at UNIFRAN (Franca-SP)

Prof. Dr. Fernando Dias de Ávila Pires – FIOCRUZ e UFSC (Florianópolis-SC)

Technicians and Students:

Michelle Andrade Furtado, MSc ; GIS Technician at UNIFRAN (Franca-SP)

Patrícia Pellegrino Colugnati – MSc Student on Health Promotion at UNIFRAN (Franca-SP)

Mateus Ribeiro – MSc Student on Health Promotion at UNIFRAN (Franca-SP)

Natália Gonçalves Amâncio – MSc Student on Health Promotion at UNIFRAN (Franca-SP)

Graduate Programme on Health Promotion

Global Environmental Change and Human Health (2007) Science Plan and Implementation Strategy, ESSP Retort No. 4.

RONDONIABRAZIL

BOLIVIA

PERU

ACRE

SOUTH-WESTERN

AMAZONIA

N

Tri-national

Frontier

Acre River

Beni

CobijaRONDONIA PANDO

Lago Titicaca

ACREUHE

St. Antonio

3,600 MW

UHE Jirau

3,900 MW

UHE

Bi-national

3,000 MW10 GW

US$ 5.5 Billion

Guayaramerin-

La Paz Highway

US$460 MillionPuertoMaldonado

4,000 km of

navigable rivers

Rio Branco

Assis Brasil

MADRE DE DIÓS

BR 364

BR 317

Sena Madureira

On-going Mega-infrastructure projects in the South-Western Amazon regionSources: NASA, M. Steininger, CI, CAF- IIRSA

More than 30 million people live in a radius of 750 Km of Acre State

ROAD PAVING HAS BEEN A VERY IMPORTANT DRIVER FOR LUCC IN AMAZONIA

LAND USE/COVER CHANGE IN AMAZONIA:

DEFORESTATION/FOREST FIRES, LOGGING AND FARMING,

MOSTLY ALONG ROADS

The effect of road paving on deforestation in Amazonia

(by WHRC/IPAM, after Britaldo Soarez, with data from PRODES)

“For each 1%

increase in

deforestation, the

amount of

A. darlingi

increases 8%”Jonathan Patz apud Amy Victor, 2003

Lutzomyia sp.

Cutaneous Leishmaniasis

in Brazil

Bartonellosis in Peru

Visceral Leishmaniasis

in Brazil

Spatial Distribution of

Visceral Leishmaniasis cases,

according to place of residence.

Brasil, 1983-2006

Source: SVS/MS1983-1988

1989-1994

1995-2000

2000-2006

1 dot = 1 caseExample of expansion of

Visceral Leishmaniasistransmission area

RONDONIABRAZIL

BOLIVIA

PERUACRE

SOUTH-WESTERN

AMAZONIA

N

BARTONELOSIS

Vector-borne Zoonosis

LUCC (deforestation)

Human Migration

Climate Variability

Large Infrastructure Projects (roads)

HUACO (pottery) representing the

millenary known Peruvian Wart (Bartonellosis chronic form)

The Lima – La Oroya Railway,

known as the highest railway in the world,

was built in the years 1870-1875 and 1890-1893,

resulting in 152 km, 61 bridges and 65 tunnels,

as well as in

7,000 deaths only during the

La Oroya Fever 1871 outbreak.

CARRION`S DISEASE(BARTONELLOSIS,

Bartonella baciliformis)

NUMBER OF ANNUAL CASES AND INCIDENCE OF BARTONELLOSIS IN PERU, 1997-2005

0

2000

4000

6000

8000

10000

12000

1 2 3 4 5 6 7 8 9

YEARS

CA

SE

S

0

5

10

15

20

25

30

35

40

45

IN

CID

EN

CE

1997 1998 1999 2000 2001 2002 2003 2004 2005

Source: OFICINA GENERAL DE EPIDEMIOLOGIA

MINISTERIO DE SALUD - PERU.

INC

IDE

NC

E P

ER

100,0

00 I

NH

AB

ITA

NT

S

NU

MB

ER

OF

CA

SE

S P

ER

YE

AR

BARTONELLOSIS IN PERU, FROM 1997 TO 2005

NUMBER OF CASES PER YEAR AND INCIDENCE PER 100,000 INHABITANTS

YEARS

CUSCOCAJAMARCA

BAGUACAJAMARCA

PIURA ICAJAMARCA

JAENANCASH

AMAZONASHUANUCO

LA LIBERTADLAMBAYEQULIMA NORTE

LIMA SUR

DISA

0 5 10 15 20

Letalidad (%)GRUPO DE TAREA PATOGENOS ESPECIALESOFIC INA GENERAL DE EPIDEMIOLOGIA* HASTA LA S.E. 32

Tasa de letalidad de la bartonelosis. Perú 2004.

RONDONIABRAZIL

BOLIVIA

PERUACRE

SOUTH-WESTERN

AMAZONIA

N

LEISHMANIASIS

Vector-borne Zoonosis

LUCC (deforestation)

Human Migration

Climate Variability

Large Infrastructure Projects (roads)

Cutaneous Leishmaniasis Detection Coeficient

Source: Brazilian Health Ministry,

2007 data.

CASE DENSITY AND CIRCUITS OF

LEISHMANIASIS PER MUNICIPALITY

( AVERAGE 2003-2005 )

Density

(Cases/Km²)

Cutaneous

Leishmaniasis

Detection

Coeficient

(number of cases

per 100,000

inhabitants)

Scales

18 Average in Brazil, in the last 20 years

13 to 40 Average in Peru, from 1985 to 1994

71 Level of very high risk of transmission,

according to the Brazilian Ministry of

Health

93 Brazilian Northern Region

(average in the last 20 years)

126 Acre State (average 2000-2007)

1,232 Assis Brasil (average 2000-2007)

198 to 1,622 Variation between the six Bolivian

municipalities along the tri-national

borders (2004)

Phlebotomines collected

during 5 days field-work, in 2008:

3,334 male individuals

distributed in 59 species, of which

12 not yet registered in Acre;

2 unknown/new.

OBJECTIVES

The General Objective of this project is to develop adaptation

strategies and tools to face the negative impacts of Global

Climate Change on Human Health.

The Specific Objectives are:

•to monitor and map changes in the eco-epidemiology of

Cutaneous Leishmaniasis and Bartonellosis (Carrión Disease) at

the tri-national frontier;

•to monitor and map local/regional climatic- (temperature, rainfall,

air humidity, wind, altitude) and land use/cover changes;

•to identify the sand fly vectors (Diptera: Psychodidae:

Phlebotominae) involved with the transmission of both diseases in

the tri-national region and map their occurrence;

•to develop the Early Warning System for Emerging Infectious

Diseases in Southwestern Amazonia;

• to broadly disseminate the results/achievements.

SPECIFIC OBJECTIVES and METHODS

•to monitor and map changes in the eco-epidemiology of Cutaneous

Leishmaniasis and Bartonellosis (Carrión Disease) at the tri-national

frontier (2000-2012);

•to monitor and map local/regional climatic- (temperature, rainfall, air

humidity, wind, altitude) and land use/cover changes (2000-2012);

•to identify the sand fly vectors (Diptera: Psychodidae: Phlebotominae)

involved with the transmission of both diseases in the tri-national region

and map their occurrence.

In the first two years the following tasks will be performed:

Serum-epidemiological inquires;

Laboratorial analysis of blood samples and vectors;

Vectors’ identification and ecology assessment;

Mapping changes in land use/cover in the region;

GIS databank building.

SPECIFIC OBJECTIVES and METHODS

•to develop the Early Warning System for Emerging Infectious

Diseases in South-western Amazonia;

• to broadly disseminate the results/achievements.

By the end of the fourth year, this project will have produced the Early

Warning System for Emerging Infectious Diseases in Southwestern

Amazonia using techniques of : Spatial Epidemiology, Univariate and

Multivariate Analysis, Cluster Analysis, Principal Components Analysis,

Discriminate Analysis, Correspondence Analysis, and Neural

Networks/Artificial Intelligence for assessing infectious diseases.

It will have communicated its results to the relevant scientific

communities through scientific and media publications, and through the

scientific meetings attended. Moreover, the results/achievements will be

multiplied by means of workshops for health-service managers and

policy-makers, as well as by training courses for students.

Preliminarily identified needs for collaboration

and/or data interchange within the FAPESP

Global Climate Change Research Programme:

• access to local/regional climate data: temperature,

precipitation, air and soil humidity, winds, ENSO,

etc. (2000-2012);

• access to local/regional satellite imagery and data

on land use/cover change (2000-2012).

“When I was a child, there was a lot of

forest, a lot of game, many fruits; our river was

large and very deep.

Today we can`t even swim, the water level

is under my knees; the fruits are scarce, little

fish and little game; the weather changed a lot.

I am getting old, more and more concerned

with the future of my grandchildren ...”

Report from an

Amazonian rubber tapper:

THANK YOU FOR YOUR ATTENTION

manuel.cesario@uol.com.br