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Twitter @e_epidemic

WE ACKNOWLEDGE THE WURUNDJERI PEOPLE OF THE KULIN NATION

• Prof Raina MacIntyre UNSW

• A/Prof Martyn Kirk, ANU

• Prof Archie Clements ANU

• Prof Paul Komesaroff, Monash

• Prof Sahotra Sakar, U Texas

• Prof Wang Quanyi, Beijing CDC

• A/Prof David Heslop, UNSW/ADF

• Prof Bill Rawlinson, SEALS

• Prof Michael Baker, U Otago NZ

• Dr Paul De Barro, CSIRO

Chief Investigators

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Associate Investigators

• Professor Obijiofor Aginam, United Nations University

• Dr Anthony Stewart, WHO/GOARN

• Associate Professor Joanne Travaglia, UTS

• Dr Gina Samaan, WHO

• Dr Anita Heywood, UNSW

• Dr Nicholas Coatsworth, AusMAT/NTCCC

Post docs

• Dr Katrina Roper, ANU/ADF

• Dr Alex Rosewell, UNSW

• Dr Lauren Gardner, UNSW

• Dr Ben Coghlan, Burnet Institute

• Dr Abrar A Chughtai, UNSW

• Dr Kerri Viney, ANU

• Dr Katherine Lau, SESIAHS

Affiliates

• Dr David Muscatello UNSW

• Associate Professor Sarah Williams UNSW Law

• Chief Thomas Engells UTMB

• A/Prof Brian Gerber ASU

• Dr Rob Menzies UNSW

• A/Prof Matthew Scotch ASU

• Dr Sasha Steltzer-Braid SEALS

• Professor Abba Gumel, ASU

• Associate Professor Samsung Lim UNSW

• Professor Raja Jurdak CSIRO

• Dr Dean Paini CSIRO

Phd and master students

Links: ARM network, WHO GOARN, CDC, SPC, Australian and NZ govtagencies (health, defence)

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A gap in capacity • No national CDC• Jurisdictions have no mandate for national or regional response• MAE is the only field epiedmiology training program (FETP) in Australia.• CDNA has coordination and communication functions, but no

workforce/deployees answering to them as an entity.• AusReady funded from 2007-2010, limited success• AusMAT – trauma focus, no remit for public health• RedR – general emergency and disaster relief remit

• Australia has a high quality FETP, the MAE, and a large body of other highly skilled public health professionals who are willing to assist in infectious diseases emergencies – yet no clear mechanism to do so.

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ARM - functions • ARM capacity for rapid response to national and regional infectious

disease emergencies

• A pool of public health professionals is available (more than 150 members)

• Partnership model with other agencies.

• Annual training to add value to employers

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ISER Research priorities – determined by

the nature of epidemic/pandemics

• Acute perturbations to systems

• Immediate health, social and economic impacts

• A natural disaster

• Global solutions are required for epidemic control.

• Impacts worse If baseline systems are weak

• May require complex cross-sectorial and global response

• Inter-sectorial cooperation can be challenging and can undermine response

• Failures in epidemic response often not due to lack of technical expertise or biomedical resources, but due to systems failures

What is an epidemic?

0

5

10

15

20

25

30

35

1 2 3 4 6 7 8 9 10 11 12 13

Sporadic

Epidemic

Endemic

N cases

Time

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NOT AN EPIDEMIC

• Diabetes

• Heart disease

• Malaria

• Ice

• Obesity

• Cancer

DIABETES

0%

2%

4%

6%

8%

10%

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

Pre

vale

nce

Low-income

Lower middle-income

Upper middle-income

High-income

Source: WHO estimates http://www.who.int/diabetes/global-report/en/

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DECLINE IN HIV INCIDENCE AND MORTALITY OVER TIME

0

500 000

1 000 000

1 500 000

2 000 000

2 500 000

3 000 000

3 500 000

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

People dying from AIDS-related causes globally

People newly infected with HIV/AIDS globally

Source: UNAIDS/WHO estimates http://www.who.int/hiv/pub/progressreports/2016-progress-report/en/

.

CLASSIC EPIDEMIC CURVE - EBOLA

28,616 cases

11,310 deaths

Data source: WHO

Exponential riseAcute pertubations of systemsSurge capacityEvery day of delay averted saves lives

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Acute economic impacts

Unanticipated challenges

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Global collaboration

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RESPONSE TO EPIDEMICS• Emergency response – multisystems, many sectors• Surge capacity and protection of baseline systems

• Command and control coordination – clearly defined roles and responsibilities

• Epidemiologic investigation

• Crisis communications – to the public and responders

• Public and other health legislation

• Pharmaceutical interventions (drugs, vaccines)

• Non-pharmaceutical measures (social distancing, quarantine, border control, hospital infection control)

• Management and prioritisation of stockpiles

• Protection of first responders

• Law and order

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Investment in biosecurity research

Drugs and vaccines

Non-pharmaceuticalcountermeasures andsystems

Contribution to control of serious recent epidemics

Drugs and vaccines

Non-pharmaceuticalcountermeasures andsystems

Ebola, MERS CoV, SARS

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N Engl J Med 2016; 374:1281-1287March 31, 2016

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Bui CM, Chughtai AA, Adam DC, MacIntyre CR. An overview of the epidemiology and emergence of influenza A infection in humans over time. Arch

Public Health 2017 Mar 27;75:15. doi: 10.1186/s13690-017-0182-z PubMed PMID: 28352464

GENE EDITING

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Gryphon report, USEU Report

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DIY BIOLOGY

– ANYONE, ANYWHERE

A perfect storm

for biosecurity

Increased risk of pandemics of natural or unnatural origin

Poor mechanisms for regulation, response and mitigation

Lack of global

governance

Genetic engineering

of pathogens

Insider threat

Emerging

infectious

diseases

Lab accidents

Bioterrorism

DIY science

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ACCELERATION OF PANDEMIC THREATS,

WITHIN STATIC SYSTEMS

• Quantum advances in science and accessible methods for

gene editing

• Global oversight required – governance, legal, ethical,

research conduct. IHR, BWC, CP not fit for purpose.

• SDGs fail to address pandemic threat systematically

• Vertical systems of critical stakeholders – health, law

enforcement, military, emergency management,

agriculture, animal health, food

• Epidemic response, control and prevention

• Epidemic intelligence and risk analysis

• ISER academy

Research Programs & Focus

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ISER Launch 9th December 2015

Stakeholders workshop 23rd May 2016

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• ISER – CRC Spatial Information workshop

• ISER- CSIRO meeting on big data and collaborations

• Modelling stakeholders meeting

• Hot topics in biosecurity and epidemic response. Special International Seminar - 24 May 2016

• Seminar and Ice Breaker, with “mentoring moments” Nov 2016

• Pacific collaboration meeting, Wellington NZ Feb 2017

• WCPH World leadership dialogues – a pandemic experience April 2017

• Biolegalities meeting June 2017

• Civil-military workshop at CDC conference June 2017

Other ISER meetings 2016-17

WCPH Pandemic hypothetical

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MEGYN JELLYMost feared investigative

journalist on Sox News

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Billionaire software developerand founder of Propaganda Wars,

an Alt-right Youtube news channel

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THERMOSCANNERS

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V4Virk reacts

DISCLAIMER

• The scenario, all names, characters, and

incidents portrayed in this production are

fictitious. No identification with actual

persons (living or deceased), places,

buildings, and products is intended or

should be inferred.

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ISER ImpactEstablishment of the ISER Academy: A forum for cross-sectoral collaboration and engagement. Two events held in 2016 including a pandemic exercise.

ARM network: links to the MAE program at ANU, key NGOs and other organisations involved in epidemic response facilitate this research. ISER contain the largest body of Australian expertise in field epidemiology and epidemic response. Research on field response and deployment. Joint ARM/ISER events

Epidemic Observatory – EpiWATCH: Global outbreak scanning and rapid critical analysis of important epidemics for use by policy makers, government and other stakeholders. Made up of three products – Daily Alerts, Weekly Digests and ad hoc watching briefs

Epiwatch

• 3 cases of Bas Congo Virus in DRC

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• 80 cases of clostridium perfringens in Colorado

Why do global outbreaks matter?

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Transmission map of MERS outbreak in South Korea

조치. Current epidemiological situation of Middle East respiratory syndrome coronavirus clusters and implications for public healthresponse in South Korea. J Korean Med Assoc. 2015 Jun;58(6):487-97.

Four generations of MERS cases• 1 index case

• 29 secondary cases

• 125 third generation cases

• 25 fourth generation cases

(6 cases without clear generation data)

Hospital triage a critical issue worldwide

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Innovative surveillance technologies• ZikaHACK 2016 – worldwide student competition launched in August 2016

by ISER & EpiWATCH in partnership with thinkable.org. The challenge is to detect the Zika Virus outbreak earlier than traditional surveillance using public domain data. Participants were challenged to design and develop a concept and tool or algorithm using Zika Virus as a case study.

Research impact60 peer reviewed publications in influenza, Ebola, dengue, avian influenza, Zika virus and other areas.10 conference plenaries9 seed grants awarded to early career researchersResearch student supportPeer reviewed grant success

Examples of current research

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Using new point-of-care tests (POCT) to improve outbreak response to epidemic and emerging

pandemic influenza• Dr Sacha Stelzer-Braid (UNSW/POWH) and Dr Katrina Roper (ANU)• New POCT

• Samples from South Eastern Area Laboratory Services (SEALS) • Compare sensitivity, specificity, and turn around time to gold standard

multiplex real-time PCR • Modelling to determine whether POCT beneficial during 2009 Swine Flu

pandemic.

Biofire FilmArray® Cepheid GeneXpert®

Results within 30-45min

and others… Including

Impact of vaccination

• An estimated of 145,469 medical visits attributed to

influenza averted by inoculating schoolchildren, in

2013/14 season.

Modelling the impact of extended vaccination strategies on the medical visits attributable to influenza (Yi Zhang)

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Respiratory viruses on medical masks in a hospital setting (CI: Abrar A

Chughtai,)Background

Reuse of medical masks is common, particularly during the outbreaks/ pandemics

Respiratory pathogens may be present on used masks layers and may lead to self-contamination by the wearer

This study aims to estimate the level of contamination on the surface of medical masks

Methodology

The study will be conducted in respiratory wards and fever clinics of three selected hospitals in Beijing China. We aim to recruit 150 participants for this study.

Participants will be asked to wear medical masks for a shift (6-8 hours)

Used masks will be collected and tested for presence of pathogens on the surface

Pilot study will be conducted on 20 HCWs in POW & St Vincent's hospitals in Sydney

Mask will also be donned on mannequin in laboratory setting, fluorescent particles will be sprayed and maximum concentration of particles will be quantified using UV light

Avian influenza modelling – C Bui

Purchasing license for Geneioussoftware to analyse sequence data

– Bui, C., et al. (2017). "Influenza A H5N1 and H7N9 in China: A spatial risk analysis." PLoS One 12(4): e0174980.

– Bui, C. M., et al. (2017). "An overview of the epidemiology and emergence of influenza A infection in humans over time." Arch Public Health 75: 15.

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Geo-referenced data linked to BN

Interactive & dynamic risk mapping

Predictive Risk Mapping of Epidemics using Geospatial Bayesian Network (BN) Tools

Risk scenarios can be defined using web-based BN tool

Colleen Lau1, Helen Mayfield1, Carl Smith2, Michael Baker3

1 Australian National University, 2University of Queensland, 3University of Otago

Early detection and monitoring of infectious diseases through social media Ross Sparks, Sarvnaz Karimi, Cecile Paris, Raina MacIntyre, Paul De Barro

Infectious diseases lead to widespread death and financial loss. Time-critical interventions can be launched if outbreaks are detected earlier. Social media content can provide immediate information about the initial evolution of syndromes. This can lead to more rapid and effective responses, and better understanding of the impact on the

community.Disease Networks and Mobility (DiNeMo) Raja Jurdak, Dean Paini, Kim, Lauren Gardner, Reza

Arablouei, Kanchana ThilakarthnaThe Disease Networks and Mobility (DiNeMo) project focuses on using massive signals from online social media and open data sources, and their associated geotags to infer the time and place of likely disease outbreaks, and to map disease risk across the country.

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• Chimaera Evolution:– Computational modelling of all hazards

emergency response situations– Modelling framework, and development of

libraries of agents and submodels– Epidemic and biological agent response a key

component– Extensible to civilian and civil-military

contexts– Overarching aim is to enable detailed policy

and procedure analysis exploring complex interactions between epidemic response system components

– Commencing Jul 17

• Development of novel Hybrid Models (ABM/SD/DE)1) Cambodia epidemic preparedness model

• Includes differential exposure model based on:

– Demographics– Employment– Rurality

• 24 x 107 agents• Final model: Sep 17

2) Major Incident Medical Management and Support (MIMMS) policy analysis

• Fully agent based tactical disaster management framework

• Test and evaluation of current Australian policy for tactical and operational medical response to disasters of all types

• Exposure to agents a subcomponent of the modelling scenarios

Phnom Penh

Research Projects at ANU• Historical review of Australian outbreaks

• WGS detection of enteric outbreaks

• Serious Salmonella & Campylobacter

• Preparing for international deployment

• Managing foodborne disease outbreaks

• Communicating during outbreaks

• Geospatial modelling of vector borne infections

• Avian influenza modelling

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Epidemic intelligence stakeholder workshop

• October 12

• For operational stakeholders in government and NGOs.

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Summary

• Operational systems and public health research

• Field based

• Global focus

• Cross-sectorial

• Capacity building and connecting across sectors

Engage with us• ISER Office | Room 325 | Level 3 Samuels Building

• The School of Public Health and Community Medicine | Faculty of

Medicine

• Gate 11 Botany Street, Randwick

• The University of New South Wales, Sydney, NSW 2052, Australia

• Website: https://sphcm.med.unsw.edu.au/centres-units/centre-

research-excellence-epidemic-response

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• Twitter:@e_epidemics