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A Time Line of Emerging Zoonoses
and Epidemics of the 21st Century
A Global Perspective on the Epidemics of Foot-and-Mouth Disease, BSE,
    West Nile Encephalitis, SARS, Monkey Pox, and Avian Influenza.




  FMD
                                                  Avian Influenza
         West Nile Virus Infections
         Human cases       2003… 9862           Monkeypox
         (~44% encephalitis)
         Human deaths      2003… 264
         Human cases       2004… 2535
         Human deaths      2004… 98
         Equine deaths 1999-2004 15,000
                                                                                             2



                                Bursting Bubbles
                                   of the 21st
                                    Century Clash of
                                                                 Civilizations

Y2K Computer
    Crisis
                                                                    Right of Pre-emptive
                                                                    Action and War in Iraq

   Florida
  Hurricanes                                                                 Bioterrorism
                                         Naturally Occurring Emerging Diseases
                                                     and Epidemics
  With acknowledgement for the idea to
  Thomas Friedman
  New York Times April 24 2003
                                                                        3




What are the Driving Forces of Epidemics?

 • Accelerated global trading
   patterns of the late 20th Century
   (brought about in part by
   democracy and major trading
   blocks)
 • Technical sophistication in food              Major trading Blocks
   processing masking true origins
 • Exposure to new pathogens
                                       NAFTA



   through ecosystem disruption        Andean Pact
                                       Mecosur
                                       Caricom
                                       EFTA



   (human population pressures)        EU
                                       Europe's Associates
                                       ASEAN
                                          4



     Driving Forces of Epidemics contd.
• Evolutionary pressures through
  overpopulation and change in
  tropism
• Speed of transportation
• Unique combination of factors
  that we truly do not understand
  (i.e. akin to the Hurricanes in
  Florida in 2004)
We need to shift our focus from
  economy to ecology!
                                                                                                                                                   5

   Speed of Global Travel in Relation to
        World Population Growth
                                                                       400
                                                                                                                6




                                            )




                                                                                                                    )
                                                                       350
                                                                                                                5
                                                                       300


                                            Days to Circumnavigate (




                                                                                                                    (
                                                                       250                                      4




                                                                                                                    World Population in billions
                                                    the Globe
                                                                       200
                                                                                                                3
                                                                       150
                                                                                                                2
                                                                       100
                                                                        50                                      1

                                                                         0                                      0
                                                                             1850   1900          1950   2000
                                                                                           Year

“No city on the earth is now more than 24 hours away from any other”.
Economist 2003
“Annually, the world's airlines carry a staggering total approaching some two billion passengers.
At any one moment, about half a million people world-wide are flying in commercial aircraft “
Select Committee on Science and Technology Fifth Report UK Parliament 2000
                                                                                             6
       A Time Line for Zoonoses & Epidemics of
                   the 21st Century
Year Event                                   Comment
1999   West Nile virus arrives in New York   Poor state of preparedness of National Public
                                             Health Services in USA realized
2001   Foot-and-mouth disease hits UK        Reality check! Is USA equally unprepared?
       West Nile hits Florida                Surprise at the ferocity of the epidemic
       9-11                                  War on terrorism begins
       Anthrax bioterrorism                  The nation feels vulnerable
2003 SARS pandemic                           Canada is hit hard, but we are lucky
       Monkeypox                             Could it have been smallpox?
       Mad Cow Disease                       Did we say we would never get it?
       West Nile impacts the Mid West        Truly an epidemic now!
2004 H5N1 Avian Influenza explodes in        Some human cases and deaths. Fear of
     Asia                                    pandemic human influenza rises
2005   H5N1 Avian Influenza spreads to       Virus adapts to village poultry, ducks and
       more countries in Asia                wild birds. More human cases.
                                             Fear of human pandemic persists
                                                 7


   Recent Events Have Emphasized the
     Importance of Wildlife Species in
Understanding the Epidemiology of Zoonoses




                              West Nile
Monkeypox




                                          SARS
            Avian Influenza
                                                                                             8


    A Time Line for Zoonoses & Epidemics of the 21st Century

Year Event                                   Comment
1999   West Nile virus arrives in New York   Poor state of preparedness of National Public
                                             Health Services in USA realized
2001   Foot-and-mouth disease hits UK        Reality check! Is USA equally unprepared?
       West Nile hits Florida                Surprise at the ferocity of the epidemic
       9-11                                  War on terrorism begins
       Anthrax bioterrorism                  The nation feels vulnerable
2003 SARS pandemic                           Canada is hit hard, but we are lucky
       Monkeypox                             Could it have been smallpox?
       Mad Cow Disease                       Did we say we would never get it?
       West Nile impacts the Mid West        Truly an epidemic now!
2004 H5N1 Avian Influenza explodes in        Some human cases and deaths. Fear of
     Asia                                    pandemic human influenza rises
2005   H5N1 Avian Influenza spreads to       Virus adapts to village poultry, ducks and
       more countries in Asia                wild birds. More human cases.
                                             Fear of human pandemic persists
                          9




Video of FMD in UK 2001
                                                                                      10



FMD Progress of an Epidemic
What happened February 20 (first recognition in Essex) to
April 11 (the turning point of the epidemic) and thereafter
                                                                 21 cases
                                                                 Netherlands
                                                                 2 cases in
       April 11                                                  France
                                                                 1 case in Ireland




          June 4

 http://www.guardian.co.uk/footandmouth   http://news.bbc.co.uk/hi/english/in_depth
                                          /uk/2001/foot_and_mouth/default.stm
                                                               11


   Welfare : The Cost in Animals
                          &

The Psychological Trauma on Society




                              But animals were also
                              slaughtered on 7,549 premises
 September 30                 because they were either
 Total outbreaks   2030       Contiguous Premises/
                              Dangerous Contacts (7,294 ) or
 Slaughtered 3,940,000        Slaughtered on Suspicion (255)
                               12

   Late Summer 2001
  The Future and FMD
Where will the road take us?
                                                                                          13


    A Time Line for Zoonoses & Epidemics of the 21st Century

Year Event                                   Comment
1999   West Nile virus arrives in New York   Poor state of preparedness of National Public
                                             Health Services in USA realized
2001   Foot-and-mouth disease hits UK        Reality check! Is USA equally unprepared?
       West Nile hits Florida                Surprise at the ferocity of the epidemic
       9-11                                  War on terrorism begins
       Anthrax bioterrorism                  The nation feels vulnerable
2003 SARS pandemic                           Canada is hit hard, but we are lucky
       Monkeypox                             Could it have been smallpox?
       Mad Cow Disease                       Did we say we would never get it?
       West Nile impacts the Mid West        Truly an epidemic now!
2004 H5N1 Avian Influenza explodes in        Some human cases and deaths. Fear of
     Asia                                    pandemic human influenza rises
2005   H5N1 Avian Influenza spreads to       Virus adapts to village poultry, ducks and
       more countries in Asia                wild birds. More human cases.
                                             Fear of human pandemic persists
                                                                                  14



Bioterrorism emerges in the USA




“If that hideousness (FMD) came here, it
wouldn't be any more hideous for the animals -
                                    Smallpox
- they are all bound for a ghastly death
anyway. But it would wake up consumers...I
openly hope that it comes here.

Ingrid Newkirk President of People for the Ethical      Anthrax Oct 2001
Treatment of Animals (PETA) Talking on FMD April 2001

                                                        Economist November 2002
                                                                                          15


    A Time Line for Zoonoses & Epidemics of the 21st Century

Year Event                                   Comment
1999   West Nile virus arrives in New York   Poor state of preparedness of National Public
                                             Health Services in USA realized
2001   Foot-and-mouth disease hits UK        Reality check! Is USA equally unprepared?
       West Nile hits Florida                Surprise at the ferocity of the epidemic
       9-11                                  War on terrorism begins
       Anthrax bioterrorism                  The nation feels vulnerable
2003 SARS pandemic                           Canada is hit hard, but we are lucky
       Monkeypox                             Could it have been smallpox?
       Mad Cow Disease                       Did we say we would never get it?
       West Nile impacts the Mid West        Truly an epidemic now!
2004 H5N1 Avian Influenza explodes in        Some human cases and deaths. Fear of
     Asia                                    pandemic human influenza rises
2005   H5N1 Avian Influenza spreads to       Virus adapts to village poultry, ducks and
       more countries in Asia                wild birds. More human cases.
                                             Fear of human pandemic persists
                                                 16


Severe Acute Respiratory Syndrome
              SARS
    A new disease; a new virus!




                    SARS map courtesy of WebMD
                                                                                                                            17




SARS Outbreak, Worldwide
      Cases by Country (June 3, 2003)
                                                  Germany: 10
                                                    Sweden: 3
                                                      Finland: 1


                                                                       Russian Federation: 1

 Canada: 198                                          Romania: 1
                          United Kingdom: 4                                                              Mongolia: 9
                                Ireland: 1
                                                                                                         Rep. Of Korea: 3
                                France: 7
United States: 66                Spain: 1                                    China: 5,328              Taiwan: 684
                                 Switzerland: 1
                                                                                                       Hong Kong: 1,746
                                    Italy: 9                             India: 3
                                                                                                       Macao: 1
                                                                                                       Philippines: 12
                                                                Kuwait: 1
                                                                                                       Vietnam: 63
Colombia: 1                                                                                             Indonesia: 2
                                                                      Thailand: 8

                     Brazil: 2                                      Singapore: 206
                                                                       Malaysia: 5


                                                                                               Australia: 5
                                                  South Africa: 1



                    According to the World Health Organization (WHO),
                    during the SARS outbreak of 2003, a total of 8,098 people                  New Zealand: 1

                    worldwide became sick with SARS; of these, 774 died.
                                        18



The first clues that
 SARS may be a
 zoonotic disease
• Food handlers with
  likely animal contact    Video
  were over represented
  in early cases (9/23,
  39%)
• People living near
  markets were over       Masked Palm
                          Civets
  represented in early    Courtesy AP



  cases
                                                                                   19




                                                                       12,500 Km

                                                 2000 Km

                                                        Guangzhou

                                 3200 Km


                                                                4900 Km



The International Trade in Wildlife
Slide Courtesy of Dr Billy Karesh Wildlife Conservation Organization
                                                                                          20


    A Time Line for Zoonoses & Epidemics of the 21st Century

Year Event                                   Comment
1999   West Nile virus arrives in New York   Poor state of preparedness of National Public
                                             Health Services in USA realized
2001   Foot-and-mouth disease hits UK        Reality check! Is USA equally unprepared?
       West Nile hits Florida                Surprise at the ferocity of the epidemic
       9-11                                  War on terrorism begins
       Anthrax bioterrorism                  The nation feels vulnerable
2003 SARS pandemic                           Canada is hit hard, but we are lucky
       Monkeypox                             Could it have been smallpox?
       Mad Cow Disease                       Did we say we would never get it?
       West Nile impacts the Mid West        Truly an epidemic now!
2004 H5N1 Avian Influenza explodes in        Some human cases and deaths. Fear of
     Asia                                    pandemic human influenza rises
2005   H5N1 Avian Influenza spreads to       Virus adapts to village poultry, ducks and
       more countries in Asia                wild birds. More human cases.
                                             Fear of human pandemic persists
                                             21


Did Smallpox hit the USA
     in May 2003?
  Fortunately not! It was
       Monkeypox.
                            Dr Kurt Zaeske, DVM
                            Wauwatosa, WI
                                                                      22



Monkeypox in monkeys and humans
   in West and Central Africa




                                                           Smallpox


                http://www.cdc.gov/ncidod/monkeypox/index.htm
   WHO / AFIP
                                                               23




Monkeypox and the reservoir host




               http://www.cdc.gov/ncidod/monkeypox/index.htm
  WHO / AFIP
                                                       24


Human cases (71) of monkeypox in USA 2003
by date of onset MMWR July 11, 2003 / 52(27);642-646
                       25




How did this happen?




      Prairie dogs
                                                           26




Movement of
Imported
African
Rodents

MMWR July 11,
2003 / 52(27);642-
646




   http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5227a5.htm
                                                    27


Is there any precedent?

             Human, Cow and
             Cat Infections
             with Cowpox       Bank Vole
             Virus in Europe   Clethrionomys glareolus
                                                                                          28


    A Time Line for Zoonoses & Epidemics of the 21st Century

Year Event                                   Comment
1999   West Nile virus arrives in New York   Poor state of preparedness of National Public
                                             Health Services in USA realized
2001   Foot-and-mouth disease hits UK        Reality check! Is USA equally unprepared?
       West Nile hits Florida                Surprise at the ferocity of the epidemic
       9-11                                  War on terrorism begins
       Anthrax bioterrorism                  The nation feels vulnerable
2003 SARS pandemic                           Canada is hit hard, but we are lucky
       Monkeypox                             Could it have been smallpox?
       Mad Cow Disease                       Did we say we would never get it?
       West Nile impacts the Mid West        Truly an epidemic now!
2004 H5N1 Avian Influenza explodes in        Some human cases and deaths. Fear of
     Asia                                    pandemic human influenza rises
2005   H5N1 Avian Influenza spreads to       Virus adapts to village poultry, ducks and
       more countries in Asia                wild birds. More human cases.
                                             Fear of human pandemic persists
                                                                         29


Avian Influenza H5N1 in Asia
    “Enemy at the gate”


           Pandemic threat
              of human
              influenza




                        With thanks to V. Martin, L. Sims, J. Lubroth,
                        S. Kahn, J. Domenech, C. Benigno
                        and Wantanee Kalpravidh of FAO
                                                     30


H5N1 Influenza virus in Poultry
    and Humans in Asia
• New virus, which, if it mutates to easily infect
  humans, could infect entire human population.




• If were to occur in the USA, 15-35% of the
  population might be affected, at a cost between
  $71 and $167 billion
                                                 31

The agricultural landscape of Vietnam is based
              on rice production
                                          32



Interactions on the farm and the market
                                                 33



              Influenza A
          A promiscuous virus!
                                HA
• Orthomyxovirus
  – Envelope
                                                NA
  – Surface spikes
     • Hemagglutinin protein
       (HA) (16 types)
     • Neuraminidase protein                8
                                    34 5 67
                               12
       (NA) (9 types)
  – SS(-) RNA
  – 8 segmented genes
                                                                           34




     Why H5N1 is of particular concern
Traditional belief of antigenic shift   H5NI influenza is able to infect
leading to pandemics of human           humans directly
influenza




                      The pig is the              ?
                      “Mixing Vessel”
                                                                            35




                                                                  DPRK
                                                                    H7




                                                              Philippines
                                                              H5



                                        Malaysia
                                           H5N1




                    Situation in July, but
                    constantly changing!

H5-affected countries with cases in the last 3 months
H5-affected countries without cases in the last 3 months
H7-affected countries
H5-affected countries with reported human clinical cases/seropositive
                                                                                                  36

     Recent Spread of H5N1and the
   Questioned Role of Migratory Birds
                                                                                      17 August




               The East Asian-
               Australasian Flyway




                                         Bar-headed goose
http://www.tasweb.com.au/awsg/eafw.htm   http://www.scz.org/animals/g/bhgoose2.html
                                               37




  History and Evolution of H5N1 HPAI viruses
Key epidemiological findings

•Nomadic or free-range ducks
   •Contact wild waterbirds
   •Virus shedding and spreading
   • Reservoir of infection

•Live bird markets
•Cultural practices
                                                       38




Conclusions & an Agenda for Action
Zoonoses & Emerging Diseases of the 21st Century
 What have we learned and how are we adapting?


                                     Avian Influenza

   FMD
                         Monkeypox
                                                                                                  39


A Time Line for Zoonoses & Epidemics of the 21st Century
 Year   Event                                   Comment

 1999   West Nile virus arrives in New York     Poor state of preparedness of National Public
                                                Health Services in USA realized
 2001   Foot-and-mouth disease hits UK          Reality check! Is USA equally unprepared?
        West Nile hits Florida                  Surprise at the ferocity of the epidemic
        9-11                                    War on terrorism begins
        Anthrax bioterrorism                    The nation feels vulnerable
 2003   SARS pandemic                           Canada is hit hard, but we are lucky
        Monkeypox                               Could it have been smallpox?
        Mad Cow Disease                         Did we say we would never get it?
        West Nile impacts the Mid West          Truly an epidemic now!
 2004   H5N1 Avian Influenza explodes in Asia   Some human cases and deaths. Fear of pandemic
                                                human influenza rises
 2005   H5N1 Avian Influenza spreads to more    Virus adapts to village poultry, ducks and wild
        countries in Asia                       birds. More human cases.
                                                Fear of human pandemic persists



 But do not forget Eastern Equine Encephalitis, Lassa,
 Ebola, Nipah, Hendra, and Rift Valley Fever! All of
 which threatened during the same time span.
                                                                               40



 Risk Assessment for Viral Zoonoses
Minor zoonotic           Significant zoonotic      Epidemic, even
potential                potential, but            pandemic, potential
(Social impact of        technology available      with limitations in
control may be           for control and           technology for control
significant)             prevention                and prevention
Orf in sheep             Rabies                    Avian Influenza H5 and H7
                                                   subtypes
Newcastle Disease        Mad Cow Disease (Prion)   SARS


Foot-and-mouth disease                             West Nile

                                                   Ebola


                                                   Nipah and Hendra

                                                   Rift Valley Fever


                                                   The unknown agent
                                                                                                41

                     Today we have
                  “Microbial Club Med”
                           (concept courtesy of Lonnie King)

• 75% of emerging
  diseases are zoonotic
• viruses most common
• 60% of pathogens are
  zoonotic
  (Taylor et al., Proc. Roy. Soc. 2001)




                                            More than 99% of viruses remain to be discovered.
                                            Huge potential for future zoonotic emergence
                                            Daszak, 2003
                                                                                               42

    A Time Line for Zoonoses & Epidemics of the 21st Century

Year     Event                         Lessons Learned/Actions Initiated by event
1999     West Nile virus arrives in    Greater coordination of Public Health Services,
         New York                      improved research and diagnostics
2001     Foot-and-mouth disease hits   USA biosecurity is seen as important and food
         UK                            supply seen as vulnerable to bioterrorism. The
                                       power of the media
         9/11 & Anthrax bioterrorism Preparedness for bioterrorism accelerates
2003     SARS pandemic                 Global surveillance and international cooperation
                                       needs improvement. Increasing awareness of
                                       wildlife importance in zoonoses
         Monkeypox in the USA          Jurisdiction and concerted action clarified for
                                       international trade in wildlife
         Mad Cow Disease in the        Awareness of international sensitivity and trade. The
         USA                           interface of complex biology and complex trade
2004/5   H5N1 Avian Influenza          All of the above. Need for $ support for developing
         explodes in Asia              countries. The importance of WHO and FAO

   Risk assessment is a great approach, but preparedness is all important!
                                                        43


         Society’s role in
       meeting the challenge
       of emerging diseases
           and zoonoses
“I know of no safe depository of the ultimate posers
of society but the people themselves, and if we think
them not enlightened enough to exercise control with
a wholesome discretion, the remedy is not to take it
from them, but to inform their discretion.”
                              Thomas Jefferson


           We must educate!

				
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