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The Possible Effect of Climate Change on Selected Infectious Diseases in South Florida

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Lyme disease. Bacterial infection by Borrelia burgdorferi. ... Reported Cases of Lyme Disease by Year, United States, 1991-2005. WHO, Fact Sheet, 2006 ... – PowerPoint PPT presentation

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Title: The Possible Effect of Climate Change on Selected Infectious Diseases in South Florida


1
The Possible Effect of Climate Change on Selected
Infectious Diseases in South Florida
  • Office of Epidemiology and Disease Control
  • Miami-Dade County Health Department
  • Juan A. Suarez
  • Regional Environmental Epidemiologist
  • Presentation at the Medical Campus of
  • Miami Dade College
  • January 28, 2008

2
Contributors
  • This presentation was adapted from a November
    2007 version prepared by
  • Fermin Leguen, MD, MPH, Director
  • Office of Epidemiology and Disease Control
  • Juan A. Suarez
  • Regional Environmental Epidemiologist
  • Menhel Kinno, MPH candidate, Intern OEDC
  • Some additional data slides from the Bureau of
    Community Environmental Health-FDOH

3
Introduction
  • Climate change in the form of global warming and
    extreme weather are increasingly mentioned in the
    media and journal articles as issues to be dealt
    with in the next decades.
  • Human health will be affected by changes in the
    environment of insects and microorganisms that in
    turn are vectors or agents for disease in man.

4
Assumptions
  • The following discussion assumes rise in sea
    levels, global increase in temperature, and
    intrusion of the ocean water on fresh bodies of
    water and drinking water wells.
  • The science behind these assumptions is based on
    observations but also on predictions.
  • Causes of these effects remain controversial.
    Anthropogenic vs. natural variations.
  • The physical results are based on the
    Intergovernmental Panel on Climate Changes
    report.

5
Selected Infectious Diseases
  • Vector borne diseases
  • Water borne diseases
  • Rodent borne diseases
  • Rabies

6
Vector-borne diseases
  • Mosquito transmitted diseases
  • Dengue Dengue Hemorrhagic Fever
  • Yellow Fever
  • West Nile Fever
  • Malaria
  • Other insects transmitted diseases
  • Lyme disease
  • Tularemia
  • Chagas disease

7
Dengue Fever Dengue Hemorrhagic Fever
  • genus Flavivirus
  • There are four serotypes of the virus that cause
    the disease.
  • Transmitted by Aedes aegypti (a domestic,
    day-biting mosquito, has a world wide
    distribution in tropical area)
  • Clinical features
  • High Fever, headache,
  • Backache, joint pain, eye pain,
  • Rash
  • Nausea and vomiting
  • Hemorrhagic manifestation (DHF) which is
    potentially lethal.
  • No specific treatment is available.
  • No vaccination is available.
  • Mosquito control.

8
Dengue Fever Dengue Hemorrhagic Fever
  • In 2005, 2.5 billion people at risk of Degue
    fever.
  • The Aedes mosquito has a worldwide distribution
    in the tropical and sub-tropical areas.

9
Yellow Fever
  • Genus Flavivirus
  • It is also transmitted by Aedes mosquito.
  • This virus is restricted to only 2 regions
    Africa and South America.
  • Clinical Features (incubation period of 3-6
    days)
  • Asymptomatic.
  • Acute phase Fever (sometimes Paradoxical fever
    with low pulse rate), aches, Nausea and vomiting,
  • 15 Toxic phase jaundice, abdominal pain with
    vomiting. Bleeding can occur from the mouth,
    nose, eyes and/or stomach. ½ die within 10-14
    days.
  • Three types of transmission cycle
  • Sylvatic (jungle) sporadic cases in forest.
  • Intermediate yellow fever in Africa only.
  • Urban yellow fever epidemics.
  • No specific treatment is available.
  • Prevention Vaccination and mosquito control

10
West Nile Fever
  • Genus Flavivirus
  • Transmitted by female Culex pipiens mosquitoes
  • Clinical Features
  • Incubation period 2-15 days
  • fever, headache, tiredness, and body aches,
    occasionally with a skin rash and swollen lymph
    glands
  • 1 in 150 ( Neuro-invasive disease, West Nile
    encephalitis or meningitis or West Nile
    poliomyelitis)
  • Treatment no specific treatment (antiviral
    Ribravirin)
  • Prevention mosquito control, vaccination only
    available for horses.

11
2007 West Nile Virus Activity in the United
States(Reported to CDC as of November 6, 2007)
12
Malaria
  • Parasitic infection by Plasmodium
  • Human malaria is caused by four species
  • Plasmodium vivax ovale
  • P. malariae
  • P. falciparum
  • 41 of the global population lives in area at
    risk of malaria.
  • Malaria is transmitted by female anopheles
    mosquito.
  • Clinical Feature (incubation period of 10-14
    days)
  • Fever
  • Rigor
  • Sweating
  • Treatment anti-malarial medication and
    supportive therapy
  • Prevention prophylactic treatment and mosquito
    control.

13
Lyme disease
  • Bacterial infection by Borrelia burgdorferi.
  • It usually lives in small animals (mice,
    squirrels,
  • Transmitted by Ixodes scapularis, Ixodes
    pacificus (blacklegged ticks)
  • Clinical Feature (incubation period 3-30 days)
  • fever, headache, fatigue
  • Erythema migrans (characteristic rash in 70-80).
  • In untreated patient it can cause a wide ray of
    symptoms (Nervous system, heart, and joint).
  • Treatment oral antibiotics, intravenous AB in
    severe cases
  • Prevention vaccine is no longer available, tick
    control
  • This disease may be more of an issue in the
    Northeast/Central states, unclear if South
    Florida would be affected.

14
Reported Cases of Lyme Disease by Year, United
States, 1991-2005
15
Chagas disease
  • It is a parasitic infection by Trypanosoma cruzi
  • Transmitted by kissing bud (triatomine vector).
  • Clinical Feature
  • Acute occurs after infection and it is
    characterized by fever or swelling around the
    site of inoculation
  • Chronic Intermediate asymptomatic stage.
  • Chronic (30) life-threatening chronic
    complications (dilated cardiomyopathy, dilated
    esophagus, toxic megacolon)
  • Treatment
  • Prevention insect control.

16
Why there will be an increase in Vector
Transmitted disease?
  • Warm temperature and surface water are essential
    for insect breeding (especially mosquito)
  • Stagnant water with humid condition are both
    necessary for breeding.
  • Warmer temperature leads to
  • Enhance vector breeding,
  • Increase vector survival,
  • Increase vector biting rate,
  • Reaching higher altitude,
  • and reduce the pathogens maturation period with
    the vector.
  • Very hot temperature with dry condition can
    reduce the survival of insects.

17
Water Food borne diseases
  • Giardiasis
  • Cholera and other Vibrios
  • Salmonella

18
Giardiasis
  • Parasitic infection by Giardia lamblia
  • Transmitted mainly through contaminated water.
  • Clinical Feature (incubation period 1-2 weeks)
  • Asymptomatic.
  • Diarrhea, Nausea and Vomiting, gas and
    flatulence, abdominal cramps
  • Chronic diarrhea and malabsorption and weight
    loss.
  • Treatment oral antibiotics
  • Prevention good hygiene, avoidance of
    contaminated water and food.

19
Cholera
  • Causative agent Vibrio cholera
  • It is mainly a water-borne disease
  • Clinical symptoms
  • Acute, watery (rice water like) diarrhea.
  • Vomiting
  • Leg cramps
  • Rapid loss of body fluids and dehydration that
    might lead to death within hours without
    treatment.
  • Treatment antibiotics and IV fluids
  • Prevention oral vaccine, avoid contaminated
    water and food.

20
Salmonella
  • Bacterial infection by Salmonella
  • Water food borne disease
  • Clinical features
  • Fever
  • Diarrhea, and abdominal cramps
  • Reiter's syndrome
  • Chronic carriers
  • Treatment oral antibiotics
  • Prevention avoidance of raw or undercooked eggs,
    poultry, or meat.

21
Vibrio vulnificus
  • Causative agent marine bacterium Vibrio
    vulnificus
  • Water-borne (wounds) and consumption of raw
    oysters and shellfish
  • Incubation 12-72 hours
  • Clinical picture
  • Septicemia in immunosuppressed, or chronic liver
    disease, or hemochromatosis, or cirrhosis
  • Case fatality from 50-90
  • Cellulitis, myositis, shock, hypotension, bullous
    skin lesions, intravascular coagulation,
    thrombocytopenia
  • Treatment antibiotics
  • Prevention avoid contact of wounds with seawater
    and avoid eating raw or undercooked oysters and
    shellfish

22
Vibrio vulnificus in Florida, 1990-2006
23
Deaths from Vibrio vulnificus in Florida,
1990-2006
24
Vibrio vulnificus Cases and Deaths from Various
Exposures, Florida 1990-2006
25
Rodent-Borne Disease
  • Plague

26
Plague
  • Bacterial infection Yersinia pestis
  • Transmitted by
  • Flea bite
  • Contact with infected rodent
  • Inhalation or ingestion of infected material.
  • It is still widely distributed in the tropics and
    subtropics and in warmer areas of temperate
    countries.
  • Clinical Feature
  • Bubonic form (most common type in which the
    disease is transmitted by flea and it mainly
    affects the lymph nodes (bubo) which became
    painful and may suppurate)
  • Septicaemic form
  • Pneumonic form (least common but most virulent)
  • Treatment antibiotics and supportive therapy
  • Prevention rodent control, flea control,
    vaccination only for high risk group.

27
Rabies
  • Viral infection by
  • Animal bite (domestic and wild animals).
  • Clinical Feature
  • Initially, non-specific symptoms
  • Acute stage, signs of hyperactivity (furious
    rabies) or paralysis (dumb rabies) predominate.
  • paralysis eventually progresses to complete
    paralysis followed by coma and death in all
    cases, usually due to respiratory failure.
  • Without intensive care, death occurs during the
    first seven days of illness.
  • Treatment immediate cleaning of the wound, and
    post-exposure vaccination
  • Prevention vaccination of domestic animals,
    vaccination of individuals at high risk,
    avoidance and control of wild animals.

28
Control Measures
  • Control measures for these diseases and their
    vectors are well known and established. However,
    new challenges will be encountered in the control
    of insects and microorganisms under the new
    environmental conditions and new methods must be
    researched and implemented.

29
Summary
  • The true effects that climate change will have on
    infectious diseases will be hard to predict but
    we can, with the present knowledge, estimate
    which of these will be more of a problem.
  • We must also not forget that todays challenges
    with other issues in infectious diseases, not
    related to climate change, may also continue.
    Examples include antibiotic resistance, limited
    resources, and new emerging pathogens.

30
UN Millennium Development Goals
  • Goal 7
  • Ensure environmental sustainability
  • Integrate the principles of sustainable
    development into country policies and programmes
    reverse loss of environmental resources
  • Reduce by half the proportion of people without
    sustainable access to safe drinking water
  • Achieve significant improvement in lives of at
    least 100 million slum dwellers, by 2020

31
Dr. Julie Gerberding, CDC Oct 2007
  • Many of the activities needed to protect
    Americans from the health effects of climate
    change are mutually beneficial for overall public
    health.it is also important that potential
    health effects of environmental solutions be
    fully considered.

32
I am persuaded that global climate change is one
of the most important issues that we will face
this century. With almost 1,200 miles of
coastline and the majority of our citizens living
near that coastline, Florida is more vulnerable
to rising ocean levels and violent weather
patterns than any other stateFlorida will
provide not only the policy and technological
advances, but the moral leadership, to allow us
to overcome this monumental challenge."
33
References
  • IPCC, 2007 Summary for Policymakers. In Climate
    Change 2007 The Physical Science Basis.
    Contribution of Working Group I to the Fourth
    Assessment Report of the Intergovernmental Panel
    on Climate Change Solomon, S., D. Qin, M.
    Manning,
  • Z. Chen, M. Marquis, K.B. Averyt, M.Tignor and
    H.L. Miller (eds.). Cambridge University Press,
    Cambridge, United Kingdom and New York, NY, USA.
  • http//ipcc-wg1.ucar.edu/wg1/Report/AR4WG1_Print_S
    PM.pdf

34
References
  • Control of Communicable Diseases Manual, 18th Ed.
    David L. Heymann, MD, Editor, APHA, WHO.
  • Centers for Disease Control and Prevention
    http//www.cdc.gov/
  • Environmental Protection Agency
    http//www.epa.gov/climatechange/effects/health.ht
    ml
  • World Health Organization
  • http//www.who.int/en/
  • United Nations. UN Millennium Development Goals.
    http//www.un.org/millenniumgoals/
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