Talk at ICAN 2012 (Cape Town) on Global warming and ID. Based on a Lancet ID publication 2009 and thus geared at Europe.

1. Climate
Change
and
ID
November
2012
by
far
the
most
terrible
talk
errifying
film
you
wwill
ver
hear
you
ill
e ever
see
Andreas
Voss
iPrevent
Al
Voss
A
Gore
UMCN
&
CWZ
Nijmegen,
The
Netherlands
¤ AcceleraKng
economic
acKvity
and
fossil
fuel
¤ Worldwide
mean
surface
temperature
has
combusKon
over
the
past
century
has
increased
by
0·∙74°C
(SD
0·∙18)
over
the
past
100
years
precipitated
an
environmental
impact
of
¤ Worldwide
sea
level
has
risen
by
1·∙8
mm
per
year
unprecedented
proporKons:
since
1961
and
oceans
are
becoming
more
acidic
² Ecosystem
decline
¤ ArcKc
sea
ice
is
retreaKng
by
2.7%
(SD
0.6)
per
² Loss
of
biodiversity
decade
¤ Sea
surface
temperatures
are
warming
² Stratospheric
ozone
depleKon
¤ Mountain
glaciers
are
shrinking
² Climate
change
¤ Extreme
weather
events
are
increasing
in
frequency
and
intensity.
Hukme
et
al.
Clim
Res
17:
145–168,
2001
Andreas
Voss,
MD,
PhD
1

2. Climate
Change
and
ID
November
2012
2020s
2050s
2080s
Hukme
et
al.
Clim
Res
17:
145–168,
2001
¤ Heat waves
¤ higher
proliferaKon
and
reproducKon
rates
at
¤ Storms higher
temperatures
¤ Floods ¤ extended
transmission
season
¤ Fires ¤ changes
in
ecological
balances
¤ Droughts ¤ climate-­‐related
migraKon
of
vectors,
reservoir
hosts,
or
human
populaKons
¤ Infectious diseases
Andreas
Voss,
MD,
PhD
2

3. Climate
Change
and
ID
November
2012
¤ =
infecKons
transmiged
by
the
bite
of
infected
arthropod
species,
such
as
mosquitoes,
)cks,
sandflies,
and
blackflies.
¤ Vector-­‐borne
diseases
¤ Arthropod
vectors
are
cold-­‐blooded
and
thus
especially
sensiKve
¤ Rodent-­‐borne
diseases
to
climaKc
factors.
¤ Water-­‐borne
diseases
¤ Weather
influences:
¤ Air-­‐borne
diseases
-­‐
survival
and
reproducKon
rates
-­‐
habitat
suitability/distribuKon
¤ Food-­‐borne
diseases
-­‐
intensity
and
temporal
pagern
of
vector
acKvity
(parKcularly
biKng
rates)
throughout
the
year
-­‐
rates
of
development,
survival
and
reproducKon
of
pathogens
-­‐
changes
in
human
behaviour
Culex
spp
mosquito
¤ West
Nile
virus,
a
virus
of
the
family
Flaviviridae
that
is
part
of
the
Japanese
encephaliKs
anKgenic
group.
¤ France
2000
-­‐
Aggressiveness
of
the
vector
(Culex
modestus)
was
posiKvely
correlated
with
temperature
and
¤ West
Nile
fever
mainly
infects
birds
and
infrequently
humidity,
and
linked
to
rainfall
and
sunshine,
which
were
human
beings
through
the
bite
of
an
infected
Culex
parKcularly
high
during
the
epidemic
period
spp
mosquito.
¤ Romenia
1996
and
Israel
2000
-­‐
associated
with
a
heat
¤ In
numerous
European
countries
the
virus
has
been
wave
early
in
the
summer
with
high
minimum
isolated
in
mosquitoes,
wild
rodents,
migraKng
birds,
temperatures
hard
Kcks,
horses,
and
human
beings.
¤ Clima)c
model
for
West-­‐Nile
virus
with
mild
winters,
dry
¤ Roughly
80%
of
cases
are
asymptoma)c,
the
rate
of
springs
and
summers,
heat
waves
early
in
the
season,
and
West-­‐Nile
virus
infecKons
in
human
beings
remains
wet
autumns.
largely
unknown
Andreas
Voss,
MD,
PhD
3

4. Climate
Change
and
ID
November
2012
¤ Dengue
is
the
most
important
worldwide
arboviral
human
¤ Italy:
reported
5
new
cases,
from
the
Veneteo
disease
region
(n=4)
and
Emilia
Romagna
(n=1).
Cases
are
age
62
tot
82,
admiged
to
the
hospital
with
¤ Due
to
nearly
universal
use
of
piped
water,
the
disease
has
neurological
symptoms.
disappeared
from
Europe.
¤ France:
reports
a
41-­‐year-­‐old
paKent
in
Var
(South-­‐ ¤ Dengue
is
frequently
introduced
into
Europe
by
travellers
France).
The
last
cases
of
WNF
in
France
was
in
returning
from
dengue-­‐endemic
countries,
but
no
local
2003
(same
region,
7
humans,
4
horses).
transmission
has
been
reported
since
it
would
also
depend
on
the
reintroduc)on
of
its
principal
vector,
the
mosquito
Aedes
¤ Hungary:
2
paKents
from
central
Hungary.
aegyp*
¤ All
three
countries
started
control
measures,
WNF-­‐ ¤ However,
over
the
past
15
years
another
competent
vector
surveillance,
public
informa)on
campaigns
and
Aedes
albopictus
(Asian
Kger
mosquito)
has
been
introduced
screening
of
blood
donors.
into
Europe
and
expanded
into
several
countries,
raising
the
possibility
of
dengue
transmission
Weekly
public
health
rapport,
1
October
2009
¤ Temperature
is
a
factor
in
dengue
transmission
in
urban
areas!
¤ Climate
change
projecKons
on
the
basis
of
humidity
for
2085
suggests
dengue
transmission
to
shiG
the
la)tudinal
and
al)tudinal
range.
¤ Climate
change
could
further
increase
the
length
of
the
transmission
season
in
endemic
loca)ons
¤ Increase
in
mean
temperature
could
result
in
seasonal
dengue
transmission
in
southern
Europe
if
principal
vector
A.
aegyp2
infected
with
the
virus
were
to
become
established.
¤
IncubaKon
period
2-­‐3
(–7)
days
¤
Symptoms
²
fever
up
to
39°C
²
spot
bleeding
and
rash
(arms
and
legs)
²
painful
joints
²
headache,
photophobia,
…
¤
Mostly
self-­‐limiKng,
someKmes
chronic
joint
pain
Aedes
aegyp2-­‐
en
Aedes
albopictus
mosquito
Andreas
Voss,
MD,
PhD
4

5. Climate
Change
and
ID
November
2012
¤ Vector
surveillance
in
the
vicinity
of
the
cases
¤
Three
genotypes:
West-­‐African,
Central-­‐East-­‐
idenKfied
large
numbers
of
Aedes
albopictus
African,
and
Asian
mosquitoes
in
traps
¤
UnKl
2007
only
in
tropical
countries
¤ IntroducKons
of
A
albopictus
and
Chikungunya
¤
Sporadic,
mostly
travel-­‐related
cases
(Central-­‐
virus
into
Italy
were
accidental
events
East-­‐African
type)
in
Europe
¤ SKll,
a
clima)c
model
predicts
establishment
of
¤
Augustus
2007,
Ravenna
Italy:
first
epidemic
in
A.
albopictus
in
Europe
with
main
variables
such
as
mild
winters,
mean
annual
rainfall
exceeding
Europe
50
cm,
and
mean
summer
temperatures
¤ In
2009
hundreds
of
cases
in
Italy
and
France
exceeding
20°C.
¤ Caused
by
Plasmodium
spp
transmiged
by
female
Anopheles
spp
mosquitoes.
¤ Historically
malaria
was
endemic
in
Europe,
including
Scandinavia,
but
it
was
eventually
eliminated
in
1975
through
a
number
of
factors
related
to
socio-­‐economic
development.
¤ Any
role
that
climate
played
in
malaria
reduc)on
would
have
been
small.
Nevertheless,
the
potenKal
for
malaria
transmission
is
intricately
connected
to
meteorological
condiKons
such
as
temperature
and
precipitaKon.
¤ Condi)ons
for
transmission
in
Europe
have
remained
favourable
as
documented
by
sporadic
autochthonous
transmission
of
a
tropical
malaria
strain
by
local
vectors
to
a
suscepKble
person.
¤ The
potenKal
for
malaria
and
other
tropical
diseases
to
¤ Thus,
while
climaKc
factors
may
favour
invade
southern
Europe
is
commonly
cited
as
an
example
autochthonous
transmission,
increased
vector
of
the
territorial
expansion
of
risk
due
to
climate
change
density,
and
accelerated
parasite
¤ Portugal
projected
an
increase
in
the
number
of
days
per
development,
...
year
suitable
for
malaria
transmission;
however,
transmission
would
depend
on
infected
vectors
being
present
¤ ...
other
factors
(socio-­‐economic,
building
codes,
¤ For
the
UK,
an
increase
in
risk
of
local
malaria
land
use,
treatment,
capacity
of
health-­‐care
transmission
based
on
changes
in
temperature
projected
system,
etc)
limit
the
likelyhood
of
climate-­‐
to
occur
by
2050
was
esKmated
to
be
8–14%,
but
malaria
related
re-­‐emergence
of
malaria
in
Europe
re-­‐establishment
is
highly
unlikely.
Andreas
Voss,
MD,
PhD
5

6. Climate
Change
and
ID
November
2012
¤ Protozoan
parasi)c
infecKon
caused
by
Leishmania
infantum
that
is
transmiged
to
human
beings
through
the
bite
of
an
infected
female
sandfly.
¤ Temperature
influences
the
biKng
acKvity
rates
of
the
vector,
and
maturaKon
of
the
protozoan
parasite
in
the
vector.
¤ Sandfly
distribuKon
in
Europe
is
south
of
la)tude
45°N
and
less
than
800
m
above
sea
level,
although
it
has
recently
shiGed
to
a
laKtude
of
49°N
45°
49°
¤ Historically,
sandflies
are
from
the
Mediterranean,
but
more
recently,
have
been
reported
in
northern
Germany.
¤ The
bi)ng
ac)vity
of
European
sandflies
is
strongly
seasonal,
and
in
most
areas
is
restricted
to
summer
months.
¤ Once
condiKons
make
transmission
suitable
in
northern
la)tudes,
imported
cases
could
act
as
sources
of
infecKons,
permiong
new
endemic
foci.
¤ Conversely,
if
climaKc
condiKons
become
too
hot
and
dry
for
vector
survival,
the
disease
may
disappear
in
the
South.
Andreas
Voss,
MD,
PhD
6

7. Climate
Change
and
ID
November
2012
¤ Arbovirus
infecKon,
transmiged
by
Kcks
(predominantly
Ixodes
ricinus)
that
act
both
as
vectors
and
as
reservoirs.
¤ Temperature
accelerates
the
Kcks’
developmental
cycle,
egg
producKon,
populaKon
density,
and
distribuKon.
¤ Climate
change
(increased
temperature)
already
led
to
changes
in
the
distribuKon
of
Ixodes
ricinus
populaKons
in
Europe,
expending
into
higher
Ixodes
ricinus
al)tudes
in
the
Czech
Republic
over
the
past
two
decades.
Endemic
in
27
European
countries
¤ In
Sweden,
since
the
late
1950s
all
cases
of
encephaliKs
admiged
in
Stockholm
County
have
been
serologically
tested
for
TBE.
¤ 1960–98
=
increase
in
TBE
incidence
since
the
mid-­‐1980s
related
to
milder
and
shorter
winters,
resulKng
in
longer
Kck-­‐acKvity
seasons.
¤ The
distribuKon-­‐limit
shired
to
higher
laKtude;
¤ DistribuKon
has
also
shired
in
Norway
and
Germany.
¤ ClimaKc
changes
alone
are
unlikely
to
explain
the
surge
in
TBE
incidence
over
the
past
three
decades,
...
¤ Poten)al
causal
pathways
include:
² changing
land-­‐use
pagerns
² increased
density
of
large
hosts
for
Kcks
(eg.
deer)
² habitat
expansion
of
rodent
hosts
² alteraKons
in
recreaKonal
and
occupaKonal
human
acKvity
(habitat
encroachment)
Andreas
Voss,
MD,
PhD
7

8. Climate
Change
and
ID
November
2012
¤ InfecKon
with
the
bacterial
spirochete
Borrelia
burgdorferi,
which
is
transmiged
to
human
beings
¤ A
shir
toward
milder
winter
temperatures
due
to
during
the
blood
feeding
of
hard
)cks
of
the
genus
climate
change
may
enable
expansion
of
Lyme
Ixodes.
borreliosis
into
higher
laKtudes
and
alKtudes,
but
¤ In
Europe,
the
primary
vector
is
I.
ricinus,
also
known
only
if
all
of
the
vertebrate
host
species
required
by
as
the
deer
)ck,
and
Ixodes
persulcatus
from
Estonia
to
far
eastern
Russia.
Kck
vectors
are
equally
able
to
shiG
their
populaKon
¤ Lyme
borreliosis
is
the
most
common
)ck-­‐borne
distribu)on.
disease
in
Europe
with
at
least
85
000
cases
yearly
¤ In
contrast,
droughts
and
severe
floods
will
¤ Increasing
incidence
in
several
European
countries
nega)vely
affect
the
distribuKon,
at
least
such
as
Finland,
Germany,
The
Netherlands,
Russia,
Scotland,
Slovenia,
Sweden
….
temporarily.
¤ Caused
by
an
RNA
virus
of
the
Bunyaviridae
family
and
transmiged
by
Hyalomma
spp
)cks
from
domesKc
and
wild
animals.
¤ Most
widespread
Kck-­‐borne
arbovirus
and
is
found
in
the
eastern
Mediterranean
where
there
have
been
a
series
of
outbreaks
in
Bulgaria
in
2002
and
2003,
and
in
Albania
and
Kosovo
in
2001.
¤ Milder
weather
condiKons,
favouring
Kck
reproducKon
may
influence
CCHF
distribuKon:
² outbreak
in
Turkey
was
linked
to
a
milder
spring
season
Andreas
Voss,
MD,
PhD
8

9. Climate
Change
and
ID
November
2012
¤ Rodents
can
act
as
both
intermediate
infected
hosts
and
as
hosts
for
arthropod
vectors
such
as
fleas
and
Kcks.
¤ Rodent
populaKons
are
affected
by
weather
condiKons.
In
parKcular,
warm,
wet
winters
and
springs
increase
rodent
popula)ons.
¤ Under
climate
change
scenarios,
rodent
populaKons
could
be
anKcipated
to
increase
in
temperate
zones,
resulKng
in
greater
interacKon
between
human
beings
and
rodents
and
a
higher
risk
of
disease
transmission,
especially
in
urban
areas.
¤ In
some
European
countries
breakdown
in
sanita)on
and
inadequate
hygiene
are
contribuKng
to
serious
rat
infestaKons.
¤ Plague
is
a
zoonosis
caused
by
the
bacterium
Yersinia
pes*s
that
is
spread
by
fleas
feeding
on
black
rats
(Ragus
ragus).
¤ Since
the
last
major
plague
outbreak
in
1720,
plague
is
no
longer
circulaKng
in
Europe—neither
in
human
beings
nor
in
rodent
populaKons.
¤ Milder
weather
condiKons
are
favourable
to
rodent
popula)ons,
while
harsh
weather
condiKons
such
as
heat
waves
might
drive
rodents
indoors
in
search
of
water
and
thus
increase
contact
with
human
beings.
¤ Central
Asia:
a
1°C
increase
in
spring
temperatures
could
result
in
a
50%
increase
in
Y.
pes*s
prevalence
in
its
reservoir
host.
Belgium
–
tree
seeds
¤ Hantaviruses
are
rodent-­‐borne
viruses
with
four
genotypes
circulaKng
in
Europe,
of
which
at
least
Puumala,
Dobrava,
and
Saaremaa
viruses
are
human
pathogens.
¤ Human
beings
are
at
risk
of
exposure
through
the
inhala)on
of
virus
aerosols
from
the
excreta
of
infected
rodents.
Andreas
Voss,
MD,
PhD
9

10. Climate
Change
and
ID
November
2012
¤ Excess
prolifera)on
of
rodent
popula)ons
related
to
climaKc
changes
is
of
considerable
internaKonal
public
health
concern.
¤ Hantavirus
infecKon
is
sensiKve
to
clima)c
condi)ons;
rat
populaKons
in
Belgium
are
linked
to
tree-­‐seed
producKon
that
in
turn
has
been
linked
to
high
summer
and
autumn
temperatures.
¤ It
is
anKcipated
that
general
warming
of
the
European
climate
will
increase
the
risk
of
infecKon.
¤ Increased
mean
temperature
of
water
bodies,
¤ altering
mean
meteorological
measures
but
also
by
increasing
the
frequency
of
extreme
which
can
be
favourable
for
micro-­‐organism
events
such
as
excessive
precipitaKon,
storm
reproducKon
cycles
and
algal
blooms.
surges,
floods,
and
droughts
¤ For
example,
Vibrio
spp
bacteria
indigenous
to
¤ two
major
exposure
pathways:
drinking
water
the
Bal)c
and
the
North
Sea,
have
displayed
and
recrea)onal
water
use.
increased
growth
rates
during
unusually
hot
summers
(eg,
2006)
and
infected
open
wounds
that
can
necroKse
and
cause
severe
sepsis.
¤ Water-­‐borne
outbreaks
have
the
potenKal
to
be
rather
large
and
of
mixed
aeKology,
but
the
actual
disease
¤ Extreme
precipitaKon
events
can
overwhelm
water
burden
in
Europe
is
difficult
to
approximate
and
most
treatment
plants
and
lead
to
cryptosporidium
likely
underesKmated.
outbreaks
due
to
oocysts
infiltraKng
drinking-­‐water
reservoirs
from
springs
and
lakes
¤ In
2006,
only
17
water-­‐borne
outbreaks
were
reported
by
five
countries.
¤ A
study
from
England
and
Wales
found
that
20%
of
¤ These
outbreaks
involved
3952
pa)ents,
of
whom
181
water-­‐borne
outbreaks
in
the
past
century
were
were
hospitalised,
afflicted
by
a
number
of
causaKve
associated
with
a
sustained
period
of
low
rainfall,
agents
including
campylobacter,
calicivirus,
giardia,
compared
with
10%
associated
with
heavy
rainfall.
and
cryptosporidium
Andreas
Voss,
MD,
PhD
10

11. Climate
Change
and
ID
November
2012
¤
storms
and
floods
can
cause
a
lot
of
other
trouble
resulKng
in
…
Displacement
of
rodents
!
Displacement
of
paKents
à
overcrowded
waiKng
room
at
“open”
hospitals
¤ The
epidemic
acKvity
of
RSV
infecKon
is
related
to
meteorological
condiKons
and
thus
to
laKtude:
persistently
high
temperature
and
humidity
results
in
epidemic
peaks
in
summer
and
early
autumn,
while
in
temperate
climates
RSV
infec)on
peaks
in
the
winter.
¤ ClimaKc
factors
such
as
absolute
humidity
have
been
associated
with
the
risk
of
lower
¤ A
causal
link
with
temperature
seems
inconsistent
respiratory
tract
infecKons.
based
on
these
climaKc
data,
but
the
RSV
infecKon
season
in
England
and
Wales
has
ended
earlier
and
its
dura)on
has
shortened
as
the
climate
has
become
warmer.
¤ Increased
use
of
cooling
towers
during
heat
waves
might
increase
the
risk
for
exposure
to
Legionella
spp
¤
Increased
use
of
whirlpools
in
The
Netherlands
...
Andreas
Voss,
MD,
PhD
11

12. Climate
Change
and
ID
November
2012
¤ ...
most
commonly
reported
GI
bacterial
disease,
¤ Higher
ambient
temperatures
increase
and
is
caused
by
thermophilic
Campylobacter
spp
bacteria.
replicaKon
cycles
of
food-­‐borne
pathogens,
and
prolonged
seasons
may
augment
the
¤ In
2007,
the
European
Union
incidence
was
45·∙2
cases
per
100
000
people
(200507
confirmed
cases)
opportunity
for
food
handling
mistakes
and
broiler
meat
and
fresh
poultry
meat
were
the
biggest
idenKfied
sources
of
infecKons.
¤ In
32%
of
invesKgated
food-­‐borne
outbreaks
¤ Colonisa)on
of
broiler-­‐chicken
flocks
with
in
Europe
“temperature
misuse”
is
considered
Campylobacter
increases
rapidly
with
rising
a
contribuKng
factor.
temperatures.
The
risk
of
campylobacteriosis
is
posi)vely
associated
with
mean
weekly
temperatures.
¤ The
second
largest
number
of
human
food-­‐ ¤ Higher
ambient
temperatures
have
been
associated
borne
diseases
is
caused
by
Salmonella
spp.
with
5–10%
higher
salmonellosis
noKficaKons
for
each
degree
increase
in
weekly
temperature,
for
¤ In
2007,
the
European
Union
incidence
was
ambient
temperatures
above
5°C.
31·∙1
cases
per
100
000
populaKon
(151995
confirmed
cases)
with
eggs
being
the
biggest
¤ Roughly
one-­‐third
of
the
transmission
of
contributors
to
these
outbreaks
followed
by
salmonellosis
(populaKon
agributable
fracKon)
in
fresh
poultry
and
pig
meat.
England
and
Wales,
Poland,
the
Netherlands,
the
Czech
Republic,
Switzerland,
and
Spain
can
be
agributed
to
temperature
influences.
E³
¤ Despite
a
considerable
body
of
research
on
ECDC has recognised the need to develop an
infrastructure coined the European
the
relaKon
between
climate
and
infecKous
Environment Epidemiology (E³) Network
diseases,
substan)al
informa)on
gaps
remain,
such
as
the
impact
of
climate
change
on
the
geographical
distribuKon
of
vectors,
vector–host
relaKonships,
new
or
re-­‐emerging
pathogens,
transmission
of
food-­‐borne
pathogens,
or
the
vulnerability
of
drinking
water
supplies.
Andreas
Voss,
MD,
PhD
12

13. Climate
Change
and
ID
November
2012
Dutch
North-­‐Sea
coast
2050?
Global
warming:
mistake
of
the
Royal
Dutch
June
25-­‐28,
2013
Meteorological
Ins)tute
Geneva
Switzerland
www.icpic2013.com
Andreas
Voss,
MD,
PhD
13

14. Climate
Change
and
ID
November
2012
“We
appreciate
you
reading
&
ciKng
ARIC
and
welcome
your
manuscripts”
Andreas
Voss,
MD,
PhD
14