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International Society for Infectious Diseases (ISID): International Meeting on Emerging Infectious Diseases and Surveillance (IMED 2013)
Widespread infection outbreaks pose biggest detection challenge
VIENNA – Widespread foodborne infectious-disease outbreaks pose the greatest challenge for detection, according to an analysis of 101 U.S. outbreaks during 1998-2008.
Two U.S. Salmonella outbreaks took 492 days and 251 days to detect, respectively, by far the longest lag from onset to detection of any of the outbreaks analyzed, said Heather Allen, Ph.D., at the International Meeting on Emerging Diseases and Surveillance.
In contrast, the entire group of 101 human or animal outbreaks during 1998-2008 with data available for analysis took a median 13 days to detect, and a mean 32 days, with more than three quarters of the outbreaks detected within 50 days, reported Dr. Allen, a public health analyst with LMI, a consulting company in McLean, Va. The results Dr. Allen reported came from a study she ran before becoming an LMI employee.
Median time to detection among outbreaks that extended beyond a single U.S. region was 35 days, compared with medians of 8-11 days for outbreaks confined to a single U.S. region (Northeast, Midwest, South, or West).
In cases of widespread foodborne outbreaks, "the cases trickle in and take a while for the number to build to where it is detected," Dr. Allen said.
The slow lag to report some foodborne U.S. outbreaks occurred despite use of best practices in those episodes, including PulseNet, a network of public health and food regulatory labs coordinated by the Centers for Disease Control and Prevention that apply molecular fingerprinting to isolates of Escherichia coli, Salmonella, and other foodborne pathogens.
Factors that may decrease reporting of infections and delay outbreak detection include awareness of the need to report, how busy practitioners are, the ease of reporting, and privacy concerns of patients or animal owners. The delay between a positive infection result and reporting it to a state or federal agent can be significant, and results in large differences in response times, Dr. Allen said in an interview.
"All human disease reporting to the federal level is voluntary; reporting to the state is governed by state laws and regulations."
Published records from sources such as Morbidity and Mortality Weekly Report and ProMED-Mail included 440 outbreaks during 1998-2008; Dr. Allen had data for analysis from 101 of these outbreaks. About two-thirds were in people, 16% in domestic animals, and 18% in people and animals. Initial reporting of the outbreak by a laboratory happened in 46% of the episodes, practitioners gave the initial report for 34%, and state agencies first reported 20%. State agencies had the longest average delay, 29 days, compared with roughly 10 days when either practitioners or labs made the first report.
Dr. Allen had no disclosures.
On Twitter @mitchelzoler
Detecting infectious outbreaks worldwide has gotten faster, but does that make a difference for outcomes? Although it makes intuitive sense that faster is better, right now we lack evidence to prove that.
My associates and I reported results in 2010 showing that the time to detection of infection outbreaks had dropped worldwide during 1996-2008 (Proc. Nat. Acad. Sci. 2010;107:21701-6). We studied records for 281 outbreaks verified by the World Health Organization during that period, and found that the median time from outbreak start to discovery fell from 30 days in 1996 to 14 days in 2008. Dr. Allen’s results were consistent with ours, and I think this trend is very real. We are definitely getting faster in identifying and reporting outbreaks. Part of that is likely because of improved communications and automated communications.
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The problem with foodborne outbreaks is that often cases are not concentrated in one area, so you need to exceed the case threshold for the whole country before they are detected.
A big factor for outbreak detection is an astute primary-care physician who is on the lookout for an infection that doesn’t make sense. Something like severe respiratory illness in an otherwise healthy, young adult should raise a warning flag to call your local public health agency. Electronic reporting systems have been critical to reduced times for outbreak detection, but the best way to detect an outbreak is when someone recognizes something out of the ordinary, that doesn’t make sense.
Dr. Timothy F. Brewer is an infectious diseases physician and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles. He said that he had no disclosures. He made these comments in an interview.
Detecting infectious outbreaks worldwide has gotten faster, but does that make a difference for outcomes? Although it makes intuitive sense that faster is better, right now we lack evidence to prove that.
My associates and I reported results in 2010 showing that the time to detection of infection outbreaks had dropped worldwide during 1996-2008 (Proc. Nat. Acad. Sci. 2010;107:21701-6). We studied records for 281 outbreaks verified by the World Health Organization during that period, and found that the median time from outbreak start to discovery fell from 30 days in 1996 to 14 days in 2008. Dr. Allen’s results were consistent with ours, and I think this trend is very real. We are definitely getting faster in identifying and reporting outbreaks. Part of that is likely because of improved communications and automated communications.
|
|
The problem with foodborne outbreaks is that often cases are not concentrated in one area, so you need to exceed the case threshold for the whole country before they are detected.
A big factor for outbreak detection is an astute primary-care physician who is on the lookout for an infection that doesn’t make sense. Something like severe respiratory illness in an otherwise healthy, young adult should raise a warning flag to call your local public health agency. Electronic reporting systems have been critical to reduced times for outbreak detection, but the best way to detect an outbreak is when someone recognizes something out of the ordinary, that doesn’t make sense.
Dr. Timothy F. Brewer is an infectious diseases physician and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles. He said that he had no disclosures. He made these comments in an interview.
Detecting infectious outbreaks worldwide has gotten faster, but does that make a difference for outcomes? Although it makes intuitive sense that faster is better, right now we lack evidence to prove that.
My associates and I reported results in 2010 showing that the time to detection of infection outbreaks had dropped worldwide during 1996-2008 (Proc. Nat. Acad. Sci. 2010;107:21701-6). We studied records for 281 outbreaks verified by the World Health Organization during that period, and found that the median time from outbreak start to discovery fell from 30 days in 1996 to 14 days in 2008. Dr. Allen’s results were consistent with ours, and I think this trend is very real. We are definitely getting faster in identifying and reporting outbreaks. Part of that is likely because of improved communications and automated communications.
|
|
The problem with foodborne outbreaks is that often cases are not concentrated in one area, so you need to exceed the case threshold for the whole country before they are detected.
A big factor for outbreak detection is an astute primary-care physician who is on the lookout for an infection that doesn’t make sense. Something like severe respiratory illness in an otherwise healthy, young adult should raise a warning flag to call your local public health agency. Electronic reporting systems have been critical to reduced times for outbreak detection, but the best way to detect an outbreak is when someone recognizes something out of the ordinary, that doesn’t make sense.
Dr. Timothy F. Brewer is an infectious diseases physician and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles. He said that he had no disclosures. He made these comments in an interview.
VIENNA – Widespread foodborne infectious-disease outbreaks pose the greatest challenge for detection, according to an analysis of 101 U.S. outbreaks during 1998-2008.
Two U.S. Salmonella outbreaks took 492 days and 251 days to detect, respectively, by far the longest lag from onset to detection of any of the outbreaks analyzed, said Heather Allen, Ph.D., at the International Meeting on Emerging Diseases and Surveillance.
In contrast, the entire group of 101 human or animal outbreaks during 1998-2008 with data available for analysis took a median 13 days to detect, and a mean 32 days, with more than three quarters of the outbreaks detected within 50 days, reported Dr. Allen, a public health analyst with LMI, a consulting company in McLean, Va. The results Dr. Allen reported came from a study she ran before becoming an LMI employee.
Median time to detection among outbreaks that extended beyond a single U.S. region was 35 days, compared with medians of 8-11 days for outbreaks confined to a single U.S. region (Northeast, Midwest, South, or West).
In cases of widespread foodborne outbreaks, "the cases trickle in and take a while for the number to build to where it is detected," Dr. Allen said.
The slow lag to report some foodborne U.S. outbreaks occurred despite use of best practices in those episodes, including PulseNet, a network of public health and food regulatory labs coordinated by the Centers for Disease Control and Prevention that apply molecular fingerprinting to isolates of Escherichia coli, Salmonella, and other foodborne pathogens.
Factors that may decrease reporting of infections and delay outbreak detection include awareness of the need to report, how busy practitioners are, the ease of reporting, and privacy concerns of patients or animal owners. The delay between a positive infection result and reporting it to a state or federal agent can be significant, and results in large differences in response times, Dr. Allen said in an interview.
"All human disease reporting to the federal level is voluntary; reporting to the state is governed by state laws and regulations."
Published records from sources such as Morbidity and Mortality Weekly Report and ProMED-Mail included 440 outbreaks during 1998-2008; Dr. Allen had data for analysis from 101 of these outbreaks. About two-thirds were in people, 16% in domestic animals, and 18% in people and animals. Initial reporting of the outbreak by a laboratory happened in 46% of the episodes, practitioners gave the initial report for 34%, and state agencies first reported 20%. State agencies had the longest average delay, 29 days, compared with roughly 10 days when either practitioners or labs made the first report.
Dr. Allen had no disclosures.
On Twitter @mitchelzoler
VIENNA – Widespread foodborne infectious-disease outbreaks pose the greatest challenge for detection, according to an analysis of 101 U.S. outbreaks during 1998-2008.
Two U.S. Salmonella outbreaks took 492 days and 251 days to detect, respectively, by far the longest lag from onset to detection of any of the outbreaks analyzed, said Heather Allen, Ph.D., at the International Meeting on Emerging Diseases and Surveillance.
In contrast, the entire group of 101 human or animal outbreaks during 1998-2008 with data available for analysis took a median 13 days to detect, and a mean 32 days, with more than three quarters of the outbreaks detected within 50 days, reported Dr. Allen, a public health analyst with LMI, a consulting company in McLean, Va. The results Dr. Allen reported came from a study she ran before becoming an LMI employee.
Median time to detection among outbreaks that extended beyond a single U.S. region was 35 days, compared with medians of 8-11 days for outbreaks confined to a single U.S. region (Northeast, Midwest, South, or West).
In cases of widespread foodborne outbreaks, "the cases trickle in and take a while for the number to build to where it is detected," Dr. Allen said.
The slow lag to report some foodborne U.S. outbreaks occurred despite use of best practices in those episodes, including PulseNet, a network of public health and food regulatory labs coordinated by the Centers for Disease Control and Prevention that apply molecular fingerprinting to isolates of Escherichia coli, Salmonella, and other foodborne pathogens.
Factors that may decrease reporting of infections and delay outbreak detection include awareness of the need to report, how busy practitioners are, the ease of reporting, and privacy concerns of patients or animal owners. The delay between a positive infection result and reporting it to a state or federal agent can be significant, and results in large differences in response times, Dr. Allen said in an interview.
"All human disease reporting to the federal level is voluntary; reporting to the state is governed by state laws and regulations."
Published records from sources such as Morbidity and Mortality Weekly Report and ProMED-Mail included 440 outbreaks during 1998-2008; Dr. Allen had data for analysis from 101 of these outbreaks. About two-thirds were in people, 16% in domestic animals, and 18% in people and animals. Initial reporting of the outbreak by a laboratory happened in 46% of the episodes, practitioners gave the initial report for 34%, and state agencies first reported 20%. State agencies had the longest average delay, 29 days, compared with roughly 10 days when either practitioners or labs made the first report.
Dr. Allen had no disclosures.
On Twitter @mitchelzoler
AT IMED2013
Major finding: Infection outbreaks in multiple U.S. regions took a median 35 days to detect compared with about 10 days for localized outbreaks.
Data source: Data came from analysis of published reports on 101 U.S. infection outbreaks during 1998-2008.
Disclosures: Dr. Allen had no disclosures.
FluNearYou spearheads U.S. participatory surveillance growth
VIENNA – Look for promotion of FluNearYou, a new form of crowd-source epidemiology first rolled out to the general U.S. public last September and now up to 50,000 active participants, to intensify next summer, said one of the program’s designers.
"Now that we are confident that people are interested and stay in the system, we will have a massive campaign next flu season to really build it out and see how far we can take it in the United States," Dr. Mark Smolinski said at the International Meeting on Emerging Diseases and Surveillance. FluNearYou represents the first phase of what will likely be a series of participatory surveillance tools that allow the general public to submit real-time infection epidemiology data.
"We’re thinking about engaging the public directly for all emerging infectious diseases, expanding to include more symptoms and extend the geography," said Dr. Smolinski, director of global health threats for the Skoll Global Threats Fund in San Francisco.
People who sign up for FluNearYou, via the Internet or an app, receive a weekly query that asks them to submit whether they have, in the last week, had any of 10 influenzalike symptoms (the query also asks participants if they received their seasonal flu vaccine as a reminder to do so). The FluNearYou software then analyzes the symptom information to determine whether the participant likely has flu and then maps information on probable cases, providing participants as well as public health officials a real-time map of flu prevalence at any time.
The goal is to "reduce the lag in identifying outbreaks so that everyone has access to the information at the same time," said John Brownstein, Ph.D., an epidemiologist at Children’s Hospital in Boston who has led development of Health Map, a web-based tool for tracking the status of infectious diseases worldwide. In a separate talk at the meeting, Dr. Brownstein stressed that new methods of crowd-sourced epidemiology are seen as complements rather than replacements for traditional mechanisms of infectious disease surveillance.
"We hope to continue to move the time to identify infection outbreaks down further – fast enough so that we can eliminate the threat of pandemics spreading around the world," Dr. Smolinski said. FluNearYou came about when Dr. Smolinski and his associates decided to "just ask people directly whether they have flulike symptoms."
FluNearYou debuted in 2011 with pilot testing among members of the American Public Health Association, which resulted in about 8,000 participants by early last fall. Last September, Dr. Smolinski and his associates at Skoll began publicizing the program in the San Francisco area, primarily through advertisements on public transit vehicles, which produced about 50,000 active participants by early 2013. Nationwide publicity and enrollment is the next step, he said.
Crowd-sourced epidemiology programs for flu are now in place in Europe as Influenzanet and in Australia, and the goal is to eventually merge these systems and have them cover the entire globe, Dr. Smolinski said. He also noted that the Centers for Disease Control and Prevention has launched a pilot study with a modified version of FluNearYou, with queries for a few additional symptoms, in Puerto Rico as a way to distinguish and track cases of influenza, dengue, and leptospirosis.
FluNearYou is sponsored by the Skoll Global Threats Fund and the Skoll Foundation. Dr. Smolinski is an employee of the fund. Dr. Brownstein had no disclosures.
VIENNA – Look for promotion of FluNearYou, a new form of crowd-source epidemiology first rolled out to the general U.S. public last September and now up to 50,000 active participants, to intensify next summer, said one of the program’s designers.
"Now that we are confident that people are interested and stay in the system, we will have a massive campaign next flu season to really build it out and see how far we can take it in the United States," Dr. Mark Smolinski said at the International Meeting on Emerging Diseases and Surveillance. FluNearYou represents the first phase of what will likely be a series of participatory surveillance tools that allow the general public to submit real-time infection epidemiology data.
"We’re thinking about engaging the public directly for all emerging infectious diseases, expanding to include more symptoms and extend the geography," said Dr. Smolinski, director of global health threats for the Skoll Global Threats Fund in San Francisco.
People who sign up for FluNearYou, via the Internet or an app, receive a weekly query that asks them to submit whether they have, in the last week, had any of 10 influenzalike symptoms (the query also asks participants if they received their seasonal flu vaccine as a reminder to do so). The FluNearYou software then analyzes the symptom information to determine whether the participant likely has flu and then maps information on probable cases, providing participants as well as public health officials a real-time map of flu prevalence at any time.
The goal is to "reduce the lag in identifying outbreaks so that everyone has access to the information at the same time," said John Brownstein, Ph.D., an epidemiologist at Children’s Hospital in Boston who has led development of Health Map, a web-based tool for tracking the status of infectious diseases worldwide. In a separate talk at the meeting, Dr. Brownstein stressed that new methods of crowd-sourced epidemiology are seen as complements rather than replacements for traditional mechanisms of infectious disease surveillance.
"We hope to continue to move the time to identify infection outbreaks down further – fast enough so that we can eliminate the threat of pandemics spreading around the world," Dr. Smolinski said. FluNearYou came about when Dr. Smolinski and his associates decided to "just ask people directly whether they have flulike symptoms."
FluNearYou debuted in 2011 with pilot testing among members of the American Public Health Association, which resulted in about 8,000 participants by early last fall. Last September, Dr. Smolinski and his associates at Skoll began publicizing the program in the San Francisco area, primarily through advertisements on public transit vehicles, which produced about 50,000 active participants by early 2013. Nationwide publicity and enrollment is the next step, he said.
Crowd-sourced epidemiology programs for flu are now in place in Europe as Influenzanet and in Australia, and the goal is to eventually merge these systems and have them cover the entire globe, Dr. Smolinski said. He also noted that the Centers for Disease Control and Prevention has launched a pilot study with a modified version of FluNearYou, with queries for a few additional symptoms, in Puerto Rico as a way to distinguish and track cases of influenza, dengue, and leptospirosis.
FluNearYou is sponsored by the Skoll Global Threats Fund and the Skoll Foundation. Dr. Smolinski is an employee of the fund. Dr. Brownstein had no disclosures.
VIENNA – Look for promotion of FluNearYou, a new form of crowd-source epidemiology first rolled out to the general U.S. public last September and now up to 50,000 active participants, to intensify next summer, said one of the program’s designers.
"Now that we are confident that people are interested and stay in the system, we will have a massive campaign next flu season to really build it out and see how far we can take it in the United States," Dr. Mark Smolinski said at the International Meeting on Emerging Diseases and Surveillance. FluNearYou represents the first phase of what will likely be a series of participatory surveillance tools that allow the general public to submit real-time infection epidemiology data.
"We’re thinking about engaging the public directly for all emerging infectious diseases, expanding to include more symptoms and extend the geography," said Dr. Smolinski, director of global health threats for the Skoll Global Threats Fund in San Francisco.
People who sign up for FluNearYou, via the Internet or an app, receive a weekly query that asks them to submit whether they have, in the last week, had any of 10 influenzalike symptoms (the query also asks participants if they received their seasonal flu vaccine as a reminder to do so). The FluNearYou software then analyzes the symptom information to determine whether the participant likely has flu and then maps information on probable cases, providing participants as well as public health officials a real-time map of flu prevalence at any time.
The goal is to "reduce the lag in identifying outbreaks so that everyone has access to the information at the same time," said John Brownstein, Ph.D., an epidemiologist at Children’s Hospital in Boston who has led development of Health Map, a web-based tool for tracking the status of infectious diseases worldwide. In a separate talk at the meeting, Dr. Brownstein stressed that new methods of crowd-sourced epidemiology are seen as complements rather than replacements for traditional mechanisms of infectious disease surveillance.
"We hope to continue to move the time to identify infection outbreaks down further – fast enough so that we can eliminate the threat of pandemics spreading around the world," Dr. Smolinski said. FluNearYou came about when Dr. Smolinski and his associates decided to "just ask people directly whether they have flulike symptoms."
FluNearYou debuted in 2011 with pilot testing among members of the American Public Health Association, which resulted in about 8,000 participants by early last fall. Last September, Dr. Smolinski and his associates at Skoll began publicizing the program in the San Francisco area, primarily through advertisements on public transit vehicles, which produced about 50,000 active participants by early 2013. Nationwide publicity and enrollment is the next step, he said.
Crowd-sourced epidemiology programs for flu are now in place in Europe as Influenzanet and in Australia, and the goal is to eventually merge these systems and have them cover the entire globe, Dr. Smolinski said. He also noted that the Centers for Disease Control and Prevention has launched a pilot study with a modified version of FluNearYou, with queries for a few additional symptoms, in Puerto Rico as a way to distinguish and track cases of influenza, dengue, and leptospirosis.
FluNearYou is sponsored by the Skoll Global Threats Fund and the Skoll Foundation. Dr. Smolinski is an employee of the fund. Dr. Brownstein had no disclosures.
AT IMED 2013
Major Finding: By February 2013, FluNearYou had about 50,000 active participants, up from about 8,000 in September 2012.
Data Source: Data came from FluNearYou.
Disclosures: FluNearYou is sponsored by the Skoll Global Threats Fund and the Skoll Foundation. Dr. Smolinski is an employee of the Ffund. Dr. Brownstein had no disclosures.
'Contagion' movie built on the One Health message
The chilling final scene of the 2011 movie "Contagion" – which showed the birth of a deadly, worldwide pandemic when a presumably virus-laced morsel of food dropped from the claws of a jungle bat to a piglet that soon graced a Hong Kong restaurant table – won accolades for authenticity and accuracy at the International Meeting on Emerging Diseases and Surveillance in Vienna last month.
In fact, one of the meeting’s speakers, Dr. Mark Smolinski of the Skoll Global Threats Fund, revealed that he was a script consultant for the movie, and that an upfront goal of the film’s producers was to raise public awareness of how emerging infections can occur and the impact they can have.
"It’s an opportunity to use film to bring complicated issues to the general public," said Dr. Smolinski, director of global health for the fund in San Francisco.
A sister company of the Skoll Global Threats Fund is Participant Media, one of the producers of "Contagion." Participant usually releases documentary films, but in this case the "idea was to use a mainstream movie" to educate the public about pandemics and their causes, Dr. Smolinski said. "It emphasized the realities we have today, and a lot of the dialogue we have about One Health," the new paradigm that says animal health and the environment play key roles in determining human health.
"Contagion" began winning fans in the infectious diseases community when it opened 18 months ago. In a blog post, Dr. Larry Madoff, head epidemiologist for the Massachusetts Department of Health, said that in "Contagion," "the science is uncannily true, with rare exceptions. An epidemic like the one described in the film will almost certainly occur, though we can’t predict the details. The notion that an agent like Nipah virus, a pathogen shared by bats, pigs, and humans, and presumably the model for the virus in the movie, will break out of its niche and cause widespread disease is very believable." A not so-unlikely coincidence is that Dr. Madoff also was chairman of the program committee for the meeting last month on new infections where Dr. Smolinski spoke.
"We know that [the movie] has been used a lot for teaching students in various disciplines," Dr. Smolinski added. The movie’s famous last scene depicting the pandemic’s trigger portrays "One Health in one minute," he said.
–Mitchel Zoler
On Twitter @mitchelzoler
The chilling final scene of the 2011 movie "Contagion" – which showed the birth of a deadly, worldwide pandemic when a presumably virus-laced morsel of food dropped from the claws of a jungle bat to a piglet that soon graced a Hong Kong restaurant table – won accolades for authenticity and accuracy at the International Meeting on Emerging Diseases and Surveillance in Vienna last month.
In fact, one of the meeting’s speakers, Dr. Mark Smolinski of the Skoll Global Threats Fund, revealed that he was a script consultant for the movie, and that an upfront goal of the film’s producers was to raise public awareness of how emerging infections can occur and the impact they can have.
"It’s an opportunity to use film to bring complicated issues to the general public," said Dr. Smolinski, director of global health for the fund in San Francisco.
A sister company of the Skoll Global Threats Fund is Participant Media, one of the producers of "Contagion." Participant usually releases documentary films, but in this case the "idea was to use a mainstream movie" to educate the public about pandemics and their causes, Dr. Smolinski said. "It emphasized the realities we have today, and a lot of the dialogue we have about One Health," the new paradigm that says animal health and the environment play key roles in determining human health.
"Contagion" began winning fans in the infectious diseases community when it opened 18 months ago. In a blog post, Dr. Larry Madoff, head epidemiologist for the Massachusetts Department of Health, said that in "Contagion," "the science is uncannily true, with rare exceptions. An epidemic like the one described in the film will almost certainly occur, though we can’t predict the details. The notion that an agent like Nipah virus, a pathogen shared by bats, pigs, and humans, and presumably the model for the virus in the movie, will break out of its niche and cause widespread disease is very believable." A not so-unlikely coincidence is that Dr. Madoff also was chairman of the program committee for the meeting last month on new infections where Dr. Smolinski spoke.
"We know that [the movie] has been used a lot for teaching students in various disciplines," Dr. Smolinski added. The movie’s famous last scene depicting the pandemic’s trigger portrays "One Health in one minute," he said.
–Mitchel Zoler
On Twitter @mitchelzoler
The chilling final scene of the 2011 movie "Contagion" – which showed the birth of a deadly, worldwide pandemic when a presumably virus-laced morsel of food dropped from the claws of a jungle bat to a piglet that soon graced a Hong Kong restaurant table – won accolades for authenticity and accuracy at the International Meeting on Emerging Diseases and Surveillance in Vienna last month.
In fact, one of the meeting’s speakers, Dr. Mark Smolinski of the Skoll Global Threats Fund, revealed that he was a script consultant for the movie, and that an upfront goal of the film’s producers was to raise public awareness of how emerging infections can occur and the impact they can have.
"It’s an opportunity to use film to bring complicated issues to the general public," said Dr. Smolinski, director of global health for the fund in San Francisco.
A sister company of the Skoll Global Threats Fund is Participant Media, one of the producers of "Contagion." Participant usually releases documentary films, but in this case the "idea was to use a mainstream movie" to educate the public about pandemics and their causes, Dr. Smolinski said. "It emphasized the realities we have today, and a lot of the dialogue we have about One Health," the new paradigm that says animal health and the environment play key roles in determining human health.
"Contagion" began winning fans in the infectious diseases community when it opened 18 months ago. In a blog post, Dr. Larry Madoff, head epidemiologist for the Massachusetts Department of Health, said that in "Contagion," "the science is uncannily true, with rare exceptions. An epidemic like the one described in the film will almost certainly occur, though we can’t predict the details. The notion that an agent like Nipah virus, a pathogen shared by bats, pigs, and humans, and presumably the model for the virus in the movie, will break out of its niche and cause widespread disease is very believable." A not so-unlikely coincidence is that Dr. Madoff also was chairman of the program committee for the meeting last month on new infections where Dr. Smolinski spoke.
"We know that [the movie] has been used a lot for teaching students in various disciplines," Dr. Smolinski added. The movie’s famous last scene depicting the pandemic’s trigger portrays "One Health in one minute," he said.
–Mitchel Zoler
On Twitter @mitchelzoler
One Health Explores Animal to Human Spread of Disease
People don’t live in bubbles; people live on a planet teeming with animals and pathogens, a frothing soup that simmers or boils depending on how the environment fires the pot.
That’s an oversimplified – and overwrought – analogy, but the fact remains, people face infectious-disease risks from the living world around them. That’s the essence of the One Health concept, which is a way of thinking about how new human infections arise and spread.
One Health means that physicians "can’t just focus on people anymore" to understand human infections, Dr. Timothy Brewer told me when I spoke with him at the International Meeting on Emerging Diseases and Surveillance in Vienna.
"If my goal is to prevent infections in people, I have to think about other issues, and recognize the role of diseases in animals as a source of human disease. We all accept this concept today, but I don’t know whether people realize how novel this was 10 years ago," said Dr. Brewer, an infectious disease specialist and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles.
For example, the Centers for Disease Control and Prevention (CDC), and many state and local health departments, track West Nile virus cases in birds and horses. "That would not have happened 10 years ago," Dr. Brewer said. "Instead of waiting for human outbreaks, today we look at birds and other animals and think that maybe we can intervene before human cases occur. That’s a big shift."
He traces the concept of One Health to the 2003 outbreak of severe acute respiratory syndrome (SARS) that infected more than 8,000 people in 29 countries, with a 10% mortality rate during a roughly 1-year period. "SARS was a "wake-up call to public health agencies that we need to be aware of infections that can spread from animals to people," he said. The SARS pathogen turned out to be a bat-borne virus that first infected people via civet cats.
Another landmark was the creation of the One Health Initiative (www.onehealthinitiative.com) in 2008, after "One Health" was defined by a panel organized by the American Veterinary Medical Association and the CDC.
I also spoke at the meeting with Dr. Anne Schuchat, acting director of the CDC’s Center for Global Health, who recalled how West Nile virus was identified in 1999. "Someone at the Bronx Zoo noticed that many birds were dying," said Dr. Schuchat. The experience proved that "there are lots of ways to think about everyone being part of the same community."
Globalism is another facet of One Health. "We not only have to think about the environment and animals but also [about] public health in other countries," said Dr. Brewer. "The CDC’s job is to protect U.S. health, but to do that you need to deal with public health issues in other countries." He noted that the CDC now has about 300 employees staffed in some 60 countries to get a jump on new, suspicious infections regardless of where they first appear.
The growth of One Health has led to a heightened study of animals for the potential human pathogens they might carry, and surveillance of animals by groups like the CDC for the appearance of known pathogens, such as West Nile virus. Dr. Brewer predicted a future of heightened collaboration between physicians and veterinarians as they explore links between animal and human disease.
–By Mitchel L. Zoler
On Twitter @mitchelzoler
People don’t live in bubbles; people live on a planet teeming with animals and pathogens, a frothing soup that simmers or boils depending on how the environment fires the pot.
That’s an oversimplified – and overwrought – analogy, but the fact remains, people face infectious-disease risks from the living world around them. That’s the essence of the One Health concept, which is a way of thinking about how new human infections arise and spread.
One Health means that physicians "can’t just focus on people anymore" to understand human infections, Dr. Timothy Brewer told me when I spoke with him at the International Meeting on Emerging Diseases and Surveillance in Vienna.
"If my goal is to prevent infections in people, I have to think about other issues, and recognize the role of diseases in animals as a source of human disease. We all accept this concept today, but I don’t know whether people realize how novel this was 10 years ago," said Dr. Brewer, an infectious disease specialist and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles.
For example, the Centers for Disease Control and Prevention (CDC), and many state and local health departments, track West Nile virus cases in birds and horses. "That would not have happened 10 years ago," Dr. Brewer said. "Instead of waiting for human outbreaks, today we look at birds and other animals and think that maybe we can intervene before human cases occur. That’s a big shift."
He traces the concept of One Health to the 2003 outbreak of severe acute respiratory syndrome (SARS) that infected more than 8,000 people in 29 countries, with a 10% mortality rate during a roughly 1-year period. "SARS was a "wake-up call to public health agencies that we need to be aware of infections that can spread from animals to people," he said. The SARS pathogen turned out to be a bat-borne virus that first infected people via civet cats.
Another landmark was the creation of the One Health Initiative (www.onehealthinitiative.com) in 2008, after "One Health" was defined by a panel organized by the American Veterinary Medical Association and the CDC.
I also spoke at the meeting with Dr. Anne Schuchat, acting director of the CDC’s Center for Global Health, who recalled how West Nile virus was identified in 1999. "Someone at the Bronx Zoo noticed that many birds were dying," said Dr. Schuchat. The experience proved that "there are lots of ways to think about everyone being part of the same community."
Globalism is another facet of One Health. "We not only have to think about the environment and animals but also [about] public health in other countries," said Dr. Brewer. "The CDC’s job is to protect U.S. health, but to do that you need to deal with public health issues in other countries." He noted that the CDC now has about 300 employees staffed in some 60 countries to get a jump on new, suspicious infections regardless of where they first appear.
The growth of One Health has led to a heightened study of animals for the potential human pathogens they might carry, and surveillance of animals by groups like the CDC for the appearance of known pathogens, such as West Nile virus. Dr. Brewer predicted a future of heightened collaboration between physicians and veterinarians as they explore links between animal and human disease.
–By Mitchel L. Zoler
On Twitter @mitchelzoler
People don’t live in bubbles; people live on a planet teeming with animals and pathogens, a frothing soup that simmers or boils depending on how the environment fires the pot.
That’s an oversimplified – and overwrought – analogy, but the fact remains, people face infectious-disease risks from the living world around them. That’s the essence of the One Health concept, which is a way of thinking about how new human infections arise and spread.
One Health means that physicians "can’t just focus on people anymore" to understand human infections, Dr. Timothy Brewer told me when I spoke with him at the International Meeting on Emerging Diseases and Surveillance in Vienna.
"If my goal is to prevent infections in people, I have to think about other issues, and recognize the role of diseases in animals as a source of human disease. We all accept this concept today, but I don’t know whether people realize how novel this was 10 years ago," said Dr. Brewer, an infectious disease specialist and vice provost for interdisciplinary and cross-campus affairs at the University of California, Los Angeles.
For example, the Centers for Disease Control and Prevention (CDC), and many state and local health departments, track West Nile virus cases in birds and horses. "That would not have happened 10 years ago," Dr. Brewer said. "Instead of waiting for human outbreaks, today we look at birds and other animals and think that maybe we can intervene before human cases occur. That’s a big shift."
He traces the concept of One Health to the 2003 outbreak of severe acute respiratory syndrome (SARS) that infected more than 8,000 people in 29 countries, with a 10% mortality rate during a roughly 1-year period. "SARS was a "wake-up call to public health agencies that we need to be aware of infections that can spread from animals to people," he said. The SARS pathogen turned out to be a bat-borne virus that first infected people via civet cats.
Another landmark was the creation of the One Health Initiative (www.onehealthinitiative.com) in 2008, after "One Health" was defined by a panel organized by the American Veterinary Medical Association and the CDC.
I also spoke at the meeting with Dr. Anne Schuchat, acting director of the CDC’s Center for Global Health, who recalled how West Nile virus was identified in 1999. "Someone at the Bronx Zoo noticed that many birds were dying," said Dr. Schuchat. The experience proved that "there are lots of ways to think about everyone being part of the same community."
Globalism is another facet of One Health. "We not only have to think about the environment and animals but also [about] public health in other countries," said Dr. Brewer. "The CDC’s job is to protect U.S. health, but to do that you need to deal with public health issues in other countries." He noted that the CDC now has about 300 employees staffed in some 60 countries to get a jump on new, suspicious infections regardless of where they first appear.
The growth of One Health has led to a heightened study of animals for the potential human pathogens they might carry, and surveillance of animals by groups like the CDC for the appearance of known pathogens, such as West Nile virus. Dr. Brewer predicted a future of heightened collaboration between physicians and veterinarians as they explore links between animal and human disease.
–By Mitchel L. Zoler
On Twitter @mitchelzoler
New respiratory coronavirus shows concerning SARS echoes
The short-lived, worldwide epidemic of severe acute respiratory syndrome that began its streak across the globe 10 years ago, starting in February 2003, has been echoed over the past 8 months by what is so far a much more limited number of cases of a new, mysterious respiratory virus closely related to the SARS pathogen.
Mostly known so far as the "novel coronavirus" (NCoV), the new agent is very similar to the severe acute respiratory syndrome (SARS)-associated coronavirus, and by late February the new virus had been identified in 13 patients worldwide – in Saudi Arabia, Jordan, the United Kingdom, and Qatar – causing seven deaths and severe illness in five of the other six patients.
Since the World Health Organization (WHO) and other epidemiology groups first became aware of the NCoV last September, and as the number of identified cases has inched up, researchers have scrambled to gather information about the novel virus and heighten surveillance for new cases. SARS left a legacy of just over 8,000 probable cases in 29 countries, including 29 probable U.S. cases, with an overall fatality rate of 10%. After bursting on the scene in early 2003, SARS quickly flamed out, with the last handful of clinical cases ever seen identified in China in early 2004.
"It’s likely we will see more" of the NCoV. "We’ll need to cast a wide net since we now know there are a dozen cases and different clinical presentations," Dr. Larry Madoff said at the International Meeting on Emerging Diseases and Surveillance. Although almost every patient with confirmed NCoV infection has had severe illness, one U.K. patient who acquired the infection from another household member had a mild, flulike illness. The milder case "calls into question the [WHO] established case definition for this illness," said Dr. Madoff, director of epidemiology and immunization at the Massachusetts Department of Public Health in Boston and chairman of the meeting’s program committee.
In the days after Dr. Madoff made that assessment at the meeting, the WHO on Feb. 21 reported the 13th case, a patient in Saudi Arabia first hospitalized in late January who died in mid-February.
An effort to track down the origin of the NCoV led to the area surrounding the Saudi Arabian city of Bisha, home of the first identified Saudi case. Suspecting a bat origin for the virus because the SARS-associated virus had been identified as a bat virus (although initial human transmission came via a civet), and because the human isolates of the NCoV could infect several bat-cell lines in the lab, U.S. epidemiologist Jonathan Epstein, D.V.M., led a team that surveyed bats from the Bisha area last fall to see if they could find coronaviruses similar to NCoV. Researchers previously reported finding NCoV-like viruses in bats from other locations that are related to the bats that live in the Bisha area, Dr. Epstein said at the meeting.*
"Everywhere you look in bats there seem to be one or two new coronaviruses, but most bat coronaviruses are not SARS-like. The novel coronavirus is the second bat coronavirus in addition to the SARS virus to cause a human infection," said Dr. Epstein, vice president for conservation medicine at EcoHealth Alliance, an environmental medical research organization based in New York.
"Based on published evidence, there is close relatedness between the novel coronavirus and the SARS virus, but SARS uses a receptor that is deep in the respiratory tract. The novel virus uses a different receptor. It’s not clear whether the novel virus can infect mucosa or the upper respiratory tract, but if it could it might be more transmissible," Dr. Epstein said in an interview.
A report from a team of Swiss researchers published on Feb. 19 (subsequent to Dr. Epstein’s comments) reported that the NCoV (which the Swiss researchers call human coronavirus [HCoV]-EMC) grew very efficiently in vitro on human bronchial epithelial cells, and that interferon treatment cut replication of the virus in these cells (mBio 2013;4:e00611-2).
The episodes of human infection by the NCoV so far that seem to be geographically disparate also have a precedent with SARS.
The pattern of cases "suggests that the source of the infection is common or widespread," Dr. Epstein said. "It’s a challenge to identify common environmental features in the case histories of the infected patients. But with SARS there were multiple spill-over events in different regions of southeast China" when the SARS virus moved from civets into people.
"There clearly are many unknowns about the epidemiology" of the NCoV, Dr. Marjorie R. Pollack, a consultant medical epidemiologist based in New York, wrote in a recent comment on the new coronavirus (ProMed Mail, 2013;Archive Number: 20130221.1554109). "Genetic studies on this NCoV place it related to coronaviruses found in bats. But how did the jump from bats to humans occur? Is there an intermediate host animal?"
According to recent guidance from the WHO, member states should "continue their surveillance for severe acute respiratory infections and to carefully review any unusual patterns. Testing for the NCoV should be considered in patients with unexplained pneumonias or in patients with unexplained severe, progressive or complicated respiratory illness not responding to treatment, particularly in persons traveling from or resident in areas of the world known to be affected."
Dr. Madoff, Dr. Epstein, and Dr. Pollack had no disclosures.
On Twitter @mitchelzoler
*Correction, 3/1/2013: In an earlier version of this story, the findings regarding the Saudi Arabian bats sampled by Dr. Jonathan Epstein and his associates were misstated. Dr. Epstein and his colleagues led a team that surveyed bats from the Bisha area last fall. They have not yet reported their findings.
The short-lived, worldwide epidemic of severe acute respiratory syndrome that began its streak across the globe 10 years ago, starting in February 2003, has been echoed over the past 8 months by what is so far a much more limited number of cases of a new, mysterious respiratory virus closely related to the SARS pathogen.
Mostly known so far as the "novel coronavirus" (NCoV), the new agent is very similar to the severe acute respiratory syndrome (SARS)-associated coronavirus, and by late February the new virus had been identified in 13 patients worldwide – in Saudi Arabia, Jordan, the United Kingdom, and Qatar – causing seven deaths and severe illness in five of the other six patients.
Since the World Health Organization (WHO) and other epidemiology groups first became aware of the NCoV last September, and as the number of identified cases has inched up, researchers have scrambled to gather information about the novel virus and heighten surveillance for new cases. SARS left a legacy of just over 8,000 probable cases in 29 countries, including 29 probable U.S. cases, with an overall fatality rate of 10%. After bursting on the scene in early 2003, SARS quickly flamed out, with the last handful of clinical cases ever seen identified in China in early 2004.
"It’s likely we will see more" of the NCoV. "We’ll need to cast a wide net since we now know there are a dozen cases and different clinical presentations," Dr. Larry Madoff said at the International Meeting on Emerging Diseases and Surveillance. Although almost every patient with confirmed NCoV infection has had severe illness, one U.K. patient who acquired the infection from another household member had a mild, flulike illness. The milder case "calls into question the [WHO] established case definition for this illness," said Dr. Madoff, director of epidemiology and immunization at the Massachusetts Department of Public Health in Boston and chairman of the meeting’s program committee.
In the days after Dr. Madoff made that assessment at the meeting, the WHO on Feb. 21 reported the 13th case, a patient in Saudi Arabia first hospitalized in late January who died in mid-February.
An effort to track down the origin of the NCoV led to the area surrounding the Saudi Arabian city of Bisha, home of the first identified Saudi case. Suspecting a bat origin for the virus because the SARS-associated virus had been identified as a bat virus (although initial human transmission came via a civet), and because the human isolates of the NCoV could infect several bat-cell lines in the lab, U.S. epidemiologist Jonathan Epstein, D.V.M., led a team that surveyed bats from the Bisha area last fall to see if they could find coronaviruses similar to NCoV. Researchers previously reported finding NCoV-like viruses in bats from other locations that are related to the bats that live in the Bisha area, Dr. Epstein said at the meeting.*
"Everywhere you look in bats there seem to be one or two new coronaviruses, but most bat coronaviruses are not SARS-like. The novel coronavirus is the second bat coronavirus in addition to the SARS virus to cause a human infection," said Dr. Epstein, vice president for conservation medicine at EcoHealth Alliance, an environmental medical research organization based in New York.
"Based on published evidence, there is close relatedness between the novel coronavirus and the SARS virus, but SARS uses a receptor that is deep in the respiratory tract. The novel virus uses a different receptor. It’s not clear whether the novel virus can infect mucosa or the upper respiratory tract, but if it could it might be more transmissible," Dr. Epstein said in an interview.
A report from a team of Swiss researchers published on Feb. 19 (subsequent to Dr. Epstein’s comments) reported that the NCoV (which the Swiss researchers call human coronavirus [HCoV]-EMC) grew very efficiently in vitro on human bronchial epithelial cells, and that interferon treatment cut replication of the virus in these cells (mBio 2013;4:e00611-2).
The episodes of human infection by the NCoV so far that seem to be geographically disparate also have a precedent with SARS.
The pattern of cases "suggests that the source of the infection is common or widespread," Dr. Epstein said. "It’s a challenge to identify common environmental features in the case histories of the infected patients. But with SARS there were multiple spill-over events in different regions of southeast China" when the SARS virus moved from civets into people.
"There clearly are many unknowns about the epidemiology" of the NCoV, Dr. Marjorie R. Pollack, a consultant medical epidemiologist based in New York, wrote in a recent comment on the new coronavirus (ProMed Mail, 2013;Archive Number: 20130221.1554109). "Genetic studies on this NCoV place it related to coronaviruses found in bats. But how did the jump from bats to humans occur? Is there an intermediate host animal?"
According to recent guidance from the WHO, member states should "continue their surveillance for severe acute respiratory infections and to carefully review any unusual patterns. Testing for the NCoV should be considered in patients with unexplained pneumonias or in patients with unexplained severe, progressive or complicated respiratory illness not responding to treatment, particularly in persons traveling from or resident in areas of the world known to be affected."
Dr. Madoff, Dr. Epstein, and Dr. Pollack had no disclosures.
On Twitter @mitchelzoler
*Correction, 3/1/2013: In an earlier version of this story, the findings regarding the Saudi Arabian bats sampled by Dr. Jonathan Epstein and his associates were misstated. Dr. Epstein and his colleagues led a team that surveyed bats from the Bisha area last fall. They have not yet reported their findings.
The short-lived, worldwide epidemic of severe acute respiratory syndrome that began its streak across the globe 10 years ago, starting in February 2003, has been echoed over the past 8 months by what is so far a much more limited number of cases of a new, mysterious respiratory virus closely related to the SARS pathogen.
Mostly known so far as the "novel coronavirus" (NCoV), the new agent is very similar to the severe acute respiratory syndrome (SARS)-associated coronavirus, and by late February the new virus had been identified in 13 patients worldwide – in Saudi Arabia, Jordan, the United Kingdom, and Qatar – causing seven deaths and severe illness in five of the other six patients.
Since the World Health Organization (WHO) and other epidemiology groups first became aware of the NCoV last September, and as the number of identified cases has inched up, researchers have scrambled to gather information about the novel virus and heighten surveillance for new cases. SARS left a legacy of just over 8,000 probable cases in 29 countries, including 29 probable U.S. cases, with an overall fatality rate of 10%. After bursting on the scene in early 2003, SARS quickly flamed out, with the last handful of clinical cases ever seen identified in China in early 2004.
"It’s likely we will see more" of the NCoV. "We’ll need to cast a wide net since we now know there are a dozen cases and different clinical presentations," Dr. Larry Madoff said at the International Meeting on Emerging Diseases and Surveillance. Although almost every patient with confirmed NCoV infection has had severe illness, one U.K. patient who acquired the infection from another household member had a mild, flulike illness. The milder case "calls into question the [WHO] established case definition for this illness," said Dr. Madoff, director of epidemiology and immunization at the Massachusetts Department of Public Health in Boston and chairman of the meeting’s program committee.
In the days after Dr. Madoff made that assessment at the meeting, the WHO on Feb. 21 reported the 13th case, a patient in Saudi Arabia first hospitalized in late January who died in mid-February.
An effort to track down the origin of the NCoV led to the area surrounding the Saudi Arabian city of Bisha, home of the first identified Saudi case. Suspecting a bat origin for the virus because the SARS-associated virus had been identified as a bat virus (although initial human transmission came via a civet), and because the human isolates of the NCoV could infect several bat-cell lines in the lab, U.S. epidemiologist Jonathan Epstein, D.V.M., led a team that surveyed bats from the Bisha area last fall to see if they could find coronaviruses similar to NCoV. Researchers previously reported finding NCoV-like viruses in bats from other locations that are related to the bats that live in the Bisha area, Dr. Epstein said at the meeting.*
"Everywhere you look in bats there seem to be one or two new coronaviruses, but most bat coronaviruses are not SARS-like. The novel coronavirus is the second bat coronavirus in addition to the SARS virus to cause a human infection," said Dr. Epstein, vice president for conservation medicine at EcoHealth Alliance, an environmental medical research organization based in New York.
"Based on published evidence, there is close relatedness between the novel coronavirus and the SARS virus, but SARS uses a receptor that is deep in the respiratory tract. The novel virus uses a different receptor. It’s not clear whether the novel virus can infect mucosa or the upper respiratory tract, but if it could it might be more transmissible," Dr. Epstein said in an interview.
A report from a team of Swiss researchers published on Feb. 19 (subsequent to Dr. Epstein’s comments) reported that the NCoV (which the Swiss researchers call human coronavirus [HCoV]-EMC) grew very efficiently in vitro on human bronchial epithelial cells, and that interferon treatment cut replication of the virus in these cells (mBio 2013;4:e00611-2).
The episodes of human infection by the NCoV so far that seem to be geographically disparate also have a precedent with SARS.
The pattern of cases "suggests that the source of the infection is common or widespread," Dr. Epstein said. "It’s a challenge to identify common environmental features in the case histories of the infected patients. But with SARS there were multiple spill-over events in different regions of southeast China" when the SARS virus moved from civets into people.
"There clearly are many unknowns about the epidemiology" of the NCoV, Dr. Marjorie R. Pollack, a consultant medical epidemiologist based in New York, wrote in a recent comment on the new coronavirus (ProMed Mail, 2013;Archive Number: 20130221.1554109). "Genetic studies on this NCoV place it related to coronaviruses found in bats. But how did the jump from bats to humans occur? Is there an intermediate host animal?"
According to recent guidance from the WHO, member states should "continue their surveillance for severe acute respiratory infections and to carefully review any unusual patterns. Testing for the NCoV should be considered in patients with unexplained pneumonias or in patients with unexplained severe, progressive or complicated respiratory illness not responding to treatment, particularly in persons traveling from or resident in areas of the world known to be affected."
Dr. Madoff, Dr. Epstein, and Dr. Pollack had no disclosures.
On Twitter @mitchelzoler
*Correction, 3/1/2013: In an earlier version of this story, the findings regarding the Saudi Arabian bats sampled by Dr. Jonathan Epstein and his associates were misstated. Dr. Epstein and his colleagues led a team that surveyed bats from the Bisha area last fall. They have not yet reported their findings.
AT IMED2013
Major Finding: As of Feb. 21, 13 people had been identified as infected with a novel coronavrius since July 2012, with seven deaths.
Data Source: World Health Organization.
Disclosures: Dr. Madoff, Dr. Epstein, and Dr. Pollack had no disclosures.
Dengue surges worldwide, hits United States and Europe
VIENNA – Dengue infections surged to new worldwide highs last year, along with the first confirmed cases in Florida in more than 50 years, an ongoing outbreak on Europe’s doorstep on the island of Madeira, and a continued rise in cases elsewhere.
"The number of severe dengue cases [also known as dengue hemorrhagic fever] in the Americas skyrocketed in the past 2 years," in the context of more than 700,000 total cases in Brazil in 2012 and more than 40,000 total cases in Venezuela," Dr. Jaime R. Torres said at the International Meeting on Emerging Diseases and Surveillance.
Although Dr. Torres did not report the specific incidence of severe dengue cases last year, he said that in 2010, public health authorities in the Americas reported a total of roughly 50,000 cases of severe dengue, up from about 25,000 cases per year in 2007, 2008, and 2009, and up from a rate of 10,000 severe cases or less per year as recently as 2001, said Dr. Torres, director of the Tropical Medicine Institute of Caracas, Venezuela. Total dengue cases in the Americas in 2010 reached 1.6 million, according to the World Health Organization (WHO).
The pattern in the Americas dovetails with the worldwide experience, with more than 2.3 million officially reported cases in 2010, according to WHO. The actual number of worldwide cases per year likely ranges from 50 to 100 million, according to recent estimates from WHO.
Against this backdrop came three confirmed cases identified in the Miami area last November, the first confirmed cases in Florida in decades and a potential harbinger of more cases soon.
"Once you have the disease introduced and there is a stable population of the vector mosquito, there is the potential for domestic, person-to-person transmission," said infectious disease specialist Dr. Leo Liu in an interview at the meeting. "Dengue will occur wherever there is the vector," the Aedes mosquito. "It could have as much impact as West Nile virus. It causes a nasty flulike illness with headache and sometimes back or musculoskeletal pain," he said.
Although usually self-limiting in otherwise healthy adults, dengue can cause a more severe infection in elderly or immunocompromised people, or especially if someone becomes infected by a second dengue serotype following a first infection, said Dr. Liu, director of new initiatives for the International Society for Infectious Diseases in Brookline, Mass., the group that organized the meeting.
The dengue outbreak on the island of Madeira, located about 500 miles southwest of Lisbon, began last October and continues into 2013, another 2012 episode underscoring dengue’s spread.
By early February 2013, 2,164 dengue cases had been officially diagnosed in Madeira, Laurence Marrama, Ph.D., said at the meeting. Although the bulk of cases so far occurred last October and November, infections continued at a lower rate during subsequent weeks, with 28 cases reported in 2013 as of early February. The outbreak follows establishment of the Aedes aegypti mosquito on the island in 2005, and is the first sustained transmission in Europe since a 1920s outbreak.
"It is a huge concern" for the European Centre for Disease Control and Prevention, said Dr. Marrama, an epidemiologist with the organization. "Aedes is now very well established in Madeira," and movement of the mosquito and the virus to other parts of Europe is now very possible, she said in an interview.
The ECDC is developing recommendations on mosquito control to present to the Madeira government and the European Commission, she said. Last fall, the ECDC ran a campaign on the island to boost awareness of the dengue risk and to encourage protection against mosquitoes, and the agency also implemented blood-safety steps to curtail dengue transmission by blood products.
Dr. Torres, Dr. Liu, and Dr. Marrama had no disclosures.
On Twitter @mitchelzoler
VIENNA – Dengue infections surged to new worldwide highs last year, along with the first confirmed cases in Florida in more than 50 years, an ongoing outbreak on Europe’s doorstep on the island of Madeira, and a continued rise in cases elsewhere.
"The number of severe dengue cases [also known as dengue hemorrhagic fever] in the Americas skyrocketed in the past 2 years," in the context of more than 700,000 total cases in Brazil in 2012 and more than 40,000 total cases in Venezuela," Dr. Jaime R. Torres said at the International Meeting on Emerging Diseases and Surveillance.
Although Dr. Torres did not report the specific incidence of severe dengue cases last year, he said that in 2010, public health authorities in the Americas reported a total of roughly 50,000 cases of severe dengue, up from about 25,000 cases per year in 2007, 2008, and 2009, and up from a rate of 10,000 severe cases or less per year as recently as 2001, said Dr. Torres, director of the Tropical Medicine Institute of Caracas, Venezuela. Total dengue cases in the Americas in 2010 reached 1.6 million, according to the World Health Organization (WHO).
The pattern in the Americas dovetails with the worldwide experience, with more than 2.3 million officially reported cases in 2010, according to WHO. The actual number of worldwide cases per year likely ranges from 50 to 100 million, according to recent estimates from WHO.
Against this backdrop came three confirmed cases identified in the Miami area last November, the first confirmed cases in Florida in decades and a potential harbinger of more cases soon.
"Once you have the disease introduced and there is a stable population of the vector mosquito, there is the potential for domestic, person-to-person transmission," said infectious disease specialist Dr. Leo Liu in an interview at the meeting. "Dengue will occur wherever there is the vector," the Aedes mosquito. "It could have as much impact as West Nile virus. It causes a nasty flulike illness with headache and sometimes back or musculoskeletal pain," he said.
Although usually self-limiting in otherwise healthy adults, dengue can cause a more severe infection in elderly or immunocompromised people, or especially if someone becomes infected by a second dengue serotype following a first infection, said Dr. Liu, director of new initiatives for the International Society for Infectious Diseases in Brookline, Mass., the group that organized the meeting.
The dengue outbreak on the island of Madeira, located about 500 miles southwest of Lisbon, began last October and continues into 2013, another 2012 episode underscoring dengue’s spread.
By early February 2013, 2,164 dengue cases had been officially diagnosed in Madeira, Laurence Marrama, Ph.D., said at the meeting. Although the bulk of cases so far occurred last October and November, infections continued at a lower rate during subsequent weeks, with 28 cases reported in 2013 as of early February. The outbreak follows establishment of the Aedes aegypti mosquito on the island in 2005, and is the first sustained transmission in Europe since a 1920s outbreak.
"It is a huge concern" for the European Centre for Disease Control and Prevention, said Dr. Marrama, an epidemiologist with the organization. "Aedes is now very well established in Madeira," and movement of the mosquito and the virus to other parts of Europe is now very possible, she said in an interview.
The ECDC is developing recommendations on mosquito control to present to the Madeira government and the European Commission, she said. Last fall, the ECDC ran a campaign on the island to boost awareness of the dengue risk and to encourage protection against mosquitoes, and the agency also implemented blood-safety steps to curtail dengue transmission by blood products.
Dr. Torres, Dr. Liu, and Dr. Marrama had no disclosures.
On Twitter @mitchelzoler
VIENNA – Dengue infections surged to new worldwide highs last year, along with the first confirmed cases in Florida in more than 50 years, an ongoing outbreak on Europe’s doorstep on the island of Madeira, and a continued rise in cases elsewhere.
"The number of severe dengue cases [also known as dengue hemorrhagic fever] in the Americas skyrocketed in the past 2 years," in the context of more than 700,000 total cases in Brazil in 2012 and more than 40,000 total cases in Venezuela," Dr. Jaime R. Torres said at the International Meeting on Emerging Diseases and Surveillance.
Although Dr. Torres did not report the specific incidence of severe dengue cases last year, he said that in 2010, public health authorities in the Americas reported a total of roughly 50,000 cases of severe dengue, up from about 25,000 cases per year in 2007, 2008, and 2009, and up from a rate of 10,000 severe cases or less per year as recently as 2001, said Dr. Torres, director of the Tropical Medicine Institute of Caracas, Venezuela. Total dengue cases in the Americas in 2010 reached 1.6 million, according to the World Health Organization (WHO).
The pattern in the Americas dovetails with the worldwide experience, with more than 2.3 million officially reported cases in 2010, according to WHO. The actual number of worldwide cases per year likely ranges from 50 to 100 million, according to recent estimates from WHO.
Against this backdrop came three confirmed cases identified in the Miami area last November, the first confirmed cases in Florida in decades and a potential harbinger of more cases soon.
"Once you have the disease introduced and there is a stable population of the vector mosquito, there is the potential for domestic, person-to-person transmission," said infectious disease specialist Dr. Leo Liu in an interview at the meeting. "Dengue will occur wherever there is the vector," the Aedes mosquito. "It could have as much impact as West Nile virus. It causes a nasty flulike illness with headache and sometimes back or musculoskeletal pain," he said.
Although usually self-limiting in otherwise healthy adults, dengue can cause a more severe infection in elderly or immunocompromised people, or especially if someone becomes infected by a second dengue serotype following a first infection, said Dr. Liu, director of new initiatives for the International Society for Infectious Diseases in Brookline, Mass., the group that organized the meeting.
The dengue outbreak on the island of Madeira, located about 500 miles southwest of Lisbon, began last October and continues into 2013, another 2012 episode underscoring dengue’s spread.
By early February 2013, 2,164 dengue cases had been officially diagnosed in Madeira, Laurence Marrama, Ph.D., said at the meeting. Although the bulk of cases so far occurred last October and November, infections continued at a lower rate during subsequent weeks, with 28 cases reported in 2013 as of early February. The outbreak follows establishment of the Aedes aegypti mosquito on the island in 2005, and is the first sustained transmission in Europe since a 1920s outbreak.
"It is a huge concern" for the European Centre for Disease Control and Prevention, said Dr. Marrama, an epidemiologist with the organization. "Aedes is now very well established in Madeira," and movement of the mosquito and the virus to other parts of Europe is now very possible, she said in an interview.
The ECDC is developing recommendations on mosquito control to present to the Madeira government and the European Commission, she said. Last fall, the ECDC ran a campaign on the island to boost awareness of the dengue risk and to encourage protection against mosquitoes, and the agency also implemented blood-safety steps to curtail dengue transmission by blood products.
Dr. Torres, Dr. Liu, and Dr. Marrama had no disclosures.
On Twitter @mitchelzoler
AT IMED2013
Major finding: About 50,000 people developed severe dengue in the Americas in 2010, the highest rate ever and double the rate in 2009.
Data source: Data came from the World Health Organization.
Disclosures: Dr. Torres, Dr. Liu, and Dr. Marrama had no disclosures.
