Ecotourism, Climate Change,
And Health: Connections to Consider Mary C. Pearl, Ph.D., President Wildlife Trust September 28, 2007
Š 2006 Wildlife Trust
Today’s Remarks
What drives disease emergence and movement?
How can we predict disease events to protect human health and livelihoods?
Characteristics of Healthy Ecosystems
Positive feedback to stresses, relatively rapid recoveries
Maximum biodiversity of native species, occupied trophic levels
Sustainable reproduction rates
Genetic diversity
Minimal disease
What is Going On?
Why are Humans and Animals Getting Sick More Often?
Health: Linked to Changes in the Environment
Habitat Deterioration
Biological Diversity Impoverishment
Global Toxification
Rapid Global Movement of People and Other Living Organisms Plus Urbanization
Climate Change
IPCC 2001scenarios to 2100 ----------------Æ
Observed Sea Ice September, 1979
September, 2003
Composite satellite reconstruction © NASA Source: ACIA, 2004 © NASA
Global Warming
The global average surface temperature has increased over the last century and will continue to rise.
Many areas have seen increases in rainfall. Floods will increase.
Frequency and intensity of droughts have increased. Drought risk will increase.
Episodes of El Nino have been more frequent, persistent and intense. El Nino trend may continue.
The Challenge: Mitigating the Health Impacts of a Rapidly Changing Environment
These issues work synergistically to diminish ecosystem function.
The result: “Ecological Stress Syndrome” unprecedented environmental changes, leading to health concerns.
Conservation Medicine
Conservation Medicine Â?
Takes one aspect of consequences of environmental crisis: Health Impacts
Â?
Focuses on assembling diagnostic and forecasting tools tracing New Health Risks
Emerging/Re-emerging Infectious Diseases 1996 - 2001 Multidrug-resistant Salmonella E. coli O157 BSE nvCJD
Cryptosporidiosis
Lyme borreliosis
E. coli non-O157 Typhoid
West Nile fever Legionellosis Lassa fever
Malaria West Nile fever
Echinococcosis
Yellow fever Venezuelan equine encephalitis
E. coli O157
Dengue haemhorragic fever
Rift Valley fever
Influenza A (H5N1) Nipah virus encephalitis Diphtheria
Cholera 0139 O’nyong-nyong fever Human monkeypox
Hantavirus pulmonary syndrome
Ebola haemhorragic fever
Hendra virus infection
Cholera
Cholera Legionellosis
n.b.:ž also found in other species
Source: WHO, 2001
Economic Impact of Some Emerging Infectious Diseases
Economic Impact (Billion $)
1000
BSE, UK (Mad cow) $11-13bn
100
Foot & Mouth, UK, $25bn Lyme disease USA, $16bn
Bird Flu, Asia, $130bn SARS $50bn
10
1
0.1 1990
Cholera, Peru $775m
West Nile virus, USA, $1.5bn
Foot & Mouth, Taiwan, $5bn Nipah virus, Malaysia $400m
1992
1994
1996
1998
2000
2002
2004
2006
HEALTH EFFECTS OF CLIMATE CHANGE
CLIMATE CHANGE Temperature Rise 1 Sea level Rise 2 Hydrologic Extremes 1 2
3°C by yr. 2100 40 cm “ “ IPCC estimates
Urban Heat Island Effect
Heat Stress Cardiorespiratory failure
Air Pollution & Aeroallergens
Respiratory diseases, e.g., COPD & Asthma
Vector-borne Diseases
Malaria Dengue Encephalitis Hantavirus Rift Valley Fever
Water-borne Diseases
Cholera Cyclospora Cryptosporidiosis Campylobacter Leptospirosis
Water resources & food supply Patz, 1998
Environmental Refugees
Malnutrition Diarrhea Toxic Red Tides Forced Migration Overcrowding Infectious diseases Human Conflicts
December 4, 2006 CDC:
Climate change a health threat
By Christine Dell'Amore UPI Consumer Health Correspondent The "rising scientific certainty" of climate change should mobilize environmental health professionals to take aggressive action, a Centers for Disease Control and Prevention director said at a meeting here Monday."Climate change is perhaps the largest looming public health challenge we face, certainly in the environmental health field," Dr. Howard Frumkin, director of the CDC's National Center for Environmental Health, told United Press International in an interview. In the past year, climate change has reached a tipping point, in which many of the climate change predictions have become alarming, said Frumkin, who spoke at the opening session of the 2006 National Environmental Public Health Conference in Atlanta.
European Heat Wave of 2003
Temperature
Â?
Â?
Warmer water affects diseases transmitted through water, such as cholera Warmer temperatures affect vector-carried diseases, such as mosquito-borne malaria, dengue, and west Nile virus
Extreme Weather:+600,000 deaths globally in the 1990s
Heavy rains Floods Hurricanes Cyclones
Air pollution health effects
Â?
Â?
Long term: asthma, lung disease, cancer Short term (3-4 days): stroke, heart attack
• “The severity and duration of summertime regional air pollution episodes are projected to increase in the Northeast and Midwest US by 2045-2052 due to climate-change-induced decreases in the frequency of surface cyclones.” (IPCC, 2007)
• By 2050, warming alone may increase by 68% the number of Red Ozone Alert days across the Eastern US. (IPCC, 2007 -Bell et al, 2006)
Water and Food-Borne Diseases
Â?
Â?
Cholera = flooding x temperature rise Increase in Diarrheal diseases
Wildlife-borne diseases
Basic Concepts in Emerging Infectious Diseases (EID)
Patterns for EID’s are complex
The concept of the microbe as the cause of the disease is incomplete and inadequate
Human caused environmental changes are the most potent factors driving disease emergence
Current climate change trends favor disease emergence
Case Studies on Two EID’s
Nipah Virus
West Nile virus
Nipah Virus
40% mortality in Malaysian outbreak Caught from pigs Origin in fruit bats
Nipah emergence
Nipah emergence
Nipah virus in Malaysia, 1997-1999 • Nearly
300 human cases
• > 1 million pigs culled • 800 pig-farms demolished • 36,000 jobs lost •> $300 (US) million exports lost
Nipah emergence= land use change + El Nino + drought + fire + bats + pigs + pig handlers
Disease: West Nile Virus
Emerged in New York 1999
Spread rapidly across U.S. over past 8 years
Now, most dominant vector-borne infectious disease in U.S.*
Lethal to birds, mammals and reptiles
Next stop? Hawaii, Galapagos Islands
* 940,000 infected people, 190,000 illnesses: Petersen & Hayes, NEJM 351:2257-9
Disease: West Nile Virus Final 1999 West Nile Virus Activity in the U.S.
Source: www.cdc.gov
Disease: West Nile Virus Final 2001 West Nile Virus Activity in the U.S.
Source: www.cdc.gov
Disease: West Nile Virus Final 2003 West Nile Virus Activity in the U.S.
Source: www.cdc.gov
Disease: West Nile Virus Final 2005 West Nile Virus Activity in the U.S.
Source: www.cdc.gov
Disease: West Nile Virus 2006 West Nile Virus Activity in the U.S.
Source: www.cdc.gov
Disease Cycle: West Nile Virus Birds:
Infectious period 7 days
Mosquitoes:
Infectious period 30 - 64 days
Risk to Humans: West Nile Virus
Probability or risk that a species of mosquito will infect a human with WNV can be estimated as:
Risk = A × Fm × P × Cv
A is the abundance
Fm is the fraction of blood meals taken from mammals
P is the WNV infection prevalence
Cv is an index of vector competence (fraction of infected mosquitoes that transmit virus in subsequent bite)
Kilpatrick et al., EID 11:3, 2005
Whodunit: West Nile Virus Which mosquito species threatens humans?
Ochlerotatus canadensis
Culex pipiens Ochlerotatus japonicus
Aedes vexans Culex salinarius
Risk to Humans: West Nile Virus Risk = Relative measure of WNV infectious bites on mammals
RISK (vector species) = A•P•Cv•Fm Abundance
Prevalence(MIR)
Vector competence
Fraction mammal
Ae de s
ve xa ns
Co q. pe rtu Cu rb le an x s pi pi en s/ re st ua ns Cu le x sa lin ar iu Cu s lis et a m el an ur a O c. ca na de ns is O c. ja po ni cu s O c. so lic ita ns O c. tri vit ta tu s
1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0
Data sources: A,P from NYSDOH, Rockland & Suffolk County DOH, Cv from Sardelis et al. 2001, Goddard et al. 2002, Turell et al. 2000,2001, Fm from Apperson et al. 2002, Ngo & Kramer 2003
0 trivittatus
Oc.
solicitans
Oc.
japonicus
Oc.
canadensis
Oc.
melanura
Culiseta
salinarius
Culex
Cx. restuans
Cx. pipiens +
perturbans
Coq.
vexans
Aedes
Percent of Total Risk
The Guilty Party: Culex pipiens! Risk of transmission to mammals in Northeast, U.S.
60
50
40
30
20
10
New Findings: West Nile Virus
Â?
“The strain of West Nile virus (WNV) that emerged for the first time in North America during the record hot July, 1999, requires warmer temperatures than other strains. The greatest WNV transmissions during the epidemic summers of 2002-2004 in the U.S. were linked to aboveaverage temperatures.� (Reisen et al. in press)
West Nile Virus = Rapid global travel + standing
water + warm temperatures + bird/human proximity
Global map of the point origin for every emerging infectious disease reported from 1940 to 2004
Global EID “Hot Spots”
Emerging Infectious Diseases (EID)
Climate/Ecological change
Human demographic & behavior shifts
International travel and commerce
Technology and industry
Microbial adaptation and change
Breakdown in public health measures
Global allocation of resources for study and reporting of infectious disease
Vector-borne disease “hotspot” map
Next Steps:
GRAZE
Global Rapid Assessment of Zoonotic Emergence
Ready teams of scientific professionals to: • Set up surveillance and reporting • Conduct research on risk assessment and
chains of causation
HEALTH EFFECTS OF CLIMATE CHANGE
CLIMATE CHANGE
Patz,
LOOK 1998AGAIN
Urban Heat Island Effect
Heat Stress Cardiorespiratory failure
Air Pollution & Aeroallergens
Respiratory diseases, e.g., COPD & Asthma
Vector-borne Diseases
Malaria Dengue Encephalitis Hantavirus Rift Valley Fever
Water-borne Diseases
Cholera Cyclospora Cryptosporidiosis Campylobacter Leptospirosis
Water resources & food supply Environmental Refugees
Malnutrition Diarrhea Toxic Red Tides Forced Migration Overcrowding Infectious diseases Human Conflicts
Mental, nutritional, and other health effects
Be aware of predictable risks, and fight to mitigate environment change, but… …in the end, ecotourism is one of the best things one can do for one’s health
The Built Environment: Transportation, Land Use, Community Design
Courtesy: H. Frumkin
Obesity Trends* Among U.S. Adults BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Bring the lessons of ecotourism home
Bicycle Commuting a “triple win” [Patz]
If Madison replaced 20% of car trips with bike trips, in one year: • •
10 lbs lost/person 12% drop in ozone
• 18,000 fewer lost work days • 1,900 fewer asthma admissions • 15,000 fewer acute respiratory cases • $40 million saved in health costs
Nearly 17,000 tons of CO2 NOT EMITTED!
And That Will be Good News for Nature and Our Common Health…and the Future of Ecotourism!
Wildlife Trust 460 West 34th Street - 17th Floor New York, New York 10001 (t) 212-380-4460
(f) 212-380-4465
marypearl@wildlifetrust.org
The Origins ofâ&#x20AC;Ś Avian Influenza H5N1
Goal: Estimate the relative risk of introduction of H5N1 into a country by each of 3 pathways retrospectively and prospectively
Methods Three pathways:
Live poultry Trade in wild birds Migratory birds – ducks, geese, and swans only (primary hosts for AI, especially H5, H7)
Risk for each pathway is quantified as: Infectious bird days = # birds * prevalence * days shedding
Methods: Poultry, Wild Bird Trade
Quantify trade from country A to country B based on reported imports and exports
Data from FAO
To minimize under reporting biases, we used the maximum of: • Country A reported imports from country B • Exports reported by country B to country A
Methods: Migratory Bird Migration Summer breeding areas Branta ruficollis, Red breasted goose
Wintering areas
Previous H5N1 outbreak areas
Data: # Birds
For each country A where H5N1 has been introduced: • Sum # of birds from all other countries that have
H5N1 at time of outbreak that will reach country A ▪ Poultry & Wild bird trade – exports into country A from countries with H5N1 ▪ Migratory birds – birds flying from or through H5N1 affected countries into or through country A
Data: Prevalence, Shedding
Prevalence (China, Hong Kong): • Poultry 512 / 51,121 • Migratory birds 6 / 4,674 (also 4 of 466 in Russia) • Wild bird trade 6 / 13,115
Shedding period • Poultry 2d ± sd = 1.0 • Migratory birds 6d ± 0.95 • Wild bird trade 3d ± 3
(Hulse-Post et al 2005 PNAS; Chen et al 2006 PNAS)
Kilpatrick et al. PNAS Dec 2006
Predicting future spread: Migratory birds
Conclusions 1.
Much of spread of H5N1 in Asia by poultry, spread to European countries by wild birds
2.
Highest risk of H5N1 introduction to the Americas is poultry, not from migratory birds
3.
Synergy between poultry and migratory bird pathways elevate risk to countries adjacent to poultry importers, including the USA
Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO as of 10 September 2007 2003
Country cases
2004
deaths
cases
deaths
2005 cases
deaths
2006 cases
2007
deaths
cases
Total
deaths
cases
deaths
Azerbaijan
0
0
0
0
0
0
8
5
0
0
8
5
Cambodia
0
0
0
0
4
4
2
2
1
1
7
7
China
1
1
0
0
8
5
13
8
3
2
25
16
Djibouti
0
0
0
0
0
0
1
0
0
0
1
0
Egypt
0
0
0
0
0
0
18
10
20
5
38
15
Indonesia
0
0
0
0
20
13
55
45
31
27
106
85
Iraq
0
0
0
0
0
0
3
2
0
0
3
2
Laos
0
0
0
0
0
0
0
0
2
2
2
2
Nigeria
0
0
0
0
0
0
0
0
1
1
1
1
Thailand
0
0
17
12
5
2
3
3
0
0
25
17
Turkey
0
0
0
0
0
0
12
4
0
0
12
4
Viet Nam
3
3
29
20
61
19
0
0
7
4
100
46
Total
4
4
46
32
98
43
115
79
65
42
328
200