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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

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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

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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

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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

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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

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“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