Emerging infections and Health Protection In Scotland

Looking to the future

Kirsty Roy and Martin Donaghy

Health Protection Scotland

Scottish Government

19th October 2011, Edinburgh

UK definition

An emerging infectious disease can be either– a newly recognised infectious disease

or– a known disease

Whose reported incidence within the past 2

decades is increasing (or threatens to increase) in a specific place, or among a specific population

Human Animal Infections and Risk Surveillance (HAIRS) Group

Global map of emerging infections

Morgens et al Nature, 2005

The convergence model of emerging infectious diseases

• Human demographics, behaviour and vulnerability

• Technology and industry• Economic development, land

use, climate and changing ecosystems

• International travel and commerce

• Microbial adaptation and change

• Poverty, social inequality and breakdown of public health measures

• Intent to harm

(Factors contributing to emerging infections. IoM, 1992 and 2003)

Detection of emerging infections in the UK

Combination of • Detecting ‘unusual incidents’• Horizon scanning and surveillance. Detection of

incidents/events of potential threat to public health. Systematic review of informal and formal reports and maintenance of a log recording significant incidents which are then followed up

– National– Locally international (Europe)– International (Global)

National Expert Panel for New and Emerging Infections (NEPNEI)

Indentify key areas for action and to advise on priorities by

– Identifying emerging and potential infectious threats to public health both nationally and internationally

– Placing emerging infections to the wider clinical and public health contexts

– Advising on prevention and control measures– Prioritising areas for surveillance and for information– Advising on research, including technological

development needs

UK Horizon scanning for infectious diseasesHuman Animal Infections and Risk Surveillance (HAIRS)

Group

• Health Protection Agency• DEFRA• Veterinary Laboratory Agency• Department of Health• Chair of National Expert Panel on New and

Emerging Infections (NEPNEI)• Food Standards Agency• NPHS Wales• Health Protection Scotland

Horizon scanning and hazard identification

UK Foresight ‘Infectious Diseases: preparing for the future’

To use the best available science to evaluate the threats of infectious diseases In humans, animals and plants over the next 10-25 years; and to produce a vision for their management, specifically

through systems for detection, identification and monitoring.

Future disease risk

• New pathogen or novel variants of existing pathogens

• Pathogens acquiring resistance e.g. to microbicides

• Zoonosis

• HIV/AIDS, tuberculosis and malaria

• Epidemic plant disease

• Acute respiratory infections

• Sexually transmitted infections included HIV

• Transboundary animal diseases

Potential moderate and high risk factors influencing human disease risks, 2030, UK

UK Government’s Foresight project “Infectious Diseases: preparing for the future

Scottish drivers for emerging infectious disease

• More susceptible population – older population, increasing prevalence of chronic infection, greater use of high technology medicine

• Rural Scotland set to grow bigger • Scottish climate 2.5-3.5oC warmer by the turn of the century• Food production to decline (over-reliance on the international

market)• Increased air travel (predominantly through central belt

airports)• Bio- and nanotechnology industry increasing

Horizon scanning for Scotland’s Futures: The next 30 years (and beyond) (Scotland & N. Ireland Forum for Environmental Research, 2007)

Dealing with emerging infections

Be prepared develop and strengthen our capacity to detect and rapidly

respond to any kind of health threat

Detection, investigation and management

(DIM) systems

Dealing with emerging infections• Surveillance and response

detect, investigate and monitor unusual, unexpected, unexplained pathogens, the diseases they cause and the factors influencing their emergence and respond to problems as identified

• Applied researchdevelopment of predictive models based on epidemiological data, climate change surveillance and human behaviour

• Infrastructure and trainingstrengthen infrastructures to support surveillance, response and research and to implement prevention and control programs. Integrate laboratory and epidemiology to increase effectiveness of public health practice. Provide the work force with knowledge and tools it needs

• Prevention and controlEnsure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases

Role of Health Protection

• Establish systems for detecting unusual diseases and drug resistant agents (from medical intelligence, surveillance and other information sources)

• Assure laboratory capacity to investigate new agents and confirm known agents

• Promote national and international collaboration• Develop plans for handling clusters/outbreaks of

unknown agents (case reporting, investigation and appropriate follow-up)

• Education – physicians, public and policy makers• Promote a long term flexible approach