One Health for Emerging and Re-emerging Infectious Diseases in China

Jiahai Lu, Ph.D.

School of Public Health, Sun Yat-sen University, China

E-mail: lujiahai@mail.sysu.edu.cn

Infectious Diseases In China 1

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One Health In China

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LJH team’s work

Location: Center of Southern China

As the Frontier of Deng Xiaoping’s “Reform and Opening” policy, Guangdong has been well-developed since 1980s and now could be named as the center of Southern China for its booming economy.

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PART 1

Prominent Natural Characters

Subtropical climate

1) Average annual temperature 20～

22℃ (68～71.6 F).

2) Average relative humidity 77%.

Variety of mosquito vectors

Including Aedes, Culex, Anopheles.

Locates in the main migration routes of

migratory birds

The main migration routes of migratory birds in China

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PART 1

Prominent Social Characters

Immigration and floating population

The population in Guangdong province have reached to 108,490,000 in 2015, including non-resident populations(29.51%).

Open-mind food culture of Cantonese

Eat everything with legs except a table and everything with wings except an airplane”.

"Eating in Guangzhou" has become a popular saying both at home and abroad.

Highly diverse livestock and wildlife species

Livestock and wildlife transaction

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PART 1

Frequent outbreak of emerging infectious diseases

1978- 2002-2003

2005-2006

2009-2010

2013- 2015 2016-

SARS H5N1 New H1N1 H7N9 MERS ZIKA Dengue

Guangdong became vulnerable to emerging infectious diseases due to these social-natural

factors all this time.

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PART 1

Feng, et al. Tropical Medicine and International Health, 2009.

(1) SARS-CoV——first outbreak in Guangdong

1) First pandemic transmissible disease in Guangdong in 2002, and subsequently spread to other provinces and other countries.

2) 1504 SARS cases occurred in Guangdong, in which was one of the most severely affected area.

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PART 1

SARS-CoV——which was the origin

The ancestor of the civet and human strains seems to have been a bat virus.

Transmission path: infected bats and uninfected civets came into contact at a market, the virus was transmitted to civets and then multiplied and evolved in civets (or other animals) in the public market, until eventually the virus hopped to humans.

Lau, et al. PNAS, 2005; Li, et al. Science, 2005. 8

PART 1

(2) Neglected zoonosis - Brucellosis

• Brucellosis is a common bacterial zoonosis，which is usually epidemic in pastoral area.

• However, as an urbanized area，Guangdong has become an emerging foci for brucellosis in recent decade.

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PART 1

A “three-step reassortant” model of avian-origin H7N9 viruses, consist of H9N2, H7N3 and H7N9.

(3) H7N9 Virus ——emerging infectious disease

Wang, et al. Scientific Reports, 2013.

the origin of H7N9 virus

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PART 1

Spatial distribution of human infections with avian influenza A (H7N9) The largest number of human cases has been reported in eastern and southern China.

H7N9——geographic distribution in China

Li, et al. Scientific Reports, 2015. 15

PART 1

Zhang, et al. Infection, Genetics and Evolution, 2016.

The emergence of novel reassortants genotype virus H5N6 in humans in China

(4) H5N6 ——The another outbreak in China?

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PART 1

“1110” measures for avian influenza

• Administrative measures on management of poultry of Guangdong was implemented by Guangdong government in 15th Jan, 2015.

1: Cleaning and sterilizing once a day.

1: Cleaning up thoroughly once a week.

1: Closing the live poultry markets once a month.

0: Banning on live bird inventories overnight.

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PART 1

Effect of Closing market

The positive rates of AIV increased significantly since 2 days after market closure.

The positive rates of AIV in market environment increased shortly via introduction of type A AIV-positive poultry.

Failed to get the expected result.

*MC: market closure.

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PART 1

However, the “1110” measures were not effective enough.

why?

Consumers contact the live poultry directly(without mask or gloves), which increase the risk of infection.

Reason 1: Eating fresh chicken habits lead to exposure

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PART 1

Reason 2: Poor sanitation in stalls, cages and vehicles

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PART 1

• Poultry infected with H7N9 usually do not develop

clinical symptoms, different with H5N1, which

could be regarded as a situation of “carrier”.

• The different attitude for the control strategies of

H7N9 among public health department and

agriculture department (veterinary department).

• How do this virus transmit from animal or

environment to human is still unclear.

Healthy Non-carriers

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PART 1

The poultry traders against the “1110“measures.

Issues resulted from the mandatory closure measures

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PART 1

Infectious Diseases In China 1

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One Health In China

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LJH team’s work

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One Health Concept is needed

Collaborative, international, cross-sectoral, multidisciplinary mechanism to address threats and reduce risks of detrimental infectious diseases at the animal-human-environment interface。

• Human health • Animal Health • Environmental Health • Food Safety and Security • Agriculture

PART 2

Hendra virus control with One Health method in Queensland is one of the successful cases

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•It was reported that the outbreak of HeV infections

in Queensland in 1994

•The virus can transmitted as Bats-horses-humans

PART 2

One Health Research Center

One Health Research Center in SYSU was set up in 2014

PART 2

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First One Health international symposium in China PART 2

The training courses of One Health in China

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Participants were from CDC, university and veterinary departments in the course

Participants were master and PhD students from different universities

PART 2

• 13th Five Year Plan from NHFPC for emerging infectious diseases （2016-2020）

• Health and Family planning administrative departments at all levels coordinates agriculture, forestry and other department, employ and strengthen One Health concept to integrate into the relevant sectoral policies and planning on control measures of acute infectious diseases.

One Health Concept used by National Health and

Family Planning Commission (NHFPC)

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PART 2

Infectious Diseases In China 1

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3

One Health In China

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LJH team’s work

JHL team work

• SARS

• Avian influenza

• Dengue fever

• Rabies

• One Health

PART 3

(1) SARS related research

• In 2004, our team as a member of SARS research group whose research about Molecular evolution of the SARS coronavirus during the course of the SARS epidemic in China[J]. Science. 2004, 303(5664): 1666-1669.

PART 3

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The study is about SARS immune recognition mechanism

This result published in the journal of physiological Genomics, the results showed

that carbohydrate chip technology used to detect the SARS - CoV of serum

glycoprotein - resistant to serum salivary acid mucin (ASOR) reaction. This has brought

large social impact.

Glycomics research

Wang D, Lu J. Glycan arrays lead to the discovery of autoimmunogenic activity of SARS-CoV[J]. Physiol Genomics. 2004, 18(2): 245-248.

PART 3

(2) Avian Influenza research

1) The aerosol sampling methods can be used for monitoring of influenza A virus or other Airborne viruses.

2) Climate factors, farm work could increase the risk of occupational exposure to influenza virus among swine workers.

Anderson, et al. Journal of Infectious Diseases, 2016. 37

PART 3

Serological evidence and risk factors for swine influenza infections among swine workers

Ma, et al. PloS One, 2015.

Swine workers have a higher risk of infecting with swine influenza virus than the general population.

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PART 3

Find aerosolized H5N6 in live poultry market

First find and isolate H5N6 influenza virus by aerosol sampling method.

Wu, et al. Journal of Infection, 2016. 39

PART 3

Prediction of H7N9 epidemic in China PART 3

PART 3

Guzman M G, Harris E. Lancet 2015; 385: 453-465.

more than 128 countries in the tropic and sub-tropic areas, incidence has increased 30-fold in the past 50 years.

390 million people have dengue virus infections with 96 million cases annually.

(3) Dengue fever PART 3

Global dengue burden

The geographic distribution of dengue

Panel A: The distribution of dengue cases in 2013 (N = 4,779). Panel B: The distribution of dengue cases in 2014 (N = 47,056).

Lai S, et al. BMC Med 2015; 13: 100.

During 2005-2014, all 53,053 indigenous cases were limited to just seven provinces: Guangdong, Fujian, Yunnan,

Guangxi, Zhejiang, Hainan, Henan;

94.3% were reported in Guangdong from 2006 to 2014

PART 3

The outbreak of DF in China, 1990 - 2014

Lai S, et al. BMC Med 2015; 13: 100.

PART 3

Epidemic trends for dengue fever in China from 1990 to 2014

Early emergence: one month earlier than previous years

Long duration of epidemic period: lasted 193 days (11th Jun 2014 to 21st Dec 2014)

Speedy progress: After August, the number of reported cases raised rapidly. Between late September and late

November, the daily reported cases was around 1,000.

Large impact scope: Cases reported in all districts in Guangzhou

Lots of severe cases: 14,055 hospitalized and 5 deaths

High risk population: including elderly (above 60 years old) and floating population

The epidemic characteristics in Guangzhou in 2014

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PART 3

1. The research suggests high inapparent infection is the critical factor to improve the transmission of DF outbreak. 2. The occurrence of DF outbreak in Guangzhou may influence DF outbreak in Zhongshan due to human movement, climate factors, mosquitos.

1. Zhang YT, et al., PLoS Neglected Tropical Diseases, 2016； 2. Jing QL, Lu JH, et al., BMC infectious diseases, 2012; 3. Wang T, Lu JH, et al., PLoS Neglected Tropical Diseases, 2015.

PART 3

Figure 1 Figure 2

Figure Results of time-series classification and regression tree modeling the

relationship among mosquito density, diurnal temperature range and the time

interval between onset and diagnosis and monthly autochthonic DF incidence

rates during the period January 2001 and December 2013 in Zhongshan, China.

Guangdong province

Zhongshan

Figure 1 Location of Zhongshan, Guangdong, China.

The timeliness of diagnosis, mosquito density, diurnal temperature range played a key role in the epidemic of DF in Zhongshan, China.

Risk assessment of DF in Zhongshan, China: a time series regression tree analysis

Liu KK, et al. Epidemiology and Infection, 2016.

PART 3

Weekly distribution of DF cases and Baidu search query data in Guangzhou, 2010-2014.

Estimation and monitor of dengue fever epidemics using Baidu search query data

PART 3

The regression tree modeling the hierarchical relationship between weekly DF epidemic and Baidu search query data between 1 January 2010 and 31 December 2014 in Guangzhou and Zhongshan, China

Baidu search engine combining with the traditional diseases surveillance system may be considered for early prediction of DF in China; and may assess the effects of control of DF.

Liu KK, et al. Scientific report, 2016

PART 3

(4) Rabies research in China

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The distribution of rabies during 1960-2014 The epidemic of rabies during 1950-2015

PART 3

1.Si H, BMC Infectious Diseases , 2008. 2.Li GW, Emerging infectious diseases, 2014; 3. Li GW, Journal of Venomous Animals and Toxins including Tropical Diseases, 2015.

Human Rabies in Henan province（2010-2012）

Regional distribution of human rabies in the south of China from 2005 to 2013

Regional distribution of human rabies in Henan province,

2005 -2013

PART 3

(5) One Health approach for infectious diseases in the future responses

Lu J, Milinovich G, Hu W. One Health, 2016. 52

A brief historical overview of emerging infectious disease response in China and the need for

a One Health approach in future responses.

Retrospect of the different stages of the response for the emerging infectious diseases

control in China：

Passive response:

• based on social stability: SARS, avian influenza et, al emerging infectious diseases

• Preserving department benefit: Agriculture department, Health officials

Active response: The challenge and the prospect for infectious diseases prevention and control

PART 3

Monitoring the zoonosis of occupational population

cohort with One Health approach

• Establishing cohort of occupational populations at human-animal-environment interfaces, and find clues of EIDs outbreaks as well as early warning.

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Sun Yat-Sen University was founded by Dr. Sun Yat-Sen who was the first president and founding father of the Republic of China, which is located in Guangzhou, Guangdong, China.

Sun Yat-Sen University has developed into a modern comprehensive university.

including three campuses in the three cities of Guangzhou, Zhuhai and Shenzhen, and ten affiliated hospitals.

Sun Yat-Sen University

• The North Campus in Guangzhou is the medical campus

• School of Public Health consists of five departments:

• Preventive Medicine (Toxicology, Environment Health , Occupational Health)

• Nutrition

• Maternal and Child Health

• Health Service Management)

• Medical Statistics and Epidemiology (Dr. Lu)

• Health Inspection and Quarantine (Dr. Lu)

• One Health (Dr. Lu)

• Zhongshan Research Institute (Zhongshan CDC, Dr. Lu)

Thank You!