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When Neglected Tropical Diseases Knock on California's Door

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When Neglected Tropical Diseases Knock on California's Door When Neglected Tropical Diseases Knock on California’s Door Anne Kjemtrup, DVM, MPVM, PhD California Department of Public Health Vector-Borne Disease Section Overview of Today’s Topics • Neglected tropical diseases: setting the stage for impact on California • California Public Health Overview – Surveillance/response structure – Vector-Borne Disease program areas THE MONSTER RETURNS • Two examples: Peter McCarty – Arbovirus introduction (dengue, chikungunya, zika) – Re-emergence of Rocky Mountain spotted fever (not really NTD but similar principals) Neglected Tropical Diseases* • Buruli Ulcer • Leishmaniasis • Chagas disease • Leprosy (Hansen disease) • Dengue and Chikungunya • Lymphatic filariasis • Dracunculiasis (guinea • Onchocerciasis (river worm disease) blindness) • Echinococcosis • Mycetoma • Endemic treponematoses • Rabies (Yaws) • Schistosomiasis • Foodborne trematodiases • Soil-transmitted • Human African helminthiases trypanosomiasis (sleeping • Taeniasis/Cysticercosis sickness) • Trachoma * from: http://www.who.int/neglected_diseases/diseases/en/ Neglected Tropical Diseases • Buruli Ulcer • Leishmaniasis • Chagas disease • Leprosy (Hansen disease) • Dengue and Chikungunya • Lymphatic filariasis • Dracunculiasis (guinea • Mycetoma worm disease) • Onchocerciasis (river • Echinococcosis blindness) • Endemic treponematoses • Rabies (Yaws) • Schistosomiasis • Foodborne trematodiases • Soil-transmitted • Human African helminthiases trypanosomiasis (sleeping • Taeniasis/Cysticercosis sickness) • Trachoma California has vector and/or disease agent State Reportable Diseases California Department of Public Health l 81 human diseases or conditions (including all the national diseases), 2 animal diseases (rabies and plague) • Vector-Borne diseases include: • Anaplasma/Ehrlichiosis • Babesiosis • Colorado Tick Fever (to be removed next year) • Dengue • Hantavirus cardiopulmonary syndrome • Lyme Disease • Malaria • Plague (human or animal) • Relapsing fever • Rocky Mountain spotted fever • Tularemia • West Nile virus • Yellow Fever Intervention/Response Surveillance (Improved) diagnosis, treatment(s) recommendations hospital Notifiable/reportable Health care provider Public education General pop.:Symptomatic General pop.: (A)symptomatic infected Sero-surveillance, surveys Vaccination, General population: exposure Disease burden Disease prophylaxis Vector control Vector-surveillance Vector: presence/absence/abundance/distribution pathogen- pathogen control surveillance Risk Reservoir hosts: presence/absence/abundance/distribution Public Health Surveillance, 101 Adapted from Braks et al, Parasites and Vectors 2011, 4: 192 7 Notifiable Disease Surveillance: Route of Information Reporting mandated by state law (Title 17 CCR) Health care providers, laboratories, others, report to local health department (LHD) LHD submits reports to CDPH Reports transmitted to Centers for Disease Control and Prevention (CDC) Notifiable Disease Surveillance: Route of Information Reporting mandated by state law (Title 17 CCR) Reportable TBD include: anaplasmosis, babesiosis, Lyme disease, relapsing fever (B. hermsii), spotted fever and non-spotted fever group rickettsia Local health department (LHD) receives, follows-up, reviews reports LHD submits reports to CDPH Reports transmitted to Centers for Disease Control and Prevention (CDC) Vector-Borne Disease Section Primary Vector Programs • Mosquito • Flea • Rodent • Tick Information for Action Rodent Borne and Flea-Borne Disease Surveillance • CDPH’s program for plague, hantavirus includes: • investigations of human and domestic felid plague cases; investigation of human hantavirus cases • serologic monitoring of wild carnivores (plague) • evaluation of bacterial/virus activity in rodents: • Exposure potential to humans from vector fleas assessed • Past history of epizootics and/or human plague cases in the region reviewed • Recommendations and actions taken to reduce vectors and public exposure Tick Surveillance Mosquito Borne Disease Surveillance Mosquito-borne diseases often have complex lifecycles requiring complex surveillance West Nile virus transmission cycles in California Rural cycles Urban cycle ?? ?? Bird/Mosquito Culex Aedes, Culiseta Aedes, Culiseta Movement? pipiens stigmat. Culex tarsalis ?erythro. ?? Dead end hosts Mosquito-Borne Disease Surveillance Aedes albopictus and Aedes aegypti have arrived and become established in CA Aedes albopictus Asian tiger mosquito Aedes aegypti 2008: First introduced then Yellow fever mosquito eradicated 2013: Madera, Fresno, 2011: Los Angeles County San Mateo Counties Aedes modes of introduction into U.S. Lucky Bamboo (California) Imported used tires (Southeastern U.S.) Impact of invasive Aedes introduction to California • Vector: Dengue, chikungunya, Zika • Increased risk of introduction of exotic mosquito-borne viruses • Aggressive day-biting mosquitoes • Prefer to bite people (rather than birds or other animals) • Difficult to control: Breed in containers Aedes aegypti and Aedes albopictus Mosquitoes in California 125 cities/census designated places with Aedes aegypti and/or albopictus Aedes aegypti and Aedes albopictus Detection Sites by County/City Fresno Los Angeles (continued) Orange (continued) Clovis South Whittier* Mission Viejo Firebaugh Whittier Santa Ana Fowler Willowbrook* Buena Park Fresno Alhambra Garden Grove Kerman Altadena* Huntington Beach Mendota Arcadia Los Alamitos Sanger Avocado Heights* Mission Viejo Tranquillity* Azusa Newport Beach Imperial Baldwin Park Orange Andrade* Bradbury Santa Ana Brawley City of Industry Riverside Aedes aegypti Calexico Claremont Cathedral City El Centro Covina Coachella Heber* Duarte Corona Aedes albopictus Holtville El Monte East Hemet* Imperial Glendora Indio Seeley* Irwindale Palm Springs Kern La Cañada Flintridge Perris La Mirada Arvin Riverside La Puente McFarland San Jacinto La Verne Arvin Los Angeles San Bernardino Los Angeles Monrovia Colton Montclair Alhambra Monterey Park Upland San Mateo Avocado Heights* Pico Rivera Bell Rosemead San Diego Fresno Bellflower San Dimas Bonita* Bell Gardens San Gabriel Chula Vista Carson San Marino Coronado Cerritos Santa Fe Springs El Cajon Tulare Commerce Sierra Madre Escondido Cudahy South El Monte Imperial Beach Diamond Bar South Pasadena Lakeside* Downey South Whittier* La Mesa East Los Angeles* Temple City La Presa* Kern Florence-Graham* Walnut Lemon Grove San Bernardino Hacienda Heights* West Covina National City Hawaiian Gardens Whittier* Oceanside Huntington Park Madera San Diego La Mirada Santee Madera Los Angeles Spring Valley* Madera Ranchos* Los Angeles Maywood Parkwood* Tecate* Riverside Montebello Vista Orange Monterey Park Orange Carlsbad Imperial Paramount Anaheim San Diego Pico Rivera Buena Park ü Costa Mesa San Mateo San Diego Pomona Atherton Garden Grove Rosemead Menlo Park § New detection within the previous four weeks Orange Rowland Heights* Tulareü *Unincorporated Census-Designated Places Santa Fe Springs La Habra Exeter üNo Aedes detections in 2016 South Gate Lake Forest Climate Change and Invasive Aedes Mosquitoes in CA • Tropical species – Warm weather enhances survival, reproduction, and spread • Drought: unintended consequence – Residents store water in backyard buckets, containers, and rain barrels – Do not maintain swimming pools • Aedes establishment and spatial distribution may be enhanced due to climate change Local Mosquito Control Response Example Human Dengue, Chikungunya and Zika Surveillance in California Looking Beyond the Unfortunate Travel Souvenir Viruses and Transmission • Chikungunya is an alpha virus similar to WEE and Ross River virus • Dengue and Zika viruses are both flaviviruses similar to yellow fever and Japanese encephalitis virus • All are arboviruses and transmitted primarily human to human by Aedes aegypti and Ae. albopictus Dengue, Chikungunya, Zika mosquito transmission cycles Additional Modes of Zika Virus Transmission • Mosquito-borne • Congenital • Sexual • Care giving (rare) • Blood transfusion Geographic spread Dengue virus area of risk Spread of Chikungunya virus Arboviruses Ease of Introduction Chikungunya Virus • Alpha virus (WEE, Ross River) • First identified in the 1950s in East Africa • In urban epidemics, humans are the primary reservoir for chikungunya virus • Confirmed chikungunya cases First detection of local reported in the Americas by transmission in the PAHO 180,000 Americas, December 2013 160,000 140,000 120,000 • 2014-2016 PAHO reported 100,000 80,000 220,939 confirmed cases 60,000 40,000 across the Americas 20,000 0 2014 2015 2016 Dengue • Flavivirus (WNV, Yellow fever) • Dengue is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean • 2.5 Billion people live in areas with a risk of dengue transmission • The World Health Organization Confirmed dengue cases estimates 50 to 100 million reported in the Americas by PAHO infections annually 700,000 600,000 • 2014-2016 PAHO reported 500,000 400,000 300,000 >1.4 million confirmed cases 200,000 100,000 across the Americas 0 2014 2015 2016 California, USA Dengue and Chikungunya in California and Location of Invasive Aedes Aedes aegypti Aedes albopictus 2015-2016 travel associated human dengue and chikungunya cases No reported cases San Mateo 1-10 reported cases Madera 11-20 reported cases Fresno >21 reported cases Tulare Kern San Bernardino Los Angeles Riverside Orange San Diego Imperial Zika • Flavivirus (dengue, WNV, Yellow fever) • Historically limited to Africa and South East Asia – First
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