Climate, Infectious Disease and Human Health in an Era of Climate Change

Science Diplomacy 2015: Scientific Drivers for Diplomacy

Earth and Environmental Sciences Session

April 29, 2015

Rita R. Colwell, Ph.D., D.Sc. Distinguished University Professor University of Maryland College Park and Johns Hopkins University Bloomberg School of Public Health

Water-related diseases Cases per year Deaths per year

Amoebiasis 48,000,000 110,000

Arsenic 28-35m exposed to drinking

water with elevated levels Diarrhoeal disease, 1.5 billion 1,800,000 Including cholera

Dracunuliasis (guinea worm) > 5000 -

Fluorosis 26 million (China) -

Giardiasis 500,000 Low

Hepatitis A 1,500,00 -

Intestinal helminths 133,000,000 9400

Malaria 396,000,000 1,300,000

Schistosomiasis 160,000,000 > 10,000

Trachoma 500,000,000 -

Typhoid 500,000 25,000

West Virginia University Civil and Environmental Engineering G. Constantin de Magny

What is reported about cholera and macro-scale processes?

Cholera outbreaks have been linked to environmental and climate variables precipitation (Hashizume et al. 2008) floods (Koelle et al., 2005) river level (Emch et al., 2008) sea surface temperature (Colwell, 1996; Lobitz et al., 2000) coastal salinity (Miller et al., 1982) dissolved organic material (Worden et al., 2005) fecal contamination (Islam et al., 2006) chlorophyll (Lobitz et al., 2000, Magny et al., 2008)

Environmental Signatures Related To Cholera Epidemics

Dan Zimble, ESRI Inc. Cholera and SST in the Indian Ocean Six-month SST lead: R2 = 0.72

R2

0 0.6+ Environmental Signatures Related To Cholera Epidemics KOLKATA

MATLAB

Fitted model Cross-validation model Constantin de Magny et al., 2008, PNAS Results Kolkata: Significant and positive relationship between cholera and CHL(t) and Rain(t). Matlab: Significant and positive relationship between cholera and Chl(t-1).

KOLKATA MATLAB +1 mg.m-3 in CHL(t) => +32.5% in number +1 mg.m-3 in CHL(t-1) => +31.4% in of cholera cases (95% CI 8.3%-62.0%) number of cholera cases (95% CI 13.0%- +1 mm.day-1 in Rain(t) => +6.5% in number 52.7%) of cholera cases (95% CI 1.6%-11.7%)

Constantin de Magny et al., 2008, PNAS

Location of areas in the Indus River Basin where cholera outbreaks were reported from 1875-1900.

Relationship between cholera outbreaks and air temperatures Theoretical framework for predicting cholera outbreaks in epidemic regions

Air Temperature Rainfall

Below average for Below average two previous months

Above average for two previous Above average months

Air

High Risk Poor or Damaged

Available Low Risk and intact

Cholera Outbreak Water and Sanitation Access

West Virginia University Civil and Environmental Engineering Could we have predicted the Haiti Cholera outbreak?

. Recent cholera outbreak in Haiti indicated the disease remains a global threat.

. Framework for developing cholera prediction models in cholera endemic (ER) and non-endemic regions (NER)

. The sharp contrast in mortality rates between ER and NER exists not because we do not know how to treat cholera patients, but because of a persistent “knowledge barrier” between ER and NER.

. We propose a pragmatic and adaptive framework which hypothesizes that convergence of three enabling situations - Inception, Environmental Conditions, and Transmission - are necessary for a cholera outbreak to become an epidemic.

Antarpreet Jutla, Elizabeth Whitcombe, Nur Hasan, Bradd Haley, Ali Akanda, Anwar Huq, Munir Alam, R. Bradley Sack and Rita Colwell. 2013. Environmental factors influencing epidemic cholera. Amer J Trop Med Hyg 89(3) 597-607 Source and Distribution of isolates collected from Haitian outbreak

Chansolmes

Bassin Bleu

Gonaives Patient Town Arrondissement Department Grande Saline Dessalines Artibonite Gonaïves Gonaïves Artibonite Grande Saline Saint-Marc Saint-Marc Artibonite Drouin Drouin Saint-Marc Artibonite Chansolmes Port-de-Paix Nord-Ouest Saint-Marc Bassin Bleu Port-de-Paix Nord-Ouest Cange Arcahaie Arcahaie Ouest Cabaret Arcahaie Ouest Montrouis Croix-des-Bouquets Croix-des-Bouquets Ouest Presumed location of En Plein Gonaïves Ouest Arcahaie original contamination Plaine Gonaïves Ouest Carbaret Léogâne Léogâne Ouest Tabarre Tabarre Port-au-Prince Ouest Cite Soleil Port-au-Prince Port-au-Prince Ouest Port-au-Prince Delmas Delmas Port-au-Prince Ouest Léogâne En Plein Petion Ville Cite Soleil Port-au-Prince Ouest Petion Ville Port-au-Prince Ouest Croix-des- Bouquets Montrouis Ouest Jacmel 18 8 3 Air temperature in Haiti in 2010 compared Monthly rainfall in Haiti in 2010 compared with historical air temperature data with historical rainfall data HC41A1 The Haitian V. cholerae O1 strains clustered HC7A1 th (c) HC80A1 with other 7 pandemic V. cholerae strains 7th pandemic (c) in a single monophyletic clade HC43A1 NCTC8457 HC23A1 BX330286 HC06A1 (a) M66-2 (b) HC46A1 MAK757 HC17A2 HC-51A1 HC22A1 2740-80 HC-02C1 Haitian strains HC32A1 HC-1A2 V52 branching HC68A1 HC-2A1 O395 HCUF01 HC-36A1 separately from RC27 HC48A1 Haiti, HC-50A1 South Asian V. HC20A2 LMA3984-4 HC-55B2 2010 cholerae strains HC61A1 12129(1) HC-55C2 2010-EL1786 MZO-3 HC-57A1 2010-EL1792 AM-19226 HC-59A1 HC38A1 HE-25 HC-59B1 HC49A2 HC-60A1 TMA21 HC21A1 HC-61A2 HFU02 623-39 HC-78A1 2010-EL1798 1587 HC-56A1 HC40A1 MZO-2 HC-52A1 HC70A1 HE-40 HC-55A1 HC81A1 HC42A1 HE-46 0.0000005 HC57A2 HE-39 Phylogenomics HC47A1 HE-48 HC-44C1 CP1038Zimbabwe, 2009 HC-46B1 CP1048 HC-43B1 HC-1 CP1050Bangladesh, 2010 HC-41B1 HE-45 CIRS 101Bangladesh, 2002 Amazonia

TM11079-80 CP1042 Thailand, 2010 CP1040 HC-2 (b) CP1041 Zambia, 2004 V51 MO10 CT5369-93 MJ-1236 B33 RC385 CP1032 Mexico, 1991 VL426 CP1033 Mexico, 2000 HE-09 RC9 0.00002 HE-16 INDRE 91/1 N16961 0.002 Principal component analysis:

The three-dimensional PCA projection plots based on divergence of average nucleotide identity

Haitian Cluster Cloud

 10 Haitian strains (red) form a cluster cloud, distinct and yet, distant, from CP genomes (concurrent epidemic isolates form different parts of the world) (blue) and others (green).

 Interestingly, one reference strain CP 1038 (from Zambia) genome falls into the Haitian cluster. Conclusion:

 Genomic analysis provided evidence that two distinct Vibrio populations, V. cholerae O1 and V. cholerae non-O1/O139, contributed to the cholera epidemic in Haiti.

 Comprehensive genomic analysis showed:  V. cholerae O1 populations were clonal, resembling concurrent epidemic isolates from South Asia and Africa.  V. cholerae non-O1/O139 populations were not clonal but most probably serve as a reservoir for genomic and pathogenicity islands.

 V. cholerae non-O1/O139 populations in Haiti harbor a genomic backbone similar to that of toxigenic V. cholerae O1 circulating in the Western hemisphere.

 Genomic analysis of Haitian V. cholerae O1 strains has provided evidence of:  a distinct VNTR genotype,  genetic polymorphisms of rstB and ctxB,  nucleotide (GTA) deletions in rstB,  an increased number (five) of ToxR binding repeats,  mutations in gyrA and parC gene, and  a genetically similar set of MGE’s shared with isolated elsewhere

 Core gene and SNP-derived phylogenies suggest, and PCA findings reinforce, that quite quickly, i.e., within a three week period early in the cholera epidemic, significant genomic diversity accumulated in the circulating population.

FullFull Study Study

1.401.40

1.201.20

1.001.00

0.800.80

0.600.60

0.40 Population 0.40

0.200.20

0.000.00 Cases of Cholera Per 1000 Cases of CholeraCases of1000 PopulationPer ControControll SariSari NylonNylon Test TestGroup Group “When one tugs at a single thing in nature, he finds it hitched to the rest of the universe.” John Muir (1838-1914) Collaborators and Colleagues

Antarpreet Jutla, Anwar Huq, Assistant Professor Professor, University of Maryland, West Virginia College Park, MD University

Morgantown, WV

Dr. Nur Hasan Dr. Seon Young Vice-President, Choi, Research and Bioinformatic Development Scientist, CosmosID, Inc. CosmosID Inc. College Park, MD College Park, MD

Courtesy of GB Nair, NICED, Kolkata, India