The Influence of Global Environmental Change on Infectious Disease Dynamics Workshop Summary (2014) / Chapter Skim
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Appendix A Contributed Manuscripts A1 ANIMAL MIGRATION AND INFECTIOUS DISEASE RISK1 Sonia Altizer,2 Rebecca Bartel,2 and Barbara A Han2 Abstract Animal migrations are often spectacular, and migratory species harbor zoonotic pathogens of importance to humans.
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112 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Billions of animals from groups as diverse as mammals, birds, fish, and insects undertake regular long-distance movements each year to track seasonal changes in resources and habitats (Dingle, 1996)
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APPENDIX A 113 FIGURE A1-2 Representative migratory species, including migration distances and routes, known parasites and pathogens, and major threats to species persistence. Infectious diseases have been examined in the context of migration for some, but not all, of these species.
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114 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS of reproduction [e.g., (McKinnon et al., 2010)
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APPENDIX A 115 FIGURE A1-3 Points along a general annual migratory cycle where key processes can increase (red text) or decrease (blue text)
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116 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS including zoonotic pathogens important for human health such as Ebola virus in bats, avian influenza viruses in waterfowl and shorebirds, and Lyme disease and West Nile virus (WNV) in songbirds.
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APPENDIX A 117 residing in the same area year-round (Figure A1-3)
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118 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS host–parasite interactions, including research on reindeer (Rangifer tarandus) , which showed that the abundance of warble flies (Hypoderma tarandi)
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APPENDIX A 119 as a model system to study the effects of migration on host–pathogen interactions (Box A1-1) and found that both migratory culling and migratory escape can cause spatiotemporal variation in prevalence within populations and extreme differences in prevalence among populations with different migratory strategies.
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120 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS BOX A1-1 Lessons from a Model System: Monarch Migration Drives Large-Scale Variation in Parasite Prevalence During the past 10 years, we studied monarch butterflies (Danaus plexippus) and a protozoan parasite (Ophryocystis elektroscirrha)
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APPENDIX A 121 that breed year-round in southern Florida (C) , Hawai'i, the Caribbean Islands, and Central and South America (Ackery and Vane-Wright, 1984)
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122 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS birds. Thus, the demands of migration could ultimately lead to more severe infections and greater removal of infected hosts.
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APPENDIX A 123 carried by flying foxes (Pteropus fruit bats; Figure A1-2) : These animals are highly mobile and seasonally nomadic in response to local food availability (Daszak et al., 2006)
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124 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS warming extends hosts' breeding seasons, migrations may cease altogether, with year-round resident populations replacing migratory ones (Box A1-1) , leading to greater pathogen prevalence through a loss of migratory culling and escape.
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APPENDIX A 125 FIGURE A1-4 A compartmental model illustrating infectious disease dynamics (S-I model) in a migratory host population moving between geographically distinct breeding and overwintering habitats.
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126 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS and Moore, 2006)
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APPENDIX A 127 Interdisciplinary studies to connect the fields of migration biology and infectious disease ecology are still in the early stages, and there are many exciting research opportunities to examine how infection dynamics relate to animal physiology, evolution, behavior, and environmental variation across the annual migratory cycle. Most evidence comes from studies of avian-pathogen systems, especially viruses.
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128 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS S Krauss et al., PLoS Pathog.
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130 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS The life cycles and transmission of many infectious agents -- including those causing disease in humans, agricultural systems, and free-living animals and plants -- are inextricably tied to climate (Garrett et al., 2013; Harvell et al., 2002)
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APPENDIX A 131 Harvell et al., 2009)
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132 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A2-2 Rising interest in climate–disease interactions. Research focused on associations between infectious disease and climate change has increased steadily over the past 20 years.
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APPENDIX A 133 effects can be nonlinear and sometimes conflicting, such as warmer temperatures accelerating invertebrate development but reducing life span, a central challenge has been to identify the net outcomes for fitness (Harvell et al., 2002)
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134 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS in nematode transmission each year under warming conditions (Figure A2-3C) , a result consistent with field observations (Hoar et al., 2012; Molnár et al., 2013)
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APPENDIX A 135 temperature; maximal pathology (limb malformations) (Figure A2-1)
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136 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS endemic parasites could follow from climate change, potentially reducing disease or conversely releasing more pathogenic organisms from competition. In other cases, multiple pathogens can put entire host communities at risk of extinction.
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APPENDIX A 137 of global change, such as land-use change and habitat loss, when extending predictions from focused host–pathogen interactions to larger spatial and taxonomic scales. Shifts in Behavior, Movement, and Phenology of Hosts and Parasites Changes in climate are already affecting the phenology of interactions between plants and pollinators, predators and prey, and plants and herbivores (Parmesan and Yohe, 2003)
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138 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Changes in the timing of vector life stages and feeding behavior can also arise from interactions between climate and photoperiod. For several tick-borne infections (Figure A2-1)
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APPENDIX A 139 Consequences for Conservation and Human Health Climate change is already contributing to species extinctions, both directly and through interactions with infectious disease (Thomas et al., 2004)
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140 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS signal. Several unresolved issues include identifying conditions under which climate warming will cause range expansions versus contractions, understanding the impact of increasing variability in precipitation, and determining the additional economic costs associated with increased disease risk caused by warming.
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APPENDIX A 141 test model predictions under realistic conditions, and with retrospective studies to detect the "fingerprint" of climate-induced changes in infection. Scientists still know relatively little about the conditions under which evolution will shape host and pathogen responses to climate change.
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142 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS facilitate effective responses to new or expanding health threats. Surveillance programs capable of detecting pathogen or disease emergence are essential and, in many instances, predicting and detecting local-scale impacts might be more important than predicting global-scale changes.
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APPENDIX A 145 S Laaksonen, J
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146 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS T Wheeler, J
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APPENDIX A 147 seldom receive proper health care, particularly undocumented migrants who have left home countries. They can experience treatment delays and gaps, barriers to access and care, and lack many protective commodities such as bed nets, water filters, and condoms that would decrease further exposures.
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148 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Before the First Ivorian Civil War, around 2001, a sizeable number of health care staff worked around the country. In the north, there were 38 doctors and 257 nurses; in the central region, there were 127 doctors and 471 nurses; and, in the west, there were 69 doctors and 310 nurses.
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APPENDIX A 149 challenges victims of disasters may face, but the 2008 Cyclone Nargis and the response of the Myanmar government best shows the overwhelming problem of human rights within the context of conflict and natural disasters. Case Study: Cyclone Nargis and Burma/Myanmar In May of 2008, Cyclone Nargis hit the southwest corner of Myanmar and sent a massive storm surge into the Irrawaddy Delta.
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150 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS ambassador to the UN, noted, they were "not able to [deliver aid] because they [wouldn't]
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APPENDIX A 151 Instability Bias In times of conflict, diseases and health problems do not subside. In fact, as we have discussed, the opposite is true.
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152 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A3-2 Bibliometric analysis of HIV publications, Democratic Republic of Congo, 1982–2004. SOURCE: Beyrer and Pizer, 2007.
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APPENDIX A 153 FIGURE A3-3 Malaria studies initiated, Democratic Republic of Congo, 1980–2004. SOURCE: Beyrer and Pizer, 2007.
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154 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Lischer, S
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APPENDIX A 155 that environmentally driven host movements are a critical element in infectious disease dynamics. Movement and mobility are known to be important underlying mechanisms driving the spatiotemporal dynamics of infectious diseases, both within and between populations (Altizer et al., 2011; Bharti et al., 2010; Bradley and Altizer, 2005; Gray et al., 2009; Loehle, 1995; Morgan et al., 2007; Tatem et al., 2009, 2012; Viboud et al., 2006)
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156 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS the periodicity of outbreaks (Bartlett, 1957) , and the aggregation of susceptibles increased contact rates raised transmission rates and triggered measles outbreaks (Fine and Clarkson, 1982)
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APPENDIX A 157 Niger's measles outbreaks are strongly seasonal, occurring only during the annual dry season. Although the magnitude of outbreaks can vary greatly between years, the timing is extremely consistent (Ferrari et al., 2008)
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158 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Fortunately, advances in technology and methodology have improved our abilities to measure movement patterns at high spatiotemporal resolution. Various aspects of human presence can be captured and traced by satellite imagery (Elvidge et al., 1997, 2009; Sutton et al., 1997, 2001)
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APPENDIX A 159 FIGURE A4-1 Measles transmission rates and brightness for three cities in Niger (adapted from Bharti et al., in prep)
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160 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A4-2 Measles and brightness in the communes of Niamey (adapted from Bharti et al., 2011)
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APPENDIX A 161 probability of a contact event occurring between an infected and a susceptible person, and (2) the probability of a transmission event occurring, given such a contact (Begon et al., 2002)
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162 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS migration within the state and determined that movement should be considered when planning a measles vaccination strategy. Relocating also increased the risk that a child would miss a vaccination for polio in India, Angola, and Pakistan (Unicef, 2013)
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APPENDIX A 163 important patterns of movement can be difficult to identify and measure. Interdisciplinary research and technological and methodological advances have made immense progress towards enhancing our understanding of movement and mobility in the context of the environment and health.
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164 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Castillo-Chavez, C., C
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APPENDIX A 165 Simons, E., M
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166 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS release TB data at the county level, precluding the development of publicly available, county-level maps of TB cases and incidence rates. The lack of a more granular nationwide data set has limited the study of TB trends and socioeconomic risk factors to states (Holtgrave and Crosby, 2004)
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TABLE A5-1 Comparison of Average Annual TB Rates of U.S. Counties and Regions by Urban (Rural/Micropolitan/ Metropolitan)
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168 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A5-1 Average annual tuberculosis rate per 100,000 population, 2006–2010, by county tuberculosis data from publicly available sources. Population estimates from U.S.
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APPENDIX A 169 Publicly available county-level TB data can assist TB surveillance and control efforts. TB "hotspots" that cross state borders can be identified.
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170 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS References Cain KP, Benoit SR, Winston CA, Mac Kenzie WR. Tuberculosis among foreign-born persons in the U.S.
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APPENDIX A 171 Abstract Background: For the first time, an outbreak of chikungunya has been reported in the Americas. Locally acquired infections have been confirmed in fourteen Caribbean countries and dependent territories, Guyana and French Guiana, in which a large number of North American travelers vacation.
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172 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS of Chikungunya to previously unaffected areas. In recent years, autochthonous transmission of chikungunya has occurred in non-endemic areas such as the 2007 outbreak in Italy and 2010 outbreak in France, and most recently, in multiple Caribbean Islands where competent Aedes mosquitoes exist (Tomasello and Schlagenhauf, 2013)
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APPENDIX A 173 for Disease Control and Prevention, [2014a]
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174 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS TABLE A6-1 Leading Destination Countries for Travelers Departing Chikungunya Indigenous Areas of the Caribbean Country Traveler Volume* Global Total (%)
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APPENDIX A 175 followed by France, which accounts for almost 15% of all travelers. The United States has never reported local transmission of chikungunya virus, despite the presence of Aedes aeygpti and albopictus mosquitoes across the southeastern region of the country, while autochthonous transmission of chikungunya has previously been documented in southeastern France in 2010, where Aedes albopictus is known to exist (Vega-Rua et al., 2013)
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176 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS transport. This limitation would presumably lead to an underestimate of travelers arriving in U.S.
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FIGURE A6-1 Volume of travelers from chikungunya indigenous areas of the Caribbean* to the United States and Canada in May†.
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178 FIGURE A6-2 Volume of travelers from chikungunya indigenous areas of the Caribbean* to the United States and Canada in June†.
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FIGURE A6-3 Volume of travelers from chikungunya indigenous areas of the Caribbean* to the United States and Canada in July†.
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180 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Funding Statement This study was funded by the Canadian Institutes of Health Research. The funders did not influence the content of this manuscript nor the decision to submit it for publication.
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APPENDIX A 181 Powers AM, Logue CH. Changing patterns of chikungunya virus: re-emergence of a zoonotic arbo virus.
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182 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS A7 EIGHT CRITICAL QUESTIONS FOR PANDEMIC PREDICTION Toph Allen,24 Kris Murray,24 Kevin J Olival,24 and Peter Daszak24 Introduction Like hurricanes or earthquakes, pandemics are rare events that can be extremely devastating, causing substantial mortality and economic damages.
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APPENDIX A 183 These include strategies to analyze prior outbreaks, model future trends in pandemic drivers, conduct targeted surveillance in wildlife and human populations, and probe the depth of the zoonotic "pool" from which novel EIDs arise. Here we review some of these by posing eight critical questions for pandemic prediction.
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184 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS prediction. Both hurricane forecasting and the identification of earthquake zones look to the underlying drivers of these phenomena to identify patterns.
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FIGURE A7-1 Map of relative risk of a zoonotic disease of wildlife origin emerging in people. Because almost all prior pandemics, and the majority of emerging infectious diseases, are zoonotic in origin, with the majority of these having a wildlife host, this map acts as a potential basis for future targeted surveillance and the pre-empting of potential pandemics.
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186 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS systematically identify novel pathogens in their early stages of emergence. Once emerging diseases become pandemic, the large number of cases and wide geographic distribution make response programs costly and complicated by geopolitical issues.
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APPENDIX A 187 people, amplifying their transmission, and becoming pandemic. This approach is theoretically possible.
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188 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS with zoonotic, and pandemic, potential)
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APPENDIX A 189 capacity to infect humans. Some characteristics that may yield improvements in our predictive ability include the effects of host relatedness, relatedness of a virus to known human viruses, host range and evolutionary capacity, and predictive capacity of virulence in humans (some pathogens can infect humans but cause no disease, whereas others cause severe illness)
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190 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS route of introduction to the New World (Kilpatrick et al., 2006a)
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APPENDIX A 191 from dealing with hurricanes or earthquakes: by identifying and mitigating the underlying causes, particularly anthropogenic activities that promote pathogen spillover, amplification, and spread. Strategies include programs that educate and promote alternatives to high pandemic risk behavior like the trading, butchering, and consumption of wild animals, or the comingling of livestock and wildlife on farms.
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APPENDIX A 193 Turmelle, A
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194 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS provide powerful new tools for the current crisis and often retrospective insights into older emergences. Dynamics of Initial Cross-Over A huge number of pathogens are circulating in all free-living species of animals and plants.
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APPENDIX A 195 are unable to transmit the pathogen on to other humans; classic examples would be Brucella abortus and West Nile virus. Type III pathogens occur when the primary infections are able to infect a number of secondary hosts, but these stuttering chains of transmission quickly fade out.
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196 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS response. The second approach involves deriving algebraic expressions for R 0 in the absence of any epidemiological data.
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APPENDIX A 197 FIGURE A8-1 The expected persistence time of a pathogen that infects its hosts for 2 weeks and is infectious for the second of those weeks in populations of different sizes. The four different graphs compare populations that are divided into social groups of different sizes (left GS = 4; right GS = 10)
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198 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS to the new population. They suggest this was a dominant factor in the emergence of Nipah virus in Malaysia and show that many other pathogens have epidemic demography that would also allow them to establish in this fashion (Pulliam et al., 2007)
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APPENDIX A 199 Incubation and Infectious Period Two parameters of any model for R0 are central to our ability to control the initial emergence of a novel pathogen. Ironically we tend to worry more about the transmissibility of the pathogen, which is always the hardest thing to estimate, than we do about these other two equally vital parameters: incubation and infectious period.
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200 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A8-3 (A) Parameter estimates.
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APPENDIX A 201 geographical data and more sparse biological and epidemiological surveys. Maps also have a very distinguished history of use in epidemiology.
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202 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS emergence. This skepticism is well justified by the very limited ability of these maps to predict anything other than antibiotic-resistant strains of pathogens that tend to emerge in around Western cities where drugs are widely used and there are well-funded medical schools focused on detecting these strains.
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FIGURE A8-4 Geographic patterns and projected impact of environmental change.
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204 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A8-5 Environmental change, avian biogeography, and loss in range size. Projected latitudinal pattern in type of global environmental change, geographic range size, species richness, and the resulting loss in geographic range size (8,750 bird species, 1° bands of latitude)
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APPENDIX A 205 There are three insights that I want to make from these figures: 1. This does not mean that climate change is not important; it means we need to understand how climate interacts with other aspects of global change.
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206 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS suggests that virus hunters who head for the tropics to look for undiscovered viruses in rare species are significantly, scientifically deluded. An alternative perspective on biodiversity considers the role it may play in buffering pathogen emergence and reducing the potential for the emergence of novel pathogens.
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APPENDIX A 207 why mosquitoes and bacteria quickly evolve resistance; in contrast, birds of prey were unlikely to ever evolve resistance to egg-shell thinning: if it takes a hundred generations to evolve resistance, then what takes months for bacteria requires centuries for a bird of prey. There is really only one pathogen that has emerged recently where no attempt has been made to eradicate the pathogen and its evolution has been studied beyond the first few generations of cases.
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208 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS determined solely by governance is now seen as a deeply flawed and biased argument (Acemoglu et al., 2000, 2003; McArthur and Sachs, 2001)
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APPENDIX A 209 References Acemoglu, D., S Johnson, and J
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210 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Conroy, M
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APPENDIX A 211 Grenfell, B
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212 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS McCallum, H., and A Dobson.
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APPENDIX A 213 A9 ENVIRONMENTAL CHANGE AND INFECTIOUS DISEASE: HOW NEW ROADS AFFECT THE TRANSMISSION OF DIARRHEAL PATHOGENS IN RURAL ECUADOR26 Joseph N
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APPENDIX A 215 Gunnlaugsson et al., 1989)
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216 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A9-1 Map of study region. The 21 villages are categorized by river basin (Santiago, Cayapas, Onzole, Bajo Borbón, and road)
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APPENDIX A 217 TABLE A9-1 Community Characteristics Remoteness Remoteness Village Population size metric category River basin 1 284 0.012 Close Road 2 731 0.015 Close Road 3 78 0.022 Close Cayapas 4 482 0.027 Close Road 5 156 0.040 Medium Santiago 6 55 0.040 Medium Bajo Borbón 7 138 0.040 Medium Bajo Borbón 8 72 0.049 Medium Road 9 90 0.049 Medium Santiago 10 60 0.061 Medium Onzole 11 86 0.080 Medium Onzole 12 110 0.113 Medium Cayapas 13 135 0.122 Medium Santiago 14 83 0.140 Far Onzole 15 300 0.152 Far Santiago 16 228 0.155 Far Santiago 17 79 0.158 Far Cayapas 18 268 0.165 Far Cayapas 19 28 0.173 Far Onzole 20 443 0.190 Far Onzole 21 130 0.198 Far Cayapas Borbón 864 0 Remoteness is a measure of the time and cost of travel to Borbón. Roads provide cheaper and faster access to Borbón, and therefore remoteness is a measure of the proximity to the road.
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218 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS TABLE A9-2 Number of Cases and Controls by Remoteness No. of Remoteness No.
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TABLE A9-3 Crude Infection Prevalence by Case Status and Remoteness (prevalence per 100 persons) Overall infection prevalence, Asymptomatic infection prevalence, Symptomatic infection prevalence, Diarrhea infections/100 infections/100 infections/100 Remoteness prevalence, category cases/100 E
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220 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS TABLE A9-4 Comparison of Infection Prevalence in Communities vs. Borbón Community, cases/100 Borbón, cases/100 Relative risk (95% CI)
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APPENDIX A 221 can also increase flows of consumer goods such as processed food, material goods, and medicines and may also provide communities with increased access to health care, health facilities, and health information. By determining the transmission potential of the causal factors associated with new roads, we can better interpret the observed trends in infection rates across our study region.
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222 FIGURE A9-3 Relationship between social factors and remoteness.
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APPENDIX A 223 Our study villages show some evidence of these hypothesized relationships among demographic characteristics, social connectedness, and movement of people. Village data suggest that connectedness, as measured by the average number of individuals a given person spends time with (social network degree)
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224 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS A number of issues require further examination. In this regional analysis we compare remote and nonremote villages at a given point in time.
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APPENDIX A 225 along three rivers, the Río Cayapas, Río Santiago, and Río Onzole, all draining toward the town Borbón, the main population center of the region. Borbón, with ≈5,000 inhabitants, is distinct from the other communities along the river.
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226 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Cases were defined as an individual who had three or more loose stools in a 24-h period. Controls were defined as someone with no signs of diarrhea in the past 6 days.
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APPENDIX A 227 were trained together to ensure uniformity. All data were entered into Access (Microsoft, Redmond, WA)
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228 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS categorical indicator variables ("close" and "medium," with "far" considered baseline)
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APPENDIX A 229 Dutta P, Khan SA, Sharma CK, Doloi P, Hazarika NC, Mahanta J (1998) Southeast Asian J Trop Med Public Health 29:173–176.
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230 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS A10 IN-ROADS TO THE SPREAD OF ANTIBIOTIC RESISTANCE: REGIONAL PATTERNS OF MICROBIAL TRANSMISSION IN NORTHERN COASTAL ECUADOR32 Joseph N
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APPENDIX A 231 use rate determines which of these two factors predominate. While usually conceived as a main effect on individual risk, antibiotic use rate is revealed in this analysis as an effect modifier with regard to community-level risk of resistance.
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232 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS with colonization inhibition (Bonhoeffer et al., 1997) , complex infections with resistance (Austin et al., 1997)
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APPENDIX A 233 FIGURE A10-1 Map of study region. The 21 villages are categorized by river basin (Santiago, Cayapas, Onzole, Bajo Borbón, and road)
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234 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Methods Study Site In the northern Ecuadorian province of Esmeraldas, approximately 150 villages (ranging from 20–800 inhabitants) lie along the Cayapas, Santiago and Onzole rivers, which all flow towards Borbón, the main population centre of the region (with 5000 inhabitants)
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APPENDIX A 235 converted to the individual level by recording usage for those identified by the survey and imputing a response of "No usage" for the remaining individuals who were known to live in the house from previous demographic surveys. Classifying Remoteness For each village, travel time and total cost of travel to Borbón were recorded by field staff members.
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236 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS used together, often in the same pill. Therefore, one standard clinical approach is to screen for the combined resistance to both at the same time with discs impregnated with both antibiotics, and the resulting resistance to both antibiotics is then listed as sxt resistance.
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APPENDIX A 237 Variability of Antibiotic Use To compare the variability of antibiotic use over time and over space, two random effect models are fit with antibiotic use as the dependent variable. In the first model, the variance of the random offset corresponding to household is estimated; in the second, the variance of the random offset corresponding to time point.
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238 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Antibiotic Use and Remoteness Antibiotic use at a community level is estimated by the sample proportion of respondents who reported using antibiotics. We consider an individual to have used antibiotics if they indicate they have consumed any of: amp, amoxicillin, sulphamethoxazole, trimethiprim, or benzipenicillin.
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FIGURE A10-2 Deterministic antibiotic resistance model.
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240 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS The model assumes that human exposure to resistant bacteria comes from either: (i) the spread of these AR bacteria through standard water, sanitation, and hygiene pathways, or (ii)
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APPENDIX A 241 movement to and from outside the region in these non-remote villages (Eisenberg et al., 2006) , providing more opportunity to introduce AR bacteria.
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242 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS outside of the integron, but on the same plasmid (Miriagou et al., 2003; Woodford et al., 2009)
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APPENDIX A 243 for both cases and controls. Estimating the community prevalence based on a weighted sum of the case and control observations, there was little difference in villages of far and medium remoteness (OR = 1.1 [0.6, 1.8]
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244 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS A Transmission Perspective on the Observed Antibiotic Resistance Patterns We use a transmission model to examine how the interaction among antibiotic use, transmission rates of antibiotic resistant E coli, and introduction rates of antibiotic resistant E
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APPENDIX A 245 is virtually identical to risk ratios corresponding to fixing the introduction rate ratio to its midpoint value of two. Figure A10-3, therefore, presents a plot of the effect of the ratio of transmission rates in close versus far communities on the risk ratio for sxt–amp resistance in close versus far communities for various antibiotic use rates to display the interaction between use rate and transmission ratio (Figure A10-3)
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246 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS E coli from person to person mediated through environmental pathways, and the introduction of E
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APPENDIX A 247 pathways -- modes of spread especially strong in agricultural settings (Marshal et al., 1990) and developing countries (Calva and Bojalil, 1996)
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248 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS References Airey T 1992 The impact of road construction on the spatial characteristics of hospital utilization in the Meru district of Kenya.
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APPENDIX A 249 Fornasini M., Reves R R., Murray B
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250 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Robin F., Aggoune-Khinache N., Delmas J., Naim M., Bonnet R 2010 Novel VIM metallo-β lactamase variant from clinical isolates of Enterobacteriaceae from Algeria.
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APPENDIX A 251 A11 SOCIAL CONNECTEDNESS CAN INHIBIT DISEASE TRANSMISSION: SOCIAL ORGANIZATION, COHESION, VILLAGE CONTEXT, AND INFECTION RISK IN RURAL ECUADOR40 Jonathan L Zelner,41 James Trostle,42 Jason E
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252 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS et al., 2007; Wallace, 1988) , but researchers typically neglect the influence of these factors on community-level infectious disease risk.
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APPENDIX A 253 A road was recently built that connects some of these villages to the nearest large town, which has about 5000 inhabitants. Consequently, these villages now vary in their remoteness, measured by distance and time of travel to this trading center.
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254 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS such as sewage treatment. Alternatively, improved water quality or sanitation may result from the establishment of social norms and the reinforcement of those norms.
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APPENDIX A 255 to examine the separate effects of the contact and sociological aspects of social relationships on disease outcomes. Methods We collected our data in 18 villages in the northern coastal Ecuadorian province of Esmeraldas.
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256 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS degree to have mean zero and unit variance, and we have presented household degree in SD units from village mean household degree. This allowed us to measure the effect of ego's household social connectedness relative to the average household in her or his village.
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APPENDIX A 257 Indirect Effects of Village-Level Characteristics on Individual Risk Village remoteness and sociality networks do not directly affect disease but instead act through (or are mediated by) more immediate factors (e.g., sanitation)
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TABLE A11-1 Descriptive Characteristics of Villages: Effects of Social Relationships on Disease Outcomes, Esmeraldas, 258 Ecuador, 2007 Fever or Households Households Households Observed Sample diarrheal w/water w/improved w/improved household Remoteness size disease treatment sanitation water source hygiene index Village Continuous Category N Cases/100 % % % Mean 1 0.06 Close 158 15 25 43 43 0.64 2 0.07 Close 642 16 74 33 49 0.70 3 0.13 Close 407 13 18 55 59 0.69 4 0.20 Medium 110 11 14 61 7 0.69 5 0.20 Medium 41 14 0 64 15 0.63 6 0.20 Medium 30 23 93 11 2 0.53 7 0.25 Medium 49 8 33 100 0 0.79 8 0.25 Medium 37 30 72 55 100 0.51 9 0.31 Medium 101 12 0 15 0 0.45 10 0.40 Medium 64 15 0 26 100 0.68 11 0.57 Medium 89 18 23 50 77 0.71 12 0.62 Medium 119 19 19 7 19 0.31 13 0.71 Far 62 10 13 52 48 0.38 14 0.78 Far 185 8 33 55 55 0.71 15 0.80 Far 71 0 15 86 99 0.74 16 0.83 Far 285 8 0 41 82 0.73 17 0.96 Far 324 6 13 56 64 0.73 18 1.00 Far 138 14 5 50 28 0.68 Total -- -- 2912 12.3 30.0 45.4 52.4 0.66
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TABLE A11-2 Multivariate Models for Risk of Disease in Previous Week: Effects of Social Relationships on Disease Outcomes, Esmeraldas, Ecuador, 2007 Model 1, None, OR Model 2 Passing Model 3, Important Sociality Network Type (95% CI)
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260 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS week before the survey predicted an increased risk of illness (odds ratio [OR] = 1.11; 95% confidence interval [CI]
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TABLE A11-3 Indirect Effects of Remoteness and Village-Level Average Degree on Risk of Illness: Effects of Social Relationships on Disease Outcomes, Esmeraldas, Ecuador, 2007 Average Passing Time Average Important Remoteness, Indirect Degree, Indirect Effect Matters Degree, Indirect Pathogen Exposure Effect (95% CI)
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262 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS estimate was closer to the null (OR = 0.75; 95% CI = 0.37, 1.53) , suggesting that these variables explain much of the variability in risk associated with remoteness and are likely important mediators linking remoteness to illness.
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APPENDIX A 263 environmental transformation provides insight into the effects of these long-term processes. We postulated that remoteness would affect risk through contact networks and village cohesion (Eisenberg et al., 2006)
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264 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS may decrease risk; the scope of this analysis was not to rule out all alternative mechanisms linking remoteness to risk. In addition to the protective effects of social organization we have outlined, we found that migration between villages, measured by the proportion of households with a visitor from outside the village in the previous week, predicts increased risk of infection.
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APPENDIX A 265 References Anderson RM, May RM. Infectious Diseases of Humans: Dynamics and Control.
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266 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Rego RF, Moraes LR, Dourado I Diarrhoea and garbage disposal in Salvador, Brazil.
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APPENDIX A 267 (population nearly one million) , and populations surrounding Phoenix in Maricopa County and Tucson in Pima County of Arizona whose combined populations are approximately five million.
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268 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A12-1 Coccidioidomycosis. Estimated numbers of total annual U.S.
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APPENDIX A 269 was responsible for 66 percent of these infections and California for 31 percent. Nearly all of the remaining infections were reported from New Mexico, Utah, and Nevada.
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270 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Fourth, once diagnosed, the infection must be reported to public health authorities. How completely the second, third, and fourth of these steps is conducted has a direct effect on the resulting estimates of disease activity.
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APPENDIX A 271 Reporting newly diagnosed patients with coccidioidomycosis may not always be complete. For example, although clinicians are required to report new coccidioidomycosis, it may be difficult because of busy schedules.
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272 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A12-3 Dust storms have little effect on Arizona case rates. Weekly reported cases of coccidioidomycosis in selected Arizona counties for 2011.
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APPENDIX A 273 FIGURE A12-4 How dust storm contribution on spore density could be minimal. Hypothetical contribution of episodic wind storms to ambient atmospheric spore density if only small breezes are sufficient to produce an aerosol.
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274 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS an autocorrelation statistical procedure, they were then able to define a primary coccidioidal exposure season of August through March. By examining rainfall patterns before and during these exposure seasons, these authors identified two countervailing relationships.
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APPENDIX A 275 FIGURE A12-5 Model results (1996–2013)
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276 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A12-6 Hindcasting estimates (1950–2013)
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APPENDIX A 277 at the county level (Baptista-Rosas et al., 2007; Comrie, 2005; Tamerius and Comrie, 2011)
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278 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Washington and northern Utah (Mardo et al., 2002; Marsden-Haug et al., 2013) , far outside of known endemic areas, illustrate our poor understanding of these fungi's ecologies.
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APPENDIX A 279 between the occurrence of Coccidioides spp. and soil moisture, soil temperature, and rodent populations.
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280 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Comrie, A
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APPENDIX A 281 Levine, H
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282 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Tamerius, J
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APPENDIX A 283 U.S. Department of Health and Human Services Centers for Disease Control and Prevention (HHS/CDC)
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284 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS present, CDC allows the entry of dogs from rabies-free countries. Unvaccinated dogs may be imported without a requirement for proof of rabies vaccination if they have been located for a minimum of 6 months or more in a rabies-free country.
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APPENDIX A 285 CDC's Regulations for Turtles: Reemerging Concerns About Salmonella Due to Increased Human Contact with Small Turtles Although Salmonella is prevalent in all reptile populations, to help minimize the risk to the U.S. human population, CDC limits imports of small turtles.
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286 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS CDC's Regulations for Nonhuman Primates NHPs, particularly those recently captured in the wild, may harbor agents in their blood or other body tissues that are infectious to humans. NHPs and NHP products are a potential source of pathogens that can cause severe or fatal disease in humans, including filoviruses, hepatitis A and B viruses, herpes B virus, rabies, tuberculosis, and parasitic infections (NRC, 2003)
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APPENDIX A 287 United States from the Philippines (CDC, 1990)
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288 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS had direct or close contact with the infected prairie dogs, including 28 children at a day care center and veterinary clinic staff (Reynolds et al., 2007)
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APPENDIX A 289 CDC has interpreted this ban broadly to include all members of the family Viverridae. Although bats were ultimately discovered to be the vector of SARS, concerns about the unique susceptibility of members of the family Viverridae to SARS coronavirus, and the extremely high viral load that they experience as a result of infection, keeps the embargo in place, with exceptions allowing importation by permit for science, exhibition, or education (CDC, 2004a)
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290 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS identified simian foamy virus, cytomegalovirus, and lymphocryptovirus in NHP specimens confiscated at U.S. ports of entry.
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APPENDIX A 291 With increasing strain on their budgets, state and local public health officials are less able to comply. Recommendations There are multiple regulatory and operational challenges to preventing zoonotic diseases associated with importation of animals, animal products, and other potentially infectious items into the United States.
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292 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS history from their patients and be familiar with zoonotic diseases, including those that are not endemic to the United States. Educational strategies have already been implemented, but they need to be expanded to inform the public about the risks of zoonotic diseases.
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APPENDIX A 293 References American Academy of Pediatrics.
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294 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Cohen, J
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APPENDIX A 295 Hugh-Jones, M
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296 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Tsiodras, S., G Dougas, A
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APPENDIX A 297 A14 THE GLOBAL DISTRIBUTION AND BURDEN OF DENGUE59 Samir Bhatt,60 Peter W Gething,60 Oliver J
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298 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS population surfaces to infer the public health burden of dengue in 2010. We predict dengue to be ubiquitous throughout the tropics, with local spatial variations in risk influenced strongly by rainfall, temperature and the degree of urbanization.
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APPENDIX A 299 requirement for assessing clinical surveillance and for scoping reliably future vaccine demand and delivery strategies. Previous maps of dengue risk have used various approaches combining historical occurrence records and expert opinion to demarcate areas at endemic risk (Beatty et al., 2009; Van Kleef et al., 2009; WHO, 2012)
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300 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A14-1 Global estimates of total dengue infections. Comparison of previous estimates of total global dengue infections in individuals of all ages, 1985–2010.
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APPENDIX A 301 FIGURE A14-2 Global evidence consensus, risk and burden of dengue in 2010. a, National and subnational evidence consensus on complete absence (green)
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302 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS statistics indicated high predictive performance of the BRT ensemble mean map with area under the receiver operating characteristic (AUC)
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APPENDIX A 303 2011; Gubler, 1998; Kakkar, 2012)
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304 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS documented exhaustively, we find that the biggest source of disparity between actual and reported infection numbers is the low proportion of individuals with apparent infections seeking care from formal health facilities (see Supplementary Information, section E, Fig. 5 for full analysis)
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APPENDIX A 305 Information, section A)
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306 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS vector and disease distribution mapping (Elith et al., 2006; Stevens and Pfeiffer, 2011)
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APPENDIX A 307 The empirical relationship between incidence and the probability of occurrence was represented using a Bayesian hierarchical model. We defined a negative binomial likelihood function (Hilbe, 2011)
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APPENDIX A 309 Gething, P
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310 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Stokland, J N., Halvorsen, R
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APPENDIX A 311 threats as any other community on the globe. Through their unique relationship with nature, many of these peoples are more vulnerable to health threats generated by climate change.
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312 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A15-1 Global temperature anomalies for 2000–2009 compared to 1951–1980. Global temperatures were on average about 0.6°C higher than they were 1951–1980.
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APPENDIX A 313 seals, walrus, and whales to hunt, impacting diet nutrition and cultural well-being (Brubaker et al., 2011)
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314 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS at lower latitudes. Spring will occur earlier and the growing season will be longer.
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APPENDIX A 315 prevented by hand washing such as gastroenteritis, respiratory infections caused by respiratory syncytial virus (RSV) , influenza, skin infections, impetigo, and boils caused by MRSA (Brubaker et al., 2011; Hennessy et al., 2008; Wenger et al., 2010)
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316 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS mainly associated with contact with sled dogs. However, improvements in housing, water and sanitation, sled dog lot management, and the transition from dog sled teams to snow machines have largely eliminated dog-to-human transmission in Alaska.
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APPENDIX A 317 of the permafrost may result in spoilage of food stored below ground (Brubaker et al., 2011)
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318 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS evidence that climate change has contributed to an increase in Trichinella prevalence in Alaska or northern Canada. Loss of sea ice could interfere with resting, feeding, and breeding of marine mammals.
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APPENDIX A 319 Lyme disease. The current northern limit of Ix.
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320 FIGURE A15-2 Climate-related outbreak of Vibrio parahaemolyticus gastroenteritis, Alaska 2004. Graph shows the mean daily water temperature at an oyster farm in Prince William Sound Alaska, together case patients by date of consumed farmed oysters.
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APPENDIX A 321 FIGURE A15-3 Climate-related outbreak of Puumala virus infection in Sweden 2007.
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322 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Recommended Actions It is apparent that for many of these diseases the risk to human and animal populations is not known, largely because surveillance systems are inadequate, lacking the sensitivity and specificity to be able to determine, with any accuracy, the prevalence of disease in these populations. It is not clear whether this is because of underreporting or underdiagnosis due to the lack of diagnostics, staff issues in remote locations, or logistical difficulties associated with remote specimen collection handling and shipping.
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APPENDIX A 323 regions (Dudley et al., 2013)
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324 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A15-4 International Circumpolar Surveillance of Emerging Infectious Diseases. Established in 1998 ICS links public health laboratories, institutes, and academic centers across the circumpolar north for the purpose of monitoring and sharing information on infectious diseases of concern, collaborating on research and prevention and control activities.
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APPENDIX A 325 diseases, those commonly prevented by hand washing such as respiratory infections, skin infections, echinococcosis, and gastroenteritis caused by Giardia or Cryptosporidium. Many Arctic residents depend on subsistence hunting, fishing, and gathering for food; consequently, changes in climate may increase the potential for the food-borne transmission of toxoplasmosis, trichinosis, and brucellosis in the Arctic.
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326 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Evengård, B., J Berner, M
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APPENDIX A 327 Pettersson, L., J Boman, P
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328 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS A16 CLIMATE CHANGE AND HUMAN HEALTH: A ONE HEALTH APPROACH76 Jonathan A Patz77 and Micah B
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APPENDIX A 359 A17 IMPACTS OF CLIMATE CHANGE ON PLANT DISEASES: NEW SCENARIOS FOR THE FUTURE Marco Pautasso78 and Michael J Jeger79 Abstract In this overview, we selectively discuss recent literature on the development of new scenarios of the impacts of climate change on plant health.
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360 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Introduction Plants are essential for human health and well-being, not only because they provide ecosystem services such as photosynthesis, food production, evapotranspiration, and carbon storage, but also due to their cultural, psychological, and aesthetic benefits (Pearson-Mims and Lohr, 2000; Bringslimark et al., 2009; Eyles et al., 2010; Russell et al., 2013)
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APPENDIX A 361 · A call for multidisciplinary research to tackle the increasing challenge posed by human pathogens harboured by plants (Fletcher et al., 2013)
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362 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS plant health because of emotive and ethical considerations. The death of every child is a tragedy, but we do not hesitate to harvest vegetables, long before these plants have completed their life cycle.
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APPENDIX A 363 can be inspected (Brasier, 2008)
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364 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A17-2 New scenarios of climate change impacts on plant health will need to take into account the likely introductions of exotic plant pathogens due to increased plant trade, as well as human responses to both climate change (e.g., large-scale cultivation of biofuels) and exotic plant pathogens.
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APPENDIX A 365 exotic pathogens will disperse, but it will also tend to maintain host genetic diversity, which can result in enhanced resilience of plant hosts in the face of a new disease. Variation in host genetic diversity also influences plant phenology, which can affect host–pathogen interactions, such as by shifting the main period of host susceptibility away from (or closer to)
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366 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS predict the development of future plant pathosystems (Thompson et al., 2013)
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APPENDIX A 367 particularly in the case of large-scale deployment of monocultures (Paterson et al., 2013)
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368 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Despite the increasing plant health issues associated with movements of plants by the nursery industry, there is still little information about the structure of such plant trade networks. This is of concern, given that network structure, even in the case of small-size networks, has been shown to affect the likelihood of epidemics taking place, particularly in the presence of super-connected individuals (Moslonka-Lefebvre et al., 2011)
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APPENDIX A 369 little consideration in the assisted migration debate among conservation biologists that such plant translocations could result in the inadvertent long-distance movement of plant pathogens (Garbelotto and Pautasso, 2012)
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370 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Andrew, N
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372 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Ilbery, B., D
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APPENDIX A 373 Munkvold, G
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374 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Rosenzweig, C., A Iglesias, X
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APPENDIX A 375 A18 WATER QUALITY AND HEALTH FOR A SUSTAINABLE SOCIETY Joan B Rose,80 Georgia Mavrommati,80 and Erin A
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376 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS animals, land use change, use of fertilizers, and water use as well as the global transport of humans and animals. This has led us into the Anthropocene, in which continued water quality degradation as demonstrated by increased eutrophication and fecal contamination associated with microbial hazards and antibiotic resistance is a global phenomenon.
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APPENDIX A 377 frameworks to improve decision making for enriching the future of our complex human-coupled water systems and health. Waterborne Disease: Emerging and Zoonotic Pathogens Waterborne disease problems seem to have been solved in the United States, yet large or dramatic outbreaks continue to occur in both drinking water systems and recreational waters.
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378 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A18-2 Outbreaks in drinking water in the United States. per year (Figure A18-2)
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APPENDIX A 379 FIGURE A18-3 Outbreaks in ambient recreational water per year in the United States. in children are now showing up in association with tap water.81 Waterborne poliovirus and cholera have not been controlled, and zoonotic diseases including E
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380 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS other known enteric viruses and little is known about its resistance to wa ter treatment. These viruses remain a significant risk as they are excreted in high concentrations, survive in the environment, and can be spread through contaminated manure to people, other animals, and water.
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APPENDIX A 381 of analysis that can be understandable by decision makers and other stakeholders. The methodology of SD is based on systems thinking and recognizes that the inability to capture the structure and dynamics of complex systems stems from the lack of holistic approaches (Sterman, 2000)
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382 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS FIGURE A18-4 A causal loop diagram that represents coupled socioeconomic and biophysical systems in Lake St. Clair.
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FIGURE A18-5 A causal loop diagram that represents a reinforcing feedback loop (symbolized with R) and a counteractive feedback loop (symbolized with C)
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384 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS that dose-response modeling could be used to examine probability of infection. The Center for Advancing Microbial Risk Assessment (CAMRA)
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APPENDIX A 385 FIGURE A18-6 Comparative assessments of ID50 or LD50 (Y axis represents the dose in colonies, virons, or cells)
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386 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS This step is generally pathogen specific and has been used for static esti mates focusing on describing the most reasonably exposed individual or describing the distributions of risk with techniques such as Monte Carlo (probabilistic) analysis (Medema et al., 2006; Smeets et al., 2008)
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APPENDIX A 387 · What is the risk of an outbreak occurring? · Will it change with precipitation?
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388 GLOBAL CHANGE AND INFECTIOUS DISEASE DYNAMICS Eisenberg, J
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APPENDIX A 389 Smeets, P., G Medema, Y
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