Download Foresight China II: the Identification and detection of infectious

Foresight China II: the Identification and
detection of infectious diseases
Jianshi (Jesse) Huang, Weiyi Xiong, Angus Nicoll
Chinese Academy of Medical Sciences, Peking Union
Medical College, Beijing, China; European Centre for
Disease Prevention and Control, Health Protection Agency,
London School of Hygiene and Tropical Medicine, UK
I will discuss
 What is the Foresight method?
 Why does China need the Foresight
Project ?
 What is Foresight China II
 Methodology
 Preliminary results
 Conclusion/Implications
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What is the Foresight method?
 A scientific approach to the Future
 Combining future look at diseases &
threats with opportunities for
mitigation & control
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Eight Foresight project areas to 2006
Brain Science,
Addiction and
Drugs
Cognitive
Systems
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Detection and
Identification of
Infectious
Diseases
Flooding and
Coastal Defence
Intelligent
Infrastructure
Systems
Cyber Trust and
Crime Prevention
Obesity
Exploiting the
Electromagnetic
Spectrum
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What is the Foresight method?
 10 areas of science of relevance to
detection, identification and monitoring
systems were reviewed and analyzed:
 Intelligent sensor networks
 Data mining and fusion
 Non-invasive scanning and screening
 Predictive and real-time
epidemiological modelling
 ……
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Why does China need Foresight Project ?
 Today’s world is a small village. What happens in
China could have significant impact on Europe and
vice versa.
 It is better to have a capacity to anticipate
significant changes in infectious diseases for
emergency preparation.
 However, “It is very difficult to make predictions,
especially about the future”. (American Sage)
 Without some moderately accurate predictions or
at least early warning, we cannot have a safe global
village.
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Why does China need Foresight Project ?
Quantitative Predictions
 The existing methods used to predict future trends
in infectious diseases: (quantitative predictions)
 Predictions
 Modelling
 Drawbacks:
 Predictions - short term, max. 5 years
 Modelling – by definition all models are wrong
but some are useful
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Why does China need Foresight Project ?
 The existing quantitative approach is
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problematic:
 when we look well beyond five years.
 When we look groups of infections,
especially emergence of unknown
pathogens.
 When more than one drivers influence the
occurrence of infectious diseases
 There is much that we just can’t use the
quantitative model to predict, or…
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Chinese Sage?
大智若愚
 （世界上有）知道的已知，知道的
未知和不知道的未知。
 每一年都有一些知道的未知变成知
道的已知。
 同样，每一年我们都能了解到有更
多的不知道的未知。因此原来不知
道的未知变成了知道的未知甚至知
道的已知。
 当然，有时我们能认识到其实我们
不知道一些知道的已知，还自以为
是地认为我们知道这些知道的已知。
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…translation from an American Sage
 “…There are known knowns, known
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unknowns and unknown unknowns.
 Each year some of the known unknowns
become known knowns.
 But equally each year we become aware of
some more unknown unknowns so that they
become known unknowns or even known
knowns.
 Of course sometimes we realise that we do
not know some of the known knowns as
well as we thought we knew them…”
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Why does China need Foresight Project ?
 Instead of looking at specific disease
Foresight method identified a series of
families of factors ‘drivers’ or risks for the
study of likely trends in those drivers and
hence, families of diseases.
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Why does China need Foresight Project ?
 Two applications of information from the
Foresight approach:
 Surveillance prioritization – to detect if
the threat is materialising
 Identification of needed
countermeasures
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What was Foresight China I
 Foresight China: A novel and simple
approach to anticipating likely future
trends in drivers and families of infectious
diseases and therefore, needs for
surveillance and public health preparedness.
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What was Foresight China I
 Foresight China I: 2004-2006
 Basic Risk Model for Infectious Disease
Risks was adapted from UK colleagues, 36
leading Chinese experts were consulted.
 Supported by Foresight Funding, Enacted by
PUMC, HPA & China CDC
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What was Foresight China I?
 Some important factors affecting future risks
were identified.
 Output: Predicting changing risks not actual
disease trends so as to plan for surveillance
systems improvement and for public health
preparedness.
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Important factors affecting future risks
 Increasing movements of people, animals and animal







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products
More and greater migrations of people
Increasing tourism
Increasing amounts of animal waste
Changing sexual lifestyles
Changing public attitudes
Increasing genetic uniformity of crops and livestock
Rising wealth and levels of education
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Lessons learnt from Foresight China I
 Better definitions of each driver in the
questionnaire would have improved
consensus
 Need to ask the panel to predict the future
of the driver not its potential effect on
diseases
 Need for an expanded expert panel
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Hence Foresight China II
 Foresight China II: 2007-2008,
 A continuation of Foresight China I
 Improved methodology
 Expanded number of experts consulted to
180
 Supported by British Embassy Beijing
 Enacted by PUMC & China CDC
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Foresight China II: Methodology
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Three new features over Foresight China I:
 Systematic literature review to identify the
scientific evidence for drivers
 Extensive analysis of existing infectious
disease surveillance systems in 4 countries to
identify how they capture data on drivers
 Consultations with leading experts in 12
areas to confirm the improvement
opportunities and to assess feasibility of the
opportunities
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Basic Risk Model for Infectious Disease Risks
Drivers
Climate change,
Socio-economic drivers, etc.
Risk Analysis
Sources
Zoonoses
Natural
mutation
Available
niches
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Pathways
Soil
Airborne
Food-borne
Waterborne
Vectors
Direct
contact
Waste
disposal
Outcomes
Future diseases and levels of
infection in:
People
Plants
Animals
Ecosystems
Risk Estimate
Source:Professor Joyce Tait, University of Edinburgh
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Note the simplicity – compare with this model for
Climate Change and Health: Direct and Indirect Effects
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Source: A. McMichael et al, The Lancet 2006; 367: 859-869.
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Foresight China II: Findings
 Systematic literature review
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Foresight China II: Preliminary findings
Reviewed recent experience of newly
reported emerging human pathogens
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30
20
15
vCJD
10
5
0
1980
1985
1990
1995
SARS
25
HIV-1
Cumulative no. spp
35
2000
2005
 25 (66%) are RNA viruses
 >80% have animal reservoir/origins; broad range
 Diversity of transmission routes and drivers of emergence
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 But only a few emerging diseases are of great public health importance
Number of EID events per decade
Reference:Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious
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24 diseases,nature,2008,451(21):990-994.
Global richness map of the geographic origins of EID events from
1940 to 2004
Reflection
of local
strength of
surveillance?
Reference:Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious
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25 diseases,nature,2008,451(21):990-994.
Global distribution of relative risk of EID event
Zoonoses from wildlife
Drug resistant pathogen
Zoonoses from non-wildlife
Vector-borne pathogen
Reference:Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging infectious
diseases,nature,2008,451(21):990-994.
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The 12 families of drivers in Foresight China II
1.Governance and social cohesion
2.Demography
and
population
change
3.Conflict
4.Technology &Innovation and their
governance
5.Agriculture and land use change
6.Economic factors
7.Trade and Market related factors
8.Transport and Tourism
9.Human activity and social pressure
10.Environment related factors
11.Iatrogenic related factors
12.Animals and plants related
factors
Foresight China II
Foresight China I
1.Governance and social cohesion
2.Demography and population
change
3.Conflict
4.Technology &Innovation and their
governance
5.Agriculture and land use change
6.Economic factors
7.Trade and Market related factors
8.Transport and Tourism
9.Human activity and social
pressure
1.Environment related factors
2.Iatrogenic related factors
3.Animals and plants related
factors
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The inventory of 12 families drivers and their 50 elements
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The inventory of 12 families drivers and their 50 elements
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Foresight China II: Findings
 Extensive analysis of existing infectious
disease surveillance systems in 4 countries
 Do the surveillance systems capture data on
the drivers? E.g. social factors driving
tuberculosis spread
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How do infectious diseases
relate to the 12 family of drivers
 We identified 18 priority infectious diseases according to:
 WHO criteria
 Leading causes of death/high morbidity
 Ease to spreading
 On the international surveillance list
 Have a good, feasible preventive measures
 Case definitions are clear and ease to detect
 Have a clear goal for elimination/eradication
 Of 37 reportable diseases in China, those are
 10 leading cause of death of reportable diseases
 10 diseases with highest incidence rate
 10 diseases with highest fatality rate
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18 priority infectious diseases
 Tuberculosis (TB)
 Measles
 Typhoid\paratyphoid
 encephalitis B
 epidemic cerebrospinal
 Malaria

 newborn tetanus

 hydrophobia/rabies

 gonorrhea

 Syphilis

 HIV/AIDS
 Hemorrhagic fever with

meningitis
Leptospirosis
plague
dengue fever
Viral Hepatitis
bacillary and amoebiasis
dysentery
bird flu
Renal Syndrome (HFRS)
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Do China surveillance systems collect data on the drivers?
Not a lot!
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But neither do developed countries!
Percentage of 12 drivers/50 elements data
surveillance system collected by countries
Percentage %
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12 family drivers, 50 elements, regarding to the 18 priority surveillanced
infectious diseases. One element scores 1, The y-axis is the percents of elements
that surveillance system have.
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Foresight China II: Findings
 Leading experts consultations in 12 areas
 Characteristics of the experts
 Results
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Foresight China II: Findings
 Leading experts consultations in 12 areas
 Characteristics of the experts (available on
request)
 Results
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Foresight China II: Findings
 Leading experts consultations in 12 areas
 Characteristics of the experts
 Results
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Experts’ opinions on Four elements of Environment Related Factors
in Foresight-China Study. The variables presented below are n (%).
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Experts’ opinions on Four elements of Environment Related Factors
in Foresight-China Study. The variables presented below are n (%).
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Experts opinion on driver 1:
Governance and social cohesion
Experts opinion re: driver 1:governance and social cohesion
100%
Yes（%）, 86%
Yes（%）, 80%
80%
60%
40%
20%
0%
Drivers of Infectious Diseases ?
Need
surveillance?
Experts opinon re:The change trend of the
factor?
Weak（%）
13%
No change
（%）
17%
Strong（%）
70%
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Experts opinion on the 12 families of
drivers
Expert
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
overall
86%
opinion
re:
12
80%
Drivers of Infectious
Diseases ?
Need
drivers
78%
surveillance?
Feasibility
of
surveillance?
The change trend of the factor?
Weak, 13%
No Change,
17%
Strong,
70%
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Feasibility of surveillance for 50 Elements?
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Feasibility of surveillance
(experts opinion)
 Of 50 elements, 47 are identified as major
influencing elements
 Of the 47 major influencing elements, for
46 of them the experts considered it would
be important to monitor them
 But of the 46 elements, only 32 are
considered to be feasible for monitoring
surveillance
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Feasibility of surveillance
(experts opinion)
 Of the 46 elements:
 16 elements were considered likely to
result in trends that would be beneficial
to the control of certain infectious
diseases, e.g. education & economic
development - food poisoning,
tuberculosis
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Experts opinions on Trends in Drivers
 Of 46 elements:
 30 elements were considered to be
associated with worsening
occurrence and spreading of
infectious diseases
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Experts opinions on Trends in Drivers
 Of these 30 elements:
o 7 elements were considered likely to
improve in the future e.g. poverty, hospital
infection control and associated diseases
would lessen.
o 18 elements are likely to deteriorate e.g.
immigration, bioterrorism
o 5 elements were considered likely to stay
unchanged e.g. unemployment,
environmental pollution
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Feasibility of surveillance
One Family of Drivers 1. Governance and social
cohesion
Readily Doable
1.Bio-security governance
 2.International/national/regional interactions affecting
governance
 3.lack of interaction between policy and regulatory agencies
 4.Marginalization of some groups specify
Can be done with some effort
 E.g. Illegal practices
Difficult to do or measure ? Consider later
 E.g. Social cohesion, political leadership

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Conclusions/Implications
 We identified improvement opportunities
for identification and detection of infectious
disease using the Foresight framework in
China
 We are able to predicting changing risks not
actual disease trends of infectious diseases.
Thirty two (32) elements are identified as
doable for sureillance systems improvement.
 Now astudy is needed to test Foresight
findings in test location.
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References
 Kate E. Jones, Nikkita G. Patel, Marc A. Levy,ect. Global trends in emerging









49
infectious diseases,nature,2008,451(21):990-994.
Louise Swift, Paul R. Hunter, Alexander C. Lees, ect. Wildlife Trade and the Emergence of
Infectious Diseases. Ecohealth ,2007,4:25-30.
Mary E. Wilson. Travel and the Emergence of Infectious Diseases. Emerging infectious
disease journal.1995,1(2):39-46.
McNeill WH. Plagues and peoples. Garden City, N.Y.:Anchor Press/Doubleday, 1976.
Stephen S. Morse. Factors in the Emergence of Infectious Diseases. Emerging infectious
disease journal.1995,1(1):7-15.
Anthony Zwi, Pilar Ramos-Jimenez. Conflict, crisis and infectious disease.TDR
Nnews.2002,68.
Strategic social ,economic and behavioral research. special programme for research
&training in tropical disease(TDR). 2005,12.
Gaetan Gavazzi, Francois Herrmann, Karl-Heinz Krause. Aging and Infectious Diseases in
the Developing World. Aging and infectious disease. 2004,39:83-91.
Elizabeth M. Prescott. The Politics of Disease: Governance and Emerging Infections. Global
Health Goverance, 2007,1(1):1-8.
The Impact of Globalization on Infectious Disease Emergence and Control: Exploring the
Consequences and Opportunities, Workshop
Summary .http://www.nap.edu/catalog/11588.html.
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Acknowledgements
 UK-China Partners in Sciences
 Dr David Concar - British Embassy Beijing
 Ms. Duying - British Embassy Beijing
 142 experts consulted
 64 field interviewers
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THANKS
Q &A
How to work with
HPA and European
countries?
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