Pola Penyakit dan Distribusi

Outline
Pendahuluan:
Epidemiologi Penyakit Infeksi
Pola Pengaruh Lingkungan
Iklim sebagai Driver Lingkungan
 Climate Variability vs. Climate Change

Perubahan Iklim:
- Terus-menerus mengubah atau tren dalam kondisi
atmosfer berarti
- Perubahan saat ini belum pernah terjadi
sebelumnya dalam sejarah manusia
Variabilitas Iklim:
- Sehari-hari (cuaca) atau relatif jangka pendek
(musiman) perubahan kondisi atmosfer
- Efek pada pola penyakit yang paling mudah
dianalisis, dan digunakan dalam prakiraan
Classical Epidemiological Triad
Environment

Agent Host
 Environment*
(biophysical, psycho-social, etc.)

Agent Host
(diverse exposures, (animal, plant,
including non-contagious ) ultimately human)

*CLIMATE is an Environmental Influence

 Environment

Agent Host
Examples Involving Infectious Diseases
Environment
longevity & infectivity nutrition
outside host
hygiene
host distribution, treatment
abundance, infection
housing
e.g. cholera e.g. TB, HIV/AIDS,
hantaviral disease diarrheal diseases,
hookworm acute respiratory
schistosomiasis infections

Agent Host
tissue tropisms, e.g. rabies,
pathogenicity, Lyme disease,
malaria,
immune response, cryptosporidiosi.
host specificity
But for ALL diseases, complex interactions occur...

Environment

Altered hygiene
Improved irrigation
Redesigned housing
Better nutrition

Agent Host
 Environment
Agent transport to new areas
New antibiotics, pesticides

Labor actions affecting toxin exposure

Agent Host
 Environment

Agent Host
Exposure probability, host immunity,
support networks, availability of supportive care
Examples of Environmental and Epidemiological Data

• Iklim pola - variabilitas ... mungkin berubah ...

Tata Guna Tanah / Pola Tanah
Data kasus pada Manusia kasus data (tertentu atau
sindromik)
Kelimpahan vektor dan infeksi patogen
Kelimpahan Reservoir / prevalensi infeksi
Lingkungan penggunaan dan eksposur
Pembangunan ekonomi, demografi manusia, migrasi ...

Each of these is historically changing in

time and space
Environmental Determinants of Human Disease
Social and Economic Policies
Institutions (including medical care)
Living Conditions
Social Relationships
Individual Risk Factors
Genetic/Constitutional
Factors
Pathophysiologic
e nt
pathways nm
i r o
n v
al E
Individual/Population
ys ic
Health
Ph

Modified from Kaplan, 2002

Research Challenge – Analyze and understand
interactions!
Social and Economic Policies
Institutions (including medical care)
Living Conditions
Social Relationships
Individual Risk Factors
Genetic/Constitutional
Factors
Pathophysiologic
pathways

t e ?
Individual/Population
m a
Health
C l i
 What is climate change? Climate variability?
High
Environmental Variable
Unchanging Average, Unchanging Extremes

Average Trend
(solid line)

Actual Measure
(dashed line)
Low

Time
 High
Environmental Variable
Unchanging Average, Increasing Extremes

Average Trend
(solid line)

Actual Measure
(dashed line)
Low

Time
 High

Increasing Average, Unchanging Extremes

Environmental Variable

Average Trend
(solid line)
Actual Measure
(dashed line)

Low

Time
 High
Environmental Variable Different Rates of Increasing Averages

Average Trend
(solid line)

Actual Measure
(dashed line)

Low

Time
High
Increasing Average, Greater Extremes
Environmental Variable

Average Trend
(solid line)

Actual Measure
(dashed line)

Low

Time
High
Increasing Rate of Increasing Average,
Environmental Variable Unchanging Extremes

Average Trend
(solid line)

Actual Measure
(dashed line)

Low

Time
High
Increasing Rate of Increasing Average,
Environmental Variable Greater Extremes

Average Trend
(solid line)

Actual Measure
(dashed line)

Low

Time
Masing-masing pola perubahan iklim
mungkin memiliki dampak berbeda pada
risiko penyakit tertentu.

Efek akan tergantung pada ekologi transmisi

dan etiologi penyakit dan ekspresi.
Each exposure type should be considered in context of:
 PERSON (age, behavior, gender, SES, etc.)
 TIME (year, season, adjacent periods, etc.)
 PLACE (geographic location, habitat, proximity, etc.)
Most Epidemiological studies only superficially consider
this for environmental (climatic) exposures:
+ PERSON most often involves standard descriptors that do
not include "social" characteristics or other environmental
exposures (e.g. climatic).
 TIME is rarely dynamic, considers only recent past, and
climate pattern over long periods not always available.
 PLACE often ignored or not carefully evaluated (e.g. spatial
autocorrelation, climate patterns in regions may be
 Environment and Exposure
Direct Exposure Indirect Exposure
Environmental Exposures
Source Source

Vehicle

Humans Solar UV Humans Stream pollutants

EM Radiation Air Particulates
Tetanus Legionella

Anthroponotic Infections
Humans Humans

Vehicle Vehicle

Humans STDs Humans Malaria

Measles Dengue
Hepatitis B Roundworm

Zoonotic Infections
Animals Animals
Vehicle Vehicle

Animals Animals
Anthrax
Humans Lyme Disease
Ebola (?) Hantaviral Disease
Humans
 Environment and Exposure
Where might Climate Impact?

Direct Exposure Indirect Exposure

Environmental Exposures
Source Source

Vehicle

Humans Solar UV Humans Stream pollutants

EM Radiation Air Particulates
Tetanus Legionella
 Environment and Exposure
Where might Climate Impact?

Direct Exposure Indirect Exposure

Anthroponotic Infections
Humans Humans

Vehicle Vehicle

Humans STDs Humans Malaria

Measles Dengue
Hepatitis B Roundworm
 Environment and Exposure
Where might Climate Impact?

Direct Exposure Indirect Exposure

Zoonotic Infections
Animals Animals
Vehicle Vehicle

Animals Animals
Anthrax
Humans Lyme Disease
Ebola (?) Hantaviral Disease
Humans CJD Most arboviral diseases
 Elements of Climate and Health

Maximum Temperature Heat-related mortality

Minimum Temperature Extreme Events

Mean Temperature Air Pollution

Rainfall Amount Vector-borne Diseases

Rainfall Frequency Water-borne Diseases

Rainfall Rate Agricultural Production

 What diseases are climate sensitive?

• More sensitive • Less sensitive

High – Which are more – What about less Low
sensitive???? sensitive???

Sensitivity
Sensitivity

Moderate Lowest
 What diseases are climate sensitive?

• More sensitive • Less sensitive

High – heat stress – sexually transmitted Low

– effects of storms diseases

– air pollution effects – violence

Sensitivity
Sensitivity

– asthma – most cancers

– vector-borne diseases – atherosclerosis
– water-borne diseases – tuberculosis
– food-borne diseases – myocardial infarction
Moderate Lowest
Sexually transmitted Heat stress
Disease
Effects of Storms

Water-borne disease
Food-borne disease
Atherosclerosis Asthma
Cancer (not skin) Vector-borne Disease
Myocardial Infarction
Violence

More Climate Sensitive

Diskusi ...
Dari PENGALAMAN ANDA atau KESUKAAN:
Penyakit apa yang mungkin memiliki link dengan iklim
dan variabel apa yang mungkin berdampak pada iklim
yang berpengaruh pada penyakit?
MENGAPA? Apa jalur biologis atau sosial?
Bagaimana ini diselidiki / diteliti?
Apa informasi tambahan yang akan Anda cari?
Bagaimana Anda mengintegrasikan ini menjadi penentu
risiko LAIN?
Bisakah Anda perkiraan risiko berdasarkan analisis ini
sendirian?
Apa faktor lain harus dipertimbangkan dan mengapa?
Pentingnya temporal dan spasial data luas dalam
menganalisis dan menafsirkan peran iklim:
Perubahan iklim yang terjadi selama periode waktu yang
lama
variabilitas perubahan iklim tidak mudah untuk mengakui
tanpa pengamatan jangka panjang
Ruang-waktu perubahan pola penyakit memerlukan
pengawasan yang akurat dan konsisten (sering tidak ada,
terutama di negara-negara berkembang)
Inferensi link iklim-penyakit terbatas tanpa seksama dengan
mempertimbangkan pola ruang-waktu
 Interpreting Spatial Patterns of Risk

aa bb
•Area of risk
•Size of areas
•Location and pattern
•Inter-area distances
•Connectivity among
locations

cc dd
How can extensive time-space datasets help?

Pattern of disease
… or knowledge, SES,
exposure, etc...

T1
T2

T3
How can extensive time-space datasets help?
How can extensive temporal datasets help?
Abundance / Prevalence

Time
How can extensive temporal datasets help?

Inter-annual
Fluctuations
Abundance / Prevalence

Establishment
and Colonization
Dispersal, Invasion,
Extinction, Reinvasion

Time
How can extensive spatial datasets help?
High

Habitat
Fragmentation
Abundance or Infection

Distance
from Source
Climate variable

Change in
Suitable Habitat
Low

Low Environmental Index High

 Some Sources of Data
• Meteorological Stations (climate, weather)
• Satellite – climate, vegetation, soil moisture, etc
• Census: population, age, sex, location, etc…
• Passive or active surveillance of human cases
• Surveillance of vector, reservoir abundance
• more...
Knowing is not enough; we must apply.
Willing is not enough; we must do.
(Goethe)