- Email: [email protected]
Global climate change and health effects: challenges for the health system and the doctor
PATHOLOGY UPDATE 2009 ABSTRACT PUBLICATION
47
DIAGNOSIS AND PREVENTION OF INFECTION IN LUNG TRANSPLANTATION
laboratories to maintain optimal diagnosis and ongoing developmental programs.
Allan R Glanville The Lung Transplant Unit, St Vincent’s Hospital, Sydney, NSW, Australia
CLIMATE CHANGE AND MOSQUITO-BORNE DISEASE: LIKELY IMPACTS IN AUSTRALIA
The lung is unique amongst solid organ transplants (SOT) for its extreme exposure to the ambient environment which leads to increased vulnerability to infection, particularly when host immune response and barrier mucosal function are impaired. Moreover, resident viruses and other microbes are invariably transplanted within the donor lung(s) which may lead to primary infection within the naı¨ ve recipient. Importantly, lung allograft infection promotes both innate and adaptive immune responses with resultant chronic allograft dysfunction manifest as bronchiolitis obliterans syndrome (BOS). Infection is both a promoter and result of airway damage, particularly where mucociliary clearance is impaired. The diagnosis and prevention of infection after LTX begins with a comprehensive microbiological survey of the recipient and the potential donor to identify tolerable risks. Prophylactic therapies against identified risks as well as common important infections including herpesgroup viruses, Pneumocystis carinii pneumonia (PCP), Chlamydia species and fungi are commenced routinely with bronchoscopic graft surveillance to identify infections not diagnosed by less invasive means. While effective preventative strategies for cytomegalovirus (CMV) are now readily available, the relative importance of community acquired respiratory viruses (CARV) has increased, especially as diagnosis may be delayed by late presentation and therapies are limited in efficacy. Prevention of CARV remains a challenge.
TRANSPLANTATION, IMMUNOSUPPRESSION AND INFECTION William Rawlinson Virology Division, Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney; School of Biotechnology and Biomolecular Sciences, University of New South Wales; and School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia Recipient infection is now the primary reason for post-transplant hospitalisation, morbidity and mortality (23% in some studies). The incidence has increased due to increased numbers of transplants, use of potent immunosuppressive drugs, and longer term survival of a greater range of transplanted patients, causing increased numbers of different types of infections that need to be monitored by the laboratory. The availability of increasingly sensitive and specific molecular tests for pathogens means the pathologist and clinician have a widening armamentarium of available assays. Some of these are well established (PCR for cytomegalovirus [CMV], bacterial 16S rDNA) where development of new algorithms, such as the use of multiplexing, and combination with culture-enhanced detection, means more sensitive detection of a broader range of pathogens. Newer assays in transplantation are being directed towards specific problems, e.g., genotyping of resistance genes in MRSA, detection of resistance genotypes in CMV. It is essential to cross-talk between transplant clinicians, the transplant community, transfusion services and
Richard C Russell University of Sydney and Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia Will a warming climate increase the risk or prevalence of mosquitoborne disease in Australia, as has been projected in a number of scientific publications and governmental reports? Unfortunately, most of these ‘predictions’ do not adequately consider the current and historical distribution of the vectors and diseases, their local ecology and epidemiology, and the impact of societal features and the capacity for public health interventions in Australia. Overall, a strong case can be made that we are unlikely to see significant changes in the distribution of transmission of the exotic pathogens causing malaria and dengue, and while activity of endemic arboviruses such as Murray Valley encephalitis and Ross River viruses may possibly increase in some areas, it is likely to decrease in others. The ecologies of mosquito-borne diseases can be complex and difficult to predict, and any evaluation of potential effects of changes in climate will need a detailed examination of site-specific vector, host and other factors likely to influence the outcomes on human health. Of itself, climate change as currently projected is not likely to provide great cause for public health concern with mosquito-borne disease in Australia.
GLOBAL CLIMATE CHANGE AND HEALTH EFFECTS: CHALLENGES FOR THE HEALTH SYSTEM AND THE DOCTOR Gillian Hall, Anthony McMichael National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia Global climate change as a result of human activity is now accepted as a reality by most people. Potential impacts on human society and life are diverse and both direct and indirect health effects are expected to occur as a result of changed climates. These include effects due to increased heat and extreme weather events, changes in the habitats of vectors of arboviruses, interactive effects between climate and air quality, changed patterns of food and water borne disease and changed yields and distribution of food affecting nutrition. Social and economic disruption and human migration are likely to ultimately have the greatest impact on health. There is considerable uncertainty and debate about the scale and timing of changes in disease patterns but most agree that overall negative health effects are to be expected. The health sector has a responsibility to respond to this challenge both in terms of mitigating climate change and adapting to changes already occurring. Never before has an overarching view of health been more important to all members of the health care professions. We all have a responsibility to ensure that the sector promotes health and rises to the challenge to reduce risks.
47
DIAGNOSIS AND PREVENTION OF INFECTION IN LUNG TRANSPLANTATION
laboratories to maintain optimal diagnosis and ongoing developmental programs.
Allan R Glanville The Lung Transplant Unit, St Vincent’s Hospital, Sydney, NSW, Australia
CLIMATE CHANGE AND MOSQUITO-BORNE DISEASE: LIKELY IMPACTS IN AUSTRALIA
The lung is unique amongst solid organ transplants (SOT) for its extreme exposure to the ambient environment which leads to increased vulnerability to infection, particularly when host immune response and barrier mucosal function are impaired. Moreover, resident viruses and other microbes are invariably transplanted within the donor lung(s) which may lead to primary infection within the naı¨ ve recipient. Importantly, lung allograft infection promotes both innate and adaptive immune responses with resultant chronic allograft dysfunction manifest as bronchiolitis obliterans syndrome (BOS). Infection is both a promoter and result of airway damage, particularly where mucociliary clearance is impaired. The diagnosis and prevention of infection after LTX begins with a comprehensive microbiological survey of the recipient and the potential donor to identify tolerable risks. Prophylactic therapies against identified risks as well as common important infections including herpesgroup viruses, Pneumocystis carinii pneumonia (PCP), Chlamydia species and fungi are commenced routinely with bronchoscopic graft surveillance to identify infections not diagnosed by less invasive means. While effective preventative strategies for cytomegalovirus (CMV) are now readily available, the relative importance of community acquired respiratory viruses (CARV) has increased, especially as diagnosis may be delayed by late presentation and therapies are limited in efficacy. Prevention of CARV remains a challenge.
TRANSPLANTATION, IMMUNOSUPPRESSION AND INFECTION William Rawlinson Virology Division, Microbiology, South Eastern Area Laboratory Services, Prince of Wales Hospital, Sydney; School of Biotechnology and Biomolecular Sciences, University of New South Wales; and School of Medical Sciences, University of New South Wales, Sydney, NSW, Australia Recipient infection is now the primary reason for post-transplant hospitalisation, morbidity and mortality (23% in some studies). The incidence has increased due to increased numbers of transplants, use of potent immunosuppressive drugs, and longer term survival of a greater range of transplanted patients, causing increased numbers of different types of infections that need to be monitored by the laboratory. The availability of increasingly sensitive and specific molecular tests for pathogens means the pathologist and clinician have a widening armamentarium of available assays. Some of these are well established (PCR for cytomegalovirus [CMV], bacterial 16S rDNA) where development of new algorithms, such as the use of multiplexing, and combination with culture-enhanced detection, means more sensitive detection of a broader range of pathogens. Newer assays in transplantation are being directed towards specific problems, e.g., genotyping of resistance genes in MRSA, detection of resistance genotypes in CMV. It is essential to cross-talk between transplant clinicians, the transplant community, transfusion services and
Richard C Russell University of Sydney and Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, NSW, Australia Will a warming climate increase the risk or prevalence of mosquitoborne disease in Australia, as has been projected in a number of scientific publications and governmental reports? Unfortunately, most of these ‘predictions’ do not adequately consider the current and historical distribution of the vectors and diseases, their local ecology and epidemiology, and the impact of societal features and the capacity for public health interventions in Australia. Overall, a strong case can be made that we are unlikely to see significant changes in the distribution of transmission of the exotic pathogens causing malaria and dengue, and while activity of endemic arboviruses such as Murray Valley encephalitis and Ross River viruses may possibly increase in some areas, it is likely to decrease in others. The ecologies of mosquito-borne diseases can be complex and difficult to predict, and any evaluation of potential effects of changes in climate will need a detailed examination of site-specific vector, host and other factors likely to influence the outcomes on human health. Of itself, climate change as currently projected is not likely to provide great cause for public health concern with mosquito-borne disease in Australia.
GLOBAL CLIMATE CHANGE AND HEALTH EFFECTS: CHALLENGES FOR THE HEALTH SYSTEM AND THE DOCTOR Gillian Hall, Anthony McMichael National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia Global climate change as a result of human activity is now accepted as a reality by most people. Potential impacts on human society and life are diverse and both direct and indirect health effects are expected to occur as a result of changed climates. These include effects due to increased heat and extreme weather events, changes in the habitats of vectors of arboviruses, interactive effects between climate and air quality, changed patterns of food and water borne disease and changed yields and distribution of food affecting nutrition. Social and economic disruption and human migration are likely to ultimately have the greatest impact on health. There is considerable uncertainty and debate about the scale and timing of changes in disease patterns but most agree that overall negative health effects are to be expected. The health sector has a responsibility to respond to this challenge both in terms of mitigating climate change and adapting to changes already occurring. Never before has an overarching view of health been more important to all members of the health care professions. We all have a responsibility to ensure that the sector promotes health and rises to the challenge to reduce risks.