Environnement et ré-émergence de maladies infectieuses en bassin amazonien : risques sanitaires & évolution de pathogènes humains majeurs (Flavivirus de dengue Mycobactérium ulcerans, Plasmodium falciparum et P. vivax) – EREMIBA

Evidence is now accumulating that environmental changes may have a strong impact on the health of humans and even wildlife. The issues involved are numerous and highly complex; indeed, many different parameters acting at different spatial and time-scales may be intimately interconnected in their effects, and these problems constitute a growing challenge not only for scientists and physicians, but also for governments, international institutions and societies. The analysis of environmental hazards on health requires integrating knowledge of different disciplines, thus necessitating a holistic research agenda, which is not really met in modern epidemiology. Health is connected to local conditions, but also to the global environment, considered widely as to be dependent on physical (temperature, rainfall, humidity, etc.), biotic (vegetation, host species, predators, competitors, etc.), human (genetic susceptibility, behaviour) and socio-economical factors (nutritional status, hygiene, population density). The relationships and the two-way interactions between those factors are numerous and complex, implicating a diversity of process levels acting at different hierarchical scales that physicists and ecologists, among others, have started to study. The present project called EREMIBA (Environnement et Réémergence de Maladies Infectieuses en Bassin Amazonien) has grew from this multi-systemic context. Its overall goal is to beyond specific details upon which traditional scientific investigations have usually focused, and search for more general and rigorous two-way interactions that really occur within the so-called eco-socio-pathogen system. This “integrative approach” will adopt five levels of analyses: spatial, temporal, functional, methodological and thematic. Within this context, the present proposal aims at developing an inter-disciplinary research programme focused on the linkages between health and the environment in the specific tropical context of French Guiana, Southern America. Three diseases are attractive candidates to develop such methodological approach: malaria, dengue, and Mycobacterium ulcerans infection (Buruli ulcer), because it has been previously demonstrated that they have a strong environmental component that can be implicated in emergence, re-emergence, persistence, or spatial diffusion of the disease. Moreover, local research and medical units have already set up (i) a clinical surveillance network at the regional scale, that might be perennial, (ii) an effective multi-disciplinary team, including members of the present proposition, and (iii) some small control areas, allowing case-control studies. The characterization of environmental, biotic and abiotic, coonditions via remote sensing, and the combination of obtained data with geo-referenced epidemiological, genetic and socio-economic data of populations in a Geographic Information System (GIS) must allow the foundation of a Regional Health Observatory (ORS, Observatoire Régional de la Santé) in French Amazonia. The HPRT station, located at IRD research station at Cayenne in French Guiana, will regularly provide some new satellite images to the ORS, which will focus on control and surveillance of areas at highest risk for emergence or re-emergence of parasitic and infectious diseases. The surveillance will take place, on a first time, in French Guiana, but the aim is to expend it, in a second time, to neighbour partners with which contacts are already established (Brazil, Suriname and French West Indies). The ORS of French Guiana, focused on pathogen emergence in tropical areas, will be integrated in a wider network of International Health Observatories, in charge of the quantification of risk related to emerging infectious diseases.