Emerging and Re-emerging Infectious Diseases
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Transcript of Emerging and Re-emerging Infectious Diseases
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Emerging andRe-emerging Infectious Diseases
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INTRODUCTIONRESPONSIBLE FACTORSCLASSIFICATIONDISEASES OF CONCERNPREVENTION
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INTRODUCTION :INFECTIOUS DISEASESINFECTIOUS DISEASES
Accounted for about 26% of the 57 million deaths worldwide in 2002.
Remain among leading causes of death worldwide despite remarkable advances in medical research and treatments.
In addition, nearly 30% of all disability adjusted life years (DALYs) could be accounted to infectious diseases.
Emergence of new infectious diseases, re-emergence of old infectious diseases and persistence of intractable infectious diseases, all led to persistence and even increase in infectious diseases in many parts of the world .
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DEFINITIONSEmerging Infectious DiseasesEmerging Infectious Diseases
It includes outbreaks of previously unknown diseases or known diseases whose incidence in humans has significantly increased in the past two decades.
Re-emerging Infectious DiseasesRe-emerging Infectious Diseases
These are the known diseases that have reappeared after a significant decline in incidence.
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““Are infectious Are infectious diseases emerging more diseases emerging more recently than before?recently than before? “ “
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Major Factors Contributing to Emerging Infections: 1992
1) Human demographics and behavior
2) Technology and Industry
3) Economic development and land use
4) International travel and commerce
5) Microbial adaptation and change
6) Breakdown of public health measures
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More Factors Contributing to Emerging Infections: 2003
1) Human vulnerability2) Climate and weather3) Changing ecosystems4) Poverty and social inequality5) War and famine6) Lack of political will7) Intent to harm
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Emerging Infections:Human Demographics, Behavior, Vulnerability
More people, more crowding.
Changing sexual mores (HIV, STDs)
Injection drug use (HIV, Hepatitis C)
Changing eating habits: out more, more produce (food-borne infections)
More populations with weakened immune system: elderly, HIV/AIDS, cancer patients and survivors, persons taking antibiotics and other drugs.
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Emerging Infections:Technology and Industry
Mass food production (Campylobacter, E.coli O157:H7, etc…)
Use of antibiotics in food animals (antibiotic-resistant bacteria)
More organ transplants and blood transfusions (Hepatitis C, WNV,…)
New drugs for humans (prolonging immunosuppression)
A big city on a sunny day
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Emerging Infections:Economic Development, Land Use, Changing Ecosystems
Changing ecology influencing waterborne, vector borne disease transmission (e.g. dams, deforestation)
Contamination of watershed areas by cattle (Cryptosporidium)
More exposure to wild animals and vectors (Lyme disease, erhlichiosis, babesiosis, …)
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Emerging Infections:
International Travel and Commerce Persons infected with an exotic
disease anywhere in the world can be into your city within hours (SARS)
Foods from other countries imported routinely into your city (Cyclospora,….)
Vectors hitch-hiking on imported products (Asian tiger mosquitoes on bamboos….)
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Emerging Infections:
Microbial Adaptation and Change
Increased antibiotic resistance with increased use of antibiotics in humans and animals (VRE, VRSA, penicillin- and macrolide-resistant Strep pneumoniae, multidrug-resistant Salmonella,….)
Increase virulence (Group A Strep)
Jumping species from animals to humans (avian influenza, HIV?, SARS?)
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Emerging Infections:Poverty, Social Inequality, Breakdown of Public Health Measures
Lack of basic hygienic infrastructure (safe water, safe foods, etc..)
Inadequate vaccinations (measles, diphtheria)
Discontinued mosquito control efforts (dengue, malaria)
Lack of monitoring and reporting (SARS)
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Emerging Infections:
Intent to HarmBioterrorism: Anthrax in
US 2001Bio-Crimes: Salmonella ,
Shigella Potential agents:
Smallpox, Botulism toxin, Plague, Tularemia, ….
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LIST OF EMERGING & RE-EMERGING DISEASES
GROUP-1PATHOGENS NEWLY RECOGNIZED IN LAST
TWO DECADES
ACANTHAMOEBIASISBABESIOSISBARTONELLA HENSELEEHERLICHIOSISCORONA VIRUS(SARS)
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CONTD…H.PYLORIHEPATITIS CHEPATITIS EHUMAN HERPES VIRUS8(HHV8)HHV6LYMEBORRELIOSISPARVO VIRUS B19
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GROUP-2
REMERGING PATHOGENS
ENTEROVIRUS71CLOSTRIDIUM DEFFICILECOCCIDIOIDES IMMITISMUMPS VIRUSPRIONSTREPTOCOCCUS GROUP ASTAPHYLOCOCCUS AUREUS
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GROUP-3
AGENTS WITH BIOTERRORISM POTENTIAL
CATEGORY AB.anthracisC.botulinumY.pestisV.majorF.tulariensisHanta virus
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CATEGORY B
B.malleiB.pseudomalleiC.brunettiBrucellaRicin toxinEpsilon toxin(c.perfringens)EnterotoxinB(staphylococcus)Viral encephalitides(Japanese encephalitis
virus,kyasanur forest virus)
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CONTD…
FOOD &WATER BORNE DISEASES
BACTERIA(E.coli,Vibrio,shigella)VIRUS(Hepatitis A,Calcivirus)PROTOZOANS(Giardia,Entamoeba,Cryptospori
dium)
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CATEGORY C
TICK BORN HAEMORRHAGIC FEVERSTICK BORN ENCEPHALITIC FEVERYELLOW FEVERMDR TB & XDR TB RABIESSARS ASSOCIATED CORONAVIRUSANTIMICROBIAL RESISTANCE
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IMPORTANT RE-EMERGING DISEASESTUBERCULOSISDENGUE FEVERMALARIAMENINGOCOCCAL MENINGITISBUBONIC PLAGUEHANTA VIRUS PULMONARY SYNDROME
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HIV/AIDSPresent situation and challenges
HIV epidemic in SEAR mainly due to: Unsafe sex Injecting drug use Poverty Low literacy Widespread stigma Weak health systems.
India, Thailand, Myanmar, Indonesia and Nepal – account for the majority of the burden in the Region.
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SARS A patient was admitted in Vietnam on 26th Feb. 2003 with respiratory illness and died in March 2003.
7 health workers who cared for this patient also became ill on 5th March 2003.
Since then, the cases have been reported from many countries.
International travel facilitated its spread rapidly.
It was found that the disease initially emerged in China in November 2002.
The etiological agent is a virus -- isolated, but yet to be identified. Perhaps, it is a mutated strain of corona virus or a virus, which has jumped from an animal species to humans.
The infection is spread through droplets/aerosols. (It is also possible that SARS is transmitting through other unidentified routes.)
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AVIAN INFLUENZAAVIAN INFLUENZAREASONS FOR CONCERN ABOUT THE CURRENT OUTBREAKS
•Most outbreaks caused by the highly pathogenic H5N1 strain.•Strain has unique capacity to jump the species barrier & cause severe disease, with high mortality, in humans.
•Gene swapping between the human & viruses inside the human body can give rise to a comavian pletely new subtype of the influenza virus to which Very few, if any, humans would have natural immunity.
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•Sufficient human genes in virus direct man to man transmission Pandemic.
• influenza pandemic of 1918–1919 when the virus spread around the globe in 4-6 months.
•existing vaccines, would not be effective against completely new influenza virus.
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TuberculosisPresent situation
SEAR with 5million cases, has the highest number of TB cases among all WHO regions.
Bangladesh, India, Indonesia, Myanmar and Thailand are among the 22 high-burden countries in the world and together account for 95% of the TB burden in the Region.
TB -most common opportunistic infection among HIV-infected.
~3 million people co-infected with HIV & TB.
Every year 3 million people newly
affected. over 500000 lose their lives.
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TB has emerged as MDR-TB & XDR-TBAbout 50 million people worldwide are infected with
drug resistant TB% of MDR-TB in INDIA in 2004 was 2.4 among new
casesSTOP TB STRATEGY adopted by WHO in 2006
focusses on prevention & control of MDR-TB & HIV -TB
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MalariaPresent situation and challenges
PAST TWO DECADES
The proportion of Plasmodium falciparum malaria has increased from 12% to more than 45%.
Increasing resistance of Plasmodium falciparum to first- and second line anti- malarial drugs.
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MalariaPresent situation and challenges
India reports the largest proportion of malaria cases in the Region.
Annually there are approximately 100 million cases in SEAR
PRESENTLY
About 2.5 million cases and 4000 deaths per year.
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DENGUEPresent situation and challenges
Dengue has emerged as a serious public health problem over the last few decades.
Disease is spreading to new geographical areas, and frequency of outbreaks has increased.
During 2007, outbreaks have been reported from a number of countries in Asia including Thailand, Cambodia, Indonesia, Vietnam, Philippines and even in Singapore, which has one of the best dengue control programmes.
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State wise dengue cases and deaths, India, 1998-2001
States 1998 1999 2000 2001
Cases Deaths Cases Deaths Cases Deaths Cases Deaths
Andhra Pradesh --- --- --- --- 05 Nil 0 0
Delhi 333 05 168 02 180 02 0 0
Goa 0 0 0 0 0 0 1 0
Gujarat Nil 0 92 0 29 0 0 0
Haryana 14 0 03 0 2 0 0 0
Karnataka 115 03 39 0 168 0 45 0
Kerala 0 0 0 0 0 0 0 0
Maharashtra 199 05 59 12 66 03 05 0
Orissa 11 0 0 0 0 0 0 0
Punjab 0 0 419 01 91 01 0 0
Rajasthan 02 0 01 0 0 0 0 0
Tamilnadu 33 05 135 02 81 01 06 0
Uttar Pradesh 0 0 28 0 0 0 0 0
Total 707 18 944 17 622 07 57 0
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PLAGUEIn SEAR, natural foci of plague- exist in INDIA,
INDONESIA , MAYANMAR & NEPALNo case was reported after 1966 in INDIA till it re-
emerged in sept 2004 in MAHARASHTRA1997- outbreak of pneumonic plague in SURAT2002- 16 cases of pneumonic plague(4 deaths) in hatkoti ,
distt SHIMLA
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SCRUB TYPHUS
• During world war II, an epidemic of scrub typhus occurred in ASSAM & WEST BENGAL.
• 1970 -80,it was reported from INDIA, CHINA, JAPAN, INDONESIA & MALAYSIA.
• In july,2008 ,outbreak occurred in some areas of HP.
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Response To Response To “Threat”“Threat” Various international & national organizations
have come together to combat this threat.
WHO, CDC, NIH, Department of Defense & FDA.
ALL work in collaboration to develop strategic plans to combat the microbial emergence and re-emergence.
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Surveillance and Response
Applied Research
Infrastructure and Training
Prevention and Control
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Surveillance Global / Regional level laboratory surveillance
FLUNET : Surveillance network for monitoring influenza\ RABNET : Surveillance network for rabies
PANCET : Pacific Public Health Services Network - to improve surveillance in pacific island.
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Surveillance
GPHIN : Global Public Intelligence Network
Antimicrobial resistance information bank Global / Regional level epidemiological surveillance.
International Health Regulations (IHR) mandatory reporting of certain infectious diseases eg. Cholera, plague, yellow fever
WHO Disease / rumor outbreak list - list unconfirmed disease outbreaks worldwide.
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Global & National Surveillance Systems / Networks
At National Level - strong surveillance system is required to collect relevant, accurate & timely information of an outbreak.
WHO – at Global Level- act as focal point for data exchange. WHO has recommended surveillance standards for 40 specific diseases and 8 syndromes.
HIV/AIDS network – through sentinel sites Influenza network- Collects information from member laboratories to make
decision regarding vaccine composition .
Tuberculosis monitoring system- Produces reports on notification, results and the extent of implementation of DOTS .
Global salmonella surveillance network .
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Research: Various organizations like CDC, National Institute
of Allergy & Infectious Diseases (NIAID), National Institute of Diabetes Digestive and Kidney diseases (NIDDK), has made research contributions in field of HIV/AIDS, Tuberculosis, Malaria, Hepatitis C etc.
Advances in genomics, proteomics better understanding of pathogenesis, host immunity & drug resistance and identifying new drug targets & develop new vaccines and diagnostics.
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• Strengthen public health infrastructures to support surveillance, response, and research.
• To implement prevention and control programs.
• Provide the public health work force with the knowledge and tools it needs.
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Prevention and ControlGlobal outbreak Global outbreak
ResponseResponse:: It involves- building a
team, obtaining access and travelling to affected area, recommending and implementing control measures.
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NATIONAL LEVELNATIONAL LEVEL District epidemic management
committee:-For resource mobilization, monitoring and evaluation of control activities; dissemination of information to public & documentation of outbreak.
District rapid response team:- For investigation of outbreak and implementation of control activities at the district level.
The Health facility personnel:- For case management, reporting and education of public.
Community Leaders: Helping in controlling the epidemic.
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FETP (Field Epidemic Training ProgrammeFETP (Field Epidemic Training Programme)
PHSWOW ProgrammePHSWOW Programme (Public Health Schools without walls)- Two year field and academic training programme, established by CDC in collaboration with Rockefeller foundation.
TEPHINET :TEPHINET : Training programme in epidemiology
Epi – Aid :Epi – Aid : For rapid deployment of professional staff to aid outbreak verification & control.
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Future Outlook :MAJOR GOAL: -development and production of counter measures. -requires basic research and concept development.Application and research in molecular biology. To develop a second- generation of vaccines (safe and
effective) e.g. 1.‘naked DNA' vaccine 2. recombinant proteins to fight against HIV/AIDS, malaria and tuberculosis Sequencing the genomes develop effective vaccines
and drugs. Other developments next-generation anthrax vaccine,
Ebola vaccine and monoclonal antibodies against botulism toxin
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Partnerships among clinicians, researchers, government and industry.
Improving#surveillance, #disease control# response to an outbreak
through improved laboratory facilities
# training of personnel# establishing reliable and efficient
communication networks # strong public health
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GUIDED BY:-
DR. ANUPAM PARASHAR
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PRESENTED BY:Nandini sood(0537)Neha chauhan(0538)Nitin Sood(0539)Nishant sharma(0540)Nripen Gaur(0541)Priyanka Sood(0542)
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THANKS