Responding to Communicable Diseases

Dr. Cheryl Anderson

National RAP Conference, Vancouver , February 20, 2007

What is a Communicable Disease?

Sickness caused by transmission of an infectious agent to a susceptible host

Infectious agents include:

Viruses

Bacteria

Protozoa

Worms

How do humans get infected?

TRANSMISSION of infectious agents to Susceptible Human Host occurs in variety of ways, including:

Touching/biting/kissing

Sexual intercourse

Droplets from sneezing, coughing, spitting

Airborne particles, e.g. TB

Mother to fetus during pregnancy

Injections of contaminated blood

Does every exposed host get sick?

The Healthy host may not get sick or may have a mild response to infection:

TB – 90% of infected never get sick

The human host may become a carrier capable of infecting others without ever getting sick

Hepatitis B and C

How many people die from Infections?

Globally 1/3 of premature deaths are infection-related – mostly in poor countries:

Diarrheal disease – 2-3 million deaths yearly

Malaria – 2-3 million deaths yearly

TB – 2-3 million deaths yearly

HIV – more than 4 million deaths in 2005

Why poor countries?

Poor nutrition

Poor living conditions contaminated water

no sewage

crowded or no housing

Poor or non-existent health care –preventative & curative

What Prevents Infections?

Public Health Infrastructure

Sewage systems

Safe food

Safe water

Housing codes

Vector control, e.g. mosquitoes

Personal Prevention strategies

Good nutrition

Immunization

Hygiene

Protective coverings Condoms

Mosquito nets

Disinfestation/Disinfection

Avoid exposure

Medical interventions & infection control

Isolation of sick person e.g. TB

Prophylactic treatment of contacts

Early detection and treatment

Direct Observed Therapy (DOT) for TB Ensures completion of therapy

Reduces development of resistance to treatment

Infection control in hospitals/facilities

What puts refugees at risk?

Increased exposure to diseases endemic to

Country of origin

Refugee camp or transit country

Poor public health infrastructure

Poor nutrition

Poor immunization rates

Crowded housing

Poor or non-existent health care

How does CIC protect the Public’s Health?

Immigration Medical Examination screens for:

HIV, Tuberculosis, Syphilis

Medical Surveillance Post Landing by Public Health for:

Inactive tuberculosis

Treated positive syphilis serology

If HIV positive, immigrant advised to contact clinic specializing in HIV following entry into Canada

Who is at risk for TB in Canada?

Tuberculosis (TB) in 2005

Total cases 1616 (5.0/100,000)

Canadian born cases 519 (2.0/100,000) Aboriginal cases 308 (26.8/100,000)

Non-Aboriginal cases 211 (0.9/100,000)

Foreign born cases 1016 (14.8/100,000) Rates in top 3 source countries in 2004

China – 101/100,000

India – 168 /100,000

Philippines – 293 /1000,000

Reducing risk of infection/illness

Food Security and Nutrition

Means and access to healthy food

Canada Food Guides

Food Safety

Instruct on proper storage and preparation

Appropriate Housing

Reducing Risk of Infection

Personal hygiene

Immunizations

Avoiding exposure

Protective coverings

Condoms

Reducing Risk of Illness when Infected

Early detection and treatment

Examples – HIV, TB

Healthy living

Exercise, good nutrition, sleep

Avoiding harmful substances, e.g. nicotine

How do settlement workers stay healthy?

Healthy lifestyle – exercise, nutrition, sleep, etc.

Immunizations

Personal hygiene

Medical follow-up if: Asymptomatic but known exposure; or

Symptomatic for early detection/treatment

Public Funded Immunizations (Canada)

Diptheria Tetanus Pertussis (whooping cough) Polio Haemophilus influenzae type b Hepatitis B Measles, Mumps, Rubella Varicella (Chicken Pox) Meningococcal C conjugate Penumococcal conjugate Influenza (Flu)

Information Sources:

BC Health Files. Ministry of Health. www.gov.bc.ca

Canadian National Report on Immunization. Canada Communicable Disease Report Supplement Vol32S3 Nov, 2006. Public Health Agency of Canada.

Citizenship and Immigration Canada: Facts and Figures 2005. www.cic.gc.ca

Country Profiles on Tuberculosis, World Health Organization. www.who.int

Health Canada: Eating Well with Canada’s Food Guide, 2007. www.hc-sc.gc.ca

Heymann, David L., Editor. Control of Communicable Diseases Manual, Official Report to American Public Health Association, 18th Edition, 2004.

Tuberculosis in Canada 2005. www.publichealth.gc.ca/tuberculosis

BC Health File Topics - www.bchealthguide.org/healthfiles/index.stm

Sneezes and Diseases Handbook -http://www.vch.ca/public/communicable/docs/sneezes_diseases.pdf