Your SlideShare is downloading. ×
1710 dr leong hoe nam   infection at the workplace - we can prevent it!
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

1710 dr leong hoe nam infection at the workplace - we can prevent it!

1,251
views

Published on

Published in: Health & Medicine

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
1,251
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
8
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Expert Doctor’s ShowcaseInfection at the work place – we can prevent it! Dr Leong Hoe Nam Infectious Diseases Physician Raffles Hospital, Singapore hoe_nam@yahoo.com.sgUnrestricted Educational Grant from
  • 2. Financial Declaration• Advisory Board – Pfizer – GlaxoSmithKline – Sanofi-Pasteur – MSD• Site Principal Investigator – Sanofi-Pasteur – Dengue Vaccine Trial Unrestricted Educational Grant from
  • 3. Infection in the Workplace is PREVENTABLE Begins with PERSONAL RESPONSIBILITYStephen Covey’s 7 Habits of HighlyEffective People
  • 4. SILVER WORKFORCE• Co-morbidities – Diabetes Mellitus, Chronic Obstructive Airway Disease, Asthma, Heart Disease, etc• Reduced Immunity• Same medical condition – HIGHER MORTALITY
  • 5. INFECTIONS HIV /E Coli AIDSHaemolyticUraemic VirusesSyndrome FUNGI BACTERIA GERMS Listeriosis Contaminated Cantaloupes
  • 6. RECENT EPIDEMICS / PANDEMICS• Spread Fast• Made use of Airport Routes
  • 7. www.airliners.net
  • 8. RECENT EPIDEMICS / PANDEMICS• Spread Fast• Made use of Airport Routes• Humans were the carrier• SINGAPORE – major airport hub RESPIRATORY ROUTE!
  • 9. Germany E Coli O104, Beansprout FAECAL ORAL TRANSMISSION
  • 10. INFECTIONS• Risk of infection higher in the immunocompromised host. Cancer patients• Diabetes mellitus type 2. Good control helps “sugar to the white cells is like brandy to an alcoholic” The pleasure of it all makes them not want to work.
  • 11. Two main modes of transmission of Illness • FAECAL ORAL • RESPIRATORYbalkris.blogspot.com
  • 12. Faecal Oral Transmission 粪便口头传输Viral infection (Rotavirus, Enteroviruses)Salmonella (Typhoid fever), ShigellosisHepatitis A- diarrhoea. Chong Kneas — a floating village over Tonle Sap Great lake in Cambodia. A child refills lake water into her drinking bottle.
  • 13. Faecal Oral Transmission粪便口头传输
  • 14. Spot the Difference
  • 15. Straits TimesNov 3, 2011
  • 16. What do I do?• Keeping the environment clean – Clearing / wiping down table. – Eating at the office table
  • 17. • Cover for keyboard.• Who used the keyboard previously?
  • 18. What do I do?• Keeping the environment clean – Clearing / wiping down table. – Eating at the office table• Nothing in the mouth except FOOD!• Washing Hands• Good toileting habits
  • 19. PATIENTS with CANCER / Salmonella enteritidisIMMUNOCOMPROMISED – TAKENOTE!• Ovaries of Hens• Bacteria enters egg prior to egg shell formation • Faecal contamination Fresh eggs go through the same vent as faeces Source: salmonellablog.com Topnews.in
  • 20. Faecal Oral Transmission 粪便口头传输It’s all about…..1. Personal hygiene2. Personal responsibility3. Using some common sense….Unwell1. Seek treatment2. Rest at home3. Strict handwashing
  • 21. Respiratory (呼吸)Influenza / Tuberculosis / PertussisBiggest burden – Influenza(流行性感冒)Spread by Droplet (通过飞沫传播)Other respiratory virusesRespiratory syncytial virus (RSV), parainfluenza, enteroviruses, adenovirus,coronaviruses, bocavirus, metapeumovirusOther bacterial infectionsStreptococcus pneumoniae, Haemophilus influenzae, Moxarella catarrhalis
  • 22. RespiratorySpread by droplets- minimise exposure- cover cough- dispose of dirty tissue- no spitting- hand hygiene- surgical mask SEE A DOCTOR!Stay at home.Influenza Vaccinationsfor those with chronicIllnessesOption of antiviral therapy <48hrs for influenza
  • 23. Surgical Masks – THEY WORK! PREVENTION OF INFECTIONTHEY PROTECT THEY PROTECTTHE WEARER! OTHERS!
  • 24. INFLUENZA COUGH! 20cm PREVENTS Transmission Johnson et al. Clin Infect Dis. (2009) 49 (2): 275-277.
  • 25. Myths on Influenza• It is a whimpy virus• It doesn’t kill• There is no influenza in Singapore• The influenza vaccination doesn’t work
  • 26. Two FLU SEASONS in SINGAPORE• BIMODAL APRIL – JULY NOVEMBER – JANUARY Follows the Southern and Northen hemispheres Greater PEAK – APRIL – JULY Angela Chow et al. EID. Vol 12. No.1 Jan 2006
  • 27. All Cause Death AUnderlying Pneumonia and InfluenzaUnderlying Circulatory and Respiratory Deaths Angela Chow et al. EID. Vol 12. No.1 Jan 2006
  • 28. Influenza – excess deathINFLUENZA is responsible for DEATH in TROPICS Angela Chow et al. EID. Vol 12. No.1 Jan 2006
  • 29. Every peak of excess death paralleled Influenza peaks (except 1)
  • 30. An experiment in TTSH• ALL patients admitted over 48 hour period tested for influenza• 10% were positive for influenza by PCR• 60% had “Influenza-like illness”• “underrecognition and underdiagnosis of influenza in hospitals. “ Leo YS et al. Lancet Inf Dis. August 2009
  • 31. An experiment in TTSH• ALL patients admitted over 48 hour period tested for influenza• 10% were positive for influenza by PCR• 60% had “Influenza-like illness”• “underrecognition and underdiagnosis of influenza in hospitals. “ Leo YS et al. Lancet Inf Dis. August 2009
  • 32. INFLUENZA in the AT-RISK POPULATIONS
  • 33. RR Hospitalisation• Non-epidemic years 1.1 (1977) 1.0 (1979)• Epidemic years 5.7 (1976) 6.2 (1978)• 5 X Increase risk of HOSPITALISATION• Pneumonia RR 25.6• Death RR 30.9 (1977)  91.8 (1978)
  • 34. The adjusted rates of excess influenza-associatedhospital admissions for the three diagnosescombined amounted to 58.5, 20.0, 29.2, and 13.4per 10,000 populations aged 65 years in 1998,1999, 2000, and 2001, respectively. • .
  • 35. Pneumonia / Diabetes Mellitus / Heart + INFLUENZA = BAD NEWS What about children…..? www.colourtown.com
  • 36. • The risk of INFLUENZA on HOSPITALISATIONs<6 mo 103.8 1-3y 18.6 5-15y – 4.16 – 12 mo 49.6 3-5y 8.6 Excess/10K chn/yr
  • 37. Relationship within the family Children Parents Grandparents
  • 38. Children gives “multiple doses” (exposures) to grandparents• 1 child can give multiple doses      
  • 39. The Good News….. We have a vaccine…….
  • 40. In SingaporeA vaccine is justdead vaccinelightly salted….
  • 41. Effectiveness of the Vaccine
  • 42. • COPD• Decrease in ARI / Hospitalisation / Mechnical Ventilation
  • 43. MILDMODERATE SEVERE ALL
  • 44. • Part of PRISMA Study (Prevention of Influenza, surveillance and management Study). 75,000• 1999-2000 Influenza A• Vaccine : Control 1:4
  • 45. Reduction in Death / Hospitalisation
  • 46. BURDEN OF INFLUENZA…. BEYOND THE PATIENT…..
  • 47. The burden of respiratory illness…• All respiratory illnesses can result in visits, prescriptions, lost school and work days…• BUT – INFLUENZA – had more of them…..
  • 48. Burden of Influenza vs Others • More transmissibility in family • More prescriptions • More medical visits • More lost work / school days
  • 49. Vaccinating the YOUNG to save the OLD• Mandatory Flu vaccination in Children – 1962-87• Laws relaxed 1987• Repealed in 1994• VACCINATION of COMPULSORY CHILDREN PROTECTS ELDERLY
  • 50. Vaccine EffectivenessAdults / Children with Asthma
  • 51. >65 yo713, 872 person-years observation. VACCINATION27% reduction HOSPITALISATION (for pneumonia / influenza (OR 0.73, CI 0.68-0.77)48% reduction in Risk of Death. (OR 0.52 CI 0.5 – 0.55)
  • 52. • Vaccine effectiveness repeated in Taiwan…..
  • 53. Cost EXcluding Operating Income PRODUCTIVITY RATE 70 50 30
  • 54. Cost INcluding Operating Income PRODUCTIVITY RATE 70 50 30
  • 55. Vaccine Safety Generally safe… Pain / Ache site of infectionLimited fever post vaccination
  • 56. MOH guidelines on Influenza Vaccination• Persons aged 65 years and older;• Residents of nursing homes and other chronic care facilities;• Adults and children who have chronic disorders of the lungs or heart, including asthma;• Adults and children who have required regular medical follow-up or hospitalization during the preceding year because of chronic metabolic diseases (including diabetes mellitus), kidney or blood disorders, or lowered immunity caused by medications or by the Human Immunodeficiency Virus (HIV);• Children and teenagers aged 6 months to 18 years who are receiving long-term aspirin therapy;• Women who are in the second or third trimester of pregnancy.
  • 57. INFECTIONS are transmitted by those around the patient  INDIVIDUAL To Protect!        INDIVIDUALs in contact with patientVaccinations must include the OUTERPERIMETER – the patients’ contacts!
  • 58. 5- to 19-year-olds are expected to suffer thehighest incidence during the initial epidemicphase of an emerging infection Mossong et al. PLoS Med. 2008 Mar 25;5(3):e74.
  • 59. Lessons on influenza• Children transmit the viruses• Children pass the infection to others (YOUR EMPLOYEE / YOURSELF)  Manhours, medical leave.• Vaccinating the children of your employee helps
  • 60. Impact of Annual Influenza Epidemics• No. of workdays lost 1.5 – 4.9 days / person lab-confirmed influenza. Keech and Beardsworth. Pharmacoeconomics. 2008;26(11):911-24• Lost of productivity “reduced capacity to work” 5 - 6.2 days Kavet. Am J Public Health. 1977;67:1063-1070
  • 61. Economics of Workplace Vaccination• Cost savings….($15 to $995) per vaccinated employee) (20% attack rates) Bruce lee at al. Vaccine. 2010 August 23; 28(37): 5952–5959
  • 62. TWO LARGE RANDOMISED CONTROL TRIALSTWO WELL RECOGNISED JOURNALS
  • 63. But there are detractors….• “vaccines are undoubtedly the best preventive means for clinical influenza in healthy adults.”• “low effectiveness and high incidence of trivial local adverse effects that the trade-of is unfavourable”• “most cost-effective option is not to take any action” Demicheli V et al. Vaccine. 2000 Jan 6;18(11-12):957-1030. Review
  • 64. How much vaccination is enough?• In an epidemic of influenza• Computer Modelling• 20% compliance – MAXIMUM GAIN!60 Days to complete vaccination 120 Days to complete vaccination Vaccine Cover Attack Rates Vaccine Cover Attack Rates 100% 0.5% 100% 1.5 50% 0.6% 50% 1.5% 20% 0.7% 20% 1.8% 0% 2.8% 0% 3.8% Lee et al. Am J Prev Med. 2010 March ; 38(3): 247–257
  • 65. Physical Barriers Help
  • 66. Respiratory Infections• Influenza biggest burden• Vaccination helps! $23-25 – Hospitalisation / Deaths• Influenza has two peaks in Singapore• Surgical masks can help prevent infections.
  • 67. Barriers to Vaccination1. Doctor’s Recommendations2. Perceived benefits3. Previous vaccinations4. Convenience to vaccinations eg. Vaccination programme at workplace, at GP consultation
  • 68. Some parting words• “If there is any conceivable way a germ can travel from one species to another, some microbe will find it,” William McNeill Plagues and Peoples
  • 69. The END Infection in the Workplace is PREVENTABLE Begins with PERSONAL RESPONSIBILITY(CORPORATE RESPONSIBILITY)
  • 70. Annual Impact of Seasonal Influenza - USA• 2003 US population 294 million• 610,660 life years lost• 3.1 million hospitalised days• 31.4 million outpatient visits• Direct medical costs $10.4 billion• Lost earnings $16.3 billion• Total Economic Burden $87.1 billion
  • 71. INFECTIONS are transmitted by those around the patient  INDIVIDUAL To Protect!        INDIVIDUALs in contact with patientVaccinations must include the OUTERPERIMETER – the patients’ contacts!
  • 72. How much vaccination is enough?• In an epidemic of influenza• Computer Modelling• 20% compliance – MAXIMUM GAIN!60 Days to complete vaccination 120 Days to complete vaccination Vaccine Cover Attack Rates Vaccine Cover Attack Rates 100% 0.5% 100% 1.5 50% 0.6% 50% 1.5% 20% 0.7% 20% 1.8% 0% 2.8% 0% 3.8% Lee et al. Am J Prev Med. 2010 March ; 38(3): 247–257
  • 73. Difficulty in Studying InfluenzaINFLUENZA INFLUENZA-LIKE ILLNESSESLab-confirmed Clinically suspected low sensitivity Other viruses responsible. Characteristic features (50%) URTI only (30%) No Symptoms (20%) Costly! Parainfluenza 1,2,3 Respiratory Syncytial INFLUENZA A, B Virus, Adenovirus, Enterovirus, Coronaviruses, Mycoplasma
  • 74. Risk of Guillain Barre Syndrome• Incidence GBS – 4-10/ 1,000,000• Flu – 15-20% of the cases.
  • 75. • “the attributable rate of GBS would be 0.71 per 100,000 person-years, corresponding to an attributable risk of 0.8 excess cases of GBS per 1 million vaccinations.“
  • 76. Impact of Annual Influenza Epidemics• No. of workdays lost 1.5 – 4.9 days / person lab-confirmed influenza.• Lost of productivity “reduced capacity to work” Keech and Beardsworth. Pharmacoeconomics. 2008;26(11):911-24