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New Emerging And Reemerging Infections circa 2006

Lecture notes on New Emerging And Reemerging Infections circa 2006. I stopped updating it since the lecture was take over by Norfazilah Ahmad.

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New Emerging And Reemerging Infections circa 2006

  1. 1. drtamil@gmail.com 2006 New Emerging & Re-Emerging Infections Dr Azmi Mohd Tamil
  2. 2. drtamil@gmail.com 2006 Case History of Hantavirus • 3rd July 2003, – Petaling District Health Office received a notification of death of Hantavirus infection that occurred on 13th June 2003 at HUKM. – Deceased was a 22-year-old Myanmar male – He arrived in Malaysia with 9 other Myanmar males on 7th April 2003
  3. 3. drtamil@gmail.com 2006 Active Case Detection • Out of 9 Myanmar workers who arrived together with the deceased, only 2 workers were symptomatic & referred to HUKM – Only 1 was confirmed IgM positive for Hantavirus, currently well and on follow-up at HUKM – The other Myanmar worker was reported to be normal • However, 2 Myanmar workers had absconded from the workplace, their whereabouts & health status remained unknown. • All other co-workers were asymptomatic
  4. 4. What are emerging infectious diseases? • Diseases whose incidence in humans has increased in last 20 years or threatens to increase in future, usually due to demographic or environmental factors Institute of Medicine, 1992
  5. 5. Examples of emerging and reemerging infectious diseases • Ebola virus • HIV • Hepatitis C • Sin Nombre Virus (hantavirus) • Influenza A(H5N1 and H7N7) • SARS coronavirus • Legionella pneumophila • Escherichia coli O157:H7 • Cyclospora cayetensis • Borrelia burgdorferi • Vibrio cholerae O139 Cholera • Dengue fever • Diphtheria • Meningococcal meningitis • Monkeypox • Rift Valley fever • Yellow fever
  6. 6. Global Burden • New infections are emerging over the entire expanse of the globe. Wherever you find people, you will find the emergence of infections. The risk of emergence is not confined to poor countries:as shown by the E. coli epidemic in Japan, one of the most affluent economies in the world. There are global pandemics of HIV and cholera, and the annual influenza in USA.
  7. 7. Why are they emerging? • Global travel • Globalization of food supply and central processing of food • Population growth, increased urbanization, and crowding • Population movements due to civil wars, famines, and other man-made or natural disasters • Irrigation, deforestation, and reforestation projects that alter the habitats of disease- carrying insects and animals
  8. 8. Why are they emerging? • Human behaviors, such as intravenous drug use and risky sexual behavior • Increased use of antimicrobial agents and pesticides, hastening the development of resistance • Increased human contact with tropical rain forests and other wilderness habitats that are reservoirs for insects and animals that harbor unknown infectious agents
  9. 9. drtamil@gmail.com 2006 O’Neill, 2002 "In failing to look beyond boundaries we fail to take into account the fact that boundaries are now multiply porous. Health problems travel across boundaries not only because diseases travel, but because the mirror image of a global configuration of social and economic power is a global configuration of poverty and ill health"
  10. 10. Current International Efforts at Infectious Disease Control • Improve surveillance efforts; • Develop international standards and guidelines for disease reporting and control; • Strengthen international research; • Disproportional concern with techno fix • Encourage national governments to improve public health systems. Source: World Health Assembly. Communicable diseases prevention and control: new,emerging, and re-emerging infectious diseases. WHO Doc. WHA 48.13, May 12, 1995.
  11. 11. International Health Regulations • Established under WHO in 1951: ‘Sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease;’ • Lack of compliance almost universal; • Revisions (1995): Surveillance, response, increased number of diseases covered.
  12. 12. International Health Regulations • Intended to protect industrialized world commercial investments and armies • Global infectious disease spread through mobility, war, etc • Major effort to protect economies through control of Infectious Diseases and subsequent bad publicity.
  13. 13. Outbreaks
  14. 14. 0 20 40 60 80 100 120 140 160 180 200 Year Black Men Black Women White Men White Women *Preliminary data Trends in Rates of Death from HIV Infection among Persons 25-44 Years Old, USA, by Sex and Race, 1982-1997 From national vital statistics, Centers for Disease Control & Prevention Deathsper100,000Population 82 84 86 88 90 92 94 9683 85 87 89 91 93 95 97*
  15. 15. drtamil@gmail.com 2006 Dengue in the Americas, 1980– 1998 Unpublished data: Pan American Health Organization, March 1999 0 100 200 300 400 500 600 700 800 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998* ReportedCases(Thousands)
  16. 16. drtamil@gmail.com 2006 Human Rabies Trends: 1980-1989 versus 1990-1998 DVRD / VRZB 0 5 10 15 20 25 Bat Acquired abroad Dog/Coyote Skunk 1 7 2 20 5 2 1980 -1989 1990 -1998
  17. 17. drtamil@gmail.com 2006 Emerging / Re-emerging diseases 1996 to 2004 Cryptosporidiosis Lyme Borreliosis Reston virus Venezuelan Equine Encephalitis Dengue haemhorrhagic fever Cholera E.coli O157 West Nile Fever Typhoid Diphtheria E.coli O157 Echinococcosis Lassa fever Yellow fever Ebola haemorrhagic fever O’nyong-nyong fever Human Monkeypox Cholera 0139 Dengue haemhorrhagic fever Influenza A(H5N1) Cholera RVF/VHF nvCJD Ross River Virus Equine morbillivirus Hendra Virus BSE Multidrug- resistant Salmonella E.coli non-O157 West Nile Virus Malaria Nipah Virus Reston Virus Legionnaire’s Disease Buruli ulcer Influenza A (H7N7) SARS
  18. 18. drtamil@gmail.com 2006
  19. 19. drtamil@gmail.com 2006 Emerging disease threats in Asia • Outbreaks of known epidemic-prone diseases continue to occur – Dengue fever, Japanese encephalitis, meningococcal disease, typhoid fever, cholera, leptospirosis, polio • Newly emerging infectious diseases pose serious public health threats – Nipah virus, SARS, avian influenza A (H5N1) – Other unknown disease threats
  20. 20. drtamil@gmail.com 2006 Cross-border Spread of Dengue in Mekong Countries Jan 1998 Apr 1998 Aug 1998 < 5 5 - 9 10 - 49 50 - 99 > 100
  21. 21. drtamil@gmail.com 2006 Avian Influenza A (H5N1) in Asia As of 9 December 2005
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  32. 32. drtamil@gmail.com 2006 Severe Acute Respiratory Syndrome • WHO has revised the name of this disease to Severe Acute Respiratory Syndrome (SARS). SARS is an atypical pneumonia for which the cause has not yet been determined. • Fever (>38oC) and respiratory symptoms including cough, shortness of breath or breathing difficulty; • an outbreak of respiratory disease that began in southern China in November and has struck more than 300 people, killing five. • HK 123/2, Vietnam 57/1, S’pore 23/0, USA 14/0, Canada 1 death • the virus belongs to the paramyxoviridae family.
  33. 33. drtamil@gmail.com 2006 Family 01.048. Paramyxoviridae • Subfamily 01.048.1. Paramyxovirinae – Genus 01.048.1.01. Respirovirus – Genus 01.048.1.03. Rubulavirus – Genus 01.048.1.02. Morbillivirus – Genus 01.048.1.04. Henipavirus – Genus 01.048.1.05. Avulavirus – Genus 01.048.0.06. "TPMV-like Viruses" • Subfamily 01.048.2. Pneumovirinae – Genus 01.048.2.01. Pneumovirus – Genus 01.048.2.02. Metapneumovirus
  34. 34. drtamil@gmail.com 2006 The cost of SARS: initial estimates, Asian Development Bank 76543210 US$ billion Hong Kong China, mainland Taiwan South Korea Indonesia Singapore Thailand Malaysia Philippines US$ billionUS$ billion 4% 0.5% 1.9% 0.5% 1.4% 2.3% 1.6% 1.5% 0.8% % of GDP
  35. 35. drtamil@gmail.com 2006 Summary of the situation of AI outbreaks in poultry • Unprecedented outbreaks – Geographical spread – Silent reservoir (domestic ducks, wild migratory birds) – More outbreaks expected during the coming cold seasons – Impact on poultry • Difficult to contain – The virus is already entrenched in Asian countries – Backyard farms
  36. 36. drtamil@gmail.com 2006 Human Avian Influenza A/H5N1 Cases by Onset Date and Country ( 14 December 2005 ) 0 5 10 15 20 25 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 Date of onset No.ofcases Viet Nam (N=91) Thailand (N=22) Cambodia (N=4) Indonesia (N=14) China (N=5) 2003 2004 2005
  37. 37. drtamil@gmail.com 2006 Human Avian Influenza A/H5N1 Cases by Outcome and Age Group ( 14 December 2005 ) 0 10 20 30 40 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 Age group No.ofcases Dead (N=71) Alive (N=65) • As of 14 December, total of 138 cases were reported officially to WHO • 136 cases with available data were included
  38. 38. drtamil@gmail.com 2006 Risk factors for human infections • Still not fully understood • Most cases have occurred in domestic settings • High-risk human behaviours continue • Unhygienic animal husbandry practices
  39. 39. drtamil@gmail.com 2006 Summary of the situation of human cases • Continuous and increasing human cases • Number of countries with human cases increasing – 2004: 2 countries – 2005: 5 countries • High case fatality rate (>50%) • Most cases have been infected through direct contact with infected poultry
  40. 40. drtamil@gmail.com 2006 Current phase of pandemic alert in WHO global influenza preparedness plan
  41. 41. drtamil@gmail.com 2006 Global Polio Eradication Initiative: Major Steps • 1988: Goal to eradicate polio by the year 2000 • 1994: Americas certified polio-free • 2000: Western Pacific Region certified polio free • 2002: European Region certified polio-free • 2004: Interruption of polio transmission by the end of the year?
  42. 42. drtamil@gmail.com 2006 We Wanted These To Be The Last Polio Cases* Western Pacific Region Mum Chanty Cambodia 1997 European Region Melik Minas Turkey 1998 Americas Region Luis Fermin Tenorio Peru 1991 * Due to wild virus
  43. 43. drtamil@gmail.com 2006 Polio Epidemiology: Then and Now • 548 cases as of August 10, 2004 • Polio cases confined in 6 endemic countries
  44. 44. drtamil@gmail.com 2006 Global Cases of Polio (as of 18 August 2004) TOTAL NUMBER OF CASES : 569 Nigeria 453 India 33 Pakistan 21 Niger 19 Afghanistan 3 Egypt 1 • the remaining 6 polio-endemic countries ➢ Ongoing outbreak in northern Nigeria continue to infect new countries: - Guinea - Mali - Sudan ➢ 12 countries formerly polio-free since Jan 2003 now has cases of polio
  45. 45. drtamil@gmail.com 2006 Polio - Worldwide situation • Global Polio Eradication Initiative did not achieve the goal to eradicate polio by 2000, but still very successful ▪ 3 of the 6 WHO regions are “polio-free“ ▪ 6 polio endemic countries • Worldwide polio eradication seems possible • Epidemiological situation has an influence on vaccination strategies
  46. 46. drtamil@gmail.com 2006 Polio - 2006 • As of 2005, Indonesia became the next country with wild polio infection. • Now poliomyelitis is just next door to Malaysia……. • Will Malaysia be next?
  47. 47. drtamil@gmail.com 2006 Why?
  48. 48. drtamil@gmail.com 2006 Factors Of Emergence • HUMAN DEMOGRAPHICS AND BEHAVIOR • TECHNOLOGY AND INDUSTRY • ECONOMIC DEVELOPMENT AND LAND USE • INTERNATIONAL TRAVELAND COMMERCE • MICROBIALADAPTATION AND CHANGE • DECLINE OF PUBLIC HEALTH
  49. 49. drtamil@gmail.com 2006 HUMAN DEMOGRAPHICS AND BEHAVIOR • changes in human demographics and behavior, • increased numbers of people, and • urbanization have an impact on the emergence of disease
  50. 50. drtamil@gmail.com 2006 TECHNOLOGY AND INDUSTRY • ability to lyophilize blood products e.g. factor VIII - hemophiliacs with HIV • sophisticated Duramater transplants in neurosurgery - BSE in Thailand & Japan • medical technology and our ability to transport biological and human material probably also has a role in the dissemination, transportation and emergence of new diseases.
  51. 51. drtamil@gmail.com 2006 ECONOMIC DEVELOPMENT AND LAND USE • altered land use patterns • deforestation • Logging in the equatorial rain forest • Land use changes that prompt exposure to new vectors and diseases are thought to be one of the factors related to Ebola, although the reservoir for Ebola still has not been identified.
  52. 52. drtamil@gmail.com 2006 International Travel and Infectious Diseases
  53. 53. drtamil@gmail.com 2006 INTERNATIONAL TRAVEL AND COMMERCE • means of transportation - 400 million people per year travel now internationally - tb & influenza • Old tires & dengue • Dengue & air travel • HIV and tourism industry
  54. 54. drtamil@gmail.com 2006 WorldPopulationinbillions() DaystoCircumnavigate() theGlobe Year 1850 0 400 350 300 250 200 150 100 50 2000 0 1900 1950 1 2 3 4 5 6 Speed of Global Travel in Relation to World Population Growth From: Murphy and Nathanson. Semin. Virol. 5, 87, 1994
  55. 55. drtamil@gmail.com 2006 Infectious Disease Information
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  57. 57. drtamil@gmail.com 2006 Antimicrobial Resistance • Worldwide problem • Dramatic increase in antimicrobial- resistant community-acquired and nosocomial pathogens • Major risk factors: Antimicrobial use (misuse) Infection control practices (noncompliance)
  58. 58. drtamil@gmail.com 2006 MICROBIALADAPTATION AND CHANGE • emergence of resistant organisms • emergence of Superbugs—Streptococcus and penicillin, Gonococcus and quinolones, Staphylococcus and vancomycin, tuberculosis and isonizid, rifampin, malaria and chloroquine, mefloquine • no monitoring program for the emergence of resistance
  59. 59. drtamil@gmail.com 2006 0 5 10 15 20 25 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 ICU Non-ICU Emerging Vancomycin-resistant Enterococcal Infections* %Resistant * in U.S. NNIS Hospitals
  60. 60. drtamil@gmail.com 2006 Evolution of Antimicrobial Resistance S. aureus Penicillin  [1950s] Penicillin-resistant S. aureus Methicillin  [1980s] Methicillin-resistant S. aureus (MRSA) Vancomycin-resistant enterococcus (VRE) Vancomycin [1990s] [1997] Vancomycin (glycopeptide) - intermediate resistant S. aureus [ ? ]
  61. 61. drtamil@gmail.com 2006 DECLINE OF PUBLIC HEALTH • the late 1970’s as the International Monetary Fund and World Bank moved internationally to shore up economies, especially in Latin America and Africa, they forced a reduction in public sector investment - , immunization levels dropped, nutrition dropped, etc. • a serious lack of diagnosis and treatment in many areas of the world
  62. 62. drtamil@gmail.com 2006 Prevention of Emerging Infectious Diseases Will Require Action in Each of These Areas Surveillance and Response Applied Research Infrastructure and Training Prevention and Control
  63. 63. drtamil@gmail.com 2006 Preventing Emerging Infectious Diseases Surveillance and Response Detect, investigate, and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified.
  64. 64. drtamil@gmail.com 2006 Applied Research Integrate laboratory science and epidemiology to increase the effectiveness of public health practice. Preventing Emerging Infectious Diseases
  65. 65. drtamil@gmail.com 2006 Infrastructure and Training Strengthen public health infrastructures to support surveillance, response, and research and to implement prevention and control programs. Provide the public health work force with the knowledge and tools it needs. Preventing Emerging Infectious Diseases
  66. 66. drtamil@gmail.com 2006 Prevention and Control Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases. Preventing Emerging Infectious Diseases
  67. 67. drtamil@gmail.com 2006 Major issues & challenges • Emerging diseases continue to occur and pose serious public health threats • Many countries do not have basic public health infrastructure and capacities • Increasing needs for stronger global collaboration and partnerships • Needs for a global framework when responding to emerging diseases of international concern.
  68. 68. drtamil@gmail.com 2006 “As we face the new millennium, we must renew our commitment to the prevention and control of infectious diseases, recognizing that the competition between humans and microbes will continue long past our lifetimes and those of our children.” Jeffrey P. Koplan, Director, CDC
  69. 69. drtamil@gmail.com 2006 NCID Internet Page http://www.cdc.gov/ncidod

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Lecture notes on New Emerging And Reemerging Infections circa 2006. I stopped updating it since the lecture was take over by Norfazilah Ahmad.

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