Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
Matthew Rollosson, RN, MPH&TM, BSN
Nurse Epidemiologist
Tacoma-Pierce County Health Department
29 April 2015
Global Health...
Tropical Medicine
Tropics
 Tropic of Cancer
 Tropic of Capricorn
CIA, 2013
Tropical Medicine
 Diseases that disproportionately affect the poor
 Infectious diseases
 Non-infectious diseases
 Can...
Neglected Tropical Diseases
 Bacteria
 Buruli ulcer
 Leprosy (Hansen's disease)
 Trachoma
 Yaws
 Protozoa
 Chagas d...
Neglected Tropical Diseases
CDC, 2011
Noncommunicable Diseases
 80% of deaths caused by noncommunicable
diseases are in developing countries
 Cardiovascular d...
Trauma
 90% of deaths due to road traffic accidents
are in developing countries
 1.3 million deaths
 20 to 30 million p...
Urbanization
 70% of urban residents in developing
countries live in slums
 650 million people in Asia
 212 million in ...
Urbanization
 Increased risk of infectious diseases
 Acute respiratory diseases
 Diarrheal diseases
 HIV/AIDS
 Tuberc...
United States
 Diseases once
endemic in the U.S.:
 Hepatitis A
 Hookworm
 Malaria
 Measles
 Rubella
 Yellow fever
...
Mosquito vectors in the U.S.
 Aedes aegypti, Ae. albopictus
 Chikungunya
 Dengue
 Eastern equine encephalitis
 West N...
Influenza A
 Zoonosis
 Birds are the reservoir
 Mammals
 Antigenic shift
 8-segmented genome
 Reassorts in coinfecte...
Highly Pathogenic Avian Influenza
 Risk of reassortment with human influenza A
virus
 Novel virus with pandemic potentia...
WHO, 2015
Measles
 Eliminated from the WHO Region of the
Americas in 2002
 Importation from countries with low measles
vaccine cov...
Measles in the U.S.
 Most importations are unvaccinated U.S.
citizens returning from travel to countries with
low immuniz...
Costs of measles outbreaks in the
U.S.
 2011:
 107 cases
 16 outbreaks
 Outbreak investigation:
 $4,091 - $10,228 per...
Measles in Pierce County, WA
Malaria
 Transmitted by mosquitoes
 Roughly half of the world’s population lives in
areas where malaria is transmitted
...
Plasmodium falciparum transmission
Malaria Atlas Project
Socioeconomic impact of malaria
 Loss of household income
 Disability
 Increased health expenditures
 Macroeconomic lo...
Demographic Transition
 “I have been asked dozens of times
if help for Africa would ultimately
backfire in an even greate...
Demographic Transition
 People have fewer children when
 Child mortality decreases
 Standards of living improve
 Contr...
Under 5 mortality, fertility
Country
Deaths
per 1,000
live births
Total
births per
woman
Canada 5 1.6
France 4 2
United Ki...
U.S. Demographic Transition
Data from U.S. Census Bureau 1999,
U.S. Department of Health and Human Services 2012
Under 5 mortality
UNICEF 2012
Ebola Virus Disease
 Preferred over “Ebola hemorrhagic fever”
 Most people with EVD do not have
hemorrhagic symptoms
 D...
Transmission
 Direct contact with blood or body fluids of a symptomatic
person
 Skin
 Cuts, abrasion
 Mucous membranes...
Ebola Virus Disease
 Easily mistaken for other diseases
 Health care personnel at risk for infection
 Outbreaks frequen...
Health Workers
 Frequently infected
 Illness not
recognized as
EVD
 Lack of
appropriate PPE
 Fewer health care
workers...
Ebola epidemics, 1976 - 2013
CDC 2014
Timeline
 West African Ebola epidemic traced to a 2-year-
old child in Guinea who died from the disease
December 6, 2013
...
Timeline
 …modest further intervention efforts
at that point could have achieved
control.”
 WHO Ebola Response Team (201...
Timeline
 August 8, 2014: WHO declared the Ebola
epidemic in West Africa a Public Health
Emergency of International Conce...
Timeline
 By the end of August, the total numbers of EVD
cases and deaths exceeded that of all previous
Ebola epidemics c...
Maforki Ebola Treatment Unit
Port Loko, Sierra Leone
 100 bed capacity
 44 confirmed
 56 suspect
Maforki Ebola Treatment Unit
Maforki Ebola Treatment Unit
Admission
Suspect ward
Confirmed ward
Immediate concerns
 Infection control
 Doffing
 Chlorine
 Patient care
 Oral rehydration
solution not at bedside
 St...
Personal protective equipment
 WHO recommends:
 Face shield or
goggles
 Fluid-resistant
medical/surgical
mask
 Double ...
Disinfection
 Ebolaviruses
 Lipid envelope
 Derived from host cell
 Destroyed by
 Alcohol
 Chlorine
 Heat
 Deterge...
Zero to 60 in four weeks
Stigmatization
 Survivors
 Loss of employment, family, home, property
 Harassed
 Victims of violence
 Health workers
...
Number of cases of EVD in contacts of
health workers returning to the U.S.: 0
Current case count:
CDC, 2015
Long-term consequences
 Interruption of health care services
 Immunizations
 Outbreaks of vaccine-preventable diseases
...
Health Worker Migration
 Nursing shortage in the U.S.
 Nurses aggressively recruited from other countries
 Remittences ...
Questions?
 http://fullyvaccinated.blogspot.com
References
 Aiken, L. H. (2007). U.S. nurse labor market dynamics are key to global nurse
sufficiency. Health Service Res...
References
 Buchan, J., Parkin, T., & Sochalski, J. (2003). International nurse mobility: trends
and policy implications ...
References
 Centers for Disease Control and Prevention. (2015). 2014 Ebola outbreak in West Africa –
cumulative reported ...
References
 Hartman, A. L. (2013). Ebola and Marburg virus infections. In, A. J. Magill, D. R.
Hill, T. Solomon, & E. T. ...
References
 Newson, L., Postmes, T., Lea, S. E. G., & Webley, P. (2005). Why are modern families small?
Toward an evoluti...
References
 United Nations Children's Fund. (2012). Levels and trends in child mortality
report 2012.
http://www.who.int/...
References
 World Bank. (2015). Fertility rate, total (births per woman).
http://data.worldbank.org/indicator/SP.DYN.TFRT...
References
 World Health Organization. (2015). Measles.
http://www.who.int/mediacentre/factsheets/fs286/en.
 World Healt...
Global health
Global health
Global health
Global health
Upcoming SlideShare
Loading in …5
×

Global health

  • Login to see the comments

Global health

  1. 1. Matthew Rollosson, RN, MPH&TM, BSN Nurse Epidemiologist Tacoma-Pierce County Health Department 29 April 2015 Global Health: Tropical Medicine
  2. 2. Tropical Medicine
  3. 3. Tropics  Tropic of Cancer  Tropic of Capricorn CIA, 2013
  4. 4. Tropical Medicine  Diseases that disproportionately affect the poor  Infectious diseases  Non-infectious diseases  Cancer  Chronic diseases  Malnutrition  Envenomations/intoxications  Mental health  Substance abuse  Trauma
  5. 5. Neglected Tropical Diseases  Bacteria  Buruli ulcer  Leprosy (Hansen's disease)  Trachoma  Yaws  Protozoa  Chagas disease  Human African trypanosomiasis (sleeping sickness)  Leishmaniasis  Viruses  Chikungunya  Dengue  Rabies  Helminth (worms)  Cysticercosis  Dracunculiasis (Guinea worm disease)  Echinococcosis  Fascioliasis  Lymphatic filariasis  Onchocerciasis (river blindness)  Schistosomiasis  Soil-transmitted helminths CDC, 2011; WHO, 2015
  6. 6. Neglected Tropical Diseases CDC, 2011
  7. 7. Noncommunicable Diseases  80% of deaths caused by noncommunicable diseases are in developing countries  Cardiovascular disease  Heart disease  Stroke  Cancer  Chronic respiratory diseases  Diabetes Koehlmoos et al., 2011
  8. 8. Trauma  90% of deaths due to road traffic accidents are in developing countries  1.3 million deaths  20 to 30 million people injured or disabled  Occupational injuries  “Export hazard”  Dangerous, outdated equipment sent from high income to low income countries Koehlmoos et al., 2011
  9. 9. Urbanization  70% of urban residents in developing countries live in slums  650 million people in Asia  212 million in Africa  Overcrowding  Poor housing  Hazardous locations  Flooding  Unsafe drinking water  Unsanitary conditions Utzinger & Keiser, 2006
  10. 10. Urbanization  Increased risk of infectious diseases  Acute respiratory diseases  Diarrheal diseases  HIV/AIDS  Tuberculosis  Vector-borne diseases  Increased risks of chronic diseases  Dietary changes  Sedentary lifestyle  Tobacco use
  11. 11. United States  Diseases once endemic in the U.S.:  Hepatitis A  Hookworm  Malaria  Measles  Rubella  Yellow fever  Diseases frequently imported to the U.S.:  Chikungunya  Dengue  Hepatitis A  Malaria  Measles
  12. 12. Mosquito vectors in the U.S.  Aedes aegypti, Ae. albopictus  Chikungunya  Dengue  Eastern equine encephalitis  West Nile virus  Yellow fever  Anopheles spp.  Malaria CDC, 2014; Zucker, 1996
  13. 13. Influenza A  Zoonosis  Birds are the reservoir  Mammals  Antigenic shift  8-segmented genome  Reassorts in coinfected cells  Creates novel viruses  No immunity in the human population  Pandemic Hayden, 2007; Treanor, 2009
  14. 14. Highly Pathogenic Avian Influenza  Risk of reassortment with human influenza A virus  Novel virus with pandemic potential  Culling exposed/infected flocks  Economic loss  Loss of high quality protein food  Avian influenza A viruses in Washington State  H5N1, H5N2, H5N8 DOH; Tiongco 2008
  15. 15. WHO, 2015
  16. 16. Measles  Eliminated from the WHO Region of the Americas in 2002  Importation from countries with low measles vaccine coverage  Outbreaks in U.S. populations with low measles vaccine coverage  In the U.S., ~20% of people with measles are hospitalized with complication  145,700 measles deaths worldwide (2013)  Eradicable
  17. 17. Measles in the U.S.  Most importations are unvaccinated U.S. citizens returning from travel to countries with low immunization coverage  January – August 2013:  Half of measles importations from WHO European Region  January – May 2014:  49% of importations from the Philippines CDC 2013, 2014
  18. 18. Costs of measles outbreaks in the U.S.  2011:  107 cases  16 outbreaks  Outbreak investigation:  $4,091 - $10,228 per day  Cost per case:  $11,933 - $29,833  Estimated public health expenditures:  $2.7 million – $5.3 million Ortega- Sanchez et al., 2014
  19. 19. Measles in Pierce County, WA
  20. 20. Malaria  Transmitted by mosquitoes  Roughly half of the world’s population lives in areas where malaria is transmitted  2013:  198 million cases of malaria  584,000 deaths  Majority were children under 5 years of age in sub-Saharan Africa  Decreases in malaria morbidity and mortality following control measures
  21. 21. Plasmodium falciparum transmission Malaria Atlas Project
  22. 22. Socioeconomic impact of malaria  Loss of household income  Disability  Increased health expenditures  Macroeconomic losses  Foreign investment  Trade  Tourism  GDP for countries with intense malaria transmission is less than one-fifth that of countries without malaria Sachs & Malaney, 2002
  23. 23. Demographic Transition  “I have been asked dozens of times if help for Africa would ultimately backfire in an even greater population explosion. Would greater child survival rates not translate into more adult hunger and suffering?” Jeffery Sachs, The End of Poverty
  24. 24. Demographic Transition  People have fewer children when  Child mortality decreases  Standards of living improve  Contraception is available Brauner-Otto et al., 2007; Conley et al., 2007; Greenwood & Sesharid, 2001; Newson et al., 2005; World Bank, 2014
  25. 25. Under 5 mortality, fertility Country Deaths per 1,000 live births Total births per woman Canada 5 1.6 France 4 2 United Kingdom 5 1.9 United States 7 1.9 Democratic Republic of the Congo 119 5.9 Ethiopia 64 4.5 Guinea 101 4.9 Liberia 71 4.8 Sierra Leone 161 4.7 WHO; World Bank
  26. 26. U.S. Demographic Transition Data from U.S. Census Bureau 1999, U.S. Department of Health and Human Services 2012
  27. 27. Under 5 mortality UNICEF 2012
  28. 28. Ebola Virus Disease  Preferred over “Ebola hemorrhagic fever”  Most people with EVD do not have hemorrhagic symptoms  Disseminated intravascular coagulation  Higher risk for bleeding  Massive fluid loss due to vomiting and diarrhea  Death is usually due to dehydration and electrolyte disturbances Bausch et al., 2007; Blumberg et al., 2014; Geisbert, 2014; Hartman, 2013
  29. 29. Transmission  Direct contact with blood or body fluids of a symptomatic person  Skin  Cuts, abrasion  Mucous membranes  Parenteral  Reusing unsterilized needles  Accidental needle sticks  Funeral ceremonies  Respiratory droplets?  Not airborne  Not effectively transmitted by inanimate objects
  30. 30. Ebola Virus Disease  Easily mistaken for other diseases  Health care personnel at risk for infection  Outbreaks frequently associated with transmission in health care facilities - Hepatitis - Shigellosis - Malaria - Typhoid fever - Meningococcemia - Typhus - Plague - Yellow fever
  31. 31. Health Workers  Frequently infected  Illness not recognized as EVD  Lack of appropriate PPE  Fewer health care workers available  Death  Flee out of fear of infection
  32. 32. Ebola epidemics, 1976 - 2013 CDC 2014
  33. 33. Timeline  West African Ebola epidemic traced to a 2-year- old child in Guinea who died from the disease December 6, 2013  First outbreak of EVD in West Africa  March 10, 2014: World Health Organization (WHO) notified of an outbreak of an unknown infectious disease characterized by fever, vomiting, and diarrhea in Guinea  Zaïre ebolavirus identified in blood from patients who were hospitalized with the disease Baize et al., 2014
  34. 34. Timeline  …modest further intervention efforts at that point could have achieved control.”  WHO Ebola Response Team (2014)  Epidemic spreads to  Liberia in March  Sierra Leone in May  Nigeria in July
  35. 35. Timeline  August 8, 2014: WHO declared the Ebola epidemic in West Africa a Public Health Emergency of International Concern Cases Deaths Guinea 495 367 Liberia 554 294 Nigeria 13 2 Sierra Leone 717 298 Totals 1,779 961 WHO, 2014
  36. 36. Timeline  By the end of August, the total numbers of EVD cases and deaths exceeded that of all previous Ebola epidemics combined CDC, 2015
  37. 37. Maforki Ebola Treatment Unit Port Loko, Sierra Leone  100 bed capacity  44 confirmed  56 suspect
  38. 38. Maforki Ebola Treatment Unit
  39. 39. Maforki Ebola Treatment Unit
  40. 40. Admission
  41. 41. Suspect ward
  42. 42. Confirmed ward
  43. 43. Immediate concerns  Infection control  Doffing  Chlorine  Patient care  Oral rehydration solution not at bedside  Staff avoided contact with patients  Patient records  Census  Laboratory results  Medication administration
  44. 44. Personal protective equipment  WHO recommends:  Face shield or goggles  Fluid-resistant medical/surgical mask  Double gloves  Disposable gown/coverall  Head cover  Waterproof apron  Waterproof boots WHO, 2014 Partners in Health
  45. 45. Disinfection  Ebolaviruses  Lipid envelope  Derived from host cell  Destroyed by  Alcohol  Chlorine  Heat  Detergents  Soap  UV light
  46. 46. Zero to 60 in four weeks
  47. 47. Stigmatization  Survivors  Loss of employment, family, home, property  Harassed  Victims of violence  Health workers  Loss of employment, family, home, property  Harassed  Unnecessary quarantine Davtyan et al., 2014; De Roo et al., 1998; Hewlett & Hewlett, 2005; Hewlett & Amola, 2003
  48. 48. Number of cases of EVD in contacts of health workers returning to the U.S.: 0
  49. 49. Current case count: CDC, 2015
  50. 50. Long-term consequences  Interruption of health care services  Immunizations  Outbreaks of vaccine-preventable diseases  Could result in additional 2,000 to 16,000 measles deaths Takahashi et al., 2015  Malaria control  Estimated10,900 malaria deaths Walker et al., 2015  Prenatal, obstetric, pediatric care  Economic  Unemployment  Trade interrupted  Education  School closures  Teen pregnancy Dumbaya, 2015
  51. 51. Health Worker Migration  Nursing shortage in the U.S.  Nurses aggressively recruited from other countries  Remittences from nurses working abroad contribute to economies of countries of origin  Create shortages in countries of origin  “Brain drain”  Philippines  Exporting nurses since the 1950s  Medical doctors retrain as nurses to work in the U.S.  NCLEX testing centers:  Australia, Canada, England, Hong Kong, India, Japan, Mexico, Philippines, Puerto Rico, Taiwan Aiken, 2007; Bach, 2003; Brush & Sochalski 2007; Buchan et al., 2003; Kiringia et al., 2006; Marchal & Kegels 2003
  52. 52. Questions?  http://fullyvaccinated.blogspot.com
  53. 53. References  Aiken, L. H. (2007). U.S. nurse labor market dynamics are key to global nurse sufficiency. Health Service Research, 42(3p2), 1299-1320.  Bach, S. (2003). International migration of health workers: labour and social issues (Working Paper 209). International Labour Office: Geneva.  Baize, S., Pannetier, D., Oestereich, L., Rieger, T., Koivogui, L., Magassouba, N., et al. (Emergence of Zaire Ebola virus disease in Guinea. New England Journal of Medicine, 371(15),1418-1425. doi:10.1056/NEJMoa1404505.  Bausch, D. G., Towner, J. S., Dowell, S. F., Kaducu, F., Lukwiya, M., Sanchez, A., et al. (2007). Assessment of the risk of Ebola virus transmission from bodily fluids and fomites. Journal of Infectious Diseases, 196(Supple. 2), S142-S147.  Blumberg, L., Enria, D., & Bausch, D. G. (2014). Viral hemorrhagic fevers. In J. Farrar, P. J. Hotez, T. Junghanss, G. Kang, D. Lalloo, & N. J. White (Eds.) Manson's tropical diseases, 23rd Ed. [Electronic version]. Elsevier.  Brauner-Otto, S., Axinn, W., & Ghimire, D. (2007). The spread of health services and fertility transition. Population Studies Center Research Report 07-619. http://www.psc.isr.umich.edu/pubs/pdf/rr07-619.pdf.  Brush, B. L., & Sochalski, J. (2007). International nurse migration: lessons from the Philippines. Policy, Politics, & Nursing Practice, 8(1), 37-46.
  54. 54. References  Buchan, J., Parkin, T., & Sochalski, J. (2003). International nurse mobility: trends and policy implications (WHO/EIP/OSD/2003.3). World Health Organization: Geneva.  Centers for Disease Control and Prevention. (2011). Neglected tropical diseases. http://www.cdc.gov/globalhealth/ntd/diseases/index.html.  Centers for Disease Control and Prevention. (2013). Measles – United States, January 1 – August 24, 2013. Morbidity and Mortality Weekly Report, 62(36), 741-743. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6236a2.htm.  Centers for Disease Control and Prevention. (2014). Dengue homepage. http://www.cdc.gov/dengue/entomologyEcology/index.html.  Centers for Disease Control and Prevention. (October 3, 2014). Ebola virus disease outbreak – Nigeria, July-September, 2014. Morbidity and Mortality Weekly Report, 63(39), 867-872. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6339a5.htm.  Centers for Disease Control and Prevention. (2014). Measles – United States, January 1 – May 23, 2014. Morbidity and Mortality Weekly Report, 63(22), 496- 499. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6322a4.htm.  Centers for Disease Control and Prevention. (2015). Outbreaks chronology: Ebola virus disease. http://www.cdc.gov/vhf/ebola/outbreaks/history/chronology.html.
  55. 55. References  Centers for Disease Control and Prevention. (2015). 2014 Ebola outbreak in West Africa – cumulative reported cases in Guinea, Liberia, and Sierra Leone. http://www.cdc.gov/vhf/ebola/csv/graph1-cumulative-reported-cases-all.csv.  Conley, D., McCord, G. C., & Sachs, J. D. (2007). Africa's lagging demographic transition: evidence from exogenous impacts of malaria ecology and agricultural technology. National Bureau of Economic Research Working Paper Series No. 12892. http://www.nber.org/papers/w12892.  Davtyan, M., Brown, B., & Folayan, M. O. (2014). Addressing Ebola-related stigma: lessons learned from HIV/AIDS. Global Health Action, 7(26058). http://dx.doi.org/10.3402/gha.v7.26058.  De Roo, A. D., Ado, B., Rose, B., Guimard, Y., Fonck, K.,& Colebunders, R. (1998). Survey among survivors of the 1995 Ebola epidemic in Kikwit, Democratic Republic of Congo: their feelings and experiences. Tropical Medicine and International Health, 3(11), 883-885.  Dumbaya, C. (January 29, 2015). Sierra Leone's First Lady: 'Ebola has increased teenage pregnancy rates.' http://www.eboladeeply.org/articles/2015/01/7263/sierra-leones-lady-ebola- increased-teenage-pregnancy-rates.  Geisbert, T. W. (2014). Marburg and Ebola hemorrhagic fevers (Filoviruses). In J. E. Bennett, R. Dolin, & M. J. Blaser (Eds.). Mandell, Douglas, and Bennett's principles and practice of infectious diseases, 8th Ed. [Electronic version]. Elsevier.  Greenwood, J. & Sesharid, A. (2001). The U.S. demographic transition. AEA Papers and Proceedings, 92(2), 153-159. http://www.econ.wisc.edu/~aseshadr/publication_pdf/usdt.pdf.
  56. 56. References  Hartman, A. L. (2013). Ebola and Marburg virus infections. In, A. J. Magill, D. R. Hill, T. Solomon, & E. T. Ryan (Eds.) Hunter's tropical medicine, 9th Ed. [Electronic version]. Elsevier.  Hewlett, B. L. & Hewlett, B. S. (2005). Providing care and facing death: nursing during Ebola outbreaks in Central Africa. Journal of Transcultural Nursing, 16(4), 289-297.  Hewlett, B. S. & Amola, R. P. (2003). Cultural contexts of Ebola in northern Uganda. Emerging Infectious Diseases, 9(10), 1242-1248.  Hayden, F. G. (2007). Influenza. In Goldman, L., & Ausiello, D. (Eds.) Cecil medicine, (23rd Ed.). [Electronic version]. Elsevier.  Kiringia, J. M., Gbary, A. R., Muthuri, L. K., Nyoni, J., & Seddoh, A. (2006). The cost of health professionals’ brain drain in Kenya. BMC Health Services Research, 6(89), doi:10.1186/1472-6963-6-89.  Koehlmoos, T. P., Anwar, D., & Cravioto, A. (2011). Global health: chronic diseases and other emergent health issues in global health. Infectious Disease Clinics of North America, 25(3), doi:10.1016.j.idc.2011.05.008.  Marchal, B., & Kegels, G. (2003). Health workforce imbalances in times of globalization: brain drain or professional mobility. International Journal of Health Planning and Management, 18(S1), S89-S101.
  57. 57. References  Newson, L., Postmes, T., Lea, S. E. G., & Webley, P. (2005). Why are modern families small? Toward an evolutionary and cultural explanation for the demographic transition. Personality and Social Psychology Review, 9(4), 360-373.  Ortega-Sanchez, I. R., Vijayaraghavan, M., Barskey, A. E., & Wallace, G. S. (2014). The economic burden of sixteen measles outbreaks on Unites States public health departments in 2011. Vaccine, 32(11). doi:10.1016/j.vaccine.2013.10.012.  Sachs, J. D. (2005). The end of poverty: economic possibilities for our time. New York: The Penguin Press.  Sachs, J., & Malaney, P. (2002). The economic and social burden of malaria. Nature, 415(6872), 680-685.  Takahashi, S., Metcalf, C. J. E., Ferrari, M. J., Moss, W. J., Truelove, S. A., Tatem, A. J.,et al. (2015). Reduced vaccination and the risk of measles and other childhood diseases. Science, 347(6227), doi:10.1126/science.aaa3438.  Tiongco, M. (2008). Costs and Benefits of HPAI Prevention and Control Measures: A Methodological Review. Africa/Indonesia Team Working Paper No. 13. http://r4d.dfid.gov.uk/Output/178612.  Treanor, J. J. (2009). Influenza viruses, including avian influenza and swine influenza. In Mandell, G. L., Bennett, J. E., & Dolin, R. (Eds.). Mandell, Douglas, and Bennett's principles and practice of infectious diseases (7th Ed.) [Electronic version].
  58. 58. References  United Nations Children's Fund. (2012). Levels and trends in child mortality report 2012. http://www.who.int/maternal_child_adolescent/documents/levels_trends_child_m ortality_2012.pdf.  U.S. Census Bureau. (1999). 20th Century Statistics. Statistical abstract of the United States: 1999. http://www.census.gov/prod/www/statistical_abstract.html.  U.S. Department of Health and Human Services. (2012). United States Life Tables, 2008. National Vital Statistics Report, 61(3).  Utzinger, J. & Keiser, J. (2006). Urbanization and tropical health – then and now. Annals of Tropical Medicine and Parasitology, 100(5 and 6), doi:10.1179/136485906X97372.  Walker, P. G. T., White, M. T., Griffin, J. T., Reynold, A. Ferguson, N. M., & Ghani, A. C. (2015). Malaria morbidity and mortality in Ebola-affected countries caused by decreased health capacity, and the potential effect of mitigation strategies: a modelling analysis. Lancet Infectious Diseases, doi:10.1016/S1473- 3099(15)70124-6  Washington State Department of Health. (n.d.) Avian influenza. http://www.doh.wa.gov/YouandYourFamily/IllnessandDisease/AvianInfluenza.  World Bank. (2014). Data. http://data.worldbank.org.
  59. 59. References  World Bank. (2015). Fertility rate, total (births per woman). http://data.worldbank.org/indicator/SP.DYN.TFRT.IN.  World Health Organization. (March 30, 2014). Ebola virus disease in Liberia. http://www.who.int/csr/don/2014_03_30_ebola_lbr/en.  World Health Organization. (May 26, 2014). Ebola virus disease, West Africa – update. http://www.who.int/csr/don/2014_05_28_ebola/en.  World Health Organization. (August 8, 2014). Ebola virus disease update – West Africa. http://www.who.int/csr/don/2014_08_08_ebola/en.  World Health Organization (October 31, 2014). Personal protective equipment (PPE) in the contact of Filovirus disease outbreak response: technical specification for PPE equipment to be used by health workers providing clinical care for patients. http://apps.who.int/iris/bitstream/10665/137411/1/WHO_EVD_Guidance _SpecPPE_14.1_eng.pdf.  World Health Organization. (2014). Under-five mortality. http://apps.who.int/gho/data/view.main.180?lang=en.  World Health Organization. (2015). Malaria. http://www.who.int/mediacentre/factsheets/fs094/en.
  60. 60. References  World Health Organization. (2015). Measles. http://www.who.int/mediacentre/factsheets/fs286/en.  World Health Organization. (2015). Neglected tropical diseases. http://www.who.int/neglected_diseases/diseases/en.  World Health Organization. (2015). Influenza at the human- animal interface: summary and assessment as of 31 March 2015. http://www.who.int/influenza/human_animal_interface/Influenza_ Summary_IRA_HA_interface_31_March_2015.pdf.  World Health Organization Ebola Response Team. (2014). Ebola virus disease in West Africa – the first 9 months of the epidemic and forward projections. New England Journal of Medicine, 371(16), doi:10.1056/NEJMoa1411100.  Zucker, J. R. (1996). Changing patterns of autochthonous malaria transmission in the United States: a review of recent outbreaks. Emerging Infectious Diseases, 2(1), doi:10.3201/eid0201.960104.

×