3. Infectious Disease Mortality in
the United States, 1980-1996 80
70
Deaths per 100,000 population
60
Crude ID Mortality Rate
50
40
30
20
10
0
80
82
84
86
88
90
92
94
96
19
19
19
19
19
19
19
19
19
Year
Source: JAMA 1996;275:189-193 and unpublished CDC data CDC
4. Emerging Infections in the
World and US since 1973
1973 Rotavirus Enteritis/Diarrhea
1976 Cryptosporidium Enteritis/Diarrhea
1977 Ebola virus VHF
1977 Legionella Legionnaire’s dz
1977 Hantaan virus VHF w/ renal flr
1977 Campylobacter Enteritis/Diarrhea
1980 HTLV-1 Lymphoma
1981 Toxin prod. S.aureus Toxic Shock Synd.
1982 E.coli 0157:H7 HUS
1982 HTLV-II Leukemia
1982 Borrelia burgdorferi Lyme disease
5. Emerging Infections in the
World and US since 1973
1983 HIV AIDS
1983 Helicobacter pylori Peptic ulcer dz
1988 Hepatitis E Hepatitis
1989 Hepatitis C Hepatitis
1990 Guanarito virus VHF
1991 Encephalitozoon Disseminated dz
1992 Vibrio cholerae O139 Cholera
1992 Bartonella henselae Cat scratch dz
6. Emerging Infections in the
World and US since 1973
1993 Sin Nombre virus Hanta Pulm. Synd.
1994 Sabia virus VHF
1994 Hendra virus Respiratory dz
1995 Hepatitis G Hepatitis
1995 H Herpesvirus-8 Kaposi sarcoma
1996 vCJD prion Variant CJD
1997 Avian influenza (H5N1) Influenza
1999 Nipah virus Encephalitis
1999 West Nile virus Encephalitis
2001 BT Bacillus anthracis Anthrax
2003 Monkeypox Pox
2003 SARS-CoV SARS
7. Institute of Medicine 1992
Report on Emerging Infections
Defined emerging infections as:
“New, reemerging or drug-resistant
infections whose incidence in
humans has increased within the
past two decades or whose
incidence threatens to increase in
the near future.”
8. 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
Institute of Medicine Report, 1992
9. More Factors Contributing to
Emerging Infections: 2003
7. Human vulnerability
2. Climate and weather
3. Changing ecosystems
4. Poverty and social inequality
5. War and famine
6. Lack of political will
7. Intent to harm
Institute of Medicine Report, 2003
11. SARS-CoV (AY278741)
• 29727 nucleotide, polyadenylated
RNA
• 41% of the residues: G or C
• 5’ replicase (rep),
spike (S),
enveolpe (E),
membrane (M)
nucleocapside (N) 3’
• Rep gene: 2/3 of genome
Rota et al Science 2003
12. WHO- SARS 確定 病例新定義
臨床定義：
1 . 發燒 (> 38O C )
2. 咳嗽 , 呼吸困難或呼吸短促
呼吸困難或
3.X- ray 出現肺炎
4. 無其他診斷可解釋
實驗室：
1 、 S ARS - C o V PC R 陽性，或
2 、利用 E LIS A 或 IF A 的抗體陽轉，或
(S E RO C O N VE RS IO N ）
3 、病毒分離陽性
19. West Nile Virus—Clinical Disease
• Historically infrequent outbreaks of mild
febrile illness
• Since 1996:
– More frequent outbreaks
– More reports of severe CNS disease,
fatalities
• Understanding of clinical picture based
mainly on recent outbreaks
20. Clinical Syndromes—
Understanding the Scope of Illness
• West Nile fever
• Emerging clinical
syndromes
– Movement disorders
– Parkinsonism
– Flaccid paralysis
– Rhabdomyolysis
• Outcomes / prognosis
• Future directions
21. WNV and Movement Disorders
• Neuroimaging:
lesions in basal
ganglia, thalamus,
pons
• Histopathology—virus
detected in basal
ganglia, thalamus,
brainstem
26. Routes of Exposure and HIV
INFECTION ROUTE RISK OF INFECTION
Sexual Transmission
a. Female-to-male transmission…………1 in 700 to 1 in 3,000
b. Male-to-female transmission………… 1 in 200 to 1 in 2,000
e. Male-to-male transmission…………… 1 in 10 to 1 in 1,600
f. Fellatio??………………………………… 0 (CDC) or 6% (SF)
Parenteral transmission
i. Transfusion of infected blood………….95 in 100
j. Needle sharing………………………….1 in 150
c. Needle stick…………………………..…1 in 200
d. Needle stick /AZT PEP…………………1 in 10,000
Transmission from mother to infant
a. Without AZT treatment………...…….1 in 4
b. With AZT treatment………………….Less than 1 in 10
Royce, Sena, Cates and Cohen, NEJM 336:1072-1078, 1997
34. Clinical manifestation-1
In Australia and Thailand…
• Pneumonia: 50%
• Skin abscess: 13%
• Soft tissue abscess: 4%
• Osteomyelitis or septic arthritis: 4%
In Australia…
• Prostatic abscess: 18%
• Neurological melioidosis: 4%
~Currie BJ et al. Clin Infect Dis 2000
35. Clinical manifestation-2
• Pneumonia: high mortality if bilateral
multi-nodular infiltrates
• Lobar pneumonia, lung abscess, lung
mass
• Empyema, pyopericardium: less
common
36. Clinical manifestation-3
• Mycotic aneurysm w or w/o positive B/C
• Respiratory failure……resulted from
(1)Acute necrotizing pneumonia
+ (2)ARDS
~Putucheary SD et al. Singapore Med J 2001
• BW loss: due to reduced intake
~Paton NI et al. Clin Sci 2001
37. Dengue fever-History
• 1780 Benjamin Rush; first case report
• 1905 Viral etiology was documented
• 1920 Siler and Simons; name as arbovirus
• 1944 Sabin; multiple serotypes
• 1954 DHF in Philippine epidemic
• 1966 Halstead; pathogenesis of DHF
• 1975 Dramatically increased in SEA
• 1980 Epidemic problems in US
• 1990 Live attenuated vaccine study in Thailand
38. Dengue fever-Epidemiology
• Endemic in South East Asia, India,
the Western Pacific and Cuba
• 100 million individuals in the world
become infected each year
• Confirmed case number in Taiwan in
2006 till Nov 8th: 603 cases (DHF:14
cases, Mortality:2 cases)
41. Clinical features of Dengue fever
• Fever (often biphasic, last • Leukopenia with
for 4-5 days) relative lymphocytosis
• Myalgia(Breakbone pain) • Thrombocytopenia
• Rash • GI or GU hemorrhage
• Retroorbital headache (with preexisting lesions)
• Puffy, flushed facies • Abnormal liver function
• Lymphadenopathy • Positive tourniquet test
*Incubation period :2-7 days (longest-15 days)
42. Diagnostic criteria of dengue hemorrhagic
fever(DHF) and dengue shock syndrome(DSS)-
WHO criteria
DHF and DSS
• Fever for 2 or more days
• Thrombocytopenia (<100x109 /L)
• Capillary leakage: pleural effusions(greater on the
right side than on the left side), rising hematocrit
(usually more than 20% higher than convalescent
value)
• Evidence of recent dengue infection
DSS only
• In addition to the features listed above, hypotension
for age or narrow pulse pressure ( <20mmHg)
43. Preventing Emerging
Infectious Diseases: More to Do
Enhance communication: locally, regionally,
nationally, globally
Increase global collaboration
Share technical expertise and resources
Provide training and infrastructure support globally
Ensure political support
Ensure judicious use of antibiotics
Vaccines for all
Editor's Notes
1. ＳＡＲＳ - ＣｏＶ ＰＣＲ陽性 利用下列任一種方法： a. 至少兩個不同的臨床檢體，比如：咽喉和糞便 或者 b. 相同部位但在疾病過程中，兩個或兩個以上不同場合、不同時間取得的檢體， 比如：一系列咽喉抽取液 或者 c. 從臨床取得的檢體萃取出 RNA 作兩次不同的檢驗或重複的 PCR 呈陽性者 2. 利用 ELISA 或 IFA 的抗體陽轉（ SEROCONVERSION ） a. 急性期血清抗體陰性但在恢復期血清抗體呈陽性者 或者 b. 疾病恢復期的抗體血清指數是急性期的四倍或四倍以上 3. 病毒分離 從任一檢體取得 SARS-CoV 的細胞培養分離出 SARS-CoV 病毒而且經 PCR 證實者
5.8 million new infections in 1998 or 16,000 per day (~43% in women). Total cases of AIDS since the pandemic began ~47 million with ~13.9 million deaths. As of 2000, ~34 million persons will be living with HIV infection worldwide. Approximately 40,000 new infections/year in the U.S. Alone.
The culmination of all of these efforts is the prevention and control of infectious diseases. Disease prevention alerts people to the threats of new and reemerging diseases and teaches them how to protect themselves and their families. Disease control applies the most effective tools and technologies to counteract infectious microbes and strengthen personal and national protections against emerging diseases.
