course material

1. Communicable Diseases Discussion Paper
Communicable Diseases Discussion PaperCommunicable Diseases Discussion PaperThe
Importance of Communicable Diseases• In 2016, 15% of all deaths worldwide & 19%
DALYs• Cause 40% of deaths and 40% of DALYs in lowand middle-income countries•
Disproportionately affect the poor• Enormous economic consequences• Relevance to SDGs•
Much of the burden of communicable diseases is avoidable, many can be prevented or
treatedORDER COMPREHENSIVE SOLUTION PAPERS ON Communicable Diseases
Discussion PaperSustainable Development Goals
(SDGs)http://www.un.org/sustainabledevelopment/sustainable-development-goals/Key
Terms• Communicable disease synonymous with infectious disease (includes infectious and
parasitic diseases)• Infectious: caused by infectious agents (bacteria, viruses, fungi, prions)•
Tuberculosis• Parasitic: caused by parasites, an organism that lives in or on another
organism and takes its nourishment from that organism• Hook wormTransmission paths
for communicable diseases:• Foodborne: Salmonella, E. coli• Waterborne: Cholera,
rotavirus• Sexual or bloodborne: Hepatitis, HIV• Vector-borne: Malaria, onchocerciasis•
Inhalation: Tuberculosis, influenza, meningitis• Nontraumatic contact: Anthrax• Traumatic
contact: RabiesModes of transmission• Direct transmission• Person-to-person• TB, HIV•
Vectorborne• Spread by insects• Malaria, dengue, Zika, Chikungunya• Fecal-oral
transmission• Ingesting products contaminated with fecal material• Cholera• Vertical
transmission• Mother-to-childModes of transmission• Anthroponotic diseases• transmitted
from human to other animals• Zoonotic diseases• Transmitted from animals to humans•
Viral Chatter: What is viral chatter and why should we care about viral chatter in global
health• Interview with author of “Spillover: Animal infections and the Next Human
Pandemic”https://www.npr.org/2020/02/05/803040983/coronavirus-animalinfections-
the-next-pandemicDifferent control measures:• Vaccination• Mass chemotherapy• Vector
control• Improved water, sanitation, hygiene• Improved care seeking, disease recognition•
Case management (treatment) and improved caregiving• Case surveillance, reporting, and
containment• Behavioral changeThe Burden of Communicable Diseases• Cause 40% of
deaths and 40% of DALYs in low- and middle-income countries• Sub-Saharan Africa and
South Asia have the highest burden of deaths from communicable diseases• Largest cause
of death only in sub-Saharan AfricaThe Costs and Consequences of Communicable Diseases•
Constrain health and development of children, affecting schooling and adult productivity•
Strong stigma and discrimination associated with HIV, TB, and others such as leprosy• Limit
productivity and income of adult workers• Costs of treatment burden families• High rates of

2. communicable diseases reduce investment in a country’s developmentThe Burden of
Emerging and Reemerging Infectious Diseases• Truly global threats and “a perpetual
challenge”• Zoonoses cause of about 60%• Key factors include microbial adaptation and
change, climate, changing ecosystems, international travel and commerce, and war• 578
outbreaks in 132 countries from 1998–2001 The Burden of Emerging and Reemerging
Infectious Diseases• Examples of emerging infectious diseases:• SARS, China (2002)• MERS,
Arabian Peninsula (2012)• COVID-19, China (2020)• Examples of reemerging infectious
diseases:• Cholera, Peru (1997)• Ebola, West Africa (2014)The Consequences of Emerging
and Reemerging Infectious Diseases• Substantial direct and indirect costs, that are not
proportional to deaths from these events• Drug resistance costs are also very high•
Treating a case of drug-resistant TB has been estimated to be about 175 times the cost of
treating a case with first-line drugsThe Consequences of Emerging and Reemerging
Infectious DiseasesAddressing Emerging and Reemerging Infectious Diseases• Sensitive
surveillance systems and public health laboratories• Global collaboration and willingness to
share information with other countries• Rapid detection of new outbreaks• Mechanisms for
effective containmentAddressing Emerging and Reemerging Infectious DiseasesGlobal
Outbreak Alert and Response Network(GOARN)A network of existing disease surveillance
networks established in 2000http://www.who.int/ihr/alert_and_response/outbr ak-
network/en/Future Challenges• Impact of economic crisis on governments’ ability to fund
public health functions• Rapidly evolving pathogens, population growth, climate change will
increase number of emerging diseases• Possibility of a major pandemic• Accelerating drug
resistance• Limited number of anti-infective drugs being developedEbola virus diseaseWhat
is ebola?• First discovered in 1976 near the Ebola River in what is now Democratic Republic
of Congo (DRC)• It is caused by an infection with a group of viruses within the genus
Ebolavirus• Five recognized strains: Zaire, Bundibugyo, Sudan, Reston, Tai Forest• Spreads
to people through direct contact with blood, bodily fluids, and tissues• Person-to-person
through direct contact with bodily fluids of a sick person or a person who has died from it.•
No cure• 2019 European Medicines Agency (EMA) announces vaccine• Randomized trial
started in 2015 in West Africa• 8 vaccines undergoing clinical evaluation 2014 Ebola
outbreak• March 2014 WHO reports cases in Guinea• Initial case Dec. 2013, 18- month old
boy, believed to be infected by bats• Virus soon spread to the capital• Weak surveillance &
public health structure• By July it spread to Liberia & Sierra Leone• Local leaders key to
curbing the outbreak• WHO 2015 response
videohttps://www.cdc.gov/vhf/ebola/pdf/contacttracing.pdfEbola virus disease “Panic in
the Streets” podcast• Major themes that emerged• Effective strategies• What would you do?
Think about comprising yourvalues.• Human behaviorPolio• Highly infectious• Caused by
the poliovirus• Invades nerve cells• 3 strains – type 1 & 2 eradicated• Spread via person-to-
person contact• Shed into environment (feces) and can spread rapidly (fecal-oral route)•
Most have very few to no symptoms• For others: fever, fatigue, headache, vomiting, stiffness
in neck, pain in limbs• No cure, only treatment• Invades an infected person’s brain and
spinal cord, which can cause irreversible
paralysishttp://www.who.int/features/qa/07/en/Polio• Prevention via immunization•
Two types of vaccine• Inactivated poliovirus vaccine (IPV)• Used in U.S. since 2000• Oral

3. poliovirus vaccine (OPV)• Used in lower income countries throughout much of theworld•
Polio cases have decreased by over 99% since 1988• Endemic countries = Pakistan &
Afghanistan• Failure to eradicate polio could result in as many as200,000 new cases every
year, within 10 years, allover the
world.http://www.who.int/features/qa/07/en/http://www.who.int/immunization/diseas
es/poliomyelitis/en/Polio• Global Polio Eradication Initiative (GPEI)• coordinates and
supports an extensive program of research from awide range of core scientific disciplines.•
Public-private partnership• Objectives:• To identify, develop, and evaluate new tools
andtailored approaches to maximize the impact oferadication efforts.• To inform long-term
policy for the post-eradicationera.April 2020 GPEI halts polio campaign Due to COVID-
19.Iron lungA negative pressureventilator enables aperson to breathe.“Kansas City polio
survivor is one of the last iron lung users in U.S.”HIV/AIDS: Who is most at risk?• Anyone
who comes into contact with blood or body fluids• Universal Precautions• Women•
Biologically/anatomically• Marry young and may not have the power to demand condom
use• Victims of sexual violence• Children• Through infections from mothers• AIDS
orphans• Sex workers•
http://www.ted.com/talks/shereen_el_feki_how_to_fight_an_epidemic_of_bad_laws•
http://www.ted.com/talks/elizabeth_pisani_sex_drugs_and_hiv_let_s_get_rational_1• Men
who have sex with Men (MSM)The Burden of HIV/AIDS• When HIV first appears in a
population, it is generally concentrated in sex workers, men who have sex with men, or
injection drug users• New HIV infections predominantly in people aged 15–24, or infants
from mother-to-child transmissionHIV TreatmentPEPFAR:President’s Emergency Plan for
AIDS Reliefhttps://www.hiv.gov/federal-response/pepfar-global-aids/pepfarHIV
Treatment• UNAIDS• Global Fund to fight AIDS, tuberculosis, andmalaria• IAVI:
International AIDS Vaccine Initiative• HIV Vaccine Trials NetworkAddressing the Burden of
HIV/AIDS• Need for a vaccine• Successful efforts have included strong politicalleadership
and open communication• Approach to prevention must vary with nature ofepidemic•
Efforts need to combine education and behavioralchange, bio-medical approaches,
structuralapproaches, and early treatmentAddressing the Burden of HIV/AIDSSuccessful
efforts will involve:• Condom promotion• Screening and treatment for STIs• Prevention of
mother-to-child transmission• Interventions that target populations thattransmit the virus
from high-risk to low-riskpopulationsWhat is the 90-90-90 goals to beachieved by
2020?90-90-90 goals by 2020• 90% of the people with HIV will know their HIVstatus• 90%
of those with HIV will be receivingantiretroviral therapy• 90% of those being treated will
haveundetectable viral loadshttps://www.unaids.org/en/resources/909090Critical
Challenges in HIV/AIDS• Developing a vaccine• Cost-effective approaches to prevention
indifferent settings• Universal treatment for all those who areeligible• Financing treatment•
Management of TB and HIV co-infection• Management of HIV and substance usedisorders
(SUDs)Here at UMKC…Addiction TechnologyTransfer Center (ATTC)NetworkInternational
HIV ATTCsSouth AfricaSoutheast AsiaVietnamUkraineTuberculosis (TB)• Caused by
bacteria (Mycobacterium tuberculosis)• Affects the lungs• Spread through the air – cough,
losis (TB)• Most live

4. in low- and middle-income countries• Generally a “disease of poverty”• Leading cause of
mortality for people living with HIV• About half of all people with TB can be found in 8
countries• SDG to end TB by 2030Check out country
profiles:https://www.who.int/tb/data/GTBreportCountryProfiles.pdf?ua=1Top 10
countries with TB patientsIndiaChinaIndonesiaNigeriaSouth
AfricaBangladeshEthiopiaPakistanPhilippinesDemocratic Republic of the CongoThe Burden
of TB• An untreated person with active pulmonary TB can infect 10 to 15 people annually•
About two-thirds of those with active TB disease will die of the disease if not treated
properly• TB remains latent in the bodies of about 90% of those infected and they are not
sick now but can develop TB later Addressing the Burden of TB• Bacillus Calmette–Guérin
(BCG) vaccine has limited impact on incidence or prevalence• Control of TB depends on
effective treatment of active tuberculosis and social determinants• WHO recommends a 6-
month regimen for drugsusceptible disease; includes four drugs; highly cost-effective: $5–
$50 per DALY averted• Patient adherence with TB regimen is essential Tuberculosis & HIV
co-infection• TB is an opportunistic infection of HIV• WHO recommends:• Intensified case
finding• Giving isoniazid (antibiotic) to people with HIV to help prevent their getting TB•
Enhancing infection control in healthcare settings so that TB does not spreadChallenges in
TB Control• The WHO End TB Strategy seeks to end the global epidemic by 2030, with a
95% reduction in deaths and reduce incidence to 10 per 100,000 people• Focuses on
expanding TB prevention and care• Putting the new strategy in place requires additional
financial and technical resources Challenges in TB Control• Need for more effective
vaccines, inexpensive and rapid diagnostics, and drug therapy that will lessen duration of
treatment• Improving identification and treatment of multidrug resistant TB and
extensively drug resistant TB• Further efforts at linking all providers of TB diagnosis and
treatment with national TB control
programsMalariahttps://www.mayoclinic.org/diseasesconditions/malaria/multimedia/ma
laria-transmission-cycle/img-20006373The Burden of Malaria• Number of people at risk of
infection: 3.2 billion• In 2018• malaria cases 228 million• malaria-related deaths 405,000•
Children under 5 most vulnerable, 67% of malariadeaths• Burden of malaria-related deaths,
94% in Africa• The WHO African Region carries adisproportionately high share of the
globalmalaria burden.Malaria – treatment & prevention• Prevention – vector control•
Insecticide-treated mosquito nets• Indoor residual spraying• Treatment• Early diagnosis
reduces disease and prevents deaths• Artemisinin-based combination therapy (ACT)• Drug
resistance• Vaccine• RTS,S/AS01 (RTS,S)Addressing the Burden of MalariaKey
interventions:• Prompt treatment of those infected, based onconfirmed diagnosis•
Intermittent preventive therapy for pregnantwomen• Long-lasting insecticide-treated
bednets forpeople living in malarial zones• Indoor residual spraying in malarial zonesCosts
and Consequences ofMalaria• Individuals often have malaria up to 5 times peryear• Indirect
costs are greater than direct costs oftreatment due to lost days of work• Roll Back Malaria
suggests that economic costsin countries with a high burden are equal to1.3% of GDP per
yearChallenges in Addressing Malaria• Substantial gaps in diagnosis and treatment•
National malaria programs must find effectiveways of working with private medical
providers• Better diagnostics and development of newdrugs• Growing resistance to the

5. insecticides used forindoor residual spraying• A safe, effective, and affordable vaccineWhy
has the global communitybeen unable to get rid ofmalaria and what do we needto do to
address
malaria?https://www.ted.com/talks/sonia_shah_3_reasons_we_still_haven_t_gotten_rid_of_
malaria#t-52752The Burden of Neglected TropicalDiseases• There are 13 parasitic and
bacterial infections• Worldwide: more than 1 billion infected (about 1in 6); about 500
million children• Diseases of poverty• Terrible impact on health, impede child growthand
development, harm pregnant women, andoften cause long-term debilitating
illnessesORDER COMPREHENSIVE SOLUTION PAPERS ON Communicable Diseases
Discussion PaperNeglected Tropical DiseasesThe Consequences of the Neglected Tropical
Diseases• Other possible complications: blindness, liver cancer, remarkable swelling, and
skin problems• Increase susceptibility to other infectious diseases• Social stigma• Impact
on productivity, school attendance, and future wage-earning capacity Addressing the
Neglected Tropical Diseases• Rapid-impact package of drugs for the seven mostcommon
NTDs• Importance of public-private partnerships, such aspharmaceutical companies
donating the drugs forrapid-impact package• Periodic deworming of young children is also
a“best buy” in global health• Opportunities to integrate NTD treatment programswith
existing HIV and malaria control programsChagas disease• Caused by the protozoan
Typanosoma Cruzi (T Cruzi) & istransmitted by the feces of triatomine bugs “kissing bugs”•
Acute chagas disease: no symptoms, or mild fever, headache• Chronic chagas disease:
cardiac disorders & digestive disorders• 7-8 million people are infected worldwide•
According to the CDC 300,000 people in the US have theinfectionBuruli ulcer• Caused by the
bacteria Mycobacterium Ulcerans• 6,000 cases annually• Seen in 33 countries in the
Americas, Africa, Asia &Western Pacific• Benin, Cameroon, DRC & Ghana report the most
cases• Mainly in children under 15 (48% in Africa, 10% inAustralia, 19% in Japan)•
http://www.youtube.com/watch?v=W0Gu3kNE_9c&feature=youtu.beGuinea worm•
Parasitic infection caused by Dracunculus medenisisroundworm• Spread through drinking
of contaminated stagnant water thatcontains the guinea worm larvae• Males and females
mate inside the body of an individual andwhen female is ready reproduce painful lesion
forms• Incidence was 3.5 million in 1986 and is now has been
nearlyeradicatedhttps://video.cartercenter.org/Default.aspx?youtube_id=ALP9XjcluE&cate
gory=&filter=Future Challenges to the Controlof Communicable Diseases• Enhance political
commitment to the preventionand control of these diseases• Work with communities to
overcome underlyingcauses• Because health systems in many low- and middleincome
countries will continue to be weak, it willbe important for efforts to be based
onpartnerships, building on the success of publicprivate partnershipsFuture Challenges to
the Control ofCommunicable Diseases• Strengthening the surveillance of disease at thelocal,
national, and global levels• The lack of adequately trained and appropriatelydeployed
human resources for health• The challenge of financing enhanced efforts• Scientific and
technical challenges• Develop models in low- and middle-incomecountries to provide
chronic care of people withHIV/AIDSReferences• Skolnik, Richard (2016). Global Health
101 (3rd ed.). Burlington, MA: Jones & Bartlett Learning ISBN-13:

6. 97812840505547Communicable Diseases Discussion Paper Communicable Diseases
Discussion Paper Communicable Diseases Discussion Paper