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Emerging & re emerging infections
- 1. Emerging & Re-emerging Infections DrSwati Shikha Assistant Professor Dept. of Community Medicine
- 2. Learning objectives • Whatis emerging and re emerging infections • Factors responsible for emergence and re-emergence of infections • Emerging infectious diseases: Ebola virus, Zika virus, Nipah virus, Lassa fever • Examples of re-emerging infectious diseases • Public health actions to be taken 09-10-2020 2
- 3. Emerging infectious diseases (Newdiseases; New Threats) Defined as: • Those which were not experienced previously • Those with already known causative agents but – • Not previously known to infect humans OR • Occuring in new regions where previously they were not existent OR • Occuring in new age group with new clinical features AND • Developing resistance to existing treatment • Examples : • AIDS after 1981 • Vibrio cholera O139 emerged in 1992 • ACT resistant malaria • MDR and XDR tuberculosis 09-10-2020 3
- 4. Re-emerging Infectious Diseases (Olddiseases; New Threats) • Re emerging infectious diseases are those which was previously controlled and efficaciously treated but have recurred in a new epidemiological setting with increased frequency and mortality or in a more virulent form to be a significant public health problem. • Due to development of resistance by the organism for the drugs OR by the vector for the pesticides/insecticides • Example: Malaria, dengue 09-10-2020 4
- 5. Factors • Improper planningof township • Population explosion, poor living condition with overcrowding • Industrialization/urbanization • Lack of proper health care services • Intense international travel • Indiscriminate use of antibiotics • Increase contact with animals • Environmental degradation with changing weather pattern 09-10-2020 5
- 6. Emerging infectious diseases Theycan be grouped into 2 groups D/t new agents d/t new variant of old pathogen Ebola virus disease * 0157.HF strain of E.coli Zika * Exanthem subitum Nipah and hanta virus * 0139 strain of cholera Lassa fever MERS SARS RVF CCHF 09-10-2020 6
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- 8. Introduction • A seriousviral hemorrhagic fever (EHF) • Initially detected in 1976 around ebola river of Zaire (DRC) • 35 outbreaks occurred from 1976 – 2016 • Largest outbreak in west Africa in 2014 – 2016 • In 2014, declared as PHEIC by WHO 09-10-2020 8
- 9. Epidemiological determinants Agent RNAVirus Family: Filoviridae 5 species: reston virus has not caused disease in human yet 2014 outbreak: zaire species Reservoir Animal borne virus Monkeys, gorillas, chimpanzees Fruit bat are natural host Infective material Blood & body fluids: urine, saliva, sweat, feces, vomitus, breast milk, semen of infected person Fomites: needles, surgical instruments Mode of transmission Close contact with blood and body secretion of infected animal Direct contact transmission between humans 09-10-2020 9
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- 11. Pathogenesis Virus damages theblood vessels Altered arrangement of endothelial lining of blood vessels Coagulation of blood becomes difficult Fluid leakage Drastic decrease in blood pressure Hypovolemic shock 09-10-2020 11
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- 13. Treatment & Prevention •No specific treatment available, only supportive care • Vaccines are under different phases of trial • PRECAUTIONS: • Use of disposable medical equipments • Sterilization of surgical instruments • Personal precautions • High standard of personal hygiene • Avoid contact with bats, non human primates or blood, body fluid or raw meat from these animals • Avoid sexual contact with person who have recovered from ebola • After returning from endemic areas, health should be monitored for 21 days09-10-2020 13
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- 15. Introduction • Till 1952,zika virus was known to be the disease specific to monkeys • The largest outbreak in 2015 – 2016 affected >33 countries • Declared a PHEIC by WHO on 1st feb 2016 • India has recorded its biggest outbreak with > 100 cases in October 2018 from state of Rajasthan. 09-10-2020 15
- 16. The virus • Icosahedral,enveloped, single stranded RNA virus • Arbovirus of genus Flavivirus • Transmitted by bite of Aedes mosquito • Also transmitted • from pregnant mother to fetus • Through sexual contact • Hemotransfusion • Organ transplant 09-10-2020 16
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- 20. Clinical features • IP= 3 – 14 days • Duration of viremia = 3 days (3rd to 5th day after onset of symptoms) • About 80% are asymptomatic 09-10-2020 20
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- 26. Introduction • Nipah virusdisease is a zoonotic disease, associated with high fatality and virulence among people • Mainly affects pigs (dogs, cats, horses and sheep may be affected) • 1st recognised in Malayasia in 1999 when outbreak occurred among pig farmers • Most recent outbreak occurred in India in kerala in 2018. • Infects endothelial cells and neurons causing neurological symptoms • Systemic vasculitis with extensive thrombosis and parenchymal necrosis in CNS are found. 09-10-2020 26
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- 33. Introduction • A zoonoticdisease • Viral hemorrhagic fever • Virus: • Family: Arenaviridae • Single stranded retrovirus • Transmitted by coming in contact with infected rodents (Mastomys rats) • Reuse of contaminated medical equipments leads to person to person transmission • Poor sanitary condition and overcrowding increases the risk 09-10-2020 33
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- 38. Re-emerging infectious diseases •Malaria: resurgence of malaria • Kala-azar: was controlled but again it started to increase due to factors such as deforestation, industrialization, urbanization, poor living condition, livestocks in the house. • Dengue fever: re emerged due to factors pre disposing to breeding of Aedes aegypti mosquito and development of insecticide resistance. • Plague: during 1960s plague was totally under control but re emerged in 1994 in Maharashtra, later in Surat, Delhi, Punjab. 09-10-2020 38
- 39. Public health actions Surveillance Complyingwith IHR Building public health capacity Research and Development Information sharing and partnership GOARN 09-10-2020 39
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