This document discusses several emerging and re-emerging infectious diseases including influenza, Marburg virus, Ebola virus, and HIV/AIDS. It provides definitions of emerging and re-emerging diseases and describes some of the driving forces for their emergence such as human intrusion into new ecosystems, climate change, urbanization, and international travel. Prevention and treatment strategies are summarized for some of the diseases.

1. Emerging and
re- emerging diseases
JOSE AMALA ANILDA S. M.Sc(N)
NURSING TUTOR, BCON

2. introduction
• Emerging and re-emerging infectious
disease is an infectious disease, whose
incidence has increased in the past 20 years
and could increase in the near future.
Emerging infections account for at least 12%
of all human pathogens. Despite remarkable
advances in medical science and treatment
during 20th century, infectious diseases remain
the leading cause of death worldwide.

3. Definition
• Emerging diseases:
Diseases that have not occurred in humans before
or that occurred only in small numbers in isolated
places.
• Re- emerging diseases:
Diseases that once were major health
problems globally or in a particular country, and
then declined dramatically, but are again
becoming health problems for a significant
proportion of the population.

4. DRIVING FORCES TO ENERGE:
• Ecological disruption and human intrusion into new
ecological system increases the exposure of human to
new infectious agents.
• Climate changes is another potential driver that shifts
the ecological niche or range of the diseases.
• Long- term impact of global warming, some major
climatic events caused disease outbreaks in the areas
that have not experienced the diseases before.
• Urbanization and industrialization impact the
prevalence and scope of both infectious and chronic
diseases.

5. Cont.d
• High risked sexual practices, multiple sexual
partners and use of substances directly transmit
the disease.
• Overcrowding causes person to person rapid
spreading of diseases.
• Poor housing quality, poor sanitation and water
supply infrastructure.
• International trade of goods and services through
international border facilitate the spread of
diseases by bringing pathogen to new
geographical areas.

6. Cont.d
• Travelers are exposed to variety of pathogen,
many of them have never encountered and no
immunity to many diseases.
• Reduced human immunity, increased number
of immunocompromised hosts.
• War& political conflict cause breakdown of
public health infrastructure has role in
emergence of diseases.

7. Emerging diseases
• "Emerging" infectious diseases can be defined
as infections that have newly appeared in a
population or have existed but are rapidly
increasing in incidence or geographic range.
These include ecological, environmental, or
demographic factors that place people at
increased contact with a previously unfamiliar
microbe or its natural host or promote
dissemination.

10. • Influenza, commonly known as "the flu", is
an infectious disease caused by an influenza
virus Symptoms can be mild to severe. The
most common symptoms include: high fever,
runny nose, sore throat, muscle pains,
headache, coughing, sneezing, and feeling
tired. These symptoms typically begin two
days after exposure to the virus and most last
less than a week.

11. Cont.d
The cough, however, may last for more than
two weeks. In children, there may be diarrhea
and vomiting, but these are not common in
adults. Diarrhea and vomiting occur more
commonly in gastroenteritis, which is an
unrelated disease and sometimes inaccurately
referred to as "stomach flu" or the "24-hour
flu".

12. Infection control:
• These are the main ways that influenza spreads
• by direct transmission (when an infected person
sneezes mucus directly into the eyes, nose or
mouth of another person);
• the airborne route (when someone inhales the
aerosols produced by an infected person
coughing, sneezing or spitting);
• Through hand-to-eye, hand-to-nose, or hand-to-
mouth transmission, either from contaminated
surfaces or from direct personal contact such as a
hand-shake.

13. Prevention
• Frequent hand washing reduces the risk of
viral spread with soap and water, or with
alcohol-based hand rubs);.
• Wearing a surgical mask is also useful.
• The vaccine is usually effective against three
or four types of influenza .
• Antiviral drugs such as the neuraminidase
inhibitor oseltamivir, among others, have been
used to treat influenza.

14. Prevention
• Avoiding close contact with sick people; and
staying home yourself if you are sick.
• Avoiding spitting is also recommended.
• Although face masks might help prevent
transmission when caring for the sick, there is
mixed evidence on beneficial effects in the
community.

15. MARBURG VIRUS

16. Marburg virus is a hemorrhagic fever virus of
the Filoviridae family of viruses and a member
of the species Marburg marburgvirus, genus
Marburgvirus. Marburg virus (MARV) causes
Marburg virus disease in humans and
nonhuman primates, a form of viral
hemorrhagic fever. The virus is considered to
be extremely dangerous.

17. Signs and symptoms:
A maculopapular rash, petechiae, purpura,
ecchymoses , and hematomas (especially
around needle injection sites) are typical
hemorrhagic manifestations. Death occurs due
to multiple organ dysfunction syndrome
(MODS) due to fluid redistribution,
hypotension, disseminated intravascular
coagulation, and focal tissue necroses

18. Stages
Incubation: 2–21 days, averaging 5–9 days.
Generalization Phase: Day 1 up to Day 5 from
onset of clinical symptoms. MHF presents
with a high fever 104 °F (~40˚C) and a sudden,
severe headache, with accompanying chills,
fatigue, nausea, vomiting, diarrhea,
pharyngitis, maculopapular rash, abdominal
pain, conjunctivitis, & malaise.

19. • Early Organ Phase: Day 5 up to Day 13.
Symptoms include dyspnea, edema, conjunctival
injection, and CNS symptoms, including
encephalitis, confusion, delirium, apathy, and
aggression. Hemorrhagic symptoms typically
occur late and herald the end of the early organ
phase, leading either to eventual recovery or
worsening & death. Symptoms include bloody
stools, ecchymoses, blood leakage from
venipuncture sites, mucosal & visceral
hemorrhaging, and possibly hematemesis.

20. • Late Organ Phase: Day 13 up to Day 21+.
Symptoms bifurcate into two constellations for
survivors & fatal cases. Survivors will enter a
convalescence phase, experiencing myalgia,
fibromyalgia, hepatitis, asthenia, ocular
symptoms, & psychosis. Fatal cases continue to
deteriorate, experiencing continued fever,
obtundation, coma, convulsions, diffuse
coagulopathy, metabolic disturbances, shock and
death, with death typically occurring between
Days 8 and 16.

21. Treatment
There is currently no effective marburgvirus-
specific therapy for MVD. Treatment is primarily
supportive in nature and includes minimizing
invasive procedures, balancing fluids and
electrolytes to counter dehydration,
administration of anticoagulants early in infection
to prevent or control disseminated intravascular
coagulation, administration of procoagulants late
in infection to control hemorrhaging, maintaining
oxygen levels, pain management, and
administration of antibiotics or antimycotics to
treat secondary infections

22. EBOLA VIRUS

23. • Ebola virus EBOV, formerly designated Zaire
ebolavirus) is one of five known viruses within
the genus Ebolavirus Four of the five known
ebolaviruses, including EBOV, cause a severe and
often fatal hemorrhagic fever in humans and other
mammals, known as Ebola virus disease (EVD).
Ebola virus has caused the majority of human
deaths from EVD, and is the cause of the 2013–
2015 Ebola virus epidemic in West Africa which
resulted in at least 28,616 suspected cases and
11,310 confirmed deaths.

25. Infection control
People who care for those infected with Ebola
should wear protective clothing including masks,
gloves, gowns and goggles. Ebolaviruses can be
eliminated with heat (heating for 30 to 60 minutes
at 60 °C or boiling for 5 minutes). To disinfect
surfaces, some lipid solvents such as some
alcohol-based products, detergents, sodium
hypochlorite (bleach) or calcium hypochlorite
(bleaching powder), and other suitable
disinfectants may be used at appropriate
concentrations.

26. Management
• No specific treatment is currently approved.
The Food and Drug Administration (FDA)
advises people to be careful of advertisements
making unverified or fraudulent claims of
benefits supposedly gained from various anti-
Ebola products.

27. Standard support
• Treatment is primarily supportive in nature. Early
supportive care with rehydration and symptomatic treatment
improves survival. Rehydration may be via the oral or
intravenous route. These measures may include pain
management, and treatment for nausea, fever, and anxiety.
The World Health Organization (WHO) recommends
avoiding aspirin or ibuprofen for pain management, due to
the risk of bleeding associated with these medications.
• Blood products such as packed red blood cells, platelets, or
fresh frozen plasma may also be used. Other regulators of
coagulation have also been tried including heparin in an
effort to prevent disseminated intravascular coagulation and
clotting factors to decrease bleeding. Ant malarial
medications and antibiotics are often used before the
diagnosis is confirmed, though there is no evidence to
suggest such treatment helps.

29. HUMAN IMMUNODEFICIENCY VIRUS
(HIV)
HIV is a virus that damages the immune
system. The immune system helps the body
fight off infections. Untreated HIV infects and
kills CD4 cells, which are a type of immune
cell called T cells. Over time, as HIV kills
more CD4 cells, the body is more likely to get
various types of infections and cancers.

30. AIDS
AIDS is a disease that can develop in people
with HIV. It’s the most advanced stage of HIV.
But just because a person has HIV doesn’t
mean they’ll develop AIDS.HIV kills CD4
cells. Healthy adults generally have a CD4
count of 500 to 1,500 per cubic millimeter. A
person with HIV whose CD4 count falls below
200 per cubic millimeter will be diagnosed
with AIDS.

31. To develop AIDS, a person has to have
contracted HIV. But having HIV doesn’t
necessarily mean that someone will develop
AIDS.
• Cases of HIV progress through three stages:
• stage 1: acute stage, the first few weeks after
transmission
• stage 2: clinical latency, or chronic stage
• stage 3: AIDS

32. HIV transmission:
Anyone can contract HIV. The virus is transmitted in bodily fluids that include:
• blood
• semen
• vaginal and rectal fluids
• breast milk
Some of the ways HIV is spread from person to person include:
• through vaginal or anal sex — the most common route of transmission,
especially among men who have sex with men
• by sharing needles, syringes, and other items for injection drug use
• by sharing tattoo equipment without sterilizing it between uses
• during pregnancy, labor, or delivery from a woman to her baby
• during breastfeeding
• through “pre-mastication,” or chewing a baby’s food before feeding it to
them
• through exposure to the blood of someone living with HIV, such as through
a needle stick

33. HIV does NOT spread through:
• skin-to-skin contact
• hugging, shaking hands, or kissing
• air or water
• sharing food or drinks, including drinking
fountains
• saliva, tears, or sweat (unless mixed with the
blood of a person with HIV)
• sharing a toilet, towels, or bedding
• mosquitoes or other insects

34. Early symptoms of HIV can include:
• fever
• chills
• swollen lymph nodes
• general aches and pains
• skin rash
• sore throat
• headache
• nausea
• upset stomach

35. HIV medications
More than 25 antiretroviral therapy medications are
approved to treat HIV. They work to prevent HIV from
reproducing and destroying CD4 cells, which help the
immune system fight infection. This helps reduce the risk of
developing complications related to HIV, as well as
transmitting the virus to others.
• These antiretroviral medications are grouped into six
classes:
• nucleoside reverse transcriptase inhibitors (NRTIs)
• non-nucleoside reverse transcriptase inhibitors (NNRTIs)
• protease inhibitors
• fusion inhibitors
• CCR5 antagonists, also known as entry inhibitors
• integrase strand transfer inhibitors

36. HIV prevention
• Safer sex
• The most common way for HIV to spread is through anal or vaginal sex without a condom.
This risk can’t be completely eliminated unless sex is avoided entirely, but the risk can be
lowered considerably by taking a few precautions. A person concerned about their risk of HIV
should:
• Get tested for HIV.
• Get tested for other sexually transmitted infections (STIs
• Use condoms
• Limit their sexual partners
• Take their medications as directed if they have HIV.
Other prevention methods
• Avoid sharing needles or other drug paraphernalia. HIV is transmitted through blood and
can be contracted by using contaminated materials.
• Consider PEP. A person who has been exposed to HIV should contact their healthcare
provider about obtaining post-exposure prophylaxis (PEP). PEP can reduce the risk of
contracting HIV. It consists of three antiretroviral medications given for 28 days. PEP should
be started as soon as possible after exposure, but before 36 to 72 hours have passed.
• Consider PrEP. A person at a high risk of HIV should talk to their healthcare provider about
pre-exposure prophylaxis (PrEP). If taken consistently, it can lower the risk of contracting
HIV. PrEP is a combination of two drugs available in pill form.

38. • The hepatitis C virus is a disease of the liver. A
virus is an incredibly tiny infectious agent that
incorporates itself into the cells of the body,
programming them to start producing more of
the virus. This causes damage to the cells, but
in hepatitis C, the major damage is not actually
done by the virus itself. Rather, the major
damage caused to the liver is actually due to
the inflammation that the body creates trying
to fight off the virus.

39. Risk Factors for Hepatitis C virus (HCV)
• While initially the major route of infection was in blood
transfusion current screening techniques mean that this
form of transmission has dropped to practically zero.
Other forms of blood to blood contact are currently the
highest risk factors. Unsafe injecting practice by illicit
drug users is currently the highest risk factor for
hepatitis C infection. Hepatitis C can also be
transmitted through occupational exposure, such as the
possibility of a ‘needle-stick’ injury by medical staff.
• While theoretically hepatitis C could be transmitted
sexually and from mother to unborn baby, these modes
of transmission are actually very inefficient for hepatitis
C.

40. Some symptoms that have a prevalence of
greater than one in ten are:
• Fatigue
• Joint pain
• Changes in sensation
• Muscle pain
• Itching
• Sjogren’s syndrome

41. Diagnosis:
• As patients with hepatitis C are usually
asymptomatic, it is often picked up only
following a routine biochemical test, with liver
function tests being slightly odd. A full blood
count can also show some mild changes,
secondary to the liver problems.
• Liver biopsy is a very useful test in hepatitis C. It
is not necessary for diagnosis but gives useful
information about the stage of disease (the
amount of liver damage that has already
occurred). It can also be helpful for ruling out
other causes of liver damage.

42. Treatment:
• It is important to counsel all people, especially high-
risk individuals, about the possible sources of hepatitis
C infection and to provide adequate information to help
avoid them. Once infection has been confirmed through
the presence of hepatitis C in the blood along with
chronic hepatitis on a liver biopsy, treatment should be
started.
• The primary therapy is a combination of pegylated
interferon and ribivirin. The dosages and duration of
treatment vary with the subtype of the infecting virus.
Side effects of the treatment can include breakdown of
the red blood cells, itching and nasal congestion.

43. Nipah virus

44. • Nipah virus (NiV) is a zoonotic virus (it is
transmitted from animals to humans) and can
also be transmitted through contaminated food
or directly between people. In infected people,
it causes a range of illnesses from
asymptomatic (subclinical) infection to acute
respiratory illness and fatal encephalitis. The
virus can also cause severe disease in animals
such as pigs, resulting in significant economic
losses for farmers.

45. Transmission
• During the first recognized outbreak in Malaysia,
which also affected Singapore, most human
infections resulted from direct contact with sick
pigs or their contaminated tissues. Transmission is
thought to have occurred via unprotected
exposure to secretions from the pigs, or
unprotected contact with the tissue of a sick
animal.
• In subsequent outbreaks in Bangladesh and India,
consumption of fruits or fruit products (such as
raw date palm juice) contaminated with urine or
saliva from infected fruit bats was the most likely
source of infection.

46. Signs and symptoms
• Human infections range from asymptomatic infection
to acute respiratory infection (mild, severe), and fatal
encephalitis.
• Infected people initially develop symptoms including
fever, headaches, myalgia (muscle pain), vomiting and
sore throat. This can be followed by dizziness,
drowsiness, altered consciousness, and neurological
signs that indicate acute encephalitis. Some people can
also experience atypical pneumonia and severe
respiratory problems, including acute respiratory
distress. Encephalitis and seizures occur in severe
cases, progressing to coma within 24 to 48 hours.

47. Diagnosis
• Nipah virus infection can be diagnosed with
clinical history during the acute and convalescent
phase of the disease. The main tests used are real
time polymerase chain reaction (RT-PCR) from
bodily fluids and antibody detection via enzyme-
linked immunosorbent assay (ELISA).
• Other tests used include polymerase chain
reaction (PCR) assay, and virus isolation by cell
culture.

48. Treatment
There are currently no drugs or vaccines
specific for Nipah virus infection although
WHO has identified Nipah as a priority disease
for the WHO Research and Development
Blueprint. Intensive supportive care is
recommended to treat severe respiratory and
neurologic complications.

49. Prevention
• Controlling Nipah virus in pigs
• Reducing the risk of infection in people
• Public health educational messages should
focus on:
• Reducing the risk of bat-to-human transmission
• Reducing the risk of animal-to-human
transmission.
• Reducing the risk of human-to-human
transmission.
• Controlling infection in health-care settings

51. • Severe acute respiratory syndrome (SARS) is a
serious form of pneumonia. It is caused by a
virus that was first identified in 2003. Infection
with the SARS virus causes acute respiratory
distress (severe breathing difficulty) and
sometimes death.

52. Transmission
• An epidemic of SARS affected 26 countries and resulted in more
than 8000 cases in 2003. Since then, a small number of cases have
occurred as a result of laboratory accidents or, possibly, through
animal-to-human transmission (Guangdong, China).
• Transmission of SARS-CoV is primarily from person to person. It
appears to have occurred mainly during the second week of illness,
which corresponds to the peak of virus excretion in respiratory
secretions and stool, and when cases with severe disease start to
deteriorate clinically. Most cases of human-to-human transmission
occurred in the health care setting, in the absence of adequate
infection control precautions. Implementation of appropriate
infection control practices brought the global outbreak to an end.

53. • Symptoms are influenza-like and include fever,
malaise, myalgia, headache, diarrhoea, and
shivering (rigors). No individual symptom or
cluster of symptoms has proved to be specific for
a diagnosis of SARS. Although fever is the most
frequently reported symptom, it is sometimes
absent on initial measurement, especially in
elderly and immunosuppressed patients.
• Cough (initially dry), shortness of breath, and
diarrhoea are present in the first and/or second
week of illness. Severe cases often evolve rapidly,
progressing to respiratory distress and requiring
intensive care.

54. Zika virus

55. Transmission
• Zika virus is primarily transmitted by the bite of
an infected mosquito from the Aedes genus,
mainly Aedes aegypti, in tropical and subtropical
regions. Aedes mosquitoes usually bite during the
day, peaking during early morning and late
afternoon/evening. This is the same mosquito that
transmits dengue, chikungunya and yellow fever.
• Zika virus is also transmitted from mother to fetus
during pregnancy, through sexual contact,
transfusion of blood and blood products, and
organ transplantation.

56. Signs and symptoms
• The incubation period (the time from exposure
to symptoms) of Zika virus disease is
estimated to be 3–14 days. The majority of
people infected with Zika virus do not develop
symptoms. Symptoms are generally mild
including fever, rash, conjunctivitis, muscle
and joint pain, malaise, and headache, and
usually last for 2–7 days.

57. Complications of Zika virus disease
• Zika virus infection during pregnancy is a cause
of microcephaly and other congenital
abnormalities in the developing fetus and
newborn. Zika infection in pregnancy also results
in pregnancy complications such as fetal loss,
stillbirth, and preterm birth.
• Zika virus infection is also a trigger of Guillain-
Barré syndrome, neuropathy and myelitis,
particularly in adults and older children.

58. Diagnosis
• Infection with Zika virus may be suspected based
on symptoms of persons living in or visiting areas
with Zika virus transmission and/or Aedes
mosquito vectors. A diagnosis of Zika virus
infection can only be confirmed by laboratory
tests of blood or other body fluids, such as urine
or semen.
Treatment
• There is no treatment available for Zika virus
infection or its associated diseases.

59. WHO response
• WHO is supporting countries to control Zika virus disease
by taking actions outlined in the Zika Strategic Response
Framework:
• Advancing research in prevention, surveillance, and control
of Zika virus infection and associated complications.
• Developing, strengthening and implementing integrated
surveillance systems for Zika virus infection and associated
complications.
• Strengthening the capacity of laboratories to test for Zika
virus infection worldwide.
• Supporting global efforts to implement and monitor vector
control strategies aimed at reducing Aedes mosquito
populations.
• Strengthening care and support of affected children and
families affected by complications of Zika infection.

60. RE-EMERGING DISEASES
• Any condition, usually an infection, that had
decreased in incidence in the global population
and was brought under control through
effective health care policy and improved
living conditions, reached a nadir, and, more
recently, began to resurge as a health problem
due to changes in the health status of a
susceptible population.
Examples Cholera, dengue, diphtheria,
malaria, tuberculosis

61. DENGUE FEVER
• Dengue fever is a painful, debilitating mosquito-borne disease caused by
any one of four closely related dengue viruses. These viruses are related to
the viruses that cause West Nile infection and yellow fever.
• An estimated 390 million dengue infections occur worldwide each year,
with about 96 million resulting in illness. Most cases occur in tropical areas
of the world, with the greatest risk occurring in:
• The Indian subcontinent
• Southeast Asia
• Southern China
• Taiwan
• The Pacific Islands
• The Caribbean (except Cuba and the Cayman Islands)
• Mexico
• Africa
• Central and South America

62. • Dengue fever is transmitted by the bite of an
Aedes mosquito infected with a dengue virus.
The mosquito becomes infected when it bites a
person with dengue virus in their blood. It
can’t be spread directly from one person to
another person

63. Symptoms of Dengue Fever
• Symptoms, which usually begin four to six days after
infection and last for up to 10 days, may include
• Sudden, high fever
• Severe headaches
• Pain behind the eyes
• Severe joint and muscle pain
• Fatigue
• Nausea
• Vomiting
• Skin rash, which appears two to five days after the onset of
fever
• Mild bleeding (such a nose bleed, bleeding gums, or easy
bruising)

64. Diagnosing Dengue Fever
• Doctors can diagnose dengue infection with a blood test
to check for the virus or antibodies to it.
Treatment for Dengue Fever
• There is no specific medicine to treat dengue infection.
If you think you may have dengue fever, you should
use pain relievers with acetaminophen and avoid
medicines with aspirin, which could worsen bleeding.
You should also rest, drink plenty of fluids, and see
your doctor. If you start to feel worse in the first 24
hours after your fever goes down, you should get to a
hospital immediately to be checked for complications.

65. Preventing Dengue Fever
• There is no vaccine to prevent dengue fever. The best way to prevent the
disease is to prevent bites by infected mosquitoes, particularly if you are
living in or traveling to a tropical area. This involves protecting yourself
and making efforts to keep the mosquito population down.
• To protect yourself:
• Stay away from heavily populated residential areas, if possible.
• Use mosquito repellents, even indoors.
• When outdoors, wear long-sleeved shirts and long pants tucked into socks.
• When indoors, use air conditioning if available.
• Make sure window and door screens are secure and free of holes. If
sleeping areas are not screened or air conditioned, use mosquito nets.
• If you have symptoms of dengue, speak to your doctor.
• To reduce the mosquito population, get rid of places where mosquitoes can
breed. These include old tires, cans, or flower pots that collect rain.
Regularly change the water in outdoor bird baths and pets' water dishes

67. • Malaria is a life-threatening disease. It’s
typically transmitted through the bite of an
infected Anopheles mosquito. Infected
mosquitoes carry the Plasmodium parasite.
When this mosquito bites you, the parasite is
released into your bloodstream. Malaria is
typically found in tropical and subtropical
climates where the parasites can live. The
World Health Organization (WHO) states that,
in 2016, there were an estimated 216 million
cases of malaria in 91 countries.

68. Causes of malaria
• Malaria can occur if a mosquito infected with the
Plasmodium parasite bites you. There are four
kinds of malaria parasites that can infect humans:
Plasmodium vivax, P. ovale, P. malariae, and P.
falciparum.
• P. falciparum causes a more severe form of the
disease and those who contract this form of
malaria have a higher risk of death. An infected
mother can also pass the disease to her baby at
birth. This is known as congenital malaria.

69. Common symptoms of malaria
• shaking chills that can range from moderate to severe
• high fever
• profuse sweating
• headache
• nausea
• vomiting
• abdominal pain
• diarrhea
• anemia
• muscle pain
• convulsions
• coma
• bloody stools

70. Diagnosis of malaria
• Your doctor will be able to diagnose malaria.
During your appointment, your doctor will review
your health history, including any recent travel to
tropical climates. A physical exam will also be
performed.
• Your doctor will be able to determine if you have
an enlarged spleen or liver. If you have symptoms
of malaria, your doctor may order additional
blood tests to confirm your diagnosis.

71. Life-threatening complications of
malaria
• Malaria can cause a number of life-threatening
complications. The following may occur:
• swelling of the blood vessels of the brain, or
cerebral malaria
• an accumulation of fluid in the lungs that causes
breathing problems, or pulmonary edema
• organ failure of the kidneys, liver, or spleen
• anemia due to the destruction of red blood cells
• low blood sugar

72. Treatment
• Malaria can be a life-threatening condition, especially if
you’re infected with the parasite P. falciparum.
Treatment for the disease is typically provided in a
hospital. Your doctor will prescribe medications based
on the type of parasite that you have.
• In some instances, the medication prescribed may not
clear the infection because of parasite resistance to
drugs. If this occurs, your doctor may need to use more
than one medication or change medications altogether
to treat your condition.

73. Prevention of malaria
• There’s no vaccine available to prevent malaria. Talk to
your doctor if you’re traveling to an area where malaria
is common or if you live in such an area. You may be
prescribed medications to prevent the disease.
• These medications are the same as those used to treat
the disease and should be taken before, during, and
after your trip.
• Talk to your doctor about long-term prevention if you
live in an area where malaria is common. Sleeping
under a mosquito net may help prevent being bitten by
an infected mosquito. Covering your skin or using bug
sprays containing DEET may also help prevent
infection.

74. Cholera

75. • Cholera is an infectious disease that causes
severe watery diarrhea, which can lead to
dehydration and even death if untreated. It is
caused by eating food or drinking water
contaminated with a bacterium called Vibrio
cholerae.
• The disease is most common in places with poor
sanitation, crowding, war, and famine. Common
locations include parts of Africa, south Asia, and
Latin America.

76. Causes
• Vibrio cholerae, the bacterium that causes cholera, is usually found
in food or water contaminated by feces from a person with the
infection. Common sources include:
• Municipal water supplies
• Ice made from municipal water
• Foods and drinks sold by street vendors
• Vegetables grown with water containing human wastes
• Raw or undercooked fish and seafood caught in waters polluted with
sewage
• When a person consumes the contaminated food or water, the
bacteria release a toxin in the intestines that produces severe
diarrhea.
• It is not likely you will catch cholera just from casual contact with
an infected person.

77. Signs and symptoms
• Rapid heart rate
• Loss of skin elasticity (the ability to return to
original position quickly if pinched)
• Dry mucous membranes, including the inside of
the mouth, throat, nose, and eyelids
• Low blood pressure
• Thirst
• Muscle cramps
• If not treated, dehydration can lead to shock and
death in a matter of hours.

78. Treatment and Prevention
• Although there is a vaccine against cholera, the CDC and World Health
Organization don't normally recommend it, because it may not protect up to half of
the people who receive it and it lasts only a few months. However, you can protect
yourself and your family by using only water that has been boiled, water that has
been chemically disinfected, or bottled water. Be sure to use the bottled, boiled, or
chemically disinfected water for the following purposes:
• Drinking
• Preparing food or drinks
• Making ice
• Brushing your teeth
• Washing your face and hands
• Washing dishes and utensils that you use to eat or prepare food
• Washing fruits and vegetables
• Unpeeled fruits and vegetables
• Unpasteurized milk and milk products
• Raw or undercooked meat or shellfish
• Fish caught in tropical reefs, which may be contaminated

80. • Tuberculosis -- or TB, as it’s commonly called
-- is a contagious infection that usually attacks
the lungs. It can also spread to other parts of
the body, like the brain and spine. A type of
bacteria called Mycobacterium tuberculosis
causes it.
• In the 20th century, TB was a leading cause of
death in the United States. Today, most cases
are cured with antibiotics. But it takes a long
time. You have to take meds for at least 6 to 9
months.

81. How Is It Spread:
• Through the air, just like a cold or the flu.
When someone who’s sick coughs, sneezes,
talks, laughs, or sings, tiny droplets that
contain the germs are released. If you breathe
in these nasty germs, you get infected.
• TB is contagious, but it’s not easy to catch.
The germs grow slowly. You usually have to
spend a lot of time around a person who has it.
That’s why it’s often spread among co-
workers, friends, and family members.

82. How Does Tuberculosis Affect Your
Body
• A TB infection doesn’t mean you’ll get sick. There are two
forms of the disease:
• Latent TB: You have the germs in your body, but your
immune system stops them from spreading. That means you
don’t have any symptoms and you’re not contagious. But
the infection is still alive in your body and can one day
become active. If you are at high risk for re-activation —
for instance, you have HIV, your primary infection was in
the last 2 years, your chest X-ray is abnormal, or you are
immunocompromised--- your doctor will treat you with
antibiotics to lower the risk for developing active TB.
• Active TB disease: This means the germs multiply and can
make you sick. You can spread the disease to others. Ninety
percent of adult cases of active TB are from the reactivation
of a latent TB infection.

83. But there are usually signs if you have active TB disease.
They include:
• A cough that lasts more than 3 weeks
• Chest pain
• Coughing up blood
• Feeling tired all the time
• Night sweats
• Chills
• Fever
• Loss of appetite
• Weight loss

84. Who’s at Risk
• You’re more likely to get TB if you come into contact with others who have it. Here
are some situations that could increase your risk:
• A friend, co-worker, or family member has active TB disease.
• You live or have traveled to an area where TB is common, like Russia, Africa,
Eastern Europe, Asia, Latin America, and the Caribbean.
• You’re part of a group where TB is more likely to spread, or you work or live with
someone who is. This includes homeless people, people with HIV, and IV drug
users.
• You work or live in a hospital or nursing home.
• A healthy immune system fights the TB bacteria. But if you have any of the
following, you might not be able to fend off active TB disease:
• HIV or AIDS
• Diabetes
• Severe kidney disease
• Head and neck cancers
• Cancer treatments, such as chemotherapy
• Low body weight and malnutrition
• Medications for organ transplants
• Certain drugs to treat rheumatoid arthritis, Crohn’s disease, and psoriasis

85. Prevention
• Take all of your medicines as they’re prescribed, until your
doctor takes you off them.
• Keep all your doctor appointments.
• Always cover your mouth with a tissue when you cough or
sneeze. Seal the tissue in a plastic bag, then throw it away.
• Wash your hands after coughing or sneezing.
• Don’t visit other people and don’t invite them to visit you.
• Stay home from work, school, or other public places.
• Use a fan or open windows to move around fresh air.
• Don’t use public transportation.

86. Treatment:
• With the proper treatment, tuberculosis (TB,
for short) is almost always curable. Doctors
prescribe antibiotics to kill the bacteria that
cause it. You’ll need to take them for 6 to 9
months. What medications you take and how
long you’ll have to take them depends on
which works to eradicate your TB. Sometimes,
antibiotics used to treat the disease don’t work.
Doctors call this "drug-resistant" TB. If you
have this form of the disease, you may need to
take stronger medications for longer.

87. Treatment for Latent TB
• There are two types of TB -- latent and active.
• Depending on your risk factors, latent TB can re-activate
and cause an active infection. That’s why your doctor might
prescribe medication to kill the inactive bacteria -- just in
case.
• These are the three treatment options:.
• Isoniazid (INH): This is the most common therapy for
latent TB. You typically take an isoniazid antibiotic pill
daily for 9 months.
• Rifampin : You take this antibiotic each day for 4 months.
It’s an option if you have side effects or contraindications to
INH.
• Isoniazid and rifapentine: You take both of these
antibiotics once a week for 3 months under your doctor’s
supervision.

88. Treatment for Active TB
• If you have this form of the disease, you’ll need to
take a number of antibiotics for 6 to 9 months.
These four medications are most commonly used
to treat it:
• Ethambutol
• Isoniazid
• Pyrazinamide
• Rifampin
• Your doctor may order a test that shows which
antibiotics will kill the TB strain. Based on the
results, you’ll take three or four medications for 2
months. Afterward, you’ll take two medications
for 4 to 7 months.