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Emerging and Re-emerging Infectious Diseases 2003. Duc J. Vugia, M.D., M.P.H. Chief, Infectious Diseases Branch Division of Communicable Disease Control California Department of Health Services. WNV . Monkeypox from Prairie Dogs . Are infectious diseases emerging more recently than before? .

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Emerging and re emerging infectious diseases 2003 l.jpg

Emerging and Re-emerging Infectious Diseases 2003

Duc J. Vugia, M.D., M.P.H.

Chief, Infectious Diseases Branch

Division of Communicable Disease Control

California Department of Health Services





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1980

1982

1984

1986

1988

1990

1992

1994

1996

Infectious Disease Mortality in the United States, 1980-1996

80

70

60

50

40

Crude ID Mortality Rate

Deaths per 100,000 population

30

20

10

0

Year

CDC

Source: JAMA 1996;275:189-193 and unpublished CDC data


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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


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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


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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


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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.”


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Major Factors Contributing to Emerging Infections: 1992

1. Human demographics and behavior

2. Technology and Industry

  • 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


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More Factors Contributing to Emerging Infections: 2003

7. Human vulnerability

  • Climate and weather

  • Changing ecosystems

  • Poverty and social inequality

  • War and famine

  • Lack of political will

  • Intent to harm

Institute of Medicine Report, 2003


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Emerging Infections:Human Demographics, Behavior, Vulnerability

  • More people, more crowding

  • Changing sexual mores (HIV, STDs)

  • Injection drug use (HIV, Hepatitis C)

  • Changing eating habits: out more, more produce (foodborne infections)

  • More populations with weakened immune system: elderly, HIV/AIDS, cancer patients and survivors, persons taking antibiotics and other drugs


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Emerging Infections:Technology and Industry

  • Mass food production (Campylobacter, E.coli O157:H7, etc…)

  • Use of antibiotics in food animals (antibiotic-resistant bacteria)

  • More organ transplants and blood transfusions (Hepatitis C, WNV,…)

  • New drugs for humans (prolonging immunosuppression)


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Organ TransplantationYear-end Waiting Lists vs. Transplanted(kidney, liver, pancreas, heart, lung)

70,000

60,000

50,000

40,000

30,000

20,000

10,000

0

Source: UNOS

CDC


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Emerging Infections:Economic Development, Land Use, Changing Ecosystems

  • Changing ecology influencing waterborne, vectorborne disease transmission (e.g. dams, deforestation)

  • Contamination of watershed areas by cattle (Cryptosporidium)

  • More exposure to wild animals and vectors (Lyme disease, erhlichiosis, babesiosis, HPS,…)


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Emerging Infections:International Travel and Commerce

  • Persons infected with an exotic disease anywhere in the world can be into major US city within hours (SARS, VHF,…)

  • Foods from other countries imported routinely into US (Cyclospora,….)

  • Vectors hitchhiking on imported products (Asian tiger mosquitoes on lucky bamboos,….)


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Speed of Global Travel in Relation to

World Population Growth

From: Murphy and Nathanson. Semin. Virol. 5, 87, 1994

CDC


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Cyclospora

10 µm

Immature oocysts

Contaminated raspberries

CDC


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Emerging Infections:Microbial Adaptation and Change

  • Increased antibiotic resistance with increased use of antibiotics in humans and food animals (VRE, VRSA, penicillin- and macrolide-resistant Strep pneumonia, multidrug-resistant Salmonella,….)

  • Increase virulence (Group A Strep?)

  • Jumping species from animals to humans (avian influenza, HIV?, SARS?)


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Emerging Vancomycin-resistant Enterococcal Infections*

% Resistant

* in U.S. NNIS Hospitals

CDC


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Emerging Infections:Poverty, Social Inequality, Breakdown of Public Health Measures

  • Lack of basic hygienic infrastructure (safe water, safe foods, etc..)

  • Inadequate vaccinations (measles, diphtheria)

  • Discontinued mosquito control efforts (dengue, malaria)

  • Lack of monitoring and reporting (SARS)


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Emerging Infections:Intent to Harm

  • Bioterrorism: Anthrax in US 2001

  • Bio-Crimes: Salmonella in OR, Shigella in TX.

  • Potential agents: Smallpox, Botulism toxin, Plague, Tularemia, ….



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Prevention of Emerging Infectious Diseases Will Require Action in Each of These Areas

Surveillance and Response

Applied Research

Infrastructure and Training

Prevention and Control

CDC


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Preventing Emerging Action in Each of These AreasInfectious Diseases

Surveillance and Response

Detect, investigate, and monitor emerging pathogens, the diseases they cause, and the factors influencing their emergence, and respond to problems as they are identified.

CDC


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Preventing Emerging Action in Each of These AreasInfectious Diseases

Applied Research

Integrate laboratory science and epidemiology to increase the effectiveness of public health practice.

CDC


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Preventing Emerging Action in Each of These AreasInfectious Diseases

Infrastructure and Training

Strengthen public health infrastructures to support surveillance, response, and research and to implement prevention and control programs.

Provide the public health work force with the knowledge and tools it needs.

CDC


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Preventing Emerging Action in Each of These AreasInfectious Diseases

Prevention and Control

Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases.

CDC


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Preventing Emerging Action in Each of These AreasInfectious 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


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Common Palm Civet Action in Each of These Areas


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