Control of Epidemics and national priority communicable diseases programmes.

1. Control of Epidemics and national priority communicable diseases programmes.

2. Components of communicable diseases Agent-living and infectious. could be viruses, bacteria,protozoa,fungi and helminthes. Host �immunity ability to resist infection Route of transmission-mechanism by which infection is transmitted from one person to another or from reservoir to new host.

3. Epidemiologic Triad Concepts Infectivity � ability to invade a host (# infected / # susceptible) X 100 Pathogenicity � ability to cause disease (# with clinical disease / # of infected) X 100 Virulence � ability to cause death (# of deaths / # with disease (cases)) X 100 All are dependent upon the condition of the host Immunity (active, passive) Nutrition Sleep Hygiene

4. Properties of infectious agent Ability to multiply Emerge from new host Reach a new host Infect the new host resvoir of infection-ecological niche on which the agent depend for survival -human as in measles,HIV/AIDs,typhoid,CSM,STI Animal �tanesis,plague,rabies,samelosis Non living �clostridial organisms

5. Incubation Period The interval between the time of contact and/or entry of the agent and onset of illness (latency period) The time required for the multiplication of microorganisms within the host up to a threshold where the parasitic population is large enough to produce symptoms

6. Each infectious disease has a characteristic incubation period, dependent upon the rate of growth of the organism in the host and Dosage of the infectious agent Portal of entry Immune response of the host Because of the interplay of these factors, incubation period will vary among individuals For groups of cases, the distribution will be a curve with cases with longer incubation periods creating a right skew

7. Mode of Transmission Person-to-person (respiratory, orogenital, skin) Examples: HIV, measles Vector (animals, insects) Examples: rabies, yellow fever Common vehicle (food, water) Examples: salmonellosis Mechanical vectors (personal effects) such as doorknobs, or toothbrushes are called FOMITES

8. Classification by Mode of Transmission Dynamics of Spread through Human Populations Spread by a common vehicle Ingestion Salmonellosis Inhalation Legionellosis Inoculation Hepatitis Propagation by serial transfer from host to host Respiratory Measles Anal-oral Shigellosis Genital Syphilis

9. Principle Reservoir of Infection Man Infectious hepatitis Other vertebrates (zoonoses) Tularemia Agent free-living Histoplasmosis Portal of Entry/Exit in Human Host Upper respiratory tract Diphtheria Lower respiratory tract Tuberculosis Gastrointestinal tract Typhoid fever Genitourinary tract Gonorrhea Conjunctiva Trachoma Percutaneous Leptospirosis Percutaneous (bite of arthropod) Yellow fever

10. Cycles of Infectious Agent in Nature Man-man Influenza Man-arthropod-man Malaria Vertebrate-vertebrate-man Psittacosis Vertebrate-arthropod-vertebrate-man Viral encephalitis Complex Cycles Helminth infections River blindness

11. Host factors Resistance to infection-specific or non specific Non specific-protective covering of skin., mucous membrane, secretions, and reflex responses Specific- acquired (active or passive), genetic (races , ethnic groups) Factors influencing host immunity-age,nutrition,sex,trauma,pregnancy and herd immunity

12. Herd Immunity The decreased probability that a group will develop an epidemic because the proportion of immune individuals reduces the chance of contact between infected and susceptible persons The entire population does not have to be immunized to prevent the occurrence of an epidemic Example: smallpox, measles

13. Carriers-person who harbors infection without showing signs of disease - healthy -incubatory/precocious - convalescent -chronic Importance-large number of carriers as compared with the sick Making contacts with uninfected over a wide area Source of infection over a long period.

14. Spectrum of Disease Exposure Subclinical manifestations Pathological changes Symptoms Clinical illness Time of diagnosis Death Whether a person passes through all these stages will depend upon infection and prevention, detection and therapeutic measures

15. Iceberg Concept of Infection

16. Spectrum of Disease (cont.) Example 90% of measles cases exhibit clinical symptoms 66% of mumps cases exhibit clinical symptoms <10% of poliomyelitis cases exhibit clinical symptoms

17. Subclinical/Clinical Ratio for Viral Infections

18. Methods of control Eliminate the reservoir human reservoir- isolation, quarantine, zoonosis- quarantine Non living- avoid exposure. Interruption of transmission-environmental sanitation, personal hygiene, vector control Protection of the host � passive and active immunization

19. Control of communicable diseases Recognizing the infection and confirmation of diagnosis-use of standard case definition and laboratory services Notifying the disease to appropriate authority-national and international notification. DSN 001 & DSN 002 forms Identifying source of infection � use of incubation period interval between infection and onset of symptoms Assessing the extent of outbreaks- other persons infected and contacts

20. Investigating an Epidemic Determine whether there is an outbreak � an excess number of cases from what would be expected There must be clarity in case definition and diagnostic verification for each case

21. Introduction An epidemic is the occurrence of a number of cases of a disease that is usually large or unexpected for the given place and time . An epidemic often evolves rapidly ,so a quick response is required to limit the outbreak and prevent future occurrence of outbreaks

22. Detection of epidemics Use of standard case definitions Routine epidemiological surveillance Active epidemiological surveillance International notification Case reporting forms- summaries in tables and graphs

23. Reliable reporting of priority diseases and conditions to the next level and appropiate health authorities DSN001- Emergency notification : any case or death to any of the following nine diseases �AIDs, Anthrax ,Cerebrospinal meningitis ,Cholera, Plague, Human rabies, Typhoid and paratyphoid, Yellow fever and Lassa fever Immediate reporting by telex, telephone and fill DSN001 form

24. Routine epidemiological surevillance DSN001- Emergency notification : any case or death to any of the following nine diseases �AIDs, Anthrax ,Cerebrospinal meningitis ,Cholera,Plague,Human rabies,Typhoid and paratyphoid,Yellow fever and lassa fever Immediate reporting by telex,telephone and fill DSN001 form

25. Experiences with some disease eradication and elimination programs show that disease control and prevention objectives are successful met when resources are dedicated to improving the ability of health workers to detect targeted diseases , obtain lab confirmation of diseases and use thresholds to initiate action at LGA level Building on these successes , WHO AFRO proposes IDSR strategy for improving communicable disease surveillance and response linking community, health facility ,LGA and national level.

26. Goal and objectives of IDSR The goal is to improve the ability of LGA to detect and respond to disease and conditions that cause high death rates , illness and disability Objectives are to strengthen the capacity of country to conduct effective surveillance Integrate multiple surveillance systems-forms , personnel and resources used more efficiently and effectively Improve the use of information for decision making Improve flow of surveillance information between and within levels of health system

27. Surveillance functions Identify cases- case definitions Report suspected cases to next level Analyse and interpret data- Investigate and confirm suspected cases and outbreaks Respond- mobilise resources Provide feedback Evaluate and improve system-timeliness, quality of information, preparedness, case mgt and overall performance

28. Diseases included Top causes of high morbidity and mortality Have epidemic potentials Surveillance required internationally Have available effective control and prevention interventions Easily identified using case definitions Have intervention programs supported by WHO.

29. 21 selected diseases Epidemic prone-cholera, measles, CSM, viral hemorrhagic fevers and yellow fever Diseases targeted for eradication and elimination-poliomyelitis, dracunculiaisis , leprosy, neonatal tetanus, filariaisis Diseases of public health importance- pneumonia and diarrhea in under 5, HIV/AIDs, malaria, onchocerciaisis, STIs, tuberculosis, dysentry ,pertussis , hepatitis B, plague.

30. DSN 002-Regular monthly notification Diseases of immediate threat to public health and diseases addressed by control programmes Cases and deaths reported monthly Forty-two diseases involved including the nine diseases notified immediately

31. IDSR 001- Immediate/Case based reporting form IDSR 002-Weekly reporting of new cases of Epidemic prone diseases IDSR 003-Routine monthly notification form Tuberculosis /leprosy quarterly reporting forms

32. Active epidemiological surveillance In-depth search for cases of a few selected diseases likely to cause epidemics e.g sentinel surveillance for EPI diseases

33. International notification Few diseases are subjected to notification on basis of international agreement These international notifiable diseases are quarantinable governed by International Sanitary Regulations Plague,cholera and yellow fever

34. Investigation of Epidemics Conduct investigation of epidemics when: Report of a suspected outbreak of immediately notifiable disease Unusual increase in number of deaths during routine analysis of data Alert or Action threshold have been reached for specific diseases Report of rumors of death from cases Cluster of deaths for which the cause is not explained

35. Steps in investigation of epidemic Confirm the existence of epidemics Verify the diagnosis by clinical symptoms , signs and laboratory confirmation Describe the epidemics in persons, place and time Notify the appropriate authorities Search for additional cases or contacts Institute control measures Write a report.

36. Verify the outbreak Source of information Severity of illness Number of cases and deaths reported Transmission mode and risk for wider transmission Political and geographical consideration Available resources

37. Confirm diagnosis Review clinical history -take history and examine patients to confirm signs and symptoms as in case definition Review the lab results if available and see if it is consistent with clinical findings Treat the patient with available recommended drugs and therapies. Search for additional cases in registers of neighboring facility and community

38. Description of epidemic by time Date of onset �exposure to causal agent Exposure over a brief period-steep up slope Exposure over a long period of time-plateau Person to person transmission-tall peaks separated by periods of incubation Timeliness of detection,investigation and response to epidemics

39. Description of epidemic by place Clustering of cases occurring in a particular area Travel patterns that relate to the method of transmission for this disease Common sources of infection for these cases-water sources,relevant geographical characteristics

40. Description of epidemic by person Age or date of birth Sex Urban or rural residence Immunization status Inpatient and outpatient status Risk factors Outcome -survive,died,unknown Other variables relevant to the disease

41. Investigating an Epidemic (cont.) Plot an epidemic curve (cases against time) Calculate attack rates If there is no obvious commonality for the outbreak, calculate attack rates based on demographic variables (hepatitis in a community) If there is an obvious commonality for the outbreak, calculate attack rates based on exposure status (a church supper)

42. Investigating an Epidemic (cont.) Determine the source of the epidemic If there is no obvious commonality for the outbreak, plot the geographic distribution of cases by residence/work/school/location to reduce common exposures If there is an obvious commonality for the outbreak, identify the most likely cause and investigate the source to prevent future outbreaks

43. Index Case Person that comes to the attention of public health authorities Primary Case Person who acquires the disease from an exposure Attack rate Secondary Case Person who acquires the disease from an exposure to the primary case Secondary attack rate

44. Calculation of Attack Rate for Food X

45. Secondary Attack Rate Used to estimate to the spread of disease in a family, household, dorm or other group environment. Measures the infectivity of the agent and the effects of prophylactic agents (e.g. vaccine)

46. Mumps experience of 390 families exposed to a primary case within the family

47. Case Fatality Rate Reflects the fatal outcome (deadliness) of a disease, which is affected by efficacy of treatment

48. Assume a population of 1000 people. In one year, 20 are sick with cholera and 6 die from the disease. The cause-specific mortality rate in that year from cholera = The case-fatality rate from cholera =

49. Identification of source of outbreak Line list for summarizing time ,place and person analysis Epidemic curve-histogram represent the course of the disease Plot the cases on a spot map-clustering of cases (common or point source) Tables of relevant characteristics of the cases-age group,sex ,immunization,etc

50. Response to outbreaks Establish epidemic management committee and epidemic rapid response team at all levels of government Prepare an epidemic response plan-mobilization of human resources,emergency stocks of required drug,medical supplies,laboratory and logistic support ,support from state ,national and donor agencies Training in epidemic response skills

51. Strengthening preventive measures Strengthen case management Update health workers skill Conduct emergency immunization campaigns Enhance surveillance during the response activity Inform and educate the public Improve access to clean water

52. Improve safe disposal of human waste Improve food handling practices Reduce exposure to mosquitoes Control vectors Disseminate the appropriate recommendation for the outbreak

53. Report on outbreak Details on the response activities-dates,places and individuals involved Epidemic curve,spot map,table of person,place analysis and line list Recommend changes to improve epidemic response in future Disseminate a report on the outbreak

54. What Are EmergingInfectious Diseases? These are human illnesses caused by microorganisms or their poisonous byproducts and having the potential for occurring in epidemic numbers. 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.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.

55. Emerging Infectious Diseases include conditions that emerge as a new infectious process re-emerge as drug resistant forms That microorganisms emerge and re-emerge is not new. This has been occurring since the beginning of time. New bacterial and viral pathogens emerge either from an unrecognized ecological environment to thrust itself upon man (e.g. AIDS, Ebola) or following scientific discovery of a new strain of a previously defined pathogen (e.g. Hepatitis C). Common bacterial pathogens (e.g. gonorrhea, malaria, enterococcus, pneumococcus, tuberculosis, staphylococcus, and streptococcus) have become resistant to many of the antibiotics used over the past 20 years and leave the medical community with no effective treatment for a growing list of infectious diseases. As pathogens strengthen their hold, broaden their reach, and pierce our defenses, our vulnerability is extending to the most mundane activities. Questions arise such as - Is my tap water safe to drink? Is the food I ordered in a restaurant safe to eat? Are my children likely to be bitten by disease-carrying insects or ticks while playing in the yard? Does my sex partner have an infection that might be passed on to me? Is it safe to vacation in a tropical country? Is the coughing person next to me on the subway or airplane spreading a deadly strain of influenza or tuberculosis? Whatever the cause, the resurgence of diseases attributed to newly emerging or re-emerging microbes poses a formidable challenge for the nation�s public health and health-care systems. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention.That microorganisms emerge and re-emerge is not new. This has been occurring since the beginning of time. New bacterial and viral pathogens emerge either from an unrecognized ecological environment to thrust itself upon man (e.g. AIDS, Ebola) or following scientific discovery of a new strain of a previously defined pathogen (e.g. Hepatitis C). Common bacterial pathogens (e.g. gonorrhea, malaria, enterococcus, pneumococcus, tuberculosis, staphylococcus, and streptococcus) have become resistant to many of the antibiotics used over the past 20 years and leave the medical community with no effective treatment for a growing list of infectious diseases. As pathogens strengthen their hold, broaden their reach, and pierce our defenses, our vulnerability is extending to the most mundane activities. Questions arise such as - Is my tap water safe to drink? Is the food I ordered in a restaurant safe to eat? Are my children likely to be bitten by disease-carrying insects or ticks while playing in the yard? Does my sex partner have an infection that might be passed on to me? Is it safe to vacation in a tropical country? Is the coughing person next to me on the subway or airplane spreading a deadly strain of influenza or tuberculosis? Whatever the cause, the resurgence of diseases attributed to newly emerging or re-emerging microbes poses a formidable challenge for the nation�s public health and health-care systems. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention.

56. Origin of EmergingInfectious Diseases Changes in environment (technology and industry) Economic development Population growth or migration Human behavior International travel and commerce Microbial adaptation Breakdown in public health measures The cause of almost all emerging infectious diseases can be traced to changes in environment (technology and industry), economic development and land use, human population growth or migration, human behavior, international travel and commerce, microbial adaptation, or a breakdown in public health measures. Under suitable circumstances, a new infection anywhere in the world could traverse entire continents within days or weeks. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention.The cause of almost all emerging infectious diseases can be traced to changes in environment (technology and industry), economic development and land use, human population growth or migration, human behavior, international travel and commerce, microbial adaptation, or a breakdown in public health measures. Under suitable circumstances, a new infection anywhere in the world could traverse entire continents within days or weeks. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention.

57. Microbial Adaptation Mechanisms of genetic diversity Respond to changes in physical and social environment. Epidemiologic triangle Host Environment Agent Microbes have enormous potential mechanisms of genetic diversity - they evolve, adapt, and emerge in response to nonmicrobial and even non-biologic changes in the physical and social environment. The development of disease is dependent on the extent of exposure to an agent, the strength or virulence of the agent, the host�s susceptbility, and the environmental conditions. Considering the epidemiological triangle - host, environment, and agent - what is not clear is how these three change over time, often in response to changes in another side of the triangle. Drotman, D.P. (1998). Emerging Infectious Disease: A Brief Biographical Heritage, Emerging Infectious Diseases, 4(3), July-September, 1998.Microbes have enormous potential mechanisms of genetic diversity - they evolve, adapt, and emerge in response to nonmicrobial and even non-biologic changes in the physical and social environment. The development of disease is dependent on the extent of exposure to an agent, the strength or virulence of the agent, the host�s susceptbility, and the environmental conditions. Considering the epidemiological triangle - host, environment, and agent - what is not clear is how these three change over time, often in response to changes in another side of the triangle. Drotman, D.P. (1998). Emerging Infectious Disease: A Brief Biographical Heritage, Emerging Infectious Diseases, 4(3), July-September, 1998.

58. Major Factors Contributing to the Emergence of Infectious Diseases Human demographics and behavior Technology and industry Economic development and land use International travel and commerce Microbial adaptation and change Breakdown of public health measures

59. New EmergingInfectious Diseases Human Immunodeficiency Virus (AIDS) Lyme disease Ebola fever Hantavirus Pulmonary Syndrome West Nile encephalitis Legionnaire�s disease Examples of emerging infectious diseases include: HIV/AIDS: First recognized in 1981, AIDS is caused by the HIV virus found in blood, semen, and vaginal secretions of infected persons. A strain of the virus has been circulating since at least 1959, and many believe that it evolved from a virus carried by a nonhuman primate. Lyme disease: First recognized in the 1970�s, it has emerged as the most frequently reported tick borne disease in the US with an average of over 12,000 cases reported annually since 1993. It is the most common vector-borne disease in the US, with the number of cases steadily increasing since 1990. Ebola virus: One of the deadliest viruses known, it causes a hemorrhagic fever. Ebola emerges periodically from unkown (probably small animal) natural reservoirs, accidentally infects humans and causes dramatic self-terminating outbreaks. Hantavirus pulmonary syndrome: Carried by rodents, it is a lung disease that was first identified during a 1993 outbreak in the southwestern US. It develops rapidly, causing severe pulmonary hemorrhage and death. West Nile encephalitis: First identified in the US in New York in 1999, it is a brain infection caused by viral and bacterial pathogens transmitted by mosquitoes. Mortality rates range from 3% to 15%, with slightly higher rates among the elderly. Legionnaire�s disease: First identified in Philadelphia in 1976, it is caused by the bacterium Legionella pneumophila. Transmitted through inhalation of aerosols of contaminated water, it is thought to account for 7% of all non-nosocomial pneumonias. (USDHHS 1998)Examples of emerging infectious diseases include: HIV/AIDS: First recognized in 1981, AIDS is caused by the HIV virus found in blood, semen, and vaginal secretions of infected persons. A strain of the virus has been circulating since at least 1959, and many believe that it evolved from a virus carried by a nonhuman primate. Lyme disease: First recognized in the 1970�s, it has emerged as the most frequently reported tick borne disease in the US with an average of over 12,000 cases reported annually since 1993. It is the most common vector-borne disease in the US, with the number of cases steadily increasing since 1990. Ebola virus: One of the deadliest viruses known, it causes a hemorrhagic fever. Ebola emerges periodically from unkown (probably small animal) natural reservoirs, accidentally infects humans and causes dramatic self-terminating outbreaks. Hantavirus pulmonary syndrome: Carried by rodents, it is a lung disease that was first identified during a 1993 outbreak in the southwestern US. It develops rapidly, causing severe pulmonary hemorrhage and death. West Nile encephalitis: First identified in the US in New York in 1999, it is a brain infection caused by viral and bacterial pathogens transmitted by mosquitoes. Mortality rates range from 3% to 15%, with slightly higher rates among the elderly. Legionnaire�s disease: First identified in Philadelphia in 1976, it is caused by the bacterium Legionella pneumophila. Transmitted through inhalation of aerosols of contaminated water, it is thought to account for 7% of all non-nosocomial pneumonias. (USDHHS 1998)

60. Drug Resistant Diseases Malaria Multiple drug resistant tuberculosis Bacterial pneumonias There is great concern that common bacterial pathogens (I.e. TB, malaria, Shigella, Salmonella, Streptococcus, Pneumococcus) have become resistant to many of the antibiotics commonly used in the past 20 years. The increase in drug resistance has resulted from several practices, including inappropriate use (prescribing an antibiotic for a viral episode), over-prescribing, poor patient compliance in completing entire treatment series, and the widespread use of antiseptics. A 1995 US government report estimated that the emergence of antimicrobial resistance among six common bacteria in hospitals added $661 million per year in hospital charges. Resistance to antimalarial drugs is widespread worldwide. For many years, chloroquine was the mainstay of treatment, but resistant strains have spread and intensified in all malaria endemic areas. There is also concern over multidrug resistant TB with an occasional �Godzilla strain� unresponsive to any current antibiotic. The CDC has established the National Tuberculosis Genotyping and Surveillance Network to track strains of drug resistant TB. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. US Congress Office of Technology Assessment (1995). Impacts of antibiotic-resistant bacteria [OTA-H-629]. Washington DC: US Government Printing Office.There is great concern that common bacterial pathogens (I.e. TB, malaria, Shigella, Salmonella, Streptococcus, Pneumococcus) have become resistant to many of the antibiotics commonly used in the past 20 years. The increase in drug resistance has resulted from several practices, including inappropriate use (prescribing an antibiotic for a viral episode), over-prescribing, poor patient compliance in completing entire treatment series, and the widespread use of antiseptics. A 1995 US government report estimated that the emergence of antimicrobial resistance among six common bacteria in hospitals added $661 million per year in hospital charges. Resistance to antimalarial drugs is widespread worldwide. For many years, chloroquine was the mainstay of treatment, but resistant strains have spread and intensified in all malaria endemic areas. There is also concern over multidrug resistant TB with an occasional �Godzilla strain� unresponsive to any current antibiotic. The CDC has established the National Tuberculosis Genotyping and Surveillance Network to track strains of drug resistant TB. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. US Congress Office of Technology Assessment (1995). Impacts of antibiotic-resistant bacteria [OTA-H-629]. Washington DC: US Government Printing Office.

61. Target Areas for Preventing Emerging Infectious Diseases Drug resistance Food borne and water borne diseases Vectorborne and zoonotic diseases Diseases transmitted through exposure to blood and body fluids Chronic diseases caused by infectious agents Vaccine development and use Overview Slide The next section will explore the six areas targeted by the Centers for Disease Control for preventing emerging infectious diseases. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. Overview Slide The next section will explore the six areas targeted by the Centers for Disease Control for preventing emerging infectious diseases. USDHHS (1998). Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention.

62. Drug Resistance The emergence of drug resistance in bacteria, parasites, viruses, and fungi is reversing medical advances of the previous 50 years. There is great concern that some common bacterial pathogens (i.e., the enteric pathogens Shigella and Salmonella and pneumonia-causing bacteria Streptococcus and Pneumococcus) have become resistant to many of the antibiotics that have been used over the past 20 years, including the last line of defense, Vancomycin. References for data on drug resistance: There is great concern that some common bacterial pathogens (i.e., the enteric pathogens Shigella and Salmonella and pneumonia-causing bacteria Streptococcus and Pneumococcus) have become resistant to many of the antibiotics that have been used over the past 20 years, including the last line of defense, Vancomycin. References for data on drug resistance:

63. Drug Resistant DiseasesMore Examples S. aureus in Japan and UK, 1997 HIV endemic in NY Problems in South Carolina Streptococccus pneumoniae Vancomycin resistant Enterrococcus - Strains of Staphylococcus aureus with diminished susceptibility to Vancomycin were reported in Japan and the United Kingdom in 1997 - A new strain of multi-drug resistant tuberculosis appearing more frequently in persons with HIV has become endemic in New York. South Carolina has a high prevalence of antibiotic resistance. - Total antibiotic resistant organisms increased 72% since 1998. - Reported cases of pneumonia, otitis media, and septiciemia caused by drug resistant Streptococccus pneumoniae have increased 66% since 1998. - Reported cases of Vancomycin resistant Enterrococcus have increased 79%, and total reported antibiotic resistant organisms increased 72% in the same time period. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC. Iskander, J.(1999). �In my Backyard: Results of the 1998 Statewide Laboratory Survey of PCN and Cephalosporin Resistant Streptococcus pneumoniae in SC�, Epi Notes, (May-June, 1999). Columbia: SCDHEC, 1999. US Congress Office of Technology Assessment (1995). Impacts of antibiotic-resistant bacteria [OTA-H-629]. Washington DC:US Government Printing Office.- Strains of Staphylococcus aureus with diminished susceptibility to Vancomycin were reported in Japan and the United Kingdom in 1997 - A new strain of multi-drug resistant tuberculosis appearing more frequently in persons with HIV has become endemic in New York. South Carolina has a high prevalence of antibiotic resistance. - Total antibiotic resistant organisms increased 72% since 1998. - Reported cases of pneumonia, otitis media, and septiciemia caused by drug resistant Streptococccus pneumoniae have increased 66% since 1998. - Reported cases of Vancomycin resistant Enterrococcus have increased 79%, and total reported antibiotic resistant organisms increased 72% in the same time period. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC. Iskander, J.(1999). �In my Backyard: Results of the 1998 Statewide Laboratory Survey of PCN and Cephalosporin Resistant Streptococcus pneumoniae in SC�, Epi Notes, (May-June, 1999). Columbia: SCDHEC, 1999. US Congress Office of Technology Assessment (1995). Impacts of antibiotic-resistant bacteria [OTA-H-629]. Washington DC:US Government Printing Office.

64. Vectorborne and Zoonotic Diseases Influenza Creutzfeldt-Jakob Disease �Mad Cow Disease� Lyme Disease Rabies Occurrence of major vector-borne disease is closely related to naturally existing environmental conditions. Changes in the climate and ecological changes due to engineering projects like dam-building can also have profound effects on rates of vector-borne and zoonotic diseases. The incidence, severity, and distribution of vector borne diseases are affected substantially by human activities. - In 1997, an avian strain of influenza that had not previously infected humans began to kill healthy person in Hong Kong. Pandemic strains of influencza have emerged from swine reservoirs. - A new variant of a fatal neurologic illness, Creutzfeldt-Jacob disease appeared in the UK and was transmitted by ingestion of beef from animals afflicted with bovine spongiform encephalopathy, also known as �Mad Cow Disease.� - The number of cases of rabies diagnosed in humans in the United States has increased significantly since 1990, with most of the increase associated with bats. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.Occurrence of major vector-borne disease is closely related to naturally existing environmental conditions. Changes in the climate and ecological changes due to engineering projects like dam-building can also have profound effects on rates of vector-borne and zoonotic diseases. The incidence, severity, and distribution of vector borne diseases are affected substantially by human activities. - In 1997, an avian strain of influenza that had not previously infected humans began to kill healthy person in Hong Kong. Pandemic strains of influencza have emerged from swine reservoirs. - A new variant of a fatal neurologic illness, Creutzfeldt-Jacob disease appeared in the UK and was transmitted by ingestion of beef from animals afflicted with bovine spongiform encephalopathy, also known as �Mad Cow Disease.� - The number of cases of rabies diagnosed in humans in the United States has increased significantly since 1990, with most of the increase associated with bats. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.

65. Vectorborne and Zoonotic Diseases West Nile Viral Encephalitis Malaria Ebola fever Hantavirus pulmonary syndrome - Cases of a West Nile-Like Viral Encephalitis first appeared in the US in 1999 in New York. This inflammation of the brain caused by viral and bacterial agents is transmitted by the bite of a mosquito infected with the West Nile virus. Mosquitoes become infected by feeding on birds infected with the virus and transmit the virus to humans and animals. The source of the US virus is unknown. Mortality rates range from 3% to 15%, with slightly higher rates among the elderly. - Malaria in humans is caused by one of four protozoan species that are transmitted by the bit of an infected female Anopheles mosquito. The estimated risk of a US traveler acquiring malaria varies markedly from area to area. From 1980 to 1992, 82 % of US malaria cases were acquired in Africa, 8% in Asia, and 5% in the Caribbean and South America. As mentioned previously, there is a world-wide problem with increasing resistance of malarial parasites to drug therapy. - Ebola virus is one of the deadliest viruses known and kills by causing high fever and severe bleeding (viral hemorrhagic fever). It emerges periodically from unknown, probably small animal, natural reservoirs, accidentally infects man, and causes dramatic self-terminating outbreaks. - Hantavirus is carried by rodents and in humans can cause severe pulmonary hemorrhage and death. It was first described during a 1993 outbreak in the southwestern US. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.- Cases of a West Nile-Like Viral Encephalitis first appeared in the US in 1999 in New York. This inflammation of the brain caused by viral and bacterial agents is transmitted by the bite of a mosquito infected with the West Nile virus. Mosquitoes become infected by feeding on birds infected with the virus and transmit the virus to humans and animals. The source of the US virus is unknown. Mortality rates range from 3% to 15%, with slightly higher rates among the elderly. - Malaria in humans is caused by one of four protozoan species that are transmitted by the bit of an infected female Anopheles mosquito. The estimated risk of a US traveler acquiring malaria varies markedly from area to area. From 1980 to 1992, 82 % of US malaria cases were acquired in Africa, 8% in Asia, and 5% in the Caribbean and South America. As mentioned previously, there is a world-wide problem with increasing resistance of malarial parasites to drug therapy. - Ebola virus is one of the deadliest viruses known and kills by causing high fever and severe bleeding (viral hemorrhagic fever). It emerges periodically from unknown, probably small animal, natural reservoirs, accidentally infects man, and causes dramatic self-terminating outbreaks. - Hantavirus is carried by rodents and in humans can cause severe pulmonary hemorrhage and death. It was first described during a 1993 outbreak in the southwestern US. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.

66. Diseases Transmitted Through Exposure to Blood and Body Fluids Human Immunodeficiency Virus Hepatitis A, B, C, D, E NANE SEN-V Bacterial pathogens Some infectious agents can be transmitted during the exchange of blood or body fluids through unsafe sex practices, needle sharing, accidental needle sticks, and blood transfusion. As many as 5.2 million people in the U.S. are infected with viral hepatitis. Five viruses (A, B, C, D, E) cause 80% to 90% of cases worldwide. The remaining 10% to 20% are of unknown origin or NANE (non-A/non-E) hepatitis. A newly identified virus, SEN-V is believed to account for 68% of all cases of chronic NANE hepatitis. It is estimated that 30% of HIV patients are infected with SEN-V. Blood transfusion is a less common source of exposure to these agents, thanks to improvements in donor screening, serologic testing, and transfusion practices that have made the US blood supply one of the safest in the world. However, blood is a human tissue, and is therefore a natural vehicle for transmission of infectious agents. During the 1980�s, HIV was transmitted through clotting factor and blood transfusions, and in the 1990�s Hepatitis C was transmitted via immunoglobin. In the late 1990s, Hepatitis C is an emerging infectious disease that affects an estimated 3.9 million persons in the US. A national campaign is underway to test, counsel and provide medical evaluation and treatment for those infected. Bacterial pathogens are also transmitted via blood. Since 1985, there have been 21 reported episodes of red blood cell transfusions contaminated with Yersinia enterocolitica leading to 12 deaths. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.Some infectious agents can be transmitted during the exchange of blood or body fluids through unsafe sex practices, needle sharing, accidental needle sticks, and blood transfusion. As many as 5.2 million people in the U.S. are infected with viral hepatitis. Five viruses (A, B, C, D, E) cause 80% to 90% of cases worldwide. The remaining 10% to 20% are of unknown origin or NANE (non-A/non-E) hepatitis. A newly identified virus, SEN-V is believed to account for 68% of all cases of chronic NANE hepatitis. It is estimated that 30% of HIV patients are infected with SEN-V. Blood transfusion is a less common source of exposure to these agents, thanks to improvements in donor screening, serologic testing, and transfusion practices that have made the US blood supply one of the safest in the world. However, blood is a human tissue, and is therefore a natural vehicle for transmission of infectious agents. During the 1980�s, HIV was transmitted through clotting factor and blood transfusions, and in the 1990�s Hepatitis C was transmitted via immunoglobin. In the late 1990s, Hepatitis C is an emerging infectious disease that affects an estimated 3.9 million persons in the US. A national campaign is underway to test, counsel and provide medical evaluation and treatment for those infected. Bacterial pathogens are also transmitted via blood. Since 1985, there have been 21 reported episodes of red blood cell transfusions contaminated with Yersinia enterocolitica leading to 12 deaths. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.

67. Other Target Areas for Prevention Chronic Diseases Caused by Infectious Agents Vaccine Development and Use Chronic Disease: Several chronic diseases once attributed to lifestyle or environmental factors (such as some forms of cancer, diabetes, heart disease, and ulcers) are actually caused by or intensified by an infectious agent. For example, the majority of peptic ulcers - long thought to be due to stress and diet - are now known to be caused by the bacterium Helicobacter pylori. Recent data indicate that Chlamydia pneumoniae infection may contribute to coronary artery disease. Findings such as these raise the possibility that some chronic diseases may one day be treated with antimicrobial drugs or prevented by vaccines. Vaccine Development and Use: Childhood diseases such as diptheria, tetanus, polio, measles, mumps, rubella, and Haemophilus influenzae type b mennigitis have been virtually eliminated in the United States through universal vaccination. Smallpox has been eradicated worldwide, and polio may be globally eradicated by 2000. Several new vaccines are undergoing clinical evaluation (against Lyme disease, rotavirus, and invasive pneumoccocal disease). No effective vaccine exists for many new or re-emerging diseases such as HIV/AIDS, dengue, hepatitis C, and malaria. Increasing vaccination rates for adults and children is a high priority in the US. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.Chronic Disease: Several chronic diseases once attributed to lifestyle or environmental factors (such as some forms of cancer, diabetes, heart disease, and ulcers) are actually caused by or intensified by an infectious agent. For example, the majority of peptic ulcers - long thought to be due to stress and diet - are now known to be caused by the bacterium Helicobacter pylori. Recent data indicate that Chlamydia pneumoniae infection may contribute to coronary artery disease. Findings such as these raise the possibility that some chronic diseases may one day be treated with antimicrobial drugs or prevented by vaccines. Vaccine Development and Use: Childhood diseases such as diptheria, tetanus, polio, measles, mumps, rubella, and Haemophilus influenzae type b mennigitis have been virtually eliminated in the United States through universal vaccination. Smallpox has been eradicated worldwide, and polio may be globally eradicated by 2000. Several new vaccines are undergoing clinical evaluation (against Lyme disease, rotavirus, and invasive pneumoccocal disease). No effective vaccine exists for many new or re-emerging diseases such as HIV/AIDS, dengue, hepatitis C, and malaria. Increasing vaccination rates for adults and children is a high priority in the US. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.

68. Populations Particularlyat Risk People with impaired host defenses Pregnant women and newborns Travelers, immigrants, refugees Several groups of people are of special concern and need to be targeted when considering emerging infectious diseases. Persons whose normal host defenses have declined with age or been impaired by illness or medical treatment are more likely to become ill with opportunistic infections. Over the past two decades, the most significant emergence of opportunistic infections has been in persons infected with HIV. Other populations at risk include recipients of bone marrow and solid organ transplants, patients receiving chemotherapy or chronic steroid therapy, burn victims, patients on renal dialysis or with indwelling medical devices, newborns and the elderly. Certain asymptomatic infections in a pregnant woman can increase the risk of prematurity, low birth weight, long term disability, or death. Some infections may be transmitted from mother to child during pregnancy, delivery, or breast feeding. Persons who cross international boundaries (e.g. tourists, workers, immigrants, and refugees) are at increased risk for contracting infectious diseases and can also disseminate diseases to new places. International travel has increased substantially in recent years, and more travelers are visiting remote locations where they can be exposed to infectious agents that are uncommon in their native countries. Immigrants may come from nations where diseases like tuberculosis are endemic, and refugees may come from sites where crowding and malnutrition create ideal conditions for the spread of diseases such as cholera, malaria, measles, and varicella. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.Several groups of people are of special concern and need to be targeted when considering emerging infectious diseases. Persons whose normal host defenses have declined with age or been impaired by illness or medical treatment are more likely to become ill with opportunistic infections. Over the past two decades, the most significant emergence of opportunistic infections has been in persons infected with HIV. Other populations at risk include recipients of bone marrow and solid organ transplants, patients receiving chemotherapy or chronic steroid therapy, burn victims, patients on renal dialysis or with indwelling medical devices, newborns and the elderly. Certain asymptomatic infections in a pregnant woman can increase the risk of prematurity, low birth weight, long term disability, or death. Some infections may be transmitted from mother to child during pregnancy, delivery, or breast feeding. Persons who cross international boundaries (e.g. tourists, workers, immigrants, and refugees) are at increased risk for contracting infectious diseases and can also disseminate diseases to new places. International travel has increased substantially in recent years, and more travelers are visiting remote locations where they can be exposed to infectious agents that are uncommon in their native countries. Immigrants may come from nations where diseases like tuberculosis are endemic, and refugees may come from sites where crowding and malnutrition create ideal conditions for the spread of diseases such as cholera, malaria, measles, and varicella. USDHHS (1998), Preventing Emerging Infectious Diseases: A Strategy for the 21st Century, Atlanta: Centers for Disease Control and Prevention. USDHHS, Morbidity and Mortality Weekly Report, 47(RR-15), September 11, 1998, Atlanta: CDC.

69. Bioterrorism as an Emerging Infectious Disease Threat Intentional dissemination of disease Infectious and toxic agents viruses, bacteria, toxins, fungi The intentional dissemination of disease adds a new dimension to threats posed by infectious and toxic agents. Bioterrorism is an issue for national security and law enforcement as well as a public health concern. Although the threat has a low probability of occurring, it does has severe consequences. Biological weapons are unique in their ability to inflict large numbers of casualties over a wide area with minimal logistical requirements and by means which can be virtually untraceable. Defense is complicated by the ease and low cost of producing an agent, the difficulty of detecting its presence, the logistics of protecting and treating victims, and the potential to selectively target humans, animals, or plants. Available mechanisms include: Aerosol delivery systems which generate long-lasting clouds of invisible suspended particles to contaminate food and water supplies and be absorbed through mucous membranes and damaged skin. Direct contamination of consumables (crops). Attempts to spread typical vector-borne diseases by releasing infected natural or unnatural arthropod hosts such as mosquitoes, ticks, or fleas. Intrinsic features of biological agents used as �weapons� include: infectivity, virulence, toxicity, pathogenicity, incubation period, transmissability, lethality, and stability. Unique to many of these agents is the ability to multiply in the body over time and actually increase their effect. Clues to the existence of a bioterrorist event include illness or death of large numbers of people, respiratory signs and symptoms, infection not common to the region, and multiple simultaneous outbreaks.The intentional dissemination of disease adds a new dimension to threats posed by infectious and toxic agents. Bioterrorism is an issue for national security and law enforcement as well as a public health concern. Although the threat has a low probability of occurring, it does has severe consequences. Biological weapons are unique in their ability to inflict large numbers of casualties over a wide area with minimal logistical requirements and by means which can be virtually untraceable. Defense is complicated by the ease and low cost of producing an agent, the difficulty of detecting its presence, the logistics of protecting and treating victims, and the potential to selectively target humans, animals, or plants. Available mechanisms include: Aerosol delivery systems which generate long-lasting clouds of invisible suspended particles to contaminate food and water supplies and be absorbed through mucous membranes and damaged skin. Direct contamination of consumables (crops). Attempts to spread typical vector-borne diseases by releasing infected natural or unnatural arthropod hosts such as mosquitoes, ticks, or fleas. Intrinsic features of biological agents used as �weapons� include: infectivity, virulence, toxicity, pathogenicity, incubation period, transmissability, lethality, and stability. Unique to many of these agents is the ability to multiply in the body over time and actually increase their effect. Clues to the existence of a bioterrorist event include illness or death of large numbers of people, respiratory signs and symptoms, infection not common to the region, and multiple simultaneous outbreaks.

70. Public Health Approach to Emerging Infectious Diseases Surveillance Epidemiology for early diagnosis Early response to outbreaks and changing disease patterns The public health approach to addressing emerging infectious disease includes: Surveillance is the ongoing, systematic collection, analysis, and interpretation of health data. It is key to detecting, investigating, and monitoring emerging pathogens, diseases they cause, factors influencing emergence, and response to problems as they are identified. Our nationwide surveillance system requires involvement and resources at all levels. Handout: Reportable diseases in SC. Medical providers (clinics, emergency rooms, labs) are required to report any of these conditions to the local health department; some require urgent action. These disease reports are monitored at the local level and sent to Columbia for state wide surveillance. Columbia in turns send data to the CDC as part of national surveillance. Epidemiology provides early diagnosis and response to outbreaks and changing disease patterns, and allows for the detection of causes of disease or spread of disease even before specific laboratory diagnosis is made. Methods include risk assessment, investigation, interviewing individuals, fact finding, consultation with state epidemiologists/CDC, analysis of laboratory data, diagnosis verification, cause determination, and mobilization of the Epi team. Early response includes rapid notification and immediate action to monitor changing disease patterns and medical management. Medical management includes medical interventions and treatment, safety measures, infection control, and isolation. The public health approach to addressing emerging infectious disease includes: Surveillance is the ongoing, systematic collection, analysis, and interpretation of health data. It is key to detecting, investigating, and monitoring emerging pathogens, diseases they cause, factors influencing emergence, and response to problems as they are identified. Our nationwide surveillance system requires involvement and resources at all levels. Handout: Reportable diseases in SC. Medical providers (clinics, emergency rooms, labs) are required to report any of these conditions to the local health department; some require urgent action. These disease reports are monitored at the local level and sent to Columbia for state wide surveillance. Columbia in turns send data to the CDC as part of national surveillance. Epidemiology provides early diagnosis and response to outbreaks and changing disease patterns, and allows for the detection of causes of disease or spread of disease even before specific laboratory diagnosis is made. Methods include risk assessment, investigation, interviewing individuals, fact finding, consultation with state epidemiologists/CDC, analysis of laboratory data, diagnosis verification, cause determination, and mobilization of the Epi team. Early response includes rapid notification and immediate action to monitor changing disease patterns and medical management. Medical management includes medical interventions and treatment, safety measures, infection control, and isolation.

71. Public Health Approach continued Public Health Laboratory support for rapid and accurate diagnosis Rapid Communication links to private providers and hospitals Communication to public Education about prevention and/or early detection Laboratory support is required for rapid and accurate diagnosis of an outbreak or unusual disease. Sometimes a definitive diagnosis may not be possible immediately. Clinical signs and symptoms of the illness may be the only information available from which to develop a differential diagnosis. Rapid communication links must be established with private medical providers and hospitals to alert them to outbreaks and disease changes as well as to facilitate collaboration, communication, and coordination. Communication with media is essential to inform the public and provide accurate information for action and prevention. Aggressive education of health care providers and the community about prevention or early identification and detection. Information should include a list of signs and symptoms, and guidelines for prophylactic treatment, protective clothing, or other personal protection. For example, during/following a hurricane, information about food spoilage and unclean water is widely disseminated along with tips on what to do with food in freezers that were without power - all in an effort to prevent secondary food and water-borne diseases in the midst of a disaster. Similarly, tetanus vaccinations are provided in flood areas where risk of a dirty injury is greater.Laboratory support is required for rapid and accurate diagnosis of an outbreak or unusual disease. Sometimes a definitive diagnosis may not be possible immediately. Clinical signs and symptoms of the illness may be the only information available from which to develop a differential diagnosis. Rapid communication links must be established with private medical providers and hospitals to alert them to outbreaks and disease changes as well as to facilitate collaboration, communication, and coordination. Communication with media is essential to inform the public and provide accurate information for action and prevention. Aggressive education of health care providers and the community about prevention or early identification and detection. Information should include a list of signs and symptoms, and guidelines for prophylactic treatment, protective clothing, or other personal protection. For example, during/following a hurricane, information about food spoilage and unclean water is widely disseminated along with tips on what to do with food in freezers that were without power - all in an effort to prevent secondary food and water-borne diseases in the midst of a disaster. Similarly, tetanus vaccinations are provided in flood areas where risk of a dirty injury is greater.

72. Your role in the prevention of emerging infectious diseases Best practices Antibiotic use Food preparation Control exposure Awareness of risk Behavior change The Centers for Disease Control and Prevention is a primary source for scientific information on emerging infectious diseases. Since human behavior is a major factor in the spread of infectious disease, the CDC emphasizes programs that change behavior by influencing individuals and organizations. The CDC also provides guidelines on how to prevent specific diseases or disease problems. These prevention guidelines are implemented in partnership with all health care workers and community groups. As a health care professional, you become part of the network for dissemination of information about prevention of infectious diseases. - Use best practices to prevent infectious disease transmission in personal and professional roles. The first and foremost best practice is HANDWASHING. Others include basic hygiene and the use of personal protective equipment. - Prescribe antibiotics prudently and appropriately, and provide patients with appropriate instruction regarding the importance of completing the entire course of antibiotic therapy. SC has undertaken a statewide physician & patient/parent outreach education program to address this issue. - Follow recommended food preparation and storage guidelines to prevent foodborne disease. - Follow recommended guidelines for vector borne diseases: dress to prevent access, check for ticks, and use insect repellants with DEET if at risk of exposure to mosquitoes. - Be aware of the risk of infectious diseases in professional and personal life. - Change behavior to incorporate preventive measures into daily activities.The Centers for Disease Control and Prevention is a primary source for scientific information on emerging infectious diseases. Since human behavior is a major factor in the spread of infectious disease, the CDC emphasizes programs that change behavior by influencing individuals and organizations. The CDC also provides guidelines on how to prevent specific diseases or disease problems. These prevention guidelines are implemented in partnership with all health care workers and community groups. As a health care professional, you become part of the network for dissemination of information about prevention of infectious diseases. - Use best practices to prevent infectious disease transmission in personal and professional roles. The first and foremost best practice is HANDWASHING. Others include basic hygiene and the use of personal protective equipment. - Prescribe antibiotics prudently and appropriately, and provide patients with appropriate instruction regarding the importance of completing the entire course of antibiotic therapy. SC has undertaken a statewide physician & patient/parent outreach education program to address this issue. - Follow recommended food preparation and storage guidelines to prevent foodborne disease. - Follow recommended guidelines for vector borne diseases: dress to prevent access, check for ticks, and use insect repellants with DEET if at risk of exposure to mosquitoes. - Be aware of the risk of infectious diseases in professional and personal life. - Change behavior to incorporate preventive measures into daily activities.

73. Your role in education about emerging infectious diseases Stay informed CDC Web Pages MMWR on Web EID Journal Educate patients/family/friends Know resources - who to call Stay informed. The Centers for Disease Control and Prevention is a source of scientific information on emerging infectious diseases available over the Internet. �Surf� the CDC Website to look at Prevention Guidelines available on virtually any disease; go to MMWR and see the most current information or visit the Public Health Training Network site to find educational offerings through on-site and distance learning. Subscribe via e-mail to Mortality and Morbidity Weekly Review from the CDC at listserv.cdc.gov or to Emerging Infectious Disease Journal. The latter is a peer-reviewed journal to enhance communication of public health information among professionals working in infectious disease and related sciences. Educate yourself. Become an informed professional in infectious diseases. Evaluate the effectiveness of infection control measures in your setting. Know the surveillance procedures and the Infection Control �coordinator� in your facility. Use safe and cost effective measures to protect yourself and your customers. Educate your clients, family, and friends. Distribute CDC Prevention guidelines. Be creative in incorporating information about prevention of infectious diseases into your personal and professional life. Offer presentations in elementary and secondary education settings in your area. Learn the resources within your practice setting, the location of your local health department and how to contact them. Stay informed. The Centers for Disease Control and Prevention is a source of scientific information on emerging infectious diseases available over the Internet. �Surf� the CDC Website to look at Prevention Guidelines available on virtually any disease; go to MMWR and see the most current information or visit the Public Health Training Network site to find educational offerings through on-site and distance learning. Subscribe via e-mail to Mortality and Morbidity Weekly Review from the CDC at listserv.cdc.gov or to Emerging Infectious Disease Journal. The latter is a peer-reviewed journal to enhance communication of public health information among professionals working in infectious disease and related sciences. Educate yourself. Become an informed professional in infectious diseases. Evaluate the effectiveness of infection control measures in your setting. Know the surveillance procedures and the Infection Control �coordinator� in your facility. Use safe and cost effective measures to protect yourself and your customers. Educate your clients, family, and friends. Distribute CDC Prevention guidelines. Be creative in incorporating information about prevention of infectious diseases into your personal and professional life. Offer presentations in elementary and secondary education settings in your area. Learn the resources within your practice setting, the location of your local health department and how to contact them.

74. Your role in detection of emerging infectious diseases Participate in surveillance activities within your clinical setting Be alert for �clues�; assess risk Know your resources - who to call for consultation Report to local health department - Post a current list of reportable diseases and know the procedure for internal surveillance in your setting. - Know the infection control protocols and procedures and assess whether they address the threat of emerging infectious diseases. - Assess risk and be alert for clues of infectious diseases in your personal and professional life. - Identify resources for current and accurate information and consultation and know how to access each source:. - CDC Web page cdc.gov - Disease Consultation at @ SC DHEC 1-803-898-0861 - Report diseases/situations to the local health department. - To report an urgent condition, call your local county health department�s 24 hour call system. To report a non-urgent condition, call the county health department�s business hours number, and mail the report to the appropriate office. - In South Carolina, call 1-800-616-sick (Acute Epidemiology Branch, SCDHEC). To report HIV/AIDS/STD, call 1-800-277-0873 or call your local county health department. - Post a current list of reportable diseases and know the procedure for internal surveillance in your setting. - Know the infection control protocols and procedures and assess whether they address the threat of emerging infectious diseases. - Assess risk and be alert for clues of infectious diseases in your personal and professional life. - Identify resources for current and accurate information and consultation and know how to access each source:. - CDC Web page cdc.gov - Disease Consultation at @ SC DHEC 1-803-898-0861 - Report diseases/situations to the local health department. - To report an urgent condition, call your local county health department�s 24 hour call system. To report a non-urgent condition, call the county health department�s business hours number, and mail the report to the appropriate office. - In South Carolina, call 1-800-616-sick (Acute Epidemiology Branch, SCDHEC). To report HIV/AIDS/STD, call 1-800-277-0873 or call your local county health department.

75. Validity of the notification data is heavily influenced by: 1. Medical care seeking practices 2. Diagnostic methods 3. Screening programs 4. Accuracy and completeness of reportingValidity of the notification data is heavily influenced by: 1. Medical care seeking practices 2. Diagnostic methods 3. Screening programs 4. Accuracy and completeness of reporting

76. Strategies for polio eradication Rountine immunisation of all children Supplemental immunisation- NIDs Acute flaccid paralysis Mop up

77. AFP Surveillance Any acute flaccid paralysis in children below 15 years should be brought to the notice of survellnace officer for investigation Child is kept under surevillnace and after 60 days of onset of flaccid paralysis with atrophy is suggestive of poliomyelitis AFP indicator- rate of occurrence of AFP is 1 case per year for every 100,000 population less than 15 years Country certified polio free- no new cases due to WPV in the preceeding three consecutive years

78. Intial investigation- investigate cases within 48 hours and filling the case investigation forms. 2 stool samples collected , 2 days apart 24-48 hours within 2 weeks of onset of paralysis Samples kept and transported in reversed cold chain to lab for virus isolation Report of virus isolation- 28 days Confirmation ( biological / virological)

79. isolation of virus from stool- residual paralysis on 60day follow up- confirmed case No residual paralysis on 60th day- non polio AFP successful NIDs reduce the disease from endemic to confined in focal areas Mop up � intensive house to house campaign in areas with suspicion of persistence WPV

80. Eradication of measles Like smallpox , measles can be completely eradicated because the virus does not infect other species or live in the environment. However eradication has been difficult because it is widespread and there is substantial transmission of the virus among infants below the age of rountine vaccination. WHA resolved in 1989 to reduce measles morbidity by 90% and mortality by 95%.

81. Improved rountine immunisation of infants and mass campaign targeting infants and children 9 months � 5years as complementary strategies. based on sustantial success in reducing the incidence of measles and interupting virus transmission over large geographical areas, the americas made elimination of measles a goal in year 2000

82. Most countries in region of the Americas have a low record of measles cases . However it is not certain if these measures will be sufficient to eliminate measles in Africa