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Emerging Infectious Diseases Related to Occupations

Learn about the challenges and global crises caused by emerging infectious diseases, including viral, bacterial, rickettsial, fungal, and parasitic diseases. Explore specific cases such as Nipah virus infection and Hendra outbreak, and understand the clinical features, histopathology, imaging, and virologic characteristics. Suitable for professionals in research laboratories, healthcare facilities, animal husbandry, and more.

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Emerging Infectious Diseases Related to Occupations

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  1. 與職業有關的新興傳染病 陳國東 台南市立醫院職業醫學科 國立成功大學醫學院公衛所

  2. 講授大綱 1.前言 2.病毒性傳染病 3.立克次體傳染病 4.細菌性傳染病 5.結論

  3. 前言

  4. Infectious Disease Challenges, 1993-2003 1993 Hantavirus pulmonary syndrome (United States) 1994 Plague (India) 1995 Ebola fever (Zaire) 1996 New variant Creutzfeldt-Jakob disease (United Kingdom) 1997 H5N1 influenza (Hong Kong); vancomycin-intermediate resistant Staphylococcus aureus (Japan, United States) 1998 Nipah virus encephalitis (Malaysia, Singapore) 1999 West Nile encephalitis (Russia, United States) 2000 Rift Valley fever (Kenya, Saudi Arabia, Yemen); Ebola fever (Uganda) 2001 Anthrax (United States); foot and mouth disease (United Kingdom) 2002 Vancomycin-resistant Staphylococcus aureus (United States) 2003 Severe acute respiratory syndrome (SARS) 2003 Monkeypox

  5. 新興及再浮現傳染病之全球危機

  6. Many occupational infectious diseases are zoonoses, diseases transmitted to humans from animals: • bacterial • viral • rickettsial • fungal • parasitic

  7. Workers at risk of exposure to occupational infectious diseases: – Research laboratory – Health care facilities – Forest and field workers – Food processing industries – Animal husbandry – Construction – "sick buildings“ – Hide (獸皮) and wool handling –….

  8. 病毒性傳染病

  9. Nipah virus infection

  10. 1.First report in September, 1998 in Malaysia 2. By February 1999, similar diseases were recognized in other state in Malaysia

  11. Hendra Outbreeak 1.1994年9月在 Hendra 發生馬隻嚴重的呼吸道疾病流行

  12. 2. 20匹馬感染，其中13匹死亡，但未發現致病原包括毒素、細菌、病毒。懷疑是African horse sickness。 3.馬的訓練員及其工作人員兩人發病，訓練員因呼吸道疾病而死亡。 4.在流行發生前，有一匹母馬由Paddock移到Hendra。這隻母馬於到達Hendra幾天內生病死亡。其臨床症狀與之後的病例極相似。

  13. Mackay Incidence 1.1995年Mackey農場農夫於9月開始有肌肉抽搐症狀，之後病況轉劇，於25天後因腦膜腦炎死亡。CSF檢驗發現equine morbillivirus (EMV)。 2.1994年8月農夫及妻子(獸醫)曾對兩隻死亡的馬作屍體檢驗，這馬後來檢驗也發現EMV。

  14. 特徵 1.1994年在澳大利亞昆斯蘭的Hendra的馬發生嚴重的呼吸道疾病，當時懷疑是equine morbillivirus，這次流行除了馬之外，也有兩個人受感染。 2.1995年10月同樣的病毒再次出現，且有一農人感染而死亡 3.農人的死因為腦膜腦炎，而非呼吸道疾病 4.感染源可能是一年前死亡的馬隻 5.這兩次事件可能各自為獨立的 6.全面監測flying fox可能是reservoir

  15. Malaysia Outbreak 1.1998年9月到1999年6月馬來西亞發生腦炎流行 2.發病人數：265人 死亡人數：105人 3.主要症狀：segmental myoclonus areflexia hypertension tachycardia

  16. 1. JE cases from 1989-1998 was 529 in Malaysia, ranging 9-91 per year 2. The number of death for the same period was 35, ranging from 6-10 per year in Malaysia

  17. 3. From September 1998 to December 1999, a total of 283 cases of viral encephalitis with 109 fatality (39%) 4. Highest number (231) in Negri Sebilan, followed by Perak (28)

  18. 5. 40-44 years 45 (16%) 30-34 39 (14%) 25-29 37 (13%) 6. Significant association between Nipah virus infection close contact with pig

  19. Clinical features

  20. Occurrence of respiratory illness and encephalitis in pig firstly • 2. Fever encephalitis in human • following • 3. Incubation period 4 days to 2 • months (mostly within 2 weeks)

  21. Main clinical features 1. Fever, headache, dizziness, vomiting 2. More than 50% had decreasing consciousness, brain stem dysfunction

  22. Distinct clinical signs Segmental myoclonus Areflexia, hypotonia Hypertension Tachycardia

  23. JE rare involve adults • 2. Jerking of neck and abdomen muscles

  24. Histopathology

  25. Autopsy • the brain stem the most severely affected organ but lungs, heart, and kidney were also involved • The affected organs were congested with petechial hemorrhage

  26. Histological examination • Vasculitisaffecting arterioles, venules, capillaries with endothelial damage, fibroid necrosis of vessel wall, hemorrhage and thromboisis • Giant syncytial cell formationin the endothelium of affected blood vessels

  27. Imaging features

  28. Radiological examination • Chest radiograph examination • Abnormal finding in 6-10% of patients • 2. CT scan exam of brain was normal • 3. MRI showed widespread discrete, high signal intensity focal lesion in brain

  29. Virologic features

  30. Nipah virus • Easiest virus to isolate • 2. Paramyxoviridae family

  31. Morphology of Nipah virus • Extracellular virion appeared as tangled collections of filamentous, helical nucleocapsids surrounded by the viral envelope • Particles were pleomorphic and varied in size Negative stain EM showed nucleocapsids with typical herringbone appearance • Spike along the viral envelope

  32. Virus reservoir

  33. Fruit bats of Pteropid • species • 2. Deforestation may be the cause of outbreak

  34. Control measures

  35. Health education • 2. Personal protection • 3. Pig culling • 4. Surveillance of all pig farms • 5. Separate pig farm from flying fox

  36. Conclusion

  37. Future works • Good surveillance should • be established • 2. The policy of culling the • infected animal population • should be discussed

  38. SARS

  39. Case-Fatality Proportion • As of October 4 • Hong Kong: 299/1755 = 17% • Singapore: 33/238 = 14% • Canada: 43/251 = 17% • Viet Nam 5/63 = 8% • China: 349/5327 = 7% • USA 0/29 = 0% • Taiwan: 181/668 = 27% • Taiwan: 37/346 = 11% (Lab confirmed) Over ALL CFP= 9.6% (Range 0%-17%) Chotani, 2003 Source: WHO

  40. 120 Male Female 92 90 63 63 62 Case number 55 60 47 45 43 36 31 31 25 30 24 16 15 13 10 5 0 0-9 yrs 10-19 yrs 20-29 yrs 30-39 yrs 40-49 yrs 50-59 yrs 60-69 yrs 70-79 yrs > 80 yrs Age group Age-Sex Distribution of SARS Probable Cases in Taiwan

  41. Taipei county Lien-Chiang county Taipei city Keelung city 9 (Case No.) Taoyuan county 264 > 50 Hsinchu county 32 201 Hsinchu city 7 6 > 20-50 Ilan county Kinmen county Miaoli county 3 10 > 10-20 Taichung county 6 Taichung city > 0-10 9 Changhwa county 6 0 Nantou county 1 Hwalien county 1 Yunlin county 4 Chiayi county 3 Chiayi city 5 41 Tainan county Penghu county 2 7 2 Tainan city Taitung county Kaohsiung county Date: 11 July 2003 Probable Cases: 671 18 Kaohsiung city 34 Pingtung county Geographical Distribution of SARS Probable Cases in Taiwan

  42. Figure 1. Case fatality rates of Severe Acute Respiratory by age and sex in Taiwan, February-July, 2003

  43. Variable Alive (N=487) Deceased (N=181) Age (mean  SD) 47.2 (21.1) 61.8 (18.2) Sex Male (%) 215(67) 104(33) Female 272(78) 77(22) Contact tracing Imported 51(96) 2(4) Close contact 37(90) 4(10) HCW 103(86) 17(14) Doctor 14(82) 3(18) Nurse 59(94) 4(6) Allied 30(75) 10(25) Hospital-related 138(54) 118(46) To be identified 158(83) 40(17) Chronic Disease 48(43) 64(57) Table 1. Demographic characteristics of SARS patients’ outcome, 2003

  44. SARS危險族群 航線 入境 出境 旅館 工作 就學 家庭/親友 醫護檢驗人員

  45. SARS發病圖 0C 發病 體溫 感染 溫度 發病期 潛伏期 不傳染 傳染 第 日 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 發燒日 1 2 3 4 5 6 7 8 9 10 11 12

  46. Laboratory investigation • Nasopharyngeal or stool swabs were obtained • SARS Co-V was tested by CDC, Taiwan • RT-PCR for SARS-Co-V was completed • WHO invited 10 Labs in 9 countries to confirm the tests

  47. Prevention and control

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