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Emerging & Re-emerging Infectious Diseases. Dr. KANUPRIYA CHATURVEDI. Outline Of Presentation. Infectious diseases- trends Definition of emerging & re-emerging diseases Factors contributing to emergence Examples Public health response. Infectious Disease- Trends.

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outline of presentation
Outline Of Presentation
  • Infectious diseases- trends
  • Definition of emerging & re-emerging diseases
  • Factors contributing to emergence
  • Examples
  • Public health response

Dr. KANUPRIYA CHATURVEDI

infectious disease trends
Infectious Disease- Trends
  • Receded in Western countries 20th century
  • Urban sanitation, improved housing, personal hygiene, antisepsis & vaccination
  • Antibiotics further suppressed morbidity & mortality

Dr. KANUPRIYA CHATURVEDI

infectious disease trends4
Infectious Disease- Trends
  • Since last quarter of 20th century- New & Resurgent infectious diseases
  • Unusually large number- Rotavirus, Cryptosporidiosis, HIV/AIDS, Hantaviraus, Lyme disease, Legionellosis,

Hepatitis C……

Dr. KANUPRIYA CHATURVEDI

slide5

AIDS

Avian Influenza

Ebola

Marburg

Cholera

Rift Valley Fever

Typhoid

Tuberculosis

Leptospirosis

Malaria

Chikungunya

Dengue

JE

Antimicrobial resistance

UP

DOWN

Guinea worm Smallpox

Yaws

Poliomyelitis

Measles

Leprosy

Neonatal tetanus

Infectious Diseases: A World in Transition

?

Dr. KANUPRIYA CHATURVEDI

definition
Definition
  • Emerging infectious disease

Newly identified & previously unknown infectious agents that cause public health problems either locally or internationally

Dr. KANUPRIYA CHATURVEDI

definition7
Definition
  • Re-emerging infectious disease

Infectious agents that have been known for some time, had fallen to such low levels that they were no longer considered public health problems & are now showing upward trends in incidence or prevalence worldwide

Dr. KANUPRIYA CHATURVEDI

factors contributing to emergence
Factors Contributing To Emergence

AGENT

  • Evolution of pathogenic infectious agents

(microbial adaptation & change)

  • Development of resistance to drugs
  • Resistance of vectors to pesticides

Dr. KANUPRIYA CHATURVEDI

factors contributing to emergence9
Factors Contributing To Emergence

HOST

  • Human demographic change (inhabiting new areas)
  • Human behaviour (sexual & drug use)
  • Human susceptibility to infection (Immunosuppression)
  • Poverty & social inequality

Dr. KANUPRIYA CHATURVEDI

factors contributing to emergence10
Factors Contributing To Emergence

ENVIRONMENT

  • Climate & changing ecosystems
  • Economic development & Land use (urbanization, deforestation)
  • Technology & industry (food processing & handling)

Dr. KANUPRIYA CHATURVEDI

contd
CONTD.
  • International travel & commerce
  • Breakdown of public health measure (war, unrest, overcrowding)
  • Deterioration in surveillance systems (lack of political will)

Dr. KANUPRIYA CHATURVEDI

transmission of infectious agent from animals to humans
Transmission of Infectious Agent from Animals to Humans
  • >2/3rd emerging infections originate from animals- wild & domestic
  • Emerging Influenza infections in Humans associated with Geese, Chickens & Pigs
  • Animal displacement in search of food after deforestation/ climate change (Lassa fever)
  • Humans themselves penetrate/ modify unpopulated regions- come closer to animal reservoirs/ vectors (Yellow fever, Malaria)

Dr. KANUPRIYA CHATURVEDI

climate environmental changes
Climate & Environmental Changes
  • Deforestation forces animals into closer human contact- increased possibility for agents to breach species barrier between animals & humans
  • El Nino- Triggers natural disasters & related outbreaks of infectious diseases (Malaria, Cholera)
  • Global warming- spread of Malaria, Dengue, Leishmaniasis, Filariasis

Dr. KANUPRIYA CHATURVEDI

poverty neglect weakening of health infrastructure
Poverty, Neglect & Weakening of Health Infrastructure
  • Poor populations- major reservoir & source of continued transmission
  • Poverty- Malnutrition- Severe infectious disease cycle
  • Lack of funding, Poor prioritization of health funds, Misplaced in curative rather than preventive infrastructure, Failure to develop adequate health delivery systems

Dr. KANUPRIYA CHATURVEDI

uncontrolled urbanization population displacement
Uncontrolled Urbanization & Population Displacement
  • Growth of densely populated cities- substandard housing, unsafe water, poor sanitation, overcrowding, indoor air pollution (>10% preventable ill health)
  • Problem of refugees & displaced persons
  • Diarrhoeal & Intestinal parasitic diseases, ARI

Lyme disease (B. burgdorferi)- Changes in ecology, increasing deer populations, suburban migration of population

Dr. KANUPRIYA CHATURVEDI

human behaviour
Human Behaviour
  • Unsafe sexual practices (HIV, Gonorrhoea, Syphilis)
  • Changes in agricultural & food production patterns- food-borne infectious agents (E. coli)
  • Increased international travel (Influenza)
  • Outdoor activity

Dr. KANUPRIYA CHATURVEDI

antimicrobial drug resistance
Antimicrobial Drug Resistance
  • Causes:
  • Wrong prescribing practices
  • non-adherence by patients
  • Counterfeit drugs
  • Use of anti-infective drugs in animals & plants

Dr. KANUPRIYA CHATURVEDI

contd18
CONTD.
  • Loss of effectiveness:
  • Community-acquired (TB, Pneumococcal) &

Hospital-acquired (Enterococcal, Staphylococcal

  • Antiviral (HIV), Antiprotozoal (Malaria), Antifungal

Dr. KANUPRIYA CHATURVEDI

antimicrobial drug resistance19
Antimicrobial Drug Resistance
  • Consequences

Prolonged hospital admissions

Higher death rates from infections

Requires more expensive, more toxic drugs

Higher health care costs

Dr. KANUPRIYA CHATURVEDI

slide20

ENVIRONMENT

Climate change

Mega-cities

Vector

proliferation

Migration

Pollution

Exploitation

Population

Growth

HUMAN

Antibiotics

Vector

resistance

Zoonosis

Food

production

VECTORS

ANIMALS

Intensivefarming

Transmission

examples of recent emerging diseases
Examples of recent emerging diseases

Source: NATURE; Vol 430; July 2004; www.nature.com/nature

Dr. KANUPRIYA CHATURVEDI

examples of emerging infectious diseases
Examples of Emerging Infectious Diseases
  • Hepatitis C- First identified in 1989

In mid 1990s estimated global prevalence 3%

  • Hepatitis B- Identified several decades earlier

Upward trend in all countries

Prevalence >90% in high-risk population

Dr. KANUPRIYA CHATURVEDI

contd23
CONTD.
  • Zoonoses- 1,415 microbes are infectious for human

Of these, 868 (61%) considered zoonotic

70% of newly recognized pathogens are zoonoses

Dr. KANUPRIYA CHATURVEDI

emerging zoonoses human animal interface

Deer tick (Ixodes scapularis)

Marburg virus

Ebola virus

Hantavirus Pulmonary Syndrome

Borrelia burgdorferi: Lyme

Mostomys rodent: Lassa fever

Emerging Zoonoses: Human-animal interface

Avian influenza virus

Bats: Nipah virus

Dr. KANUPRIYA CHATURVEDI

sars the first emerging infectious disease of the 21st century
SARS: The First Emerging Infectious Disease Of The 21st Century

No infectious disease has spread so fast and far as SARS did in 2003

Dr. KANUPRIYA CHATURVEDI

lesson learnt from sars
Lesson learnt from SARS
  • An infectious disease in one country is a threat to all
  • Important role of air travel in international spread
  • Tremendous negative economic impact on trade, travel and tourism, estimated loss of $ 30 to $150 billion

Dr. KANUPRIYA CHATURVEDI

contd27
CONTD.
  • High level commitment is crucial for rapid containment
  • WHO can play a critical role in catalyzing international cooperation and support
  • Global partnerships & rapid sharing of data/information enhances preparedness and response

Dr. KANUPRIYA CHATURVEDI

highly pathogenic avian influenza h5n1
Highly Pathogenic Avian Influenza (H5N1)
  • Since Nov 2003, avian influenza H5N1 in birds affected 60 countries across Asia, Europe, Middle-East & Africa
  • >220 million birds killed by AI virus or culled to prevent further spread
  • Majority of human H5N1 infection due to direct contact with birds infected with virus

Dr. KANUPRIYA CHATURVEDI

novel swine origin influenza a h1n1
Novel Swine origin Influenza A (H1N1)

Swine flu causes respiratory disease in pigs – high level of illness, low death rates

Pigs can get infected by human, avian and swine influenza virus

Occasional human swine infection reported

In US from December 2005 to February 2009, 12 cases of human infection with swine flu reported

Dr. KANUPRIYA CHATURVEDI

swine flu influenza a h1n1
Swine Flu Influenza A (H1N1)

March 18 2009 – ILI outbreak reported in Mexico

April 15th CDC identifies H1N1 (swine flu)

April 25th WHO declares public health emergency

April 27th Pandemic alert raised to phase 4

April 29th Pandemic alert raised to phase 5

Dr. KANUPRIYA CHATURVEDI

influenza a h1n1
Influenza A (H1N1)

By May 5th more than 1000 cases confirmed in 21 countries

Screening at airports for flu like symptoms (especially passengers coming from affected area)

Schools closed in many states in USA

May 16th India reports first confirmed case

Stockpiling of antiviral drugs and preparations to make a new effective vaccine

Dr. KANUPRIYA CHATURVEDI

pandemic hini swine flu
Pandemic HINI (Swine flu)
  • Worldwide- 162,380 cases

1154 deaths

  • India- 558 cases

1 death

Dr. KANUPRIYA CHATURVEDI

examples of re emerging infectious diseases
Examples of Re-Emerging Infectious Diseases
  • Diphtheria- Early 1990s epidemic in Eastern Europe(1980- 1% cases; 1994- 90% cases)
  • Cholera- 100% increase worldwide in 1998 (new strain eltor, 0139)
  • Human Plague- India (1994) after 15-30 years absence. Dengue/ DHF- Over past 40 years, 20-fold increase to nearly 0.5 million (between 1990-98)

Dr. KANUPRIYA CHATURVEDI

bioterrorism
Bioterrorism
  • Possible deliberate release of infectious agents by dissident individuals or terrorist groups
  • Biological agents are attractive instruments of terror- easy to produce, mass casualties, difficult to detect, widespread panic & civil disruption

Dr. KANUPRIYA CHATURVEDI

contd37
CONTD.
  • Highest potential- B. anthracis, C. botulinum toxin, F. tularensis, Y. pestis, Variola virus, Viral haemorrhagic fever viruses
  • Likeliest route- aerosol dissemination

Dr. KANUPRIYA CHATURVEDI

key tasks in dealing with emerging diseases
Key Tasks in Dealing with Emerging Diseases
  • Surveillance at national, regional, global level
    • epidemiological,
    • laboratory
    • ecological
    • anthropological
  • Investigation and early control measures
  • Implement prevention measures
    • behavioural, political, environmental
  • Monitoring, evaluation

Dr. KANUPRIYA CHATURVEDI

national surveillance current situation
National surveillance:current situation
  • Independent vertical control programmes
  • Surveillance gaps for important diseases
  • Limited capacity in field epidemiology, laboratory diagnostic testing, rapid field investigations
  • Inappropriate case definitions

Dr. KANUPRIYA CHATURVEDI

contd40
CONTD.
  • Delays in reporting, poor analysis of data and information at all levels
  • No feedback to periphery
  • Insufficient preparedness to control epidemics
  • No evaluation

Dr. KANUPRIYA CHATURVEDI

solutions
Solutions

Public health surveillance & response systems

  • Rapidly detect unusual, unexpected, unexplained disease patterns
  • Track & exchange information in real time
  • Response effort that can quickly become global
  • Contain transmission swiftly & decisively

Dr. KANUPRIYA CHATURVEDI

goarn
GOARN

Global Outbreak Alert & Response Network

  • Coordinated by WHO
  • Mechanism for combating international disease outbreaks
  • Ensure rapid deployment of technical assistance, contribute to long-term epidemic preparedness & capacity building

Dr. KANUPRIYA CHATURVEDI

slide43

Sharing Outbreak-related Information

  • with Public Health Professionals
  • with Public

Dr. KANUPRIYA CHATURVEDI

solutions44
Solutions
  • Internet-based information technologies

Improve disease reporting

Facilitate emergency communications &

Dissemination of information

  • Human Genome Project

Role of human genetics in disease susceptibility, progression & host response

Dr. KANUPRIYA CHATURVEDI

solutions45
Solutions
  • Microbial genetics

Methods for disease detection, control & preventio

  • Improved diagnostic techniques & new vaccines
  • Geographic Imaging Systems

Monitor environmental changes that influence disease emergence & transmission

Dr. KANUPRIYA CHATURVEDI

key tasks carried out by whom

Regional

Key tasks - carried out by whom?

Global

Synergy

National

Dr. KANUPRIYA CHATURVEDI

what skills are needed
What skills are needed?

Public Health

Infectious diseases

Telecom. & Informatics

International field experience

Laboratory

Epidemio-

logy

Information management

Multiple expertise needed !

Dr. KANUPRIYA CHATURVEDI

global disease intelligence a world on the alert
Global Disease Intelligence: A world on the alert

Collection

Verification Distribution

Response

Dr. KANUPRIYA CHATURVEDI

the best defense multi factorial
The Best Defense (Multi-factorial)
  • Coordinated, well-prepared, well-equipped PH systems
  • Partnerships- clinicians, laboritarians & PH agencies
  • Improved methods for detection & surveillance

Dr. KANUPRIYA CHATURVEDI

contd50
CONTD.
  • Effective preventive & therapeutic technologies
  • Strengthened response capacity
  • Political commitment & adequate resources to address underlying socio-economic factors
  • International collaboration & communication

Dr. KANUPRIYA CHATURVEDI