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Emerging and Re-emerging Infectious Diseases 2003

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  1. 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

  2. WNV

  3. Monkeypox from Prairie Dogs

  4. Are infectious diseases emerging more recently than before?

  5. 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Crude ID Mortality Rate Deaths per 100,000 population 30 20 10 0 Year CDC Source: JAMA 1996;275:189-193 and unpublished CDC data

  6. 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

  7. 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

  8. 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

  9. 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.”

  10. 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

  11. 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

  12. 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

  13. 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)

  14. 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

  15. 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,…)

  16. 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,….)

  17. Speed of Global Travel in Relation to World Population Growth From: Murphy and Nathanson. Semin. Virol. 5, 87, 1994 CDC

  18. Cyclospora 10 µm Immature oocysts Contaminated raspberries CDC

  19. 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?)

  20. Emerging Vancomycin-resistant Enterococcal Infections* % Resistant * in U.S. NNIS Hospitals CDC

  21. 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)

  22. 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, ….

  23. CDC

  24. 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

  25. Preventing EmergingInfectious 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

  26. Preventing EmergingInfectious Diseases Applied Research Integrate laboratory science and epidemiology to increase the effectiveness of public health practice. CDC

  27. Preventing EmergingInfectious 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

  28. Preventing EmergingInfectious Diseases Prevention and Control Ensure prompt implementation of prevention strategies and enhance communication of public health information about emerging diseases. CDC

  29. Preventing EmergingInfectious 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

  30. Common Palm Civet