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Communicable Diseases, Emerging and Re-Emerging Diseases Communicable Diseases, Emerging and Re-Emerging Diseases Biology 447 - Environmental Microbiology Outline q Communicable Diseases q Nosocomial Infections (hospital-acquired) q Antibiotic Resistance q Mapping Emerging Diseases q Neglected Diseases q Emerging Diseases in the US q Diseases preventable by vaccination q Global Emerging and Re-emerging Diseases - HIV - Hepatitis - Influenza - Malaria - Herpes - Ebola - Tuberculosis - HPV - SARS - Avian Influenza - West Nile virus - Trypanosomiasis - Others q Summary 10/24/2008 2 Communicable Diseases 10/24/2008 3 Introduction 10/24/2008 4 In 2001, a review of the scientific literature identified 1415 species of infectious organisms known to be pathogenic to humans, including: – 217 viruses and prions, – 538 bacteria and rickettsiae, – 307 fungi, – 66 protozoa and – 287 helminths. Of these, 61% were zoonotic and 12% were associated with diseases considered to be emerging (Taylor, Latham & Woolhouse, 2001). 10/24/2008 5 10/24/2008 6 10/24/2008 7 Communicable Diseases: Definition • Defined as • “any condition which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host, or vector, or through the inanimate environment”. • Transmission is facilitated by the following: – more frequent human contact due to • Increase in the volume and means of transportation (affordable international air travel), • globalization (increased trade and contact) – Microbial adaptation and change – Breakdown of public health capacity at various levels – Change in human demographics and behavior – Economic development and land use patterns 10/24/2008 8 CD- Modes of transmission • Direct • Blood-borne or sexual – HIV, Hepatitis B,C • Inhalation – Tuberculosis, influenza, anthrax • Food-borne – E.coli, Salmonella, • Contaminated water- Cholera, rotavirus, Hepatitis A • Indirect • Vector-borne- malaria, onchocerciasis, trypanosomiasis • Fomites • Zoonotic diseases – animal handling and feeding practices (Mad cow disease, Avian Influenza) • Nosocomial Infections- physician or health care worker induced diseases 10/24/2008 9 Importance of Communicable Diseases Significant burden of disease especially in low and middle income countries – Social impact – Economic impact – Potential for rapid spread – Human security concerns – Intentional use 10/24/2008 10 Communicable Diseases account for a significant global disease burden • In 2005, CDs accounted for about 30% of the global Burden of Disease and 60% of the BoD in Africa. • CDs typically affect LIC and MICs disproportionately. • Account for 40% of the disease burden in low and middle income countries • Most communicable diseases are preventable or treatable. 10/24/2008 11 Communicable Disease Burden Varies Widely Among Continents 10/24/2008 12 Communicable Disease Burden Varies Widely Among Continents 67% 10/24/2008 13 Communicable disease burden in Europe 10/24/2008 14 Communicable disease burden in Europe 3% 10/24/2008 15 Causes of Death Vary Greatly by Country Income Level Age distribution of death in Sierra Leone around 2005 Age distribution of death in Denm ark around 2005 Male Female Male Female 90 - 94 90 - 94 75 - 79 75 - 79 60 - 64 60 - 64 45 - 49 45 - 49 Age group 30 - 34 Age group 30 - 34 15 - 19 15 - 19 0 - 4 0 - 4 80 60 40 20 0 20 40 60 80 80 60 40 20 0 20 40 60 80 Percent of total of deaths Percent of total deaths Sierra Leone - Age Denmark - Age distribution at death distribution at death (2005) (2005) 10/24/2008 16 CDs have a significant social impact • Disruption of family and social networks – Child-headed households, social exclusion • Widespread stigma and discrimination – TB, HIV/AIDS, Leprosy – Discrimination in employment, schools, migration policies • Orphans and vulnerable children – Loss of primary care givers – Susceptibility to exploitation and trafficking • Interventions such as quarantine measures may aggravate the social disruption 10/24/2008 17 CDs have a significant economic impact in affected countries • At the macro level – Reduction in revenue for the country (e.g. tourism) • Estimated cost of SARS epidemic to Asian countries: $20 billion (2003) or $2 million per case. • Drop in international travel to affected countries by 50-70% • Malaria causes an average loss of 1.3% annual GDP in countries with intense transmission • The plague outbreak in India cost the economy over $1 billion from travel restrictions and embargoes • At the household level • Poorer households are disproportionately affected • Substantial loss in productivity and income for the infirmed and caregiver • Catastrophic costs of treating illness 10/24/2008 18 International boundaries are disappearing • Borders are not very effective at stopping communicable diseases • With increasing globalization • interdependence of countries – more trade and human/animal interactions • The rise in international traffic and commerce makes challenges even more daunting • Other global issues affect or are affected by communicable diseases. • climate change • migration • Change in biodiversity 10/24/2008 19 10/24/2008 20 Human Security concerns • Potential magnitude and rapid spread of outbreaks/pandemics. e.g. SARS outbreak – No country or region can contain a full blown outbreak of Avian influenza • Bioterrorism and intentional outbreaks – Anthrax, Small pox • New and re-emerging diseases – Ebola, TB (MDR-TB and XDR-TB), Hantavirus, etc 10/24/2008 21 Nosocomial Infections 10/24/2008 22 Nosocomial Infection Any infection that is acquired from being in a hospital or other healthcare institution (e.g., nursing home) Nosocomial: Originating or taking place in a hospital, acquired in a hospital, especially in reference to an infection. The term "nosocomial" comes from two Greek words: "nosus" meaning "disease" + "komeion" meaning "to take care of." Hence, "nosocomial" should apply to any disease contracted by a patient while under medical care. However, "nosocomial" has been whittled down over the years and now just refers to hospitals -- it is now synonymous with hospital-acquired. 10/24/2008 23 • 44,000 - 98,000 preventable deaths occur in U.S. hospitals every year • 17-29 billion healthcare dollars “wasted” because of medical errors 10/24/2008 24 Burden of Nosocomial Infection in U.S. Hospitals • 1.7 - 2 million nosocomial infections/year • Results in 80,000-100,000 deaths/year – Medication errors cause ~7,000 deaths • Cost: 5-6 billion dollars/year 10/24/2008 25 Nosocomial infection in Canada Every year, 250,000 Canadians pick up infections while they are in hospitals being treated for something else. That's one out of every nine Canadians who are admitted to hospital. Every year, those infections kill more than 8,000 people. That's more than will die of breast cancer, AIDS and car accidents combined. Many of those deaths can be prevented - by simple hand washing. 10/24/2008 26 Hand washing compliance by physicians in Australia % of appropriate occasions Self reported compliance = 74% Actual (measured) compliance = 8% Canadian compliance rates are steadily rising since the onset of Clostridium difficile and other outbreaks in hospitals. They are now estimated to be over 50% - 60% 10/24/2008 27 Epidemiology and Cholera Cholera is still a problem in some parts of the world 10/24/2008 28 10/24/2008 29 What is cholera? ...all is darkness and confusion, vague theory, and a vain speculation. Is it a fungus, an insect, a miasma, an electrical disturbance, a deficiency of ozone, a morbid off-scouring from the intestinal canal? We know nothing; we are at sea in a whirlpool of conjecture. - Wakley T. The Lancet II, 393, 1853 10/24/2008 30 English physician and a leader in the adoption of anaesthesia and medical hygiene. He is considered to be one of the fathers of epidemiology, because of his work in tracing the source of a cholera outbreak in Soho, England, in 1854. Wikipedia http://www.ph.ucla.edu/epi/ snow.html#BROAD 10/24/2008 31 Original Snow map of Soho, England during the 1854 cholera outbreak showing the individual cases of cholera 10/24/2008 32 During the next three days, 127 people living in or around Broad Street died. Few families, rich or poor, were spared the loss of at least one member. Within a week, three-quarters of the residents had fled from their homes, leaving their shops shuttered, their houses locked and the streets deserted. Only those who could not afford to leave remained there. It was like the Great Plague all over again. By 10 September, the number of fatal attacks had reached 500 and the death rate of the St Anne's, Berwick Street and Golden Square subdivisions of the parish had risen to 12.8 per cent -- more than double that for the rest of London. From Judith Summers in her history of the Soho neighborhood of London. 10/24/2008 33 He traced the outbreak in South London to contaminated water supplied by the Vauxhall Water Company -- a theory that the authorities and the water company itself were, not surprisingly, reluctant to believe. Now he saw his chance to prove his theories once and for all, by linking the Soho outbreak to a single source of polluted water. His research led him to a pump on the corner of Broad Street and Cambridge Street, at the epicenter of the epidemic. "I found," he wrote afterwards, "that nearly all the deaths had taken place within a short distance of the pump." In fact, in houses much nearer another pump, there had only been 10 deaths -- and of those, five victims had always drunk the water from the Broad Street pump, and three were schoolchildren who had probably drunk from the pump on their way to school. From Judith Summers in her history of the Soho neighborhood of London. 10/24/2008 34 Lambeth Water Company (water obtained upstream from London) – 5 per 100,000 Southwark and Vauxhall Water Company (water obtained from London) – 70 per 100,000 10/24/2008 35 He took his findings to the Board of Guardians of St James's Parish, in whose parish the pump fell.
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