12/2/2015 EMERGING INFECTIOUS DISEASES What could be emerging in North Dakota? TRACY K. MILLER, PHD, MPH STATE EPIDEMIOLOGIST [email protected] OBJECTIVES 1. Identify new or re-emerging infections 2. Identify ways outside agencies can help the health department monitor for disease 3. Determine what education needs are available. 2 WHAT ARE "EMERGING" INFECTIOUS DISEASES? Infectious diseases whose incidence in humans has increased in the past two decades or threatens to increase in the near future have been defined as "emerging." These diseases, which respect no national boundaries, include: • New infections resulting from changes or evolution of existing organisms • Known infections spreading to new geographic areas or populations • Previously unrecognized infections appearing in areas undergoing ecologic transformation 3 1 12/2/2015 WHAT ARE RE-EMERGING INFECTIOUS DISEASES? Any condition, usually an infection, that had decreased in incidence in the global population and was brought under control through effective health care policy and improved living conditions, reached a nadir, and, more recently, began to resurge as a health problem due to changes in the health status of a susceptible population. 4 REPORTABLE CONDITIONS 5 CDC’S LIST OF EIDS • malaria • drug-resistant infections (antimicrobial resistance) • Marburg hemorrhagic fever • bovine spongiform encephalopathy (Mad cow disease) & variant Creutzfeldt-Jakob disease (vCJD) • measles • campylobacteriosis • meningitis • Chagas disease • monkeypox • cholera • MRSA (Methicillin Resistant Staphylococcus aureus) • cryptococcosis • Nipah virus infection • cryptosporidiosis (Crypto) • norovirus (formerly Norwalk virus) infection • cyclosporiasis • pertussis • cysticercosis • plague • dengue fever • polio (poliomyelitis) • diphtheria • rabies • Ebola hemorrhagic fever • Rift Valley fever • Escherichia coli infection • rotavirus infection • group B streptococcal infection • salmonellosis • hantavirus pulmonary syndrome • SARS (Severe acute respiratory syndrome) • hepatitis C • shigellosis • hendra virus infection • smallpox • histoplasmosis • sleeping Sickness (Trypanosomiasis) • HIV/AIDS • tuberculosis • influenza • tularemia • Lassa fever • valley fever (coccidioidomycosis) • legionnaires' disease (legionellosis) and Pontiac fever • VISA/VRSA - Vancomycin-Intermediate/Resistant Staphylococcus aureus • leptospirosis • West Nile virus infection 6 • listeriosis • yellow fever • Lyme disease 2 12/2/2015 CDC’S LIST OF EIDS • drug-resistant infections (antimicrobial resistance) • malaria • bovine spongiform encephalopathy (Mad cow disease) & • Marburg hemorrhagic fever variant Creutzfeldt-Jakob disease (vCJD) • measles • campylobacteriosis • meningitis • Chagas disease • monkeypox • cholera • MRSA (Methicillin Resistant Staphylococcus aureus) • cryptococcosis • Nipah virus infection • cryptosporidiosis (Crypto) • norovirus (formerly Norwalk virus) infection • cyclosporiasis • pertussis • cysticercosis • plague • dengue fever • polio (poliomyelitis) • diphtheria • rabies • Ebola hemorrhagic fever • Rift Valley fever • Escherichia coli infection • rotavirus infection • group B streptococcal infection • salmonellosis • hantavirus pulmonary syndrome • SARS (Severe acute respiratory syndrome) • hepatitis C • shigellosis • hendra virus infection • smallpox • histoplasmosis • sleeping Sickness (Trypanosomiasis)(Trypanosomiasis)* • HIV/AIDS • tuberculosis • influenza • tularemia • Lassa fever • valley fever (coccidioidomycosis) • legionnaires' disease (legionellosis) and Pontiac fever • VISA/VRSA - Vancomycin-Intermediate/Resistant • leptospirosis Staphylococcus aureus 7 • listeriosis • West Nile virus infection • Lyme disease • yellow fever EMERGING INFECTIOUS DISEASES • 50 emerging and re-emerging infectious diseases • OVER 25 of them have an animal/zoonotic component • Transmitted from animals • Transmitted to animals • Animals involved in the lifecycle Next few slides will cover some of the more recent emerging and re-emerging diseases we have heard of in the news 8 MEASLES 9 3 12/2/2015 MEASLES 10 MEASLES • The United States experienced a record number of measles cases during 2014, with 667 cases from 27 states reported to CDC's National Center for Immunization and Respiratory Diseases (NCIRD). This is the greatest number of cases since measles elimination was documented in the U.S. in 2000. • The majority of people who got measles were unvaccinated. • Measles is still common in many parts of the world including some countries in Europe, Asia, the Pacific, and Africa. • Travelers with measles continue to bring the disease into the U.S. • Measles can spread when it reaches a community in the U.S. where groups of people are unvaccinated. 11 EBOLA VIRUS DISEASE (EVD) Ebola is a virus that causes hemorrhagic fever and is a severe, often fatal disease • Sudden onset of symptoms • Incubation period is 2-21 days (typically 8-10) Virus from the Filoviridae family Ebola has caused sporadic outbreaks in the past • 1st detected - Ebola River in 1976 12 4 12/2/2015 2014 OUTBREAK BEGINS 13 http://www.bbc.com/news/world-africa-28755033 Data source - WHO 2014 OUTBREAK 14 http://www.bbc.com/news/world-africa-28755033 Data source - WHO 2014 OUTBREAK 15 http://www.bbc.com/news/world-africa-28755033 Data source - WHO 5 12/2/2015 2014 OUTBREAK 16 http://www.bbc.com/news/world-africa-28755033 Data source - WHO 2014 OUTBREAK 17 http://www.bbc.com/news/world-africa-28755033 Data source - WHO EBOLA 18 6 12/2/2015 EBOLA 19 30000 28601 Total Cases Lab Confirmed Total Deaths 25000 20000 15215 15000 14122 10675 11299 10000 8704 4808 5000 3804 3351 3955 2536 3160 0 Guinea Liberia Sierra Leone Total 18 Around Sept 20th, 16 no longer receiving ND Monitoring* 14 ND Started manifests from Liberia 12 monitoring 51% Female 10 48% Male 8 6 4 Age range: 0 – 76yrs 2 0 *provisional data Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov 2014 2014 2014 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 SO WHAT ELSE IS HAPPENING IN ND? 20 AVIAN FLU 21 7 12/2/2015 TULAREMIA 22 MALARIA 23 POLIO Polio has been eliminated from the United States thanks to widespread polio vaccination in this country. However, the disease has been brought into the country by travelers with polio. The last time this happened was in 1993. It takes only one traveler with polio to bring the disease into the United States. OF NOTE: From August to October 2014, CDC received increased reports of children across the United States who developed a neurologic illness called acute flaccid myelitis (AFM). • The median age of the children was about 7 years. • Almost all of them were hospitalized; some were put on breathing machines. • Most patients had fever and/or respiratory illness before onset of neurologic symptoms. • About 7 out of 10 of the children had elevated white blood cell counts, often with elevated protein levels, in their spinal fluid. • About two thirds of the children who have been observed (median 19 days) after their illness reported some improvement in symptoms, while about one third showed no improvement. Only two of the children have fully recovered. • CDC tested many different specimens but despite extensive testing, no 24 pathogen was consistently detected. 8 12/2/2015 WHAT ELSE? Hepatitis C • Outbreak here in ND; • www.ndhealth.gov/disease/Hepatitis/HCVOutbreak2013.htm • Antibiotic resistance • Selection pressure can cause resistance or it can arise endogenously by mutation or exogenously by transfer of R- factors. • one-step or multi step mutations within the organism • MRSA, VRE, CRE • Gonorhea • Salmonella • Tuberculosis • Neisseria meningitis 25 WHAT CAN WE DO? • Judicious antibiotic use both by human and animal care providers and the public. • Reduce pressures on healthcare for antibiotics • Take antibiotics as prescribed • Conduct surveillance to watch for emergence and re- emergence of disease • Alerting healthcare providers on to watch for the unexpected. • Increase trainings and information • Improve patient history taking during illness exams • Travel should always be asked and animal exposure!! • Get vaccinated! • Take your preventative medications as directed. 26 QUESTIONS 27 9.