Emerging & Re-emerging ZOONOSIS
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Transcript of Emerging & Re-emerging ZOONOSIS
Epidemiologi Fpet
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??AIDS Avian InfluenzaEbolaMarburg CholeraRift Valley FeverTyphoidTuberculosisLeptospirosisMalaria Chikungunya DengueJEAntimicrobial resistance
UPUP
Guinea worm Smallpox
Yaws
Poliomyelitis
Measles
Leprosy
Neonatal tetanus
DOWNDOWN
Infectious Diseases: A World in Infectious Diseases: A World in TransitionTransition
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DefinitionEmerging infectious disease
Newly identified & previously unknown infectious agents that cause public health problems either locally or internationally
Re-emerging infectious diseaseInfectious 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
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Factors Contributing To EmergenceAGENT
Evolution of pathogenic infectious agents (microbial adaptation & change)
Development of resistance to drugs Resistance of vectors to pesticides
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Factors Contributing To Emergence
HOSTHuman demographic change (inhabiting
new areas)Human behaviour (sexual & drug use)Human susceptibility to infection
(Immunosuppression)Poverty & social inequality
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Factors Contributing To EmergenceENVIRONMENTClimate & changing ecosystemsEconomic development & Land use (urbanization,
deforestation)Technology & industry (food processing &
handling)International travel & commerce Breakdown of public health measure (war, unrest,
overcrowding)Deterioration in surveillance systems (lack of
political will)
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Transmission of Infectious Agent from Animals to Humans>2/3rd emerging infections originate from
animals- wild & domesticEmerging Influenza infections in Humans
associated with Geese, Chickens & PigsAnimal 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)
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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
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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
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Uncontrolled Urbanization & Population DisplacementGrowth of densely populated cities-
substandard housing, unsafe water, poor sanitation, overcrowding, indoor air pollution (>10% preventable ill health)
Problem of refugees & displaced personsDiarrhoeal & Intestinal parasitic diseases,
ARILyme disease (B. burgdorferi)- Changes in ecology, increasing deer populations, suburban migration of population
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Human BehaviourUnsafe sexual practices (HIV, Gonorrhoea,
Syphilis)Changes in agricultural & food production
patterns- food-borne infectious agents (E. coli)
Increased international travel (Influenza)Outdoor activity
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Antimicrobial Drug Resistance
Causes:• Wrong prescribing practices• non-adherence by patients• Counterfeit drugs• Use of anti-infective drugs in animals & plantsLoss of effectiveness:• Community-acquired (TB, Pneumococcal) &
Hospital-acquired (Enterococcal, Staphylococcal Antiviral (HIV), Antiprotozoal (Malaria),
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Antimicrobial Drug Resistance
ConsequencesProlonged hospital admissionsHigher death rates from infectionsRequires more expensive, more toxic drugsHigher health care costs
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HUMAN
ANIMALS
ENVIRONMENT
VECTORS
Zoonosis
PopulationGrowth
Mega-cities
Migration
Exploitation
Pollution
Climate change
Vectorproliferation
Vectorresistance
Transmission
Antibiotics
Intensive farming
Foodproduction
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Examples of recent emerging diseases
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Source: NATURE; Vol 430; July 2004; www.nature.com/nature21/04/23
Emerging Zoonoses: Human-animal interface
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Marburg virus
Hantavirus Pulmonary Syndrome
Ebola virus
Borrelia burgdorferi: Lyme Deer tick (Ixodes scapularis)
Mostomys rodent: Lassa fever
Avian influenza virus
Bats: Nipah virus
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SARS: The First Emerging Infectious Disease Of The 21st Century
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SARS Cases 19 February to 5 July 2003
China (5326)
Singapore (206)
Hong Kong (1755)
Viet Nam (63)
Europe:10 countries (38)
Thailand (9)
Brazil (3)
Malaysia (5)
South Africa (
Canada (243)
USA (72)
Colombia (1)
Kuwait (1)
South Africa (1)
Korea Rep. (3)
Macao (1)
Philippines (14)
Indonesia (2)
Mongolia (9)
India (3)
Australia (5)
New Zealand (1)
Taiwan (698)
Mongolia (9)
Russian Fed. (1)
Total: 8,439 cases, 812 deaths,30 countries in 7-8 months
Source: www.who.int.csr/sars
No infectious disease has spread so fast and far as SARS did in 2003
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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
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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
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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
emergencyApril 27th Pandemic alert raised to phase 4April 29th Pandemic alert raised to phase 5
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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 USAMay 16th India reports first confirmed caseStockpiling of antiviral drugs and
preparations to make a new effective vaccine
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Pandemic HINI (Swine flu)Worldwide- 162,380 cases
1154 deaths
India- 558 cases1 death
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Examples of Re-Emerging Infectious DiseasesDiphtheria- 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)
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BioterrorismPossible deliberate release of infectious agents
by dissident individuals or terrorist groupsBiological agents are attractive instruments of
terror- easy to produce, mass casualties, difficult to detect, widespread panic & civil disruption
Highest potential- B. anthracis, C. botulinum toxin, F. tularensis, Y. pestis, Variola virus, Viral haemorrhagic fever viruses
Likeliest route- aerosol dissemination
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Key Tasks in Dealing with Emerging Diseases
Surveillance at national, regional, global levelepidemiological, laboratoryecologicalanthropological
Investigation and early control measuresImplement prevention measures
behavioural, political, environmentalMonitoring, evaluation
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SolutionsInternet-based information technologies
Improve disease reporting Facilitate emergency communications & Dissemination of information
Human Genome ProjectRole of human genetics in disease susceptibility, progression & host response
Microbial geneticsMethods for disease detection, control & preventio
Improved diagnostic techniques & new vaccinesGeographic Imaging Systems
Monitor environmental changes that influence disease emergence & transmission
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National
RegionalGlobal
Synergy
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Multiple expertise neededMultiple expertise needed !
Infectious diseases
Epidemio-
logy
Public Health
International field
experienceInformation
management
Laboratory
Telecom. & Informatics
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CollectionCollection
VerificationVerification DistributionDistribution
ResponseResponse21/04/23
The Best Defense (Multi-factorial)Coordinated, well-prepared, well-equipped
PH systemsPartnerships- clinicians, laboritarians & PH
agenciesImproved methods for detection &
surveillanceEffective preventive & therapeutic
technologiesStrengthened response capacityPolitical commitment & adequate resources
to address underlying socio-economic factorsInternational collaboration & communication
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