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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