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Inquiry question: How can the spread of infectious diseases be controlled. Students:●      investigate and analyse the wide range of interrelated factors

involved in limiting local, regional and global spread of a named infectious disease

●      investigate procedures that can be employed to prevent the spread of disease, including but not limited to: –      hygiene practices–      quarantine–      vaccination, including passive and active immunity –      public health campaigns–      use of pesticides–      genetic engineering

●      investigate and assess the effectiveness of pharmaceuticals as treatment strategies for the control of infectious disease, for example: –      antivirals–      antibiotics

●      investigate and evaluate environmental management and quarantine methods used to control an epidemic or pandemic  

●      interpret data relating to the incidence and prevalence of infectious disease in populations, for example:  –       mobility of individuals and the portion that are immune or

immunised –      Malaria or Dengue Fever in South East Asia

●      evaluate historical, culturally diverse and current strategies to predict and control the spread of disease

●      investigate the contemporary application of Aboriginal protocols in the development of particular medicines and biological materials in Australia

and how recognition and protection of Indigenous cultural and intellectual property is important, for example:

–          bush medicine –   smoke bush in Western Australia

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Pandemics: Risks, Impacts, and MitigationNita Madhav, Ben Oppenheim, Mark Gallivan, Prime Mulembakani, Edward Rubin, and Nathan Wolf

INTRODUCTIONPandemics are large-scale outbreaks of infectious disease that can greatly increase morbidity and mortality over a wide geographic area and cause significant economic, social, and political disruption. Evidence suggests that the likelihood of pandemics has increased over the past century because of increased global travel and integration, urbanization, changes in land use, and greater exploitation of the natural environment (Jones and others 2008; Morse 1995). These trends likely will continue and will intensify. Significant policy attention has focused on the need to identify and limit emerging outbreaks that might lead to pandemics and to expand and sustain investment to build preparedness and health capacity (Smolinsky, Hamburg, and Lederberg 2003).

The international community has made progress toward preparing for and mitigating the impacts of pandemics. The 2003 severe acute respiratory syndrome (SARS) pandemic and growing concerns about the threat posed by avian influenza led many countries to devise pandemic plans (U.S. Department of Health and Human Services 2005). Delayed reporting of early SARS cases also led the World Health Assembly to update the International Health Regulations (IHR) to compel all World Health Organization member states to meet specific standards for detecting, reporting on, and responding to outbreaks (WHO 2005). The framework put into place by the updated IHR contributed to a more coordinated global response during the 2009 influenza pandemic (Katz 2009). International donors also have begun to invest in improving preparedness through refined standards and funding for building health capacity (Wolicki and others 2016).

For the purposes of this chapter, an epidemic is defined as “the occurrence in a community or region of cases of an illness . . . clearly in excess of normal expectancy” (Porta 2014). A pandemic is defined as “an epidemic occurring over a very wide area, crossing international boundaries, and usually affecting a large number of people” (Porta 2014). Pandemics are, therefore, identified by their geographic scale rather than the severity of illness. For example, in contrast to annual seasonal influenza epidemics, pandemic influenza is defined as “when a new influenza virus emerges and spreads around the world, and most people do not have immunity” (WHO 2010)

morbidity mortality mitigation epidemic pandemic immunity

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Countries preparedness for epidemics 2017

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Social distancing

Canberrans ( from ACT) are advised to take action now to reduce the risk of infection with COVID-19.

These interventions are known as ‘social distancing’  measures and can be very effective in slowing the spread of infectious diseases within the community.

From this point forward, you need to keep your personal space between you and others to at least 1.5 metres.

At 1.5 metres between you and everyone else, our community can still stay socially connected with one another, while reducing the spread of novel coronavirus.

What is social distancing?

Social distancing means separating yourself from other people as much as possible when you’re in public places and avoiding crowded places. Social distancing can be very effective, but it is recognised that it cannot be practised in all situations. The aim of social distancing is to reduce transmission of infectious diseases.

For non-essential activities outside the workplace or attendance at schools, universities and childcare, social distancing includes:

Attempting to keep a distance of 1.5 metres between yourself and other people. Avoiding crowds and large public gatherings. Avoiding shaking hands, hugging, or kissing other people. Minimising visits to vulnerable people, such as those in aged care facilities or

hospitals, infants, or people with compromised immune systems due to illness or medical treatment.

Keeping connected with others, including colleagues, friends and family, through phone, email, social media, and online work platforms when possible.

These measures should be used if you are well. If you are unwell, you should stay at home.

Use of masks

If you are healthy, you do not need to wear a mask.

Masks are recommended for healthcare workers for when they are assessing and testing sick patients for COVID-19. They are also used for people who are unwell with respiratory symptoms (e.g. coughing and sneezing) and people who are suspected or confirmed to have

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COVID-19. Masks help contain infectious droplets from sick people and keep those around them safe.

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What are antiviral drugs?

Antiviral drugs are prescription medicines (pills, liquid, an inhaled powder, or an intravenous solution) that fight against flu viruses in your body. You can only get them if you have a prescription from a health care provider. Antiviral drugs are different from antibiotics, which fight against bacterial infections.

What should I do if I think I am sick with flu?

If you get sick with flu, antiviral drugs are a treatment option. Your doctor may prescribe antiviral drugs to treat your flu illness.

Should I still get a flu vaccine?

Yes. Antiviral drugs are not a substitute for getting a flu vaccine. While flu vaccine can vary in how well it works, a flu vaccine is best way to help prevent seasonal flu and its potentially serious complications. Antiviral drugs are a second line of defence that can be used to treat flu.

What are the benefits of antiviral drugs?

Antiviral treatment works best when started soon after flu illness begins. When treatment is started within two days of becoming sick with flu symptoms, antiviral drugs can lessen fever and flu symptoms, and shorten the time you are sick by about one day. They also may reduce the risk of complications such as ear infections in children, respiratory complications requiring antibiotics, and hospitalization in adults.  For adults hospitalized with flu illness, some studies have reported that early antiviral treatment can reduce their risk of death.

When should antiviral drugs be taken for treatment?

Studies show that flu antiviral drugs work best for treatment when they are started within two days of getting sick. However, starting them later can still be beneficial, especially if the sick person is at high risk of serious flu complications or is in the hospital with more severe illness.  Follow instructions for taking these drugs.

What antiviral drugs are recommended this flu season?( in the USA)

There are four FDA-approved antiviral drugs recommended by CDC to treat flu this season.

oseltamivir phosphate (available as a generic version or under the trade name Tamiflu®),

zanamivir (trade name Relenza®) peramivir (trade name Rapivab®), and baloxavir marboxil (trade name Xofluza®) .

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Japanese flu drug 'clearly effective' in treating coronavirus, says China

Medical authorities in China have said a drug used in Japan to treat new strains of influenza appeared to be effective in coronavirus patients, Japanese media said on Wednesday.

Zhang Xinmin, an official at China’s science and technology ministry, said favipiravir, developed by a subsidiary of Fujifilm, had produced encouraging outcomes in clinical trials in Wuhan and Shenzhen involving 340 patients.

“It has a high degree of safety and is clearly effective in treatment,” Zhang told reporters on Tuesday.

Patients who were given the medicine in Shenzhen turned negative for the virus after a median of four days after becoming positive, compared with a median of 11 days for those who were not treated with the drug, public broadcaster NHK said.

In addition, X-rays confirmed improvements in lung condition in about 91% of the patients who were treated with favipiravir, compared to 62% or those without the drug.

Coronavirus: the week explained - our expert correspondents put a week’s worth developments in context in one email newsletter

Doctors in Japan are using the same drug in clinical studies on coronavirus patients with mild to moderate symptoms, hoping it will prevent the virus from multiplying in patients.

But a Japanese health ministry source suggested the drug was not as effective in people with more severe symptoms. “We’ve given Avigan to 70 to 80 people, but it doesn’t seem to work that well when the virus has already multiplied,” the source said.

The same limitations had been identified in studies involving coronavirus patients using a combination of the HIV antiretrovirals lopinavir and ritonavir, the source added.

In 2016, the Japanese government supplied favipiravir as an emergency aid to counter the Ebola virus outbreak in Guinea.

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Favipiravir would need government approval for full-scale use on Covid-19 patients, since it was originally intended to treat flu.

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THE TREASURE CALLED ANTIBIOTICSW.A. Adedeji,

Prior to the beginning of the 20th Century, infectious diseases accounted for high morbidity and mortality worldwide. The average life expectancy at birth was 47 years (46 and 48 years for men and women respectively) even in the industrialized world. Infectious diseases such as smallpox, cholera, diphtheria, pneumonia, typhoid fever, plaque, tuberculosis, typhus, syphilis, etc. were rampant.1

The discovery of penicillin in 1928 by Sir Alexander Fleming (1881-1955) marked the beginning of the antibiotic revolution.2 Ernst Chain and Howard Florey purified the first penicillin, penicillin G, in 1942 but became widely available outside the Allied military in 1945.3 This marked the beginning of the antibiotic era. This antibiotic era witnessed the discovery of many new antibiotics, and the period between the 1950s and 1970s was named the golden era of discovery of novel antibiotics, and no new classes of antibiotics have been discovered since then. After that, the approach to discovery of new drugs was the modification of existing antibiotics.4

The antibiotic era revolutionized the treatment of infectious diseases worldwide, although with much success in developed countries. In the US for example, the leading causes of death changed from communicable diseases to non-communicable diseases (cardiovascular disease, cancer, and stroke), the average life expectancy at birth rose to 78.8 years, and older population changed from 4% to 13% of the entire US population.1 And infectious diseases now become the problem of elderly, cancer patients, transplant patients, surgical patients, patients on immuno-suppressive drugs and other at-risk groups in developed countries.5 Although the developing countries also recorded a lot of improvement in the morbidity and mortality rate, infectious diseases still disproportionately affect all age groups in these parts of the world.5,6 This is due to a combination of other factors like poverty, inadequate public health measures, poor sanitation, poor vaccination coverage, etc.

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Dengue fever is a virus carried and spread by mosquitoes and widespread throughout south-east Asia and in parts of far north Queensland. It causes flu-like symptoms, including high fever, muscle and joint pains, nausea and vomiting. In severe cases of dengue fever, it can cause internal bleeding, bleeding from the mouth and gums and can be fatal if the infection becomes severe and is not treated.

According to the WHO, dengue is a leading cause of serious illness and death in south-east Asia. There is no specific treatment for the virus but early detection and medical care, including maintaining the body's fluid levels and reducing fever with paracetamol, can reduce mortality rates.

The WHO recently reported the number of cases in Cambodia was on the rise, compared to last year.

In Malaysia, 52,941 cases and 81 deaths have ben reported in the first 22 weeks of 2019, twice the number that occurred in 2018, while in the Philippines 77,040 cases of dengue and 328 deaths have been reported - twice the number for the same period of time in 2018.

Vietnam has seen 59,959 cases and four deaths reported in the first 19 weeks of 2019 - three times the number for the same period in 2018, while Singapore has reported 3886 cases in the first 21 weeks of 2019 - four times the number of cases in 2018.

Monash University professor Cameron Simmons, the director of the Oceania hub of the World Mosquito Program, said dengue was a seasonal disease throughout south-east Asia and that every few years, a sharp rise in cases of the virus occurred.

"There is one particular mosquito, the Aedes Aegypti mosquito, that is the main domesticated mosquito that loves to feed on us, take blood from us, and it is an effective transmitter of dengue."

"For travellers going to Cambodia and other parts of south-east Asia, there is always a risk. Australia typically has 500 to 1500 cases each year of Australian travellers returning from

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places like Thailand or Bali or Papua New Guinea with dengue, being diagnosed in a hospital [when they return]."

There are 100 million cases of dengue infections reported around the world each year, and about 10,000 deaths.

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Aboriginal bush medicinesWhen Aboriginal people did fall sick, they used plants in a variety of ways to quell their ills. Some plants, like goat’s foot, were crushed, heated and applied to the skin. Others were boiled and inhaled, and occasionally drunk. There were also saps which were directly smeared on the skin, and barks that were smoked or burned.

Professor Joanne Jamie, a medicinal chemist from Macquarie University, in Sydney has compiled a database on Aboriginal plants. Many of those plants, she found, contained anti-bacterial and anti-inflammatory compound that are known to western medicine.

“When plants are used in a customary way, there is a far greater success rate in them having biological activity,” she says. “The plants that were used by the Aborigines are very likely to be useful to us.” 

Common Aboriginal bush medicines1. Tea tree oil (Melaleuca alternifolia) Bundjalung Aboriginal people from the coast of New South Wales crushed tea-tree (or paper bark) leaves and applied the paste to wounds as well as brewing it to a kind of tea for throat ailments. In the 1920s, scientific experiments proved that the tea-tree oil’s antiseptic potency was far stronger than the commonly used antiseptic of the time. Since then, the oil has been used to treat everything from fungal infections of the toenails to acne.  

2. Eucalyptus oil (Eucalyptus sp.) Eucalyptus leaves can be infused for body pains and fevers and chills. Today the oil is used commercially in mouthwash, throat lozenges and cough suppressants.

3. Billy goat plum/Kakadu plum (Terminalia ferdinandiana) The world’s richest source of Vitamin C is found in this native fruit from the woodlands of the Northern Territory and Western Australia. The plum has 50 times the Vitamin C of oranges,and was a major source of food for tribes in the areas where it grows.

4. Desert mushrooms Pycnoporus sp.) Some Aboriginal people suck on the bright orange desert mushroom to cure a sore mouth or lips. It has been known to be a kind of natural teething ring and is also useful for babies with oral thrush.

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5. Emu bush (Eremophila sp.) Emu bush leaves were used by Northern Territory Aboriginal tribes to wash sores and cuts; occasionally it was gargled. In the last decade, leaves from the plant were found to have the same strength as some established antibiotics. South Australian scientists want to use the plant for sterilising implants, such as artificial hips.

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