04.Emerging and re-emerging_Covid _ 19.pdf

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1. Emerging and
Re-emerging Disease :
Covid-19 update
YovitaHartantri
Tim InfeksiKhususRSUP drHasan SadikinBandung
29 Oktober2020

2. Introduction
Infectious diseases can emerge without warning and quickly spreadin our
globally connected world, where their effects can have unprecedented reach
In 1918, as the First World War was winding to a close, a mysterious disease that
left victims blue in the face and gasping
By the time-called Spanish flu,thepandemic had infected more than a quarter
of the world’s population and resulted in some 30 million to 100 million deaths
the 1918 flu pandemic was one of the worst catastrophes of the twentieth
century.
In the 100 years that have passed since the Spanish flu first besieged the world,
no pandemic has approached its magnitude of fatality over such a short
period.
Bloom and Cadarette-Frontiers in Immunology, review 28 March 2019

3. Infectious diseases remain among the leading
causes of death worldwide for 3 reasons :
Emergence of new infectious diseases
Re –emergence of old infectious diseases
Persistence of intractable infectious diseases
What is an emerging or re-emerging infectious disease ?
Almeida SL, J. EmergNurs2015

4. What is an emerging or re-emerging
disease?
It is an infection that has newly appeared in a population or has existed but
is rapidly increasing in incidence or geographic range
If the disease was unknown in the location before, the disease is
considered to be emerging
If the disease had been present at the location in the past and was
considered eradicated or controlled, the disease is considered to be re-
emerging
Almeida SL, J EmergNurs2015

5. What are emerging infectious
diseases?
Outbreaks of previously unknown diseases
Known diseases that are rapidly increasing in incidence or
geographic range in the last 2 decades
Persistence of infectious diseases that cannot be controlled

6. Re-emerging diseases
Diseases that reappear after they have been on a significant decline
Increasing of incidence or prevalence
May happen because of a breakdown in public health measures for diseases
that were once under control
Can also happen when new strains of known disease-causing organisms
appear
Human behaviouraffects re-emergence

7. Multiple factors contribute to the emergence of new
infectious diseases :
Increasing growth and mobility of the population
Overcrowding in cities with poor sanitation
Unsanitoryfood preparation
Exposure of human to disease vectors and reservoirs
Ecological changes that alter the composition and site of insect vectors
and animal reservoirs
Almeida SL, J EmergNurs2015

8. Prominent outbreaks, endemics and pandemics of the last century
Bloom and Cadarette, Frontiers in Immunology 2019

9. Bloom and Cadarette, Frontiers in Immunology 2019

10. Covid-19 Pandemic
Also known as coronavirus pandemic
Caused by the transmission of
SARS-CoV2
First identified in Dec 2019 in Wuhan,
China
The outbreak was declared in March’20
As of 28 Oct 2020, more than 44.3 million
Cases have been confirmed, with more
Than 1.17 million death

16. Lanjutan… upayapenanggulangn

18. Reviewed Acute Emerging Infectious viral disease outbreaks in Indonesia
in the past decade (W de Jong et al, Critical Reviews in Microbiology, 2018)

19. KEPUTUSAN MENTERI KESEHATAN REPUBLIK INDONESIA
NOMOR HK.01.07/MENKES/104/2020
TENTANG
PENETAPAN INFEKSI NOVEL CORONAVIRUS (INFEKSI 2019-nCoV) SEBAGAI
PENYAKIT YANG DAPAT MENIMBULKAN WABAH DAN UPAYA
PENANGGULANGANNYA

DENGAN RAHMAT TUHAN YANG MAHA ESA

MENTERI KESEHATAN REPUBLIK INDONESIA,


Menimbang : a. bahwa berdasarkan pertimbangan peningkatan kasus
yang signifikan pada negara yang melaporkan kasus,
Infeksi Novel Coronavirus (Infeksi 2019-nCoV) telah
dinyatakan sebagai Kedaruratan Kesehatan
Masyarakat yang Meresahkan Dunia (KKMMD)/Public
Health Emergency of International Concern (PHEIC);
b. bahwa sehubungan dengan meluasnya penyebaran
Infeksi Novel Coronavirus (Infeksi 2019-nCoV) ke
berbagai negara dengan risiko penyebaran ke
Indonesia terkait dengan mobilitas penduduk,
diperlukan upaya penanggulangan dalam bentuk
peningkatan kewaspadaan dini, kesiapsiagaan, serta
tindakan antisipasi pencegahan, deteksi, pengobatan,
dan respon lain yang diperlukan;
c. bahwa berdasarkan pertimbangan sebagaimana
dimaksud dalam huruf a dan huruf b, perlu
menetapkan Keputusan Menteri Kesehatan tentang
Penetapan Infeksi Novel Coronavirus (Infeksi 2019-
nCoV) sebagai Jenis Penyakit Yang Dapat
Menimbulkan Wabah dan Upaya Penanggulangannya;
4 Pebruari2020

20. Transmission of Covid-19
La Rosa et al : Person-to-person contact through
respiratory droplets generated by breathing, sneezing, coughing, etc
contact(direct contact with an infected subject or indirect contact, from contaminated fomites
to the mouth, nose, or eyes).
Transmission through aerosols has also been implicated butis still unclear.
Indirect transmission through fomites that have been contaminated by respiratory
secretions although transmission through fomites has not been documented.
European Centre for Disease Prevention and Control, 7 September 2020

21. Droplet vs Airborne

22. Transmission in different settings
Can be particularly effective in crowded, confined
indoor spaces.
Transmission can be linked with to specific activities, such as
singing in a choir.
The duration of the indoor activity and the increased production
of respiratory droplets through loud speech and singing, likely
increased the risk of transmission.
Poor ventilation in confined indoor spaces is associated
with increased transmission of respiratory infections.
In a restaurant outbreak of 10 cases in three families in
Guangzhou, China,transmission was attributed to the spread of
respiratory droplets carrying SARS-CoV-2 by the airflow

23. Viral Shedding
Viral RNA shedding is higher at the time of symptom onset and declines
after days or weeks.
Over the course of the infection, the RNA of the virus has been identified in
respiratory tract specimens 1-2 days before the onset of symptoms and it
can persist for up to eight days in mild cases and for longer periods in more
severe cases, peaking in the second week after infection.
Prolonged viral RNA shedding has been reported from nasopharyngeal
swabs (up to 67 days among adult patients) and in faeces (more than one
month after infection in paediatric patients)
Infectious virus has been detected up to day eight post disease onset.
European Centre for Disease Prevention and Control, 7 September 2020

24. Duration of viral shedding
KariaR, Nagraj S, SN Comprehensive Clinical Medicine, 28 August 2020

25. Other source of viral shedding
KariaR, Nagraj S, SN Comprehensive Clinical Medicine, 28 August 2020

26. Lee S et al, 6 August 2020

27. Clinical courses of major symptoms & outcomes & duration of viral
shedding from illness onset in patients hospitalized with Covid-19
Zhou F et al. Lancet 2020; 395: 1054 -62

28. Pathology and Pathogenesis
Histologic findings from the lungs include
diffuse alveolar damage similar to lung injury
caused by other respiratory viruses
characteristic of SARS-CoV-2 infection is vascular
damage, with severe endothelial injury,
widespread thrombosis, microangiopathy and
angiogenesis
European Centre for Disease Prevention and Control, 7 September 2020

29. Clinical stage of the disease
Siddiqi HK et al, J of Heart and Lung Transplantation, 2020

30. Clinical Complication of Covid-19
Kordzadeh-KermaniE et al
Review, Future Microbiology
27 August 2020

31. Diagnostic
Current estimates suggest a median incubation :
five to six days
the incubation period can be from 2.3 day, before symptom onset and up to 14
days
Presymptomatic: 12,6%
Case that remained asymptomaticwas estimated at 16% (6-41%)
Diagnostic laboratory :
Detection of SARS-CoV-2 RNA by RT-PCR
Better in nasopharynxsamples compared to throat (lower respiratory samples
may have better yield)
Also detected in stool and blood

32. Radiographic findings
Chest radiographs bilateral
airspace consolidation.
Although unremarkable chest
radiographs early in the disease
Chest CT images demonstrate
bilateral peripheral ground glass
opacities
Liu Kai Caiet al, 2020

33. Characteristics
Confirmed COVID-19
(n=105)
No COVID-19
(n=73)
Gender
Female 44 (41.9) 29 (39.7)
Male 61 (58.1) 44 (60.3)
Median age (IQR) –year 49 (36-60) 54 (39-64)
History of travelling 34 (32.4) 4 (5.5)
History of case contact 58 (55.2) 2 (2.7)
Comorbidity 51 (48.6) 63 (86.3)
Symptoms
Fever 65 (61.9) 50 (68.5)
Cough 62 (59.0) 41 (5.6)
Sniffle 18 (17.1) 5 (6.8)
Sore throat 22 (20.9) 7 (9.6)
Dyspnea 57 (54.3) 49 (67.1)
Awareness
Compos mentis 103 (98.1) 55 (75.3)
Somnolent 0 (0.0) 14 (19.2)
Sopor 0 (0.0) 3 (4.1)
Coma 1 (1.0) 1 (1.4)
Median O2 saturation (IQR) 97 (94-98) 97 (96-98)
Table 1. Clinical characteristics of COVID-19 suspects in Dr Hasan SadikinGeneral
Hospital according to case category (January –July 2020)
Missing data: history of travelling (n=8), history of case contact (n=9), comorbidity (n=7), fever (n=1), sniffle (n=4), sorethroat (n=3),
awareness (n=2), O2 saturation (n=13)

34. Characteristics
Confirmed COVID-19
(n=105)
No COVID-19
(n=73)
Sign of pneumonia in X-ray 56 (53.3) 44 (60.3)
Routine blood examination
Haemoglobin 14.0 (13.0-15.1) 11.8 (9.2-14.4)
Leucocyte 7710 (5700-9450) 10480 (7360-14750)
Lymphocyte 20 (13-29) 12 (7-17)
ALC 1464 (938-1898) 1121 (817-1683)
NLCR 4.2 (2.5-6.7) 7.5 (4.8-14.7)
Thrombocyte 278000
(204000-342000)
202000
(132000-285000)
Severity
Mild (green) 53 (51.4) 13 (17.8)
Moderate (yellow) 31 (29.5) 31 (42.5)
Severe (red) 20 (19.0) 29 (39.7)
Table 2. Laboratory and Severity of COVID-19 suspects in Dr Hasan SadikinGeneral
Hospital according to case category (January –July 2020)
Missing data: Chest X-ray (n=97), haemoglobin (n=19), leucocyte (n=19), lymphocyte (n=21), ALC (n=25), NLCR (n=223),
thrombocyte (n=15), severity (n=2).

35. PedomanPencegahandan
PengendalianCovid-19

37. Covid-19 47 PEDOMAN PENCEGAHAN DAN PENGENDALIAN
CORONAVIRUS DISEASE (COVID-19) REVISI KE-5


Gambar 3. 1. Alur Manajemen Kesehatan Masyarakat

38. Pelaporan

39. Koordinasipelaporan

40. To address emerging global challenges with
regard to infectious disease :
Propose the formation of a multidisciplinary Global Technical Council on
Infectious Disease Threats. The Council would strengthen the global health
system by doing the following:
(1) improving collaboration and coordination across relevant organizations
(2) filling in knowledge gaps with respect to (for example) infectious disease
surveillance, research and development (R&D) needs, financing models,
supply chain logistics, and the social and economic impacts of potential
threats; and
(3) making high-level, evidence-based recommendations for managing
global risks associated with infectious disease.
Bloom and Cadarette-Frontiers in Immunology, review 28 March 2019

41. the development of newer techniques for surveillance
establishment of health systems at different levels
pandemic surveillance for antimicrobial resistance
up gradation of the international Health regulations
outbreak response
the dissemination of information
administrative support and training of the staff
STRATEGY /POSSIBLE INTERVENTIONS

42. Summary
Infectious diseases can emerge without warning and quickly spread and
remain the leading causes of death worldwide
Emerging disease is an infection that has newly appeared in a population
but re-emerging disease is that reappear after they have been on a
significant decline
Multiple factor contribute to the emergence of new infectious diseases
Although SARS-CoV2 infection (Covid-19) manifest in the lung, can
complicate in all organ

43. Terimakasih