Emerging and re emerging diseases

this slide is based on emerging and re - emerging diseases

1. 16/02/2016 1 SASMITA RAUT , COOMUNITY HEALTH NURSING

2. 2 Emerging and re-emerging infectious diseases Presented By: Mrs. Sasmita Nayak Tutor, KINS, KIIT, DU, BHUBANESWAR

3. Emerging infectious diseases Re-emerging infectious diseases Factors contributing to emergence and re-emergence of infectious diseases Challenges to prevent the emergence of diseases 3 CONTENT

4. INT R ODUCTION Infectious diseases are the leading cause of death worldwide, claiming at least 17 million lives every year. In the South-East Asia region, 7 million people die from diseases annually . During the last 20 years, at least 30 new diseases have emerged to threaten the health of hundreds of millions of people. For many of these diseases there is no treatment or appropriate vaccine and the possibility of preventing or controlling them is limited 4

5. 5 Infectious diseases remain the leading cause of death worldwide Emergence of new infectious diseases Re-emergence of old infectious diseases Persistence of intractable infectious Diseases.

6. Emerging infectious diseases are “New diseases ; new problem (New threats)” An emerging infectious disease is one which is caused by a newly discovered infectious agent or B y a newly identified pathogen, which has emerged and whose incidence in humans has increased during the last 2 decades and is threatening to increase in the near future. 7 Emerging Infectious Diseases

7. 8 Types

8. 9 Diseases due to new agents Year Disease Causative agent 1970 Human monkeypox Monkeypox 1973 Infantile diarrhoea Rota virus 1976 Diarrhoea Cryptosporidium parvum 1977 Diarrhoea Campylobactero jejuni 1977 Legionnaires’ Disease Legionella Pneumophila 1976 Ebola haemorrhagic fever Ebola virus 1981 MRSA infection MRSA 1983 AIDS HIV

9. 10 Cont … Year Disease Causative agent 1988 Hepatitis E Hepatitis E virus 1989 Hepatitis C Hepatitis C virus 1993 Hanta virus pulmonary syndrome Hanta vitus 1998 Nipah encephalitis Nipah virus 2002 VRSA infection VRSA infection 2003 SARS SAR S -ass o ci a ted coronavirus 2004 H5N1 influenza H5N1 virus 2012 Middle – East Respiratory Syndrome Corona virus 2015 Zika Zika

10. 11 Diseases caused by new variants of known pathogens Year Disease Causative agent 1982 Diarrhoeal diseases 0157.HF strain of E. coli 1986 Exanthem Subitum HHV - 6 1992 Cholera 0139 strain of V.cholerae 1996 - 97 Avian influenza H5N1

11. 12 Diseases caused by infectious agent but resulting in non communicable diseases Year Disease Causative agent 1982 T – cell lymphoma (lymphocytic leukemia) Human T- lymphotropic virus- 1 (HTLV-1) 1982 Hairy cell leukemia Human T- lymphotropic virus- 2 (HTLV-2) 1982 Coronary artery disease chlamydia 1989 Non-A, Non-B hepatitis, (liver cancer) Hepatitis C 1995 Kaposi’s Sarcoma HHV-8

12. 1970 - First discovered – Zire , Africa 1996- 97 : second outbreak 2003 : small outbreak in US with 79 cases 2005 : 49 cases reported from sudan Sept. 2017 – may 2019 : Nigeria September 2018 : UK May 2019 : Singapore HUMAN MONKEYPOX

13. 1976 - First discovered – America (182 cases & 29 died) 1999 : second outbreak in Netherland (318 cases &32 death) 2001 : largest outbreak in Spain (449 cases & 6 died) 2005: Canada (127 cases & 29 died 2014: Portugal (304 cases & 7 death) 2015: Northern California (81 cases) 2019: Western North Carolina (141 cases & 4 death) Every year: 8000-18000 cases occur in US. Legionnaires ’ Disease

14. EBOLA VIRAL DISEASE F irst discovered in 1976 near the Ebola River. Since then, outbreaks have appeared sporadically in Africa. The 2014 Ebola outbreak is the largest in history. Primarily affecting Guinea, Northern Liberia, and Sierra Leone . Ebola virus disease (EVD), previous known as Ebola hemorrhagic fever (Ebola HF) Fatality rate of up to 90 % Transmitted by direct contact with the blood, body fluids and tissues of infected animals or people 15

15. AIDS 16

16. 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) Canada (243) USA (72) Colombia (1) Kuwait (1) South Africa (1) India (3) Australia (5) New Zealand (1) Korea Rep. (3) Macao (1) Taiwan (698) Malaysia (5) Indonesia (2) Philippines (14) Mongolia (9) Russian Fed. (1) Total: 8,439 cases, 812 deaths, 30 countries Source: www.who.int.csr/sars SARS The First Emerging Infectious Disease Of The 21st Century No infectious disease has spread so fast and far as SARS did in 2003 13

17. 18 Swine Flu (H1N1) Pandemic outbreak since April 2009 April 15 th 2009 CDC identifies H1N1 (swine flu) April 25 th 2009 WHO declares public health emergency By May 5 th 2009 more than 1000 cases confirmed in 21 countries May 16 th 2009 India reports first confirmed case Cases of swine flu have been reported in India, with over 31,156 positive test cases and 1,841 deaths up to March 2015

18. 19 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 this virus or culled to prevent further spread Majority of human H5N1 infection due to direct contact with birds infected with virus

19. 1947: First discovered in a monkey, Uganda. In 195: First human cases detected. Before 2007 : 14 human cases documented. June 2015:- First case in Brazil. 2016:- In U.S ., over 3,000 cases. January 22, 2016, CDC activated its Emergency Operations Center (EOC) On February 8, 2016, CDC elevated its EOC activation to a Level 1, the highest level.

20. 21 Malaysian Nipah virus epidemic 1998-1999 An outbreak of Nipah virus in Malaysia & Singapore Overcrowding results in viral transmission to pig handlers The virus persists in low numbers in the island flying fox , a type of fruit bat and Malay si an flying fox . Of the 269 human cases of viral encephalitis associated with Nipah virus infection reported in Malaysia in 1999, 108 were fatal (Ministry of Health Malaysia, 2001).

21. 22 Emerging Food borne & water borne disease Accounts for 20 million cases in the world annually (T.D. Chugh-2008) Incidence is increasing Half of all known food borne pathogens discovered during the past 25 years Most common associated organisms are: Entero hemorrhagic Escherichia coli, Vibrio cholerae, Campylobacter sp.

22. 23 R e -e m e r g i ng i n fec ti ous d i s e a s es are “ old d i s e a s e s new pr o ble m . (New threats)”. A r e -e m e r g ing i n f e c t ious di s e a se i s a on e w h i ch was p revio u s l y controlled but once again has risen to be a significant health problem. This term also refers to that disease which was formerly confined to one geographic area, has now spread to other areas. Re-emerging Infectious Diseases

23. 24 Examples

24. Factors contributing to the emerging & re-emerging diseases

25. AGENT

26. EVOLUTION OF THE INFECTIOUS AGENT Genetic change Antibiotic resistance Resistance of vector

27. HOST

28. Change in behaviour Ecological disruption Increased number of immu n o c om p r o mised hosts. International travel

29. ENVIRONMENT

30. Urbanization & Industrialization Improper planning of township Overcrowding Deforestation

31. Poverty Long-term impact of global warming Climate change Breakdowns in public health measures

32. Lack of health care services War & political conflict Deterioration in surveillance system

33. 34 Controlling the reservoir Interrupting the transmission Protecting the susceptible host Strengthening of the disease surveillance system Encouraging research initiations for treatment regimens and diagnostics Encouraging research for new methods of control measures Establishment of drug resistance Control of Emerging and Re-emerging Diseases

34. 35 Increase knowledge and skill ; Educate the public Encourage partnerships with consumers and other disciplines Support health care legislation Involve in research Encourage using multidisciplinary efforts. Influence local and National economic and political options Continue to advance nursing concern Role of Doctors in Prevention

35. 36 National programme for prevention and control of vector borne diseases Legislations for elimination Communities awareness of the disease Minimizing transmission of infection: By Risk communication to the family members Minimizing vector population Minimizing vector – individual contact Reporting to the nearest public health authority Role of Public Health Authorities

36. 37 Safe water Sewage treatment and disposal Food safety programme Animal control programme Vaccination programme Public health organization Public health measures to prevent infectious diseases

37. Developing global and regional strategies Appointing Task Force Generous grant from WHO regular budget Support the World Bank grant GOARN (Global Outbreak Alert & Response Network) Mechanism for combating international disease outbreaks Ensure rapid deployment of technical assistance, contribute to long-term epidemic preparedness & capacity building 38 Response of the WHO

38. 39 Surveillance at national, regional, global level epidemiological, laboratory ecological anthropological Investigation and early control measures Implement prevention measures behavioural, political, environmental Monitoring, evaluation Key Tasks in Dealing with Emerging Diseases

39. Peripheral labor a tories District laboratories Disease Surveillance unit Disease Surveillance unit Disease Surveillance unit National laboratory State laboratories Disease Surveillance unit AC T ION 40 LAB SURVEILLANCE Recommended laboratory testing in emerging infections: Molecular testing- PCR, Rapid test – for flu, Dengue-NS1 antigen, Antimicrobial resistance-susceptibility testing , gene detection by PCR

40. Factors Solution Migration Proper health screening, vaccination Travel Immunization, infection control measure Urbanization Proper sanitation, adequate housing, good infrastructure Human behaviour Education, behaviour modification Antibiotic usage Judicious use of antibiotic Correct antibiotic for correct pathogen (with right dosage and route). Strengthen infection control measures Solutions

41. Multiple expertise needed ! Infec t ious diseases Ep i dem i o- logy Pub l ic Health I n ternati o nal field experience Infor m ation manage m ent Laboratory Telecom. & I n for m atics 42 Skills needed for prevention

42. 16/02/2016 43 SASMITA RAUT , COOMUNITY HEALTH NURSING

43. 44 Conclusion The true prevalence of many diseases is not known. Since we live in a global village, we cannot afford to be complacent about the tremendous economic, social and public health burden of these diseases. Effective surveillance is the key to their early containment. There is a need to develop epidemiology improved diagnostic facilities, a strong public health structure, effective risk communication, epidemic preparedness and rapid response.

44. 45 Reference Park .k , “ Park text book of Preventive and social medicine ”, 23 rd edition ,2015 , m/s Banarsidas Bhanot ,page no – 355-359 Suryakantha . AH ,” Community medicicines with recent advances ”,4th edition , 2017 , Jaypee Brother medical publishers ,(p)ltd, 4 th edition , page no 965-970 Dash Bijayalaskhmi , A Comprehensive Textbook of Community Health Nursing, 1 st edition, Jaypee Brothers, Publisher, 2016, Pp - 540-542.

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