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Responding to Communicable Diseases Dr. Cheryl Anderson National RAP Conference, Vancouver , February 20, 2007 What is a Communicable Disease? Sickness caused by transmission of an infectious agent to a susceptible host Infectious agents include: Viruses Bacteria Protozoa Worms How do humans get infected? TRANSMISSION of infectious agents to Susceptible Human Host occurs in variety of ways, including: Touching/biting/kissing Sexual intercourse Droplets from sneezing, coughing, spitting Airborne particles, e.g. TB Mother to fetus during pregnancy Injections of contaminated blood Does every exposed host get sick? The Healthy host may not get sick or may have a mild response to infection: TB – 90% of infected never get sick The human host may become a carrier capable of infecting others without ever getting sick Hepatitis B and C How many people die from Infections? Globally 1/3 of premature deaths are infectionrelated – mostly in poor countries: Diarrheal disease – 2-3 million deaths yearly Malaria – 2-3 million deaths yearly TB – 2-3 million deaths yearly HIV – more than 4 million deaths in 2005 Why poor countries? Poor nutrition Poor living conditions contaminated water no sewage crowded or no housing Poor or non-existent health care – preventative & curative What Prevents Infections? Public Health Infrastructure Sewage systems Safe food Safe water Housing codes Vector control, e.g. mosquitoes Personal Prevention strategies Good nutrition Immunization Hygiene Protective coverings Condoms Mosquito nets Disinfestation/Disinfection Avoid exposure Medical interventions & infection control Isolation of sick person e.g. TB Prophylactic treatment of contacts Early detection and treatment Direct Observed Therapy (DOT) for TB Ensures completion of therapy Reduces development of resistance to treatment Infection control in hospitals/facilities What puts refugees at risk? Increased exposure to diseases endemic to Country of origin Refugee camp or transit country Poor public health infrastructure Poor nutrition Poor immunization rates Crowded housing Poor or non-existent health care How does CIC protect the Public’s Health? Immigration Medical Examination screens for: HIV, Tuberculosis, Syphilis Medical Surveillance Post Landing by Public Health for: Inactive tuberculosis Treated positive syphilis serology If HIV positive, immigrant advised to contact clinic specializing in HIV following entry into Canada Who is at risk for TB in Canada? Tuberculosis (TB) in 2005 Total cases 1616 (5.0/100,000) Canadian born cases 519 (2.0/100,000) Aboriginal cases 308 (26.8/100,000) Non-Aboriginal cases 211 (0.9/100,000) Foreign born cases 1016 (14.8/100,000) Rates in top 3 source countries in 2004 China – 101/100,000 India – 168 /100,000 Philippines – 293 /1000,000 Reducing risk of infection/illness Food Security and Nutrition Means and access to healthy food Canada Food Guides Food Safety Instruct on proper storage and preparation Appropriate Housing Reducing Risk of Infection Personal hygiene Immunizations Avoiding exposure Protective coverings Condoms Reducing Risk of Illness when Infected Early detection and treatment Examples – HIV, TB Healthy living Exercise, good nutrition, sleep Avoiding harmful substances, e.g. nicotine How do settlement workers stay healthy? Healthy lifestyle – exercise, nutrition, sleep, etc. Immunizations Personal hygiene Medical follow-up if: Asymptomatic but known exposure; or Symptomatic for early detection/treatment Public Funded Immunizations (Canada) Diptheria Tetanus Pertussis (whooping cough) Polio Haemophilus influenzae type b Hepatitis B Measles, Mumps, Rubella Varicella (Chicken Pox) Meningococcal C conjugate Penumococcal conjugate Influenza (Flu) Information Sources: BC Health Files. Ministry of Health. www.gov.bc.ca Canadian National Report on Immunization. Canada Communicable Disease Report Supplement Vol32S3 Nov, 2006. Public Health Agency of Canada. Citizenship and Immigration Canada: Facts and Figures 2005. www.cic.gc.ca Country Profiles on Tuberculosis, World Health Organization. www.who.int Health Canada: Eating Well with Canada’s Food Guide, 2007. www.hcsc.gc.ca Heymann, David L., Editor. Control of Communicable Diseases Manual, Official Report to American Public Health Association, 18th Edition, 2004. Tuberculosis in Canada 2005. www.publichealth.gc.ca/tuberculosis BC Health File Topics - www.bchealthguide.org/healthfiles/index.stm Sneezes and Diseases Handbook http://www.vch.ca/public/communicable/docs/sneezes_diseases.pdf