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Current national emerging infectious disease threadsBangladesh perspective 1 Introduction • An infectious disease - is a clinically evident illness resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multi cellular parasites, and aberrant proteins known as prions. - are also called communicable diseases or transmissible diseases due to their potential of transmission from one person or species to another by a replicating agent. • Infectious Diseases responsible for 15 million (26%) of 57 million annual deaths in a global population of 6·2 billion • The prevention and control of communicable diseases represent a significant challenge to those providing health-care services in Bangladesh. • Sound knowledge on the disease epidemiology is a must for the health service providers in various levels. 2 Factors involved in infectious disease emergence • International trade and commerce • Human demographics and behavior • • • • • Human susceptibility to infection Poverty and social inequality War and famine Breakdown of public-health measures Technology and industry • Changing ecosystems • • • • • Climate and weather Intent to harm Lack of political will Microbial adaptation and change Economic development and land use Morens MD Lancet ID 2008 3 Common ID in Bangladesh The Bangladesh population is namely affected by – – – – – – – – diarrheal diseases, cholera, hepatitis A & E, Malaria, Mycobacterial Disease like Tuberculosis and Leprosy, Dengue, Japanese encephalitis, Nipah virus infection, etc. 4 Factors associated with transmission In Bangladesh the following factors are associated with transmission of Infectious diseases: – Crowding, – poor access to safe water, – inadequate hygiene and toilet facilities, – unsafe food preparation and handling practices 5 Malaria • Malaria risk Bangladesh. exists throughout the year in • Thirteen out of 64 administrative districts are high malaria endemic areas. 98% of all malaria cases reported are from these districts, which are mainly located in the border areas of India and Myanmar. 6 7 Tuberculosis • Tuberculosis still remains as a major public health problem, which ranks Bangladesh fifth among the high-TB burden countries in the world. • The present revised National Tuberculosis Program (NTP) was launched and field implementation of DOTS (Directly Observed Treatment short course) was started in 1993. 8 Leishmaniasis or Kala Azar • Leishmaniasis or Kala Azar is endemic in Bangladesh and has an incidence of 175 per 100,000 per annum. • It is caused by a protozoa which is transmitted from the bite of infected sand fly and may present in cutaneous or visceral forms (particularly common in Bangladesh). 9 Filariasis • Filariasis is a mosquito borne parasitic disease causing swelling of limbs, urogenital organs, breast, etc. with long arm disability. • In Bangladesh, it is endemic in 23 districts, mostly the bordering ones. • About 20 million people are already infected, most of whom are incapacitated. 10 Endemic Status of Filarisis in BD 11 Leprosy • Leprosy has been a major health problem in Bangladesh for a long time. • Bangladesh was considered a high endemic country and was listed among ten countries with high case load(1992). • Leprosy situation has changed globally after 1981 when the Multi Drugs Treatment (MDT) were introduced. 12 Newly detected cases of Leprosy (January – December 2008) 13 Hepatitis • Hepatitis A virus infection is common in Bangladesh with a prevalence of about 2% to 7%. • Prevalence of hepatitis C virus infection is less than 1%. Sporadic outbreak is often seen caused by hepatitis E virus infection; but presence of hepatitis D infection is not exactly known. 14 Polio • Polio free status prevailed from 2001 until now (June 2009) except a small window period in 2006 when 18 cases of child polio were seen in boarder areas of Bangladesh. • It is assumed that these cases were imported from India. 15 Dengue • Dengue fever/Dengue haemorrhagic fever (DF/ DHF) is a viral disease transmitted by the Aedes aegypty mosquito. • It is on the increase in South East Asia. • Bangladesh reported 100,000 cases in 2005. However case fatality rate (CFR) remained <1% up to 2006. 16 Source: Dengue Program, DGHS, Mohakhali, Dhaka 17 Diarrhea – The Diarrheal disease is endemic in all countries of the South East Asia Region that includes Bangladesh. – The diseases causes the bulk of the under five mortality in Bangladesh. – The main cause of death from acute diarrhea is dehydration resulting from loss of fluids and electrolytes. – The diarrhoeal diseases are of two types eatery diarrhea and bloody diarrhea (dysentery). – Several microorganisms cause the disease, but major organisms responsible for the disease are V. cholera and Shigella. 18 Diarrhoeal Report by Division and by Year (2001-2008) 19 Nipah Encephalitis • Nipah is a zoonotic viral disease first identified in Nipah village of Malaysia in 1998-1999. • In Bangladesh, Nipah emerged as a new killer disease from 2001. • It may be manifested as a mild form of viral fever to severe form causing encephalitis or severe respiratory distress syndrome. • Nipah experience in Bangladesh shows that the disease is a highly fatal one. So far 7 outbreaks have been recorded in Bangladesh. 20 Suspected Nipah outbreak in Bangladesh 21 HIV/AIDS • Since 1989 a total cumulative of 1495 cases of HIV/AIDS have been confirmed and reported as end of November 2008.Of which 476 have developed AIDS out of whom 165 have since died. • December 2007 to November 2008 a total of 288 new HIV infection recorded and reported, of which 111 new AIDS cases identified of whom 42 died. The estimated total number of people living with HIV/AIDS is around 7,500 as of December 2006. 22 Yearly Cases of HIV-AIDS (2003 to 2008) 23 Avian Influenza (Bird flu) • Avian Influenza or "Bird flu" is a contagious disease of animals caused by viruses that normally infect only birds and less commonly pigs. • Avian influenza viruses are highly species-specific, but on rare occasions cross the species barrier to infect humans. • So far one Avian Influenza case has been identified in Bangladesh on 22 May 2008, but the person is still surviving. • Total case reported to WHO till 11 February 2009 is 407. Total numbers of deaths are 254. • Case Fatality is calculated as 63%. • Since the detection of the first case in our country, Bangladesh is kept in Pandemic Alert Period. 24 Source: Bangladesh Bureau of Statistics (population) and WHO Global Tuberculosis Report (2009) (other indicators) 25