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mmmmm mmmmm mmmmm CHP400 COMMUNITY HEALTH PROGRAM-II Mohamed M. B. Alnoor mmmmm mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Contents mmmmm • Definitions • Emerging Infections since 1973 • Major factors contributing to the emergence of infectious diseases mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Definitions mmmmm Emerging Infectious Diseases “New, reemerging or drug-resistant infections whose incidence in humans has increased in the past two decades or threatens to increase in the near future.” mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Definitions mmmmm Emerging Infectious Diseases Emerging/New Newly appeared in a population. Re-emerging/Resurging Incidence increased over20 years or threatens to increase soon. Deliberately emerging: Developed for nefarious use mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases W H Y ????? mmmmm After great advances in medical research, antimicrobial drug discovery, technology development, improvement in sanitation.. WHY are microbes still posing such a problem!!?? mmmmm mmmmm Emerging and Re-emerging Infectious Diseases mmmmm mmmmm Major Factors Contributing to the Emergence of Infectious Diseases mmmmm س ص ل ل ت ظ ع ل قال رسول هللا لى هللا ليه و م « :م هر ا فاحشة في قوم قط ي ف ت ت ع ل ه ل م ل حتى نوا بها إال فشا م الطاعون واألوجاع ا تي م كن ضت في ف م رواه اين ماجه والحا مك ه أسال م الذين ضوا ». mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases 1. Ecological changes & agricultural development 2. Human demographics and behavior 3. Technology and industry 4. Economic development and land use 5. International travel and commerce 6. Microbial adaptation and change 7. Breakdown of public health measures mmmmm mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases More Factors Contributing to the Emergence of Infectious Diseases mmmmm 8. Human vulnerability 9. Climate and weather 10. Poverty and social inequality 11. War and famine 12. Lack of political will 13. Intent to harm mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 1. Ecology & agriculture Placing people in contact with a reservoir of an infection (zoonotic or arthropod-borne) either by: - Increasing proximity - Changing conditions microbe natural host mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 1. Ecology & agriculture Reforestation in USA Increased the number of deer & deer ticks Increased Human contact with deers Deer tick Human affection by Lyme disease mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 1. Ecology & agriculture Conversion of grassland to maise cultivation Rodents & people come together Rodent Argentine Haemorrhagic fever in humans mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 1. Ecology & agriculture Pig Farm China Duck farm Mixing vessels Influenza Influenza Influenza mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 1. Ecology & agriculture Increased Rice cultivation in South East Asia. Field mouse Increased human contact with Field mouse Introduction of Korean haemorrhagic fever in Humans mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 2. Human demographics and behavior Inflation of population size Insufficient infrastructures Use open containers for water Breading mosquitos Dengue fever in Asia mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 2. Human demographics and behavior Urbanization • More people concentrated in cities-often without adequate infrastructure • Increases in the elderly populations mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 2. Human demographics and behavior Urbanization • Increases in children in daycare: working woman with kids under 5 was 30% in 1970, became 75% in 2000. • Fast paced Lifestyles- increase in convenience items and more stress. • High-risk behavior- Drug use and unprotected sex mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 3. Technology and industry • Modern mass production increases the chance of accidental contamination and amplifies the effect of such contamination. -Contamination of hamburger meat by E.coli strains causing haemolytic uraemic syndrome. -Feeding cattle by byproducts of sheep causing bovine spongiform encephalitis. mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 3. Technology and industry • New diagnostics lead to identification of previously unknown microbes for known diseases e.g. Helicobacter pylori and peptic ulcer. • Medical technology - People living longer, but have weaker immune systems. - Blood & organ transplantation transmit infections. mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 4. Economic development and land use • Changing ecology influencing waterborne, vectorborne disease transmission (e.g. dams, deforestation) • More exposure to wild animals and vectors (Lyme disease, ehrlichiosis, babesiosis, HPS,…) mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 5. International travel and commerce • Circumnavigation: 365 days, now 36 hours • International travelers: 400 millions • Increased incidence of both Tuberculosis and Influenza transmission on long flights • Transportation of products - Rapid transport of disease harboring fresh products. - Transport of livestock facilitates transport of viruses and arthropods (esp. ticks) mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 5. International travel and commerce • Travel and HIV/AIDS. • Cholera and Hajj. • Historically: - Silk route and plague. - Slaves trade and yellow fever. - Migration to new world and smallpox. mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 6. Microbial adaptation and change • Lateral transfer is common: shown by genome sequencing. • Rapid adaptation: due to high mutation rates in RNA viruses. • Rapid build up of rare mutations: because of quick reproduction • Resistance: Antimicrobials used in livestock growth enhancement and over-prescription of antimicrobials by doctors. mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 7. Breakdown of public health measures • Decrease in chlorine in water supplies lead to rapid spread of cholera in South America. • Non functioning water plant in Wisconsin, USA lead to outbreak of waterborne cryptosporidium mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Major Factors Contributing to the Emergence of Infectious Diseases mmmmm 7. Breakdown of public health measures • Inadequate vaccinations and Diphtheria in former USSR independent countries. • Discontinued mosquito control efforts and dengue and re-emergence of malaria. mmmmm mmmmm mmmmm mmmmm Emerging and Re-emerging Infectious Diseases Summary mmmmm • Infectious diseases will always be there • New infectious diseases will always occur • Man and his behavior are the main reasons
