Download Biological Disaster (Epidemics in India)

1 Radio serial on understanding & Managing Disaster Episode No. XVI
Biological Disaster
(Epidemics in India)
-
Dr. Sammeta Govardhan
Science Communicator
[email protected]
Cell No.9949038471
…. Signature tune ….
….Appropriate music ….
Vignan &
Uthsuka
:
That day Vignan and Usthuka returns from school early bearing swine flue
masks covering nose to ears.
Dr.Bharathi
:
Oh… Swine flue has spread to your school also?
Vignan
:
No… mammy few of the students showed swine flue symptoms, so principal
informed their parents and sent to local Hospital. Public health department has
distributed swine flue masks as a precaution, so that it will not spread to all the
students.
Dr.Bharathi
:
That’s good. You see Airports, Railway Stations, Bus stations and people
coming from abroad all are wearing it. Whole country sems to be under attack
of swine flue.
Usthuka
:
Mummy tell about indradhanush programe ? I have brought two masks extra
one for you and one for father.
Dr.Bhrathi
:
Very good. Mission Indra dhanush was launched by Union health Minister
J.P.Nadda on December 25,2014. It aims to immunize all against seven vaccine
procurable issues namely diphtheria, wooping cough, tetanus polio, tuberculosis
measles and hepatitis-B by 2020.
Vignan
:
The main target of the mission is?
Dr.Bharathi
:
The minister launched the mission on good governance day to work the birth
anniversary of Pandit Madan Mohan Malavya and birth day of former Prime
Minister Atal Bihari Vaj Payee. The minister overall target is to vaccinate 201
high focus districts, by 2020 full coverage is done.
Usthuka
:
Is the Government doing it alone?
Dr.Bharathi
:
No. No. The Ministry will be technically supported by WHO, UNICEF, Rotary
International and other donor partners, mass media inter personal
communication etc.
Vignan
:
Mummy… tell us about Indian swine Flue out break?
Dr.Bharathi
:
Swine flue is caused by HINI influenza virus. 2015 Indian swine flue out break
left 2,035 dead (as of 30 March 2015). The status of Gujarat and Rajasthan are
the worst affected. The total number of laboratory confirmed cases crossed
33000 mark with death of more than 2000 people.
2 Usthuka
:
Under what circumstances is spreads?
Dr.Bharathi
:
Every year, there was a rise in number of cases and deaths during winter as
temperature affects virus. During 2014-15 winter there was a spurt in cases of
the end 2014. In 2015 the outbreak became wide spread through India. On 12
February, 2015 Rajasthan declared an epidemic.
<<<<
Phone rings
Dr.Bharathi
:
Hellow… who is speaking?
Dr.Pavan
:
Hello sister this is Pavan speaking.
Dr.Pavan
:
>>>>
Hello … sister … how are you and the children?
Hope they are doing well.
Dr.Bharathi
:
Hai… Pavan… How do you do .. we are doing fine. Why don’t you come over here
and spend few days with us.
Dr.Pavan
:
Ha … ha … (Laughing) everything is fine here. Next week I am planning to visit
you and stay for two days.
Dr.Bharathi
:
That’s good… children will be very happy to spend the time with you.
Dr.Pavan
:
O.K. sister … then see you .. next week.
<><> Appropriate music <><>
Dr.Bharathi
:
Vignan and Uthsuka.. get up early and be ready.
Dr.Pavan uncle will be visiting us this morning.
Vignan
:
Dr.Pavan Uncle, who is working as Community Health Officer?
Uthsuka
:
Well’: it will be a good opportunity for us. We can get lot of information on
Biohazards. You know we have to participate in the essay writing competition at
our college.
Vignan
:
Yes. Epidemics in India … also require a lot of upto date information. Sure
Dr.Pavan uncle will be an excellent source of information to us.
<><> Break <><>
Dr. Pavan
:
Hai … Vignan and Uthsuka how are you?
Namasthe uncle .. welcome to our house.
Vignan
Uthsuka
:
Good morning uncle … we are eagerly awaiting your arrival.
Dr.Pavan
:
Well what is the matter? Do you need any information? .. Are you preparing for
any competition?
3 Vignan
:
Yes… uncle, you guessed correctly, we are planning to participate in the essay
writing competition at our college on Biological hazards with particular reference
to epidemics in India
Dr. Bharathi
:
Then first let uncle take bath and we all finish breakfast; then you can sit and talk.
Dr.Pavan
:
That’s very kind of you sister. Then I will get freshened and sit with you.
<><> Appropriate music <><>
Vignan
:
Uncle: What is a biological hazard?
Dr.Pavan
:
Biological hazards, also known as biohazards, refer to biological substances that
pose a threat to the health of living organisms, primarily that of humans. This can
include medical waste or samples of microorganism, virus or toxin that can affect
human health. It can also include substances harmful to other animals.
Uthsuka
:
How the term is associated with the specific symbol generally used as a warning?
Dr.Pavan
:
The term and its associated symbol are generally used as a warning, so that those
potentially exposed to the substances will know to take precautions.
Vignan
:
Who developed the international symbol for biological hazard?
Dr.Pavan
:
The biohazard symbol was developed in 1966 by Charles Baldwin, an
environmental health engineer working for the Dow Chemical Company on the
containment products.
It is used in the labeling of biological materials that carry a significant health risk,
including viral samples and by hypodermic needles.
Uthsuka
:
Are the Bio hazards agents classified for transportation?
Dr.Pavan
:
Yes … Bio hazardous agents are classified for transportation by a distinct UN
number. They are ….
- Category A: UN 2814 – means infectious substance, affecting humans: an
infectious substance in a form capable of causing permanent disability or life
threatening or fatal disease in otherwise healthy humans or animals when
exposure to it occurs. And
- Category A: UN 2900 – Infectious substance, affecting animals only. An
infectious substance that is not in a form generally capable of causing
permanent disability of life-threatening or fatal disease in otherwise healthy
humans and animals when exposure to themselves occurs.
4 Vignan
:
Is that all … are there any more left?
Dr.Pavan
:
I will cite two more categories. Category B, UN 3373 – Biological substance
transported for diagnostic or investigation purposes and the last one … Regulated
medical waste, UN 3291 – Waste or reusable material derived from medical
treatment of an animal or human or from biomedical research, which includes the
production and testing.
Uthsuka
:
Throw some light on levels of biohazard?
Dr.Pavan
:
The UNITED STATES Centers for Disease Control and Prevention categorizes
various diseases in levels of biohazard. Level 1 being minimum risk and level-4
being extreme risk. Laboratories and other facilities are categorized as Bio safety
level 1-4 or as P1 through P4 for short.
Vignan
:
What about epidemics in India?
Dr.Pavan
:
Now let us take some rest and have coffee & snacks.
That will refresh us.
Vignan
:
Agreed … let us have coffee…
(Appropriate music)
Vignan
:
Shall we discuss … about the epidemics in India.
Dr.Pavan
:
We straightly deal with them.
India had a big history of epidemics starting from nineteenth century onwards.
Plague, cholera, hepatitis, small pox, flu, Jaundice, swine flu, have caused
innumerable deaths. Let us discuss some of the epidemics starting with
meningitis.
Uthsuka
:
What type of disease is that?
Dr.Pavan
:
Meningitis is an acute inflammation of the protective membranes covering the
brain and spinal cord known collectively as the meningitis. The inflammation
may be caused by infection with viruses, bacteria or other microorganisms,
and less commonly by certain drugs. Meningitis can be life threatening .
Vignan
:
What are the symptoms?
Dr.Pavan
:
The most common symptoms of meningitis are headache ad neck stiffness
associated with fever, confusion or altered consciousness, vomiting and an
inability to tolerate light or loud noises.
Uthsuka
:
How can be the disease diagonised and treated?
5 Dr. Pavan
:
A lumber puncture diagnoses or excludes meningitis.
The first treatment in acute meningitis consists promptly administered
antibiotics and some times antiviral drugs. Corticosteroids can also be used to
prevent complications from excessive inflammation.
Now let us take some refreshment and continue the discussion.
Dr.Bharathi
:
It’s O.K… I will serve some cookies and tea…
Vignan
:
Oh.. Let us join too.
<><> Break <><> Appropriate music <><>
Vignan
:
Will it lead to long-term consequences?
Dr.Pavan
:
Yes … meningitis can lead to long term consequences such as deafness,
epilepsy, hydrocephalus and cognitive deficits, especially if not treated
quickly. Some forms of meningitis such as those associated with meningo
cocci, Haemnophilus influenza type-B; pneumococcal or mumps virus
infections may be prevented by immunization.
In 2013 meningitis resulted in 3,03,000 deaths – down from 4,64,000 deaths in
1990.
Uthsuka
:
Next disease you are going to tell --- about…
Dr.Pavan
:
We shall now deal with measles. Measles also known as morbilli, rebeola or
red measles is a highly contagious infection caused by the measles virus. Initial
signs and symptoms typically include fever, often greaten than 400F or 4
degree Celsius , cough, runny nose, and red eyes. Two or three days after the
start of symptoms, small white spots may form inside the mouth known as
Koplik’s spots. A red, flat rash which usually stats on the face and then spread
to the rest of body.
Vignan
:
Will complications occur in this case?
Dr.Pavan
:
Yes … complications do occur in about 30% and may include diarrhea,
blindness, inflammation of the brain, and pneumonia among others. Rubella
and roseola are different diseases.
Vignan
:
How the disease spreads?
Dr.Pavan
:
Measles is an air born disease which spreads easily through coughs and
sneezes of those infected. It may also spread through contact with saliva or
nasal secretions. Nine out of ten people who are not immune, who share living
space with an infected person will catch it. People are infectious to others from
four days before to four days after the start of the rash. People usually only get
the disease at most once. Testing for the virus in suspected cases is important
for public health efforts.
6 Uthsuka
:
Will the vaccine effective in preventing the disease?
Dr.Pavan
:
Yes … the measles vaccine is effective at preventing the disease. Vaccination
has resulted in a 75% decrease in deaths from measles between 2000 and 2013
with about 85% of children globally being currently vaccinated. No specific
treatment is available. Supportive care may improve outcomes. This may
include giving oral rehydration solution, healthy food, and medication to
control the fever. Antibiotics may be used if a secondary bacterial infection
such as pneumonia occurs. Vitamin –A supplement is also recommended in
the developing world.
Uthsuka
:
Globally how many people are effected by this disease?
Dr.Pavan
:
Measles affects about 20 million people a year primarily in the developing
areas of Africa and Asia. It causes the most preventable deaths of any disease.
It resulted in about 96,000 deaths in 2013 down from 5,45,000 deaths in 1990.
In 1980, the disease is estimated to have caused 2.6 million deaths per year.
Most of those who are infected and who die are less than five year old.
Vignan
:
Please throw some light on Dengue fever?
Dr.Pavan
:
Dengue fever, also known as break bone fever, is a mosquito-borne tropical
disease caused by dengue virus. Symptoms include fever, headache, muscle
and joint pains and a characteristic skin rash that is similar to measles. In a
small proportion of cases, the disease develops into the life-threatening dengue
hemorrhagic fever, resulting in bleeding, low levels of blood platelets and blood
plasma leakage or into dengue shock syndrome, where dangerously low blood
pressure occurs.
Uthsuka
:
How the dengue fever is transmitted?
Dr.Pavan
:
Dengue is transmitted by several species of mosquito within the genus Aedes,
principally A.aegypti. The virus has five different types; infection with one type
usually gives life long immunity to that type, but only short-term immunity to
the others. Subsequent infection with a different type increase the risk of
severe complications. As there is no commercially available vaccine,
prevention is sought by reducing the habitat and the number of mosquitoes and
limiting, exposure to bites.
Vignan
:
Will you explain the treatment part?
Dr. Pavan
:
Treatment of acute dengue is supportive, using either oral or intravenous
rehydration for mild or moderate disease, and intravenous fluids and blood
transfusion for more severe cases. The number of cases of dengue fever has
increased dramatically since the 1960s, with between 50 and 528 million people
infected yearly.
Vignan
:
Overall global picture of dengue is…..
7 Dr. Pavan
:
Dengue has become a global problem since second world war and is endemic in
more than 110 countries. Apart from eliminating the mosquitoes, work is
ongoing on a dengue vaccine, as well as medication targeted directly at the
virus.
Uthsuka
:
Next disease we will discuss about…..?
Dr.Pavan
:
We shall now discuss about polio myelitis, often called polio or infantile
paralysis, is an infectious disease caused by the polio virus. Approximately
90% to 95% of infections cause no symptoms. Another 5 to 10% of people have
minor symptoms such as; fever, headache, vomiting, diarrhea, neck stiffness
and pains in the arms and legs. In about 0.5% of cases there is muscle resulting
in an inability to move.
Vignan
:
How the polio virus spread among people?
Dr. Pavan
:
Polio virus usually spread from person to person through infected feces
entering the mouth. It may also be spread by food or water containing human
feces and less common from infected saliva. The disease may be diagnosed by
finding the virus in the feces or detecting antibodies against it in the blood.
Uthsuka
:
Ha…ha. How can we prevent the spread of disease?
Dr. Pavan
:
The disease is preventable with the polio vaccine; however a number of doses
are required for it to be effective. In 2013 Polio affected 416 people down from
3,50,000 cases in 1988. In 2014 the disease was only spreading between people
in Afghanistan, Nigeria and Pakistan. In 2015 wild polio was eliminated in
Nigeria.
Vignan
:
Who developed vaccine for Polio?
Dr. Pavan
:
The first polio vaccine was developed in the 1950s by Jonas Salk. It is hoped
that vaccination efforts and early detection of cases will result in global
eradication of the disease by 2018. In 2013; however, there were reports of
new cases in Syria and in May, 2014, the World health organization declared a
public health emergency of international concern due to out breaks of the
disease in Asia, Africa and the Middle East. The disease does not naturally
occur in any other animals.
:
Let us take a break here … refresh ourselves and sit for some more time.
:
Agreed … We do … agree.
Uthsuka
<><> Break <><> Appropriate music <><>
8 Uthsuka
:
Still how many diseases we will discuss?
Dr. Pavan
:
Last but not the least … We will discuss about Typhoid fever. Typhoid fever
also known simply as typhoid is a symptomatic bacterial infection due to
salmonella typhii. Symptoms may vary from mild to severe and usually begin
six to thirty days after exposure. Often there is a gradual onset of a high fever
over several days. Weakness, abdominal pain, constipation , and headaches
also commonly occur. Diarrhea and vomiting are uncommon.
Usthuka
:
Is there any further visible symptoms?
Dr. Pavan
:
Some people develop a skin rash with rose coloured spots. In severe cases
there may be confusion without treatment symptoms may last weeks or months.
Other people may carry the bacteria without being effected; however, they are
still able to spread the disease to others. Typhoid fever is a type of enteric fever
along with paratyphoid fever.
Vignan
:
Cause of typhoid fever?
Dr. Pavan
:
As already told in the beginning, the cause is the bacterium salmonella typhii,
also known as salmonella enteric serotype typhi, growing in the intestines and
blood. Typhoid is spread by eating or drinking food or water contaminated with
the feces of an infected person. Risk factors include poor sanitation and poor
hygiene. Those who travel to the developing world are also at risk.
Vignan
:
Will it infect other animals also?
Dr. Pavan
:
No… No… the humans are the only animal infected.
Usthuka
:
How the disease is diagnosed?
Dr. Pavan
:
Diagnosis is by either culturing the bacteria or detecting the bacteriums DNA in
the blood, stool; or bone narrow. Culturing the bacterium can be difficult. Bone
marrow testing is the most accurate. Symptoms are similar to that of many
other infections diseases. Typhus is a different disease.
Uthsuka
:
Will the vaccination be of any help?
Dr. Pavan
:
Yes .. to a larger extent. A typhoid vaccine can prevent about 50% to 70% of
cases. The vaccine may be effective for upto seven years. It is recommended for
those at high risk or people travelling to areas where the disease is common.
Other efforts to prevent the disease include providing clear drinking water,
better sanitation, and better hand washing.
Uthsuka
:
Further what can be done?
9 Dr Pavan
:
Until it has been confirmed that an individual’s infection is cleared, the
individual should not prepare food for others. Treatment of disease is with
antibiotics such as Azithromycin, fluroquinolones or third generation
cephalosporins. Resistance to these antibiotics has been developing, which has
made treatment of the disease more difficult.
Vignan
:
What is the position of with regards to Spread of disease?
Dr. Pavan
:
In 2010 there were 27 million cases reported. The disease is most common in
India, and children are most commonly affected. In 2013 it resulted in about
161,000 deaths – down from 181,000 in 1990, i.e., 3% of global total. The risk
of death may be as high as 25% without treatment, while with treatment it is
between 1 and 4%.
Uthsuka
:
Can you throw some light on pests?
Dr . Pavan
:
Definitely … a pest is a plant or animal detrimental to humans or human
concerns. In its broadest sense, a pest is a competitor of humanity, pest insects,
nemartodes, parasites, gastropods, plant pests, mammals and birds infectatious
and cause damage to food, crops, skin irritation disease leading to economic
loss.
Vignan
:
Can you tell us something about cattle epidemics?
Dr. Pavan
:
When animal epidemics constitute Disasters; Livestock Plagues?
Epidemics are usually defined as occurrence of a certain disease above
expected levels in a population. A few cases of a rare disease may constitute an
epidemic, as may be gradual increase of chronic or benign disease; epidemics
may also be non-contagious like mad cow disease.
Vignan
:
Is it so….
Dr. Pavan
:
Yes…. But the word disaster likely refers to those epidemics caused by rapidly
transmitting pathogens that produce acute and serious disease in large number
of hosts. In livestock, rinderpest, new castle disease and classical swine fever
are archetypal examples.
Uthsuka
:
Will they affect human beings?
Dr.Pavan
:
Yes … the animal diseases that can affect people are known as zoonoses.
Uthsuka
:
How the livestock plague can be managed?
Dr.Pavan
:
Plagues known no boundaries and modern management is increasingly
transnational. A global level, three organizations have mandates that cover
10 livestock epidemics. The world organization for Animal health has a global
mandate to set standards for trade in animals and animal products. The food and
Agriculture organization of the united nations has had long involvement in live
stock epidemics. The World Health organization is concerned with livestock
plagues that are also zoonoses or have potential to evolve into human
pandemics. Together, the so-called three sisters of WHO, FAO and QIE
operate the Global early warning and response system which has the objective
of improving coordination for identification and management of major animal
diseases and zoonoses.
Usthuka
:
Tell us how it is managed?
Dr.Pavan
:
Management of epidemics is a major collective exercise. It involves local,
mandal, district, state and union Government. However the following activities
can effectively manage the spread of epidemics, they are
-
Quarantine
Import bans
Identification of suspicious persons and premises
Duty of reporting (Punishment)
Isolation
Disinfection
Compensation in case of loss of life.
Vignan
:
What is the role of civil society?
Dr.Pavan
:
Essentially ‘civil society’ is made up of ordinary citizens who organize
themselves outside government and the public services deal with specific issues
and concerns that normal governmental process cannot address by itself.
Societies function more effectively when the state and its citizens engage
openly on how policies are formulated and implemented.
Usthuka
:
Give us an example
Dr.Pavan
:
In the context of AIDS many different individuals and organisations participate
activity in the epidemic response outside the government structures, at the end
the spectrum they include the woman at village level planting a vegetable
garden to feed a family of orphaned children.
Vignan
:
Give us a example of case study?
Dr.Pavan
:
Let me explain a case study.
It is concerned with an out break of cholera in West Bengal, hearing objectives
were as follows. At the end of the case study the student will be able to.
1. Understand the role of the laboratory in surveillance and out break
detection.
2. Identify the number of samples to take and the transport media to use
during an outbreak of suspected cholera.
3. Provide the minimum information needed to ensure appropriate laboratory
testing.
4. Take appropriate measures to prevent contamination and /or infection when
11 collecting specimens to send to a laboratory.
5. identify the appropriate laboratory tests to request during an outbreak of
diarrhea.
6. Understand the key elements of quality assurance for laboratory.
7. Interpret vibrio cholera biotypes and serotypes.
8. Understand the relevance of antibiotic susceptibility testing during the
investigation of an outbreath of cholera.
9. Decide whether environmental samples are needed during an out break of
diarrhea
10. Integrate epidemiological and laboratory data to formulate conclusions
during cholera out break investigations.
Vignan
:
Is any thing left over to be discussed in the title topic?
Dr.Pavan
:
Yes … we shall conclude this episode with a short discussion on food
poisoning. Food poisoning is a common, yet distressing and sometimes lifethreatening problem for millions of people throught the world. People infected
with food-borne organisms may be symptom free or may have symptoms
ranging from mild intestinal discomfort to severe dehydration and bloody
diarrhea. Depending on the type of infection, people can even die as a result of
food poisoning.
Uthsuka
:
How many types of food poisoning are there?
Dr.Pavan
:
More than 250 different diseases can cause food poisoning. Some of the most
common diseases are infections caused by bacteria, such as campylobacter,
Salmonella, shigella, E.Coli, Listeria, Botulism and norovirus.
Usthsuka
:
What is compylobactor infection?
Dr.Pavan
:
Complylobactor is a bacterium that causes acute diarrhea. Transmission
usually occurs through ingestion of contaminated food, water, or unpasteurized
milk, or through contat with infected infants, pets or wild animals.
Vignan
:
What is salmonella?
Dr.Pavan
:
Salmonella is a bacterial infection that can be passed on to humans from
domestic and wild animals. But most often, it is caused by drinking
unpasteurized milk or by eating under cooked poultry and eggs.
Uthsuka
:
What is Shigella?
Dr.Pavan
:
Shigella is a bacteria generally transmitted through feces. It causes dysentery,
12 an infection of the intestine, that causes severe diarrhea. The disease generally
occurs in tropical or temperate climates, especially under conditions of
crowding, where personal hygiene is poor.
Vignan
:
What is E.Coli & Listeria infection?
Dr.Pavan
:
E.Coli is a growing cause of food borne illness
primarily found in soil and water.
Uthsuka
:
What is Botulism?
Dr.Pavan
:
The bacterium clostridium botulinum is responsible for causing the rare but
serious illness botulism.
Vignan
:
Really it was a wonderful experience to know about Biological disasters with
special reference to epidemics in India and man made disaster.
Dr.Pavan
:
Yes … we have to concentrate on our efforts on mitigation, preparedness, and
come out with minimum causualities.
(Appropriate music)
CONCLUSION
Author:
Dr.Sammeta Govardhan
H.No. 3-13-156/1
Kumarpally, Hanamkonda
Warangal – 506 001, Telangana.
Cell no. 99490 38471
and Lysteria is bacteria