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Emerging and Re-emerging Infectious Diseases INTRODUCTION RESPONSIBLE FACTORS CLASSIFICATION DISEASES OF CONCERN PREVENTION.

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Presentation on theme: "Emerging and Re-emerging Infectious Diseases INTRODUCTION RESPONSIBLE FACTORS CLASSIFICATION DISEASES OF CONCERN PREVENTION."— Presentation transcript:

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2 Emerging and Re-emerging Infectious Diseases

3 INTRODUCTION RESPONSIBLE FACTORS CLASSIFICATION DISEASES OF CONCERN PREVENTION

4 INTRODUCTION : INFECTIOUS DISEASES Accounted for about 26% of the 57 million deaths worldwide in Remain among leading causes of death worldwide despite remarkable advances in medical research and treatments. In addition, nearly 30% of all disability adjusted life years (DALYs) could be accounted to infectious diseases. Emergence of new infectious diseases, re-emergence of old infectious diseases and persistence of intractable infectious diseases, all led to persistence and even increase in infectious diseases in many parts of the world.

5 DEFINITIONS Emerging Infectious Diseases It includes outbreaks of previously unknown diseases or known diseases whose incidence in humans has significantly increased in the past two decades. Re-emerging Infectious Diseases These are the known diseases that have reappeared after a significant decline in incidence.

6 Are infectious diseases emerging more recently than before? Are infectious diseases emerging more recently than before?

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10 Major Factors Contributing to Emerging Infections: ) Human demographics and behavior 2) Technology and Industry 3) Economic development and land use 4) International travel and commerce 5) Microbial adaptation and change 6) Breakdown of public health measures

11 More Factors Contributing to Emerging Infections: ) Human vulnerability 2) Climate and weather 3) Changing ecosystems 4) Poverty and social inequality 5) War and famine 6) Lack of political will 7) Intent to harm

12 Emerging Infections: Human Demographics, Behavior, Vulnerability More people, more crowding. Changing sexual mores (HIV, STDs) Injection drug use (HIV, Hepatitis C) Changing eating habits: out more, more produce (food-borne infections) More populations with weakened immune system: elderly, HIV/AIDS, cancer patients and survivors, persons taking antibiotics and other drugs.

13 Emerging Infections: Technology and Industry Mass food production (Campylobacter, E.coli O157:H7, etc…) Use of antibiotics in food animals (antibiotic-resistant bacteria) More organ transplants and blood transfusions (Hepatitis C, WNV,…) New drugs for humans (prolonging immunosuppression) A big city on a sunny day

14 Emerging Infections: Economic Development, Land Use, Changing Ecosystems Changing ecology influencing waterborne, vector borne disease transmission (e.g. dams, deforestation) Contamination of watershed areas by cattle (Cryptosporidium) More exposure to wild animals and vectors (Lyme disease, erhlichiosis, babesiosis, …)

15 Emerging Infections: International Travel and Commerce Persons infected with an exotic disease anywhere in the world can be into your city within hours (SARS) Foods from other countries imported routinely into your city (Cyclospora,….) Vectors hitch-hiking on imported products (Asian tiger mosquitoes on bamboos….)

16 Emerging Infections: Microbial Adaptation and Change Increased antibiotic resistance with increased use of antibiotics in humans and animals (VRE, VRSA, penicillin- and macrolide- resistant Strep pneumoniae, multidrug-resistant Salmonella,….) Increase virulence (Group A Strep) Jumping species from animals to humans (avian influenza, HIV?, SARS?)

17 Emerging Infections: Poverty, Social Inequality, Breakdown of Public Health Measures Lack of basic hygienic infrastructure (safe water, safe foods, etc..) Inadequate vaccinations (measles, diphtheria) Discontinued mosquito control efforts (dengue, malaria) Lack of monitoring and reporting (SARS)

18 Emerging Infections: Intent to Harm Bioterrorism: Anthrax in US 2001 Bio-Crimes: Salmonella, Shigella Potential agents: Smallpox, Botulism toxin, Plague, Tularemia, ….

19 LIST OF EMERGING & RE- EMERGING DISEASES GROUP-1 PATHOGENS NEWLY RECOGNIZED IN LAST TWO DECADES ACANTHAMOEBIASIS BABESIOSIS BARTONELLA HENSELE EHERLICHIOSIS CORONA VIRUS(SARS)

20 CONTD… H.PYLORI HEPATITIS C HEPATITIS E HUMAN HERPES VIRUS8(HHV8) HHV6 LYME BORRELIOSIS PARVO VIRUS B19

21 GROUP-2 REMERGING PATHOGENS ENTEROVIRUS71 CLOSTRIDIUM DEFFICILE COCCIDIOIDES IMMITIS MUMPS VIRUS PRION STREPTOCOCCUS GROUP A STAPHYLOCOCCUS AUREUS

22 GROUP-3 AGENTS WITH BIOTERRORISM POTENTIAL CATEGORY A B.anthracis C.botulinum Y.pestis V.major F.tulariensis Hanta virus

23 CATEGORY B B.mallei B.pseudomallei C.brunetti Brucella Ricin toxin Epsilon toxin(c.perfringens) EnterotoxinB(staphylococcus) Viral encephalitides(Japanese encephalitis virus,kyasanur forest virus)

24 CONTD… FOOD &WATER BORNE DISEASES BACTERIA(E.coli,Vibrio,shigella) VIRUS(Hepatitis A,Calcivirus) PROTOZOANS(Giardia,Entamoeba,Cryptosporid ium)

25 CATEGORY C TICK BORN HAEMORRHAGIC FEVERS TICK BORN ENCEPHALITIC FEVER YELLOW FEVER MDR TB & XDR TB RABIES SARS ASSOCIATED CORONAVIRUS ANTIMICROBIAL RESISTANCE

26 IMPORTANT RE-EMERGING DISEASES TUBERCULOSIS DENGUE FEVER MALARIA MENINGOCOCCAL MENINGITIS BUBONIC PLAGUE HANTA VIRUS PULMONARY SYNDROME

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28 HIV/AIDS Present situation and challenges HIV epidemic in SEAR mainly due to: Unsafe sex Injecting drug use Poverty Low literacy Widespread stigma Weak health systems. India, Thailand, Myanmar, Indonesia and Nepal – account for the majority of the burden in the Region.

29 SARS A patient was admitted in Vietnam on 26th Feb with respiratory illness and died in March health workers who cared for this patient also became ill on 5th March Since then, the cases have been reported from many countries. International travel facilitated its spread rapidly. It was found that the disease initially emerged in China in November The etiological agent is a virus -- isolated, but yet to be identified. Perhaps, it is a mutated strain of corona virus or a virus, which has jumped from an animal species to humans. The infection is spread through droplets/aerosols. (It is also possible that SARS is transmitting through other unidentified routes.)

30 AVIAN INFLUENZA REASONS FOR CONCERN ABOUT THE CURRENT OUTBREAKS Most outbreaks caused by the highly pathogenic H5N1 strain. Strain has unique capacity to jump the species barrier & cause severe disease, with high mortality, in humans. Gene swapping between the human & viruses inside the human body can give rise to a comavian pletely new subtype of the influenza virus to which Very few, if any, humans would have natural immunity.

31 Sufficient human genes in virus direct man to man transmission Pandemic. influenza pandemic of 1918–1919 when the virus spread around the globe in 4-6 months. existing vaccines, would not be effective against completely new influenza virus.

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33 Tuberculosis Present situation SEAR with 5million cases, has the highest number of TB cases among all WHO regions. Bangladesh, India, Indonesia, Myanmar and Thailand are among the 22 high-burden countries in the world and together account for 95% of the TB burden in the Region. TB -most common opportunistic infection among HIV-infected. ~3 million people co-infected with HIV & TB. Every year 3 million people newly affected. over lose their lives.

34 TB has emerged as MDR-TB & XDR-TB About 50 million people worldwide are infected with drug resistant TB % of MDR-TB in INDIA in 2004 was 2.4 among new cases STOP TB STRATEGY adopted by WHO in 2006 focusses on prevention & control of MDR-TB & HIV -TB

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36 Malaria Present situation and challenges PAST TWO DECADES The proportion of Plasmodium falciparum malaria has increased from 12% to more than 45%. Increasing resistance of Plasmodium falciparum to first- and second line anti- malarial drugs.

37 Malaria Present situation and challenges India reports the largest proportion of malaria cases in the Region. Annually there are approximately 100 million cases in SEAR PRESENTLY About 2.5 million cases and 4000 deaths per year.

38 DENGUE Present situation and challenges Dengue has emerged as a serious public health problem over the last few decades. Disease is spreading to new geographical areas, and frequency of outbreaks has increased. During 2007, outbreaks have been reported from a number of countries in Asia including Thailand, Cambodia, Indonesia, Vietnam, Philippines and even in Singapore, which has one of the best dengue control programmes.

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40 State wise dengue cases and deaths, India, States CasesDeathsCasesDeathsCasesDeathsCasesDeaths Andhra Pradesh--- 05Nil00 Delhi Goa GujaratNil Haryana Karnataka Kerala Maharashtra Orissa Punjab Rajasthan Tamilnadu Uttar Pradesh Total

41 PLAGUE In SEAR, natural foci of plague- exist in INDIA, INDONESIA, MAYANMAR & NEPAL No case was reported after 1966 in INDIA till it re- emerged in sept 2004 in MAHARASHTRA outbreak of pneumonic plague in SURAT cases of pneumonic plague(4 deaths) in hatkoti, distt SHIMLA

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43 SCRUB TYPHUS During world war II, an epidemic of scrub typhus occurred in ASSAM & WEST BENGAL ,it was reported from INDIA, CHINA, JAPAN, INDONESIA & MALAYSIA. In july,2008,outbreak occurred in some areas of HP.

44 Response To Threat Various international & national organizations have come together to combat this threat. WHO, CDC, NIH, Department of Defense & FDA. ALL work in collaboration to develop strategic plans to combat the microbial emergence and re- emergence.

45 Surveillance and Response Applied Research Infrastructure and Training Prevention and Control

46 Surveillance Global / Regional level laboratory surveillance FLUNET : Surveillance network for monitoring influenza\ RABNET : Surveillance network for rabies PANCET : Pacific Public Health Services Network - to improve surveillance in pacific island.

47 Surveillance GPHIN : Global Public Intelligence Network Antimicrobial resistance information bank Global / Regional level epidemiological surveillance. International Health Regulations (IHR) mandatory reporting of certain infectious diseases eg. Cholera, plague, yellow fever WHO Disease / rumor outbreak list - list unconfirmed disease outbreaks worldwide.

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49 Global & National Surveillance Systems / Networks At National Level - strong surveillance system is required to collect relevant, accurate & timely information of an outbreak. WHO – at Global Level- act as focal point for data exchange. WHO has recommended surveillance standards for 40 specific diseases and 8 syndromes. HIV/AIDS network – through sentinel sites Influenza network- Collects information from member laboratories to make decision regarding vaccine composition. Tuberculosis monitoring system- Produces reports on notification, results and the extent of implementation of DOTS. Global salmonella surveillance network.

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52 Research: Various organizations like CDC, National Institute of Allergy & Infectious Diseases (NIAID), National Institute of Diabetes Digestive and Kidney diseases (NIDDK), has made research contributions in field of HIV/AIDS, Tuberculosis, Malaria, Hepatitis C etc. Advances in genomics, proteomics better understanding of pathogenesis, host immunity & drug resistance and identifying new drug targets & develop new vaccines and diagnostics.

53 EMERGING DISEASES RESEARCHEMERGING DISEASES RESEARCH

54 Strengthen public health infrastructures to support surveillance, response, and research. To implement prevention and control programs. Provide the public health work force with the knowledge and tools it needs.

55 Prevention and Control Global outbreak Response : Global outbreak Response : It involves- building a team, obtaining access and travelling to affected area, recommending and implementing control measures.

56 NATIONAL LEVEL District epidemic management committee:-For resource mobilization, monitoring and evaluation of control activities; dissemination of information to public & documentation of outbreak. District rapid response team:- For investigation of outbreak and implementation of control activities at the district level. The Health facility personnel:- For case management, reporting and education of public. Community Leaders: Helping in controlling the epidemic.

57 FETP (Field Epidemic Training Programme FETP (Field Epidemic Training Programme) PHSWOW Programme PHSWOW Programme (Public Health Schools without walls)- Two year field and academic training programme, established by CDC in collaboration with Rockefeller foundation. TEPHINET : TEPHINET : Training programme in epidemiology Epi – Aid : Epi – Aid : For rapid deployment of professional staff to aid outbreak verification & control.

58 Future Outlook : MAJOR GOAL: -development and production of counter measures. -requires basic research and concept development. Application and research in molecular biology. To develop a second- generation of vaccines (safe and effective) e.g. 1.naked DNA' vaccine 2. recombinant proteins to fight against HIV/AIDS, malaria and tuberculosis Sequencing the genomes develop effective vaccines and drugs. Other developments next-generation anthrax vaccine, Ebola vaccine and monoclonal antibodies against botulism toxin

59 Partnerships among clinicians, researchers, government and industry. Improving #surveillance, #disease control # response to an outbreak through improved laboratory facilities # training of personnel # establishing reliable and efficient communication networks # strong public health

60 GUIDED BY:- DR. ANUPAM PARASHAR

61 PRESENTED BY: Nandini sood(0537) Neha chauhan(0538) Nitin Sood(0539) Nishant sharma(0540) Nripen Gaur(0541) Priyanka Sood(0542)

62 THANKS


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