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Public Health Responses to Emerging and Re-emerging Disease Cheryl Chan, Sarah Garland, Elisabeth Huang, Rachel Viscontas.

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Presentation on theme: "Public Health Responses to Emerging and Re-emerging Disease Cheryl Chan, Sarah Garland, Elisabeth Huang, Rachel Viscontas."— Presentation transcript:

1 Public Health Responses to Emerging and Re-emerging Disease Cheryl Chan, Sarah Garland, Elisabeth Huang, Rachel Viscontas

2 Outline Terms Factors in Response Emergent Disease E. coli O157:H7 SARS Flu Re-emergent Disease Tuberculosis Malaria Syphilis Deliberately Emerging Disease Anthrax Conclusions

3 Terms Emerging Disease “Infections that have newly appeared in a population or have existed previously but are rapidly increasing in incidence or geographic range” (Morens et al., 2004) Re-emerging Disease “known diseases previously thought under control and no longer considered a public health problem, but that have reappeared or are causing an increased number of infections” (PHAC) Deliberately Emerging Disease “Deliberately emerging diseases are those that are intentionally introduced. These are agents of bioterror” (Fauci, 2006)

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5 Evaluating Factors for Emergence Deforestation Land development Human infringement Ecological Factors Population growth Migration International travel Urban poverty Social Factors Sexual behaviour Use of illicit drugs by injection Iatrogenic causes Other Factors

6 Public Health “The science and art of promoting health, preventing disease, and prolonging life through the organized efforts of society” (Acheson Report, 1988) Organizations World Health Organization (WHO) Department of Communicable Disease Surveillance and Response Centre for Disease Control (CDC)- USA Public Health Agency of Canada (PHAC)

7 Outbreak Procedure (WHO) Systemic Detection Outbreak Verification Real Time Alerts Rapid Response

8 Software and Technology Global tool for influenza virological surveillance and interpretation of epidemiological data FluNet Data collection instruments and data analysis, visualization, and reporting using epidemiologic methods Epi Info Check estimates of incidence, prevalence, duration and case fatality for diseases DISMOD II

9 Prevention and control strategies for infectious diseases Surveillance Epidemic investigations Epidemiologic and laboratory research Training Public education

10 Communicating Risks Need to consider: Audience – lay vs. scientific Message – what do you want to convey? Source – reputable? trusted? Channel – how is the message being conveyed?

11 Emergent Diseases E. coli O157:H7 SARS Influenza – H1N1 HIV/AIDS Hanta Virus Cryptosporidiosis Ebola Hemorrhagic Fever

12 E. Coli O157:H7 emergence E. coli acquired Shiga toxin genes  40 years ago in S. American cattle Horizontal gene transfer allows for emergence of novel organisms Local example - Walkerton, ON – 2000 Town of persons feel ill 7 died 27 children developed HUS

13 Recommended actions Report of the Walkerton Commission of Inquiry Over 100 recommendations made Communication and information dissemination Quality management system for water supplies More competent enforcement Training and certification of operators Research for possible mitigation strategies

14 Severe acute respiratory syndrome (SARS) What happened? China, Hong Kong, Toronto Pathogen involved Symptoms Transmission From:http://www.clearwisdom.net/emh/articles/2003/5/16/ htmlhttp://www.clearwisdom.net/emh/articles/2003/5/16/ html

15 SARS What went well? Very quick investigation of cause Disease tracking software updated Effective quarantine and tracking Clinics Public communication intact Importance of communication Mixed messages to public

16 SARS – What went wrong? “China revealed today that the number of people in Beijing who are infected with the deadly disease, severe acute respiratory syndrome, is ten times higher than previously reported.” (Chris Simkins, Voice of America) Mishandling of specimens Outdated software Issues with reporting to WHO Data unavailable for 2-3 weeks Trial-and-error treatment No surge capacity

17 Recommended actions by WHO Pre-pandemic Reduce opportunities for human infection Strengthen the early warning system Emergence of pandemic virus Contain or delay spread Pandemic declared and spreading internationally Reduce morbidity, mortality and social disruption

18 Influenza - Effective Response Exchange of Information Provincial, Territorial and Federal International New Structures Created When Needed Vaccine Reviewed Quickly Rapid Analysis of the Virus Clear Guidance Researchers Involved Effective Communication Fast Immunization From: disease-known-as-secondary-pneumonia.htmlhttp://www.defencepa.com/16-flu-is-a- disease-known-as-secondary-pneumonia.html

19 Flu – Needed Improvement Stop using scientific gibbldygook Public communications In planning strategies Clarify guidance documents Transfer of public health personnel Allow foreign countries to access our caches of supplies Track vaccine inventory and immunization Manage human resources properly Plan for next time

20 Re-emergent Diseases Tuberculosis (multi-drug resistant) Malaria (multi-drug resistant) Diphtheria Typhoid fever MRSA – multi-drug resistant S. aureus Cholera Syphilis

21 Tuberculosis Isoniazid and other drugs Effective tuberculosis cures Empty sanitoria Dismantling the public health control systems

22 Tuberculosis 1980s-Tuberculosis re-emerged in the era of HIV/AIDS Contributing factors: 1985 – dismantled TB programs HIV/AIDS Poverty, crowding Inadequate courses of anti-tuberculosis therapy expensive treatment strategies Local and state health departments in the United States had to reinvent tuberculosis control programme Drug resistance is major concern

23 Response to TB CDC Rapid diagnostics – determine disease burden Development of new anti-TB drugs – increase research Increased cooperation with CDC and Department of Homeland Security – prevent travel of infected persons Increase access to antiretroviral drugs – TB/HIV From: vaccine-provide-tb-prevention- people-hiv/ vaccine-provide-tb-prevention- people-hiv/

24 Malaria DDT Abandonment of other mosquito-control programmes Malaria re-emerged Development of drug resistance Current approaches: Development of vaccines and new drugs Re-establishing public health measures

25 Re-emergence STIs USA saw lowest syphilis rates in 2000 Canadians have also seen an increase in syphilis Alberta has seen an increase since 2000 From:http://www.cdc.gov/std/Syphilis2007/CA07.pdfhttp://www.cdc.gov/std/Syphilis2007/CA07.pdf

26 Syphilis - Order of Events Outbreak Criteria Met Investigation Meeting with AIDS Care Provider in LA Identify Cause Notify Healthcare Providers

27 American and BC Response

28 Alberta Response

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30 Deliberately Emerging Anthrax

31 Anthrax - What Caused The Problem Bad handling of suspicious package Lack of PPE usage Ventilation system kept on Slow evacuation Labs overwhelmed Coddling the public Floor plans not consulted immediately Public health communication with clinicians

32 Anthrax Response Antimicrobial prophylaxis given immediately Nasal samples taken Communication “Giuliani press conference model” Communication with hospital workers Public well informed Information readily available Hotline, fact sheets, websites

33 Conclusions Factors for emergence and re-emergence are complex Cooperation between countries and organizations Response Prevention Identification Treatment Communication Technology, media Planning

34 Questions?


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