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+ The New Epidemiology – Epidemiology of the 21 st century Pragna Chandrasekhar John Frias Promila Gonsalves Dhurv Misri.

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Presentation on theme: "+ The New Epidemiology – Epidemiology of the 21 st century Pragna Chandrasekhar John Frias Promila Gonsalves Dhurv Misri."— Presentation transcript:

1 + The New Epidemiology – Epidemiology of the 21 st century Pragna Chandrasekhar John Frias Promila Gonsalves Dhurv Misri

2 + Overview Introduction to Epidemiology Epidemiology in the 19 th and 20 th century Diseases most prevalent 19 th -21 st century Disease tracking and surveillance 21 st century epidemiology – The “New” epidemiology Training in applied epidemiology Organizations involved in research and healthcare improvement Epidemiology and Public Health

3 + Epidemiology What is epidemiology? What does it entail? Populations Measurements Comparison Multidisciplinary aspects

4 + Types of Epidemiology “Shoe leather” Microbial Descriptive “Risk factor” Clinical Molecular Genetic “Big” Global

5 + 19 th and 20 th Century Epidemiology The dramatic decline of infectious diseases are attributable to these socioeconomic factors: Better sanitation and hygiene Discoveries of antibiotics and vaccines Quarantine and isolation Involvement of government in legislations Scientific and technological advances in detecting and surveillance of infectious diseases

6 + 19 th and 20 th century Epidemiology Sanitation and Hygiene 19 th century increased population Industrialization and migration Inadequate public water supplies and poor waste management system Around 1900s, repeated outbreaks declined with improved public health Chlorination of water (1900s Animal and pest control programs Proper waste disposal Vaccines Various vaccine campaigns virtually eliminated diseases Eradication of small pox

7 + 19 th and 20 th century Epidemiology Antibiotics Discovery of penicillin by Alexander Fleming (1928) Antibiotic treatment used by civilians for about 57 years Problem: Emergence of drug resistance in several disease-causing microorganisms Quarantines and Isolations 1600s practices of isolation and quarantine employed to prevent spread of certain diseases Subsequently, 1800s, these practices had become common in the American colonies.

8 + 19 th and 20 th century Epidemiology Government Involvement in Legislations 1950s epidemiology widely recognized with discovery of lung cancer linked to tobacco smoking Scientific and Technological Advances Serological testing Viral isolation and tissue culture Molecular technique

9 + TIMELINE OF PREVALENT DISEASES Malaria (1600 – Present) Cholera (1831 – Present) Bubonic Plague (1855 – 1959) Small Pox( ) Spanish Flu ( ) Typhus (1600 – 1922) Aids (1981- Today) SARS (2002 – 2003) Pandemic Flu (2009) Cancer (1761 – Today)

10 + Prevalent diseases in the 19 th Century MALARIA Caused by the female Anopheles Mosquito million infected 1-3 million death yearly in the early centuries 225 million cases in 2009 CHOLERA Infection of the small intestine - Vibrio Cholerae 8 million dead in India alone between million people affected worldwide yearly now 100, ,000 death yearly BUBONIC PLAGUE Third pandemic started in 1855 in China Zoonotic disease by Yersinia pestis 12 million people died in India and China only Last active case in 1959

11 + Prevalent diseases in the20 th Century SMALL POX Caused by the Variola virus Affects children and young adults Causes lesions, fever, muscle pain and malaise million people dead Eradicated in 1979 INFLUENZA Spanish flu – H1N1 influenza virus More than 500 million infected with million death worldwide Re-emerged in 2009 as Swine Flu Killed more than people since 2009 TYPHUS Caused by Rickettisiae – obligate parasite Infected million between Killed at least 3 million Large decrease due to vaccines

12 + Prevalent Diseases in the 21 st Century AIDS First recognized in 1981 Caused by the Human Immunodeficiency virus Killed 25 million people About 40 million people living with HIV CANCER Unregulated cell growth In 2008, 7.6 million death about 13% of the population Projected increase of 45% in Cancer death by 2030 SARS Caused by SARS coronavirus Outbreak in 2002/2003 8,422 cases with 916 deaths More potent in people >65 years; 50% mortality rate

13 + new occurrence of an infectious disease Incidence “An occurrence of an infectious disease greater than would otherwise be expected at a particular time and place” EPIDEMIC “An outbreak in a specific population, community or region” PANDEMIC “An epidemic across multiple continents/ worldwide” Outbreak

14 + Disease Tracking & Surveillance Advancements in 19 th & 20 th Century (mid-1800’s): Acceptance of Microorganisms as the cause of disease (1907): Office International d'Hygiène Publique developed (OIHP) (1947): World Health Organization (WHO) assumed the role of (OIHP) (1992): Centers for Disease Control and Prevention formed (1996): infectious transmissible disease reporting mandated by WHO

15 + Diseases in red require immediate reporting by a physician, nurse, health care provider, healthcare facility, or school to the Department of Epidemiology.

16 + Disease Tracking & Surveillance WHO Reporting Requirements Periodic Reporting Requirements ItemsMode of Communication Immediate reporting First identified individual fulfilling the confirmed case: - descriptive account of any evidence of human-to-human transmission including information about the number of cases and the likely chains of transmission · any unusual or unexplained events under investigation or fax Daily Reporting- number of confirmed cases - number of confirmed cases for which there is no reported at-risk exposure and no laboratory occupational exposure - number of confirmed cases for which exposure history is unknown or undetermined - number of persons for whom Diagnosis is being considered - number of new hospital admissions , fax or via secure password- protected WHO Global Atlas web site upon request Weekly Reporting Case-based information in a line listing format including confirmed cases with updated results persons for whom diagnosis is being considered and discarded cases

17 + Disease Tracking & Surveillance Reporting Methods: The Great Divide Developed Countries Utilization of Emerging Technology and Social Trends Advanced Communication System Abundant Awareness & Preventative Methods Resources Developing Countries Creative Projects Utilizing Basic Technology Broken Communication Infrastructures Lack of Medical & Awareness Resources

18 + Disease Tracking & Surveillance Impact, Issues, & the Future Direction ImpactIssues Lag in Detection Evolution of Drug-Resistant Strains Broken Link in Communication Structure Rapid Globalization Disproportionate Allocation of Funds Disease Control Improved Education & Awareness Pharmaceutical & Research Industries

19 + Training in Applied Epidemiology Epidemic Intelligence Service (EIS) Attracts pool of candidates with PhDs and doctoral degrees 2-year program involving various training programs: Applied epidemiology Biostatistics Public health surveillance Scientific writing Working with media Emerging public health issues Degree and licensing Requirements and Eligibility Physicians Doctoral-level Scientists Veterinarians

20 + Organizations Involved in Research and Health Care Improvements World Health Organization – Global Smallpox Eradication Programme (1980) American Public Health Association Epidemiology Global Health Quality Improvement Public Health Initiatives Society of Epidemiologic Research

21 + The New Epidemiology of the 21 st century Applies epidemiology to modern healthcare Safety risks of drugs – Reye syndrome and aspirin Disproval of “safety signals” – birth defects due to exposure to bendectine Medication benefits in disease prevention – folic acid supplementation Treatment patterns Primarily: cost of drugs and treatment Number of trained pharmacoepidemiologists very small PHARMACOEPIDEMIOLOGYCHALLENGES

22 + Advances in genomics, molecular studies, proteomics, likewise – dominates the field DNA transcriptional control for population “stratification” and preventative measures Human Genome Project Compilation of DNA sequence variants Efficient, cost-effective technology to determine polymorphic sites Large-scale samples Lack of statistical ability to interpret and analyze the plethora of data produced Complex diseases difficult to identify in initial stages and replicate for research Requirement of large tissue samples Constantly changing methods of conducting studies Lack of specifity in phenotype definitions leading to limitations in identifying chronic disease associations MOLECULAR AND GENETICCHALLENGES The New Epidemiology of the 21 st century

23 + Epidemiology and Public Health “Methodologic backbone” of public health Some discoveries made due to advances in the field: Identification of health and environmental risks due to use of tobacco Linked neural tube defects in infants with folate deficiency – prevention by fortification of wheat with folic acid Connected link between hepatitis B and liver cancer – prevention by worldwide vaccination campaigns Played a major role in decline of cardiovascular deaths

24 + Increased number of people survived to old age More healthcare required Research studies and clinical trials optimally distributed to include all generations and those prone to premature mortality and disease Drastic decrease in infectious and communicable diseases Emerging resistant strains! Future control of infectious agents Globalization Bioterrorism Climate change Epidemiology and Public Health – Successes of Epidemiology

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