The World As We Know It

Introduce Common Health Problems In Various Countries Emphasis on prevalence and incidence of infectious disease, mechanisms and treatment Introduce Aid Organizations Addressing Specific Issues

Shock Value vs Immediacy

Low Income Countries: 1. Lower Respiratory Infection 2. Coronary Heart Disease 3. Diarrheal Disease 4. HIV/AIDS 5. Stroke/CVD 6. COPD 7. TB 8. Neonatal Infection 9. Malaria 10. Prematurity/Low Birth Weight Worldwide: 1. Coronary Heart Disease 2. Stroke/CVD 3. Lower Respiratory Infection 4. COPD 5. Diarrheal Disease 6. HIV/AIDS 7. TB 8. Trachea/Bronchus/Lung Cancer 9. Road Traffic Accidents 10. Prematurity/Low Birth Weight

Issues to be discussed Tuberculosis HIV/AIDS Cholera Malaria Diarrheal Disease- eg Cryptosporidosis, Rotavirus Parasitic infection- eg Leischmaniasis

1/3 rd of the worlds population is infected with TB Each year, over 9 million people are newly infected with TB and there are almost 2 million TB-related deaths.

The vast majority of TB deaths are in the developing world, with more than half occurring in Asia. Affects impoverished young adults in their most productive years. According to the CDC, over 11 thousand cases of TB were reported in 2009 in the United States. Importantly, Multi Drug Resistant-TB (MDR-TB) prevalence is increasing and is present in all countries.

Cause: air-born bacteria Mycobacterium tuberculosis Latent (non-infectious, no symptoms) and Active TB attacks the lungs, kidney, spine and brain Patients with compromised immune systems (e.g. HIV infected) are at greater risk for development of active TB infection

Symptoms: Bad cough lasting 3 weeks or longer Pain in the chest Coughing up blood/sputum Weakness/fatigue No appetite, significant weight loss Chills/fever/night sweats Transmission: Active TB is highly contagious. Spread via coughing, sneezing, speaking, etc

Treatment: Short course of chemotherapy: Isoniazid, Rifampicin, Streptomyocin, Ethambutol Isoniazid and Rifampicin are the most effective Streptomyocin are also used for certain TB bacterial populations. Ethambutol (or thiocetazine) are for preventing the emergence of resistant TB bacteria WHO recommends receiving these chemotherapeutic agents 3x/week for 6 months to a year to fully treat the patient

Directly Observed Treatment- Short Course (DOTs) DOTs relies on : continuous political commitment access to quality TB sputum microscopic analysis standardized short course of chemotherapy uninterrupted access to quality medications accurate recording and reporting of patient treatment and outcome What does this mean? A constant supply of drugs ($$$) and health care workers that ensure patients receive their drugs 3x/week.

Governmental agencies High level political commitment – e.g. Peru British Thoracic Society, TBAlert India, etc Partners In Health MDR-TB in Russia and Peru Stop TB Partnership WHO, BBC, AstraZeneca, American Lung Assoc, American Red Cross… 1644 partners total

The ICRC and many other organizations have been fighting the spread of MDR-TB in Central Asia, Africa, and Latin America for more than a decade, focusing on prisons. Prison systems serve as uncontrollable breeding grounds for the spread of TB – overcrowding, poor health care, malnutrition, co-morbidity, and inadequate ventilation all contribute.

In 2009, an estimated 33.3 million people were living with HIV, of whom more than 30 million were living in low- and middle-income countries.

More than 33 million people worldwide are infected with HIV In 2009, 2.8 million people died from AIDS, 1.3 million of which originate from sub- Saharan Africa UNAIDS estimates that in 2009, 7000 people a day became newly infected with HIV Of those 7000, 1000 are children under 15 and 97% are in low to middle income countries.

HIV is a retrovirus It incorporates itself into the hosts DNA and uses host machinery to replicate and infect. This infection leads to progressive failure of the immune system, leading to increased cancer rates and infections.

Antiretroviral Treatment (ART) Drug treatments target various phases of the virus lifecycle Fusion Inhibitors Reverse Transcriptase Inhibitors (nucleoside and non-nucleoside) Protease Inhibitors Problems: non-adherence, side effects of the drugs, resistance

Behavioral Modification RX for survival clip Thailands government sponsored initiative

National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Health (NIH), and Department of Health and Human Services (DHHS) No known functional vaccine

Estimated adult and child deaths from AIDS 2009 Western & Central Europe 8500 [6800 – ] Middle East & North Africa [ – ] Sub-Saharan Africa 1.3 million [1.1 million – 1.5 million] Eastern Europe & Central Asia [ – ] South & South-East Asia [ – ] Oceania 1400 [<1000 – 2400] North America [ – ] Central & South America [ – ] East Asia [ – ] Caribbean [8500 – ] Total: 1.8 million [1.6 million – 2.1 million]

UNAIDS (includes UNICEF, WHO, and World Bank) UNAIDS vision: Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths. Partners In Health: HIV Equity Initiative Four Pillars of the HIV Equity Initiative Doctors Without Borders HIV/AIDS adult and pediatric pandemics, Campaign For Access To Essential Medications

Every year, malaria causes nearly one million deaths. In Africa, one in every 5 childhood deaths is due to the effects of the disease.

Due of 1 of 4 species of Plasmodium, a parasite transmitted via mosquito bites. Symptoms can be non-specific and therefore difficult do diagnose. Most common symptoms include: -Fever and chills -Vomiting and diarrhea -Headache, myalgias, and weakness Most important diagnostic tool: history of travel/residence in disease-endemic area.

Depending on the infecting species, malarial paroxysms occur in three stages; cold, hot, and sweating stages. Cold – shaking chills that last less than an hour Hot – high grade fever (106°F), 2-6 hours Sweating – profuse sweating as fever subsides, 2- 4 hours P. vivax cycles every 48 hours, while P. malariae cycles every 72. P. falciparum does not show this cycling and episodes occur more frequently.

Quinine and Quinine-derivatives are given prophylactically The US Army prescribes Mefloquine and Hydrochloride as a prophylaxis for soldiers The US Army considers Falciparum Malaria to be one of the deadliest infectious threats to soldiers worldwide.

Quinine and Quinine-derivatives Chloroquinine, Artesunate (in trials) Artemisinin-based combination therapies (Get on Medical Letter) P. falciparum is now resistant to chloroquinine

This includes indoor residual spraying, insecticide treated bed nets, and larviciding in areas with great amounts of stagnant water. Vector control is the primary means of prevention for the spread of malaria

Malaria No More Malaria In California 2010 WHO Global Malaria Programme Roll Back Malaria Partnership WHO, UNICEF, UNDP, the World Bank- a total of 500 different organizations working towards a global eradication of malaria The Red Cross: Malaria Prevention Plan Partners In Health: Malaria Net Challenge Etc, etc, etc …

There are an estimated 3 to 5 million cholera cases and 100,000 – 120,000 deaths due to cholera every year. For 2008 alone, a total of 190,130 cases were notified from 56 countries, including 5,143 deaths.

Gram negative bacteria with single flagellum which infect the small intestines Symptoms: profuse, watery diarrhea (rice water) vomiting severe dehydration electrolyte imbalance

Oral Rehydration Therapy- a combination of Na+, glucose, KCl, and citrate in water to allow for rehydration and balancing of electrolytes Research shows that antibiotic treatment has no effect on transmission rates and contributes to increasing antimicrobial resistance – therefore only given to severe patients who also require IV fluids.

Recent outbreaks- Zimbabwe in 2009, Haiti in 2010 Haiti article from Wall Street Journal – need to scan

Cholera In Haiti

Diarrheal diseases are the #3 killer of people in low income countries and #5 worldwide.

Bacterial Cholera Escherichia coli Parasitic Cryptosporidiosis Virus Rotavirus

Dehydration By far the most important issue. Lack of access to water or inability to keep up with course of the disease leads to extreme dehydration, shock, loss of consciousness, and death. Cholera can kill in less than a day. Need Oral Rehydration Salts for all forms of severe diarrhea

Generally feces-contaminated water Children who are malnourished are most susceptible and are, in turn, made more malnourished by diarrhea Prevention: Rotavirus vaccination Improved sanitation and personal & food hygiene Increased health education, focused on spread of disease

Amoebiasis Entemoeba histolytica Hookworm Leishmaniasis Schistosomiasis Chagas Dracunculiasis

Low Income Countries: 1. Lower Respiratory Infection 2. Coronary Heart Disease 3. Diarrheal Disease 4. HIV/AIDS 5. Stroke/CVD 6. COPD 7. TB 8. Neonatal Infection 9. Malaria 10. Prematurity/Low Birth Weight Worldwide: 1. Coronary Heart Disease 2. Stroke/CVD 3. Lower Respiratory Infection 4. COPD 5. Diarrheal Disease 6. HIV/AIDS 7. TB 8. Trachea/Bronchus/Lung Cancer 9. Road Traffic Accidents 10. Prematurity/Low Birth Weight

Due to developments in medications and vaccinations, NGO support, increased education, etc… things are looking up. World Bank and Stop TB Partnership report higher rates of treatment, of drug development and decreases in price Globally, the percentage of people successfully treated for TB has reached its highest level, at 86%. WHO: In Africa, a total of 11 countries showed a greater than 50% reduction in either confirmed malaria cases or malaria admissions and deaths over the past decade

AIDS/HIV: had the highest increase in treatment rates ever from Declines in global child mortality – from 192 to 79 deaths per 1000 live births (1959 to 2004). Immunization coverage – 75-80% of the world

Concerns for the future: Increased antimicrobial resistance (XDR-TB) Decreases in life expectancy in Africa/Russia since 1990 Continued supply of medications to those in need Increasing maternal mortality rates Continuing and sustaining current efforts that have proved effective