Responding to Communicable Diseases Dr. Cheryl Anderson National RAP Conference, Vancouver, February 20, 2007

What is a Communicable Disease? Sickness caused by transmission of an infectious agent to a susceptible host Infectious agents include:  Viruses  Bacteria  Protozoa  Worms

How do humans get infected? TRANSMISSION of infectious agents to Susceptible Human Host occurs in variety of ways, including:  Touching/biting/kissing  Sexual intercourse  Droplets from sneezing, coughing, spitting  Airborne particles, e.g. TB  Mother to fetus during pregnancy  Injections of contaminated blood

Does every exposed host get sick? The Healthy host may not get sick or may have a mild response to infection:  TB – 90% of infected never get sick The human host may become a carrier capable of infecting others without ever getting sick  Hepatitis B and C

How many people die from Infections? Globally 1/3 of premature deaths are infection- related – mostly in poor countries:  Diarrheal disease – 2-3 million deaths yearly  Malaria – 2-3 million deaths yearly  TB – 2-3 million deaths yearly  HIV – more than 4 million deaths in 2005

Why poor countries?  Poor nutrition  Poor living conditions  contaminated water  no sewage  crowded or no housing  Poor or non-existent health care – preventative & curative

What Prevents Infections? Public Health Infrastructure  Sewage systems  Safe food  Safe water  Housing codes  Vector control, e.g. mosquitoes

Personal Prevention strategies  Good nutrition  Immunization  Hygiene  Protective coverings  Condoms  Mosquito nets  Disinfestation/Disinfection  Avoid exposure

Medical interventions & infection control  Isolation of sick person e.g. TB  Prophylactic treatment of contacts  Early detection and treatment  Direct Observed Therapy (DOT) for TB  Ensures completion of therapy  Reduces development of resistance to treatment  Infection control in hospitals/facilities

What puts refugees at risk? Increased exposure to diseases endemic to  Country of origin  Refugee camp or transit country Poor public health infrastructure Poor nutrition Poor immunization rates Crowded housing Poor or non-existent health care

How does CIC protect the Public’s Health? Immigration Medical Examination screens for:  HIV, Tuberculosis, Syphilis Medical Surveillance Post Landing by Public Health for:  Inactive tuberculosis  Treated positive syphilis serology If HIV positive, immigrant advised to contact clinic specializing in HIV following entry into Canada

Who is at risk for TB in Canada? Tuberculosis (TB) in 2005  Total cases 1616 (5.0/100,000)  Canadian born cases 519 (2.0/100,000)  Aboriginal cases 308 (26.8/100,000)  Non-Aboriginal cases 211 (0.9/100,000)  Foreign born cases 1016 (14.8/100,000)  Rates in top 3 source countries in 2004 China – 101/100,000 India – 168 /100,000 Philippines – 293 /1000,000

Reducing risk of infection/illness Food Security and Nutrition  Means and access to healthy food  Canada Food Guides Food Safety  Instruct on proper storage and preparation Appropriate Housing

Reducing Risk of Infection Personal hygiene Immunizations Avoiding exposure Protective coverings  Condoms

Reducing Risk of Illness when Infected Early detection and treatment  Examples – HIV, TB Healthy living  Exercise, good nutrition, sleep  Avoiding harmful substances, e.g. nicotine

How do settlement workers stay healthy?  Healthy lifestyle – exercise, nutrition, sleep, etc.  Immunizations  Personal hygiene  Medical follow-up if:  Asymptomatic but known exposure; or  Symptomatic for early detection/treatment

Public Funded Immunizations (Canada)  Diptheria  Tetanus  Pertussis (whooping cough)  Polio  Haemophilus influenzae type b  Hepatitis B  Measles, Mumps, Rubella  Varicella (Chicken Pox)  Meningococcal C conjugate  Penumococcal conjugate  Influenza (Flu)

Information Sources: BC Health Files. Ministry of Health. Canadian National Report on Immunization. Canada Communicable Disease Report Supplement Vol32S3 Nov, Public Health Agency of Canada. Citizenship and Immigration Canada: Facts and Figures Country Profiles on Tuberculosis, World Health Organization. Health Canada: Eating Well with Canada’s Food Guide, sc.gc.cawww.hc- sc.gc.ca Heymann, David L., Editor. Control of Communicable Diseases Manual, Official Report to American Public Health Association, 18 th Edition, Tuberculosis in Canada BC Health File Topics - Sneezes and Diseases Handbook -