2. © 2004 Aeras 1 Introduction to Clinical Research Practice Clinical Infectious Diseases 1

3. 2 Objectives State the difference between health and illness State the difference between health and illness Differentiate between infectious and non- infectious disease Differentiate between infectious and non- infectious disease Identify three microbes and a disease they cause Identify three microbes and a disease they cause List two methods for transmission of infectious agents List two methods for transmission of infectious agents

4. 3 Objectives Identify defenses a human has to fight off infection Identify defenses a human has to fight off infection Differentiate between the following terms: epidemic, endemic, pandemic, carrier Differentiate between the following terms: epidemic, endemic, pandemic, carrier Recognize ways in which to protect him/herself against infectious diseases Recognize ways in which to protect him/herself against infectious diseases Explain why DOTS is needed for TB prevention Explain why DOTS is needed for TB prevention

5. 4 Health vs. Illness Health: A state of wellbeing without disease. Illness: A state of being unable to function normally.

6. 5 Diseases Cause Illness In the process, some diseases can weaken and kill people. In the process, some diseases can weaken and kill people. Millions of people throughout the world suffer from diseases which could either be prevented or cured. Millions of people throughout the world suffer from diseases which could either be prevented or cured.

7. 6 Types Of Disease There are two main types of disease: Non-infectious diseases do not spread from a sick person to a healthy person. Non-infectious diseases do not spread from a sick person to a healthy person. Infectious diseases are spread from person to person. Infectious diseases are spread from person to person.

8. 7 Non-Infectious Diseases Something wears out or goes wrong in the body. Something wears out or goes wrong in the body. Something from outside harms or troubles the body. Something from outside harms or troubles the body. Likely to occur when lacking the right kind or amount of food. Likely to occur when lacking the right kind or amount of food. People are born with a particular problem. People are born with a particular problem.

9. 8 Infectious Diseases These diseases are mainly caused by tiny organisms called: Bacteria Viruses Parasites These are called germs or pathogens.

10. 9 Bacteria Bacteria are very small living organisms. Bacteria are very small living organisms. One million would fit on the head of a pin. One million would fit on the head of a pin. Antibiotics are the main kind of medicine which can be used to cure bacterial diseases. Antibiotics are the main kind of medicine which can be used to cure bacterial diseases. However, some disease have become resistant to antibiotics so that new ones constantly have to be developed. However, some disease have become resistant to antibiotics so that new ones constantly have to be developed.

11. 10 Some Important Bacterial Diseases Tuberculosis Tuberculosis Pneumonia Pneumonia Tetanus Tetanus Boils, sores Boils, sores Gonorrhea Gonorrhea Syphilis Syphilis

12. 11 Viruses Viruses are smaller than bacteria. Viruses are smaller than bacteria. Like bacteria, they can produce very quickly. Like bacteria, they can produce very quickly. Antibiotics do not cure disease caused by viruses. Antibiotics do not cure disease caused by viruses. Although there are no medicines which can cure viral diseases, vaccines are effective against some (such as polio and measles). Although there are no medicines which can cure viral diseases, vaccines are effective against some (such as polio and measles).

13. 12 Some Important Viral Diseases Flu Flu Hepatitis A Hepatitis A Rabies Rabies Warts Warts AIDS AIDS Measles Measles Chickenpox Chickenpox Mumps Mumps Polio Polio Colds Colds

14. 13 Parasites A parasite is an organism that lives in or on a second organism. A parasite is an organism that lives in or on a second organism. Some parasites do not cause any harm. Some parasites do not cause any harm. Some can cause harm to its human “host”. Some can cause harm to its human “host”. A tapeworm is an example of a parasite. A tapeworm is an example of a parasite.

15. 14 Important Diseases Caused By Parasites Dysentery – caused by tapeworms or amoebas. Dysentery – caused by tapeworms or amoebas. Malaria – caused by parasite in mosquitoes. Malaria – caused by parasite in mosquitoes.

16. 15 The Spread Of Disease Disease germs can enter the body by: breathing. breathing. swallowing. swallowing. breaks in the skin. breaks in the skin. through body openings. through body openings.

17. 16 Kissing Kissing Sneezing Sneezing Body fluid exchange Body fluid exchange Direct Transmission Indirect Transmission Using a dirty telephone Using a dirty telephone Touching a dirty keyboard Touching a dirty keyboard

18. 17

19. 18 First Lines Of Defense Skin Skin Mucous membranes in your nose and throat Mucous membranes in your nose and throat Tears Tears Tiny hairs in your nose Tiny hairs in your nose

20. 19 How Does It Work? When a harmful microbe is present, these protectors: Block them from entering your body, or Block them from entering your body, or Wash them away. Wash them away.

21. 20 Second Line Of Defense The immune system is a complex system that works to clear infection from the body. It includes highly specialized cells and tissues that protect the body from foreign substances.

22. 21 How the Immune System Works If germs enter the bloodstream: They are attacked by white blood cells that dissolve foreign microbes, call other defences to fight them They are attacked by white blood cells that dissolve foreign microbes, call other defences to fight them OR… OR…

23. 22 Your Body Develops Antibodies Antibodies go after germs. Antibodies go after germs. If you are exposed to a germ, your immune system can produce antibodies to “fight” the germs If you are exposed to a germ, your immune system can produce antibodies to “fight” the germs

24. 23 One Way to Avoid Disease A vaccine is made to help you from becoming sick from a particular disease. A vaccine is made to help you from becoming sick from a particular disease. After a vaccination, your body will be able to fight that disease in the future. After a vaccination, your body will be able to fight that disease in the future.

25. 24 Other Ways Of Preventing Disease Hand washing is the single most effective way to prevent the spread of infections. Wash your hands often and thoroughly, paying special attention to the area around and under your fingernails.

26. 25 When an infectious disease spreads to many people in an area at the same time, it's called an epidemic. When an infectious disease spreads to many people in an area at the same time, it's called an epidemic. When an epidemic happens in many places in the world at once, it's called a pandemic. When an epidemic happens in many places in the world at once, it's called a pandemic. Disease Terminology

27. 26 When an infectious disease keeps occurring within a specific area, region, or locality, it’s regarded as endemic to the area. Disease Terminology

28. 27 Disease Terminology The branch of medical science that studies the distribution and causes of health and disease in populations is epidemiology. The branch of medical science that studies the distribution and causes of health and disease in populations is epidemiology. A living creature that is infected with a disease and can pass it to others but does not itself display any of the symptoms is called a carrier. A living creature that is infected with a disease and can pass it to others but does not itself display any of the symptoms is called a carrier.

29. 28 About Tuberculosis It is also known as TB. It is also known as TB. TB is an infectious disease. TB is an infectious disease. It is caused by Mycobacterium tuberculosis. It is caused by Mycobacterium tuberculosis. Primarily affects the body by causing problems with the lungs and one’s ability to breathe. Primarily affects the body by causing problems with the lungs and one’s ability to breathe. TB is transmitted through the air from an infected person to another person. TB is transmitted through the air from an infected person to another person. Not everyone exposed to TB will become infected. Not everyone exposed to TB will become infected.

30. 29 Common Symptoms of TB Symptoms of TB vary, but depending on the stage can include: Feeling sick or weak. Feeling sick or weak. Weight loss. Weight loss. Fever. Fever. Night sweats. Night sweats. Coughing. Coughing. Chest pain. Chest pain. Coughing up blood. Coughing up blood.

31. 30 Protecting Yourself and Others Stay healthy and eat properly. Stay healthy and eat properly. Implement policies to protect staff and patients. Implement policies to protect staff and patients. Work toward rapid identification, isolation, evaluation, and treatment of persons likely to have TB. Work toward rapid identification, isolation, evaluation, and treatment of persons likely to have TB. Provide the specified ventilation in rooms and buildings. Provide the specified ventilation in rooms and buildings. Use respiratory protection in designated situations. Use respiratory protection in designated situations. Limit exposure to patients with TB. Limit exposure to patients with TB.

32. 31 TB Prevention TB can be prevented if people are immunized. TB can be prevented if people are immunized. Treat TB early to limit exposure of others. Treat TB early to limit exposure of others. If one person in a house has TB, everyone else should be tested for the disease. If one person in a house has TB, everyone else should be tested for the disease. An infected person should never spit on the floor and should cover his mouth when coughing or sneezing. An infected person should never spit on the floor and should cover his mouth when coughing or sneezing.

33. 32 Treating Tuberculosis Like many bacterial infectious diseases, TB can be treated by antibiotics. Like many bacterial infectious diseases, TB can be treated by antibiotics. However, the bacterium that causes TB is resistant to many of the antibiotics. However, the bacterium that causes TB is resistant to many of the antibiotics. To avoid resistance to the one antibiotic that may be prescribed, TB treatment calls for 2-3 antibiotics given together over a long period. To avoid resistance to the one antibiotic that may be prescribed, TB treatment calls for 2-3 antibiotics given together over a long period.

34. 33 Problems Treating TB TB treatment often involves taking several types of medicine over 6 months to a year. TB treatment often involves taking several types of medicine over 6 months to a year. Taking these medicines every day for 6 months is difficult, so sometimes people do not take them. Taking these medicines every day for 6 months is difficult, so sometimes people do not take them. Failure to take TB medicine keeps the person from getting better and helps the TB bacteria become “resistant” to those medicines and could spread TB to others. Failure to take TB medicine keeps the person from getting better and helps the TB bacteria become “resistant” to those medicines and could spread TB to others.

35. 34 DOTS for TB Treatment DOTS is a program that provides somebody to help a person to take the medicine and prevent TB resistance. DOTS is a program that provides somebody to help a person to take the medicine and prevent TB resistance. Directly Observed Treatment Short-course (DOTS) is a treatment program that ensures that people take their medicine. Directly Observed Treatment Short-course (DOTS) is a treatment program that ensures that people take their medicine. In DOTS, a TB-infected person must report to a health professional who will observe the actual swallowing of the medicine. In DOTS, a TB-infected person must report to a health professional who will observe the actual swallowing of the medicine.

36. 35 Key Points To Remember Health is a state of well-being without disease. Health is a state of well-being without disease. There are two main types of disease, infectious and non-infectious. There are two main types of disease, infectious and non-infectious. Disease are mainly caused by tiny organisms called bacteria, viruses and parasites. Disease are mainly caused by tiny organisms called bacteria, viruses and parasites. Infectious diseases are transmitted directly (sneezing, kissing) or indirectly (using a dirty telephone). Infectious diseases are transmitted directly (sneezing, kissing) or indirectly (using a dirty telephone).

37. 36 Key Points To Remember The key defenses that a human has to fight off disease include keeping germs out (skin, nose hairs, etc.,) and the immune system, that fights germs when they enter the body. The key defenses that a human has to fight off disease include keeping germs out (skin, nose hairs, etc.,) and the immune system, that fights germs when they enter the body. Hand washing is a good way of protecting oneself against infectious diseases. Hand washing is a good way of protecting oneself against infectious diseases. TB is an infectious disease caused by bacteria that can be treated and cured with antibiotics. TB is an infectious disease caused by bacteria that can be treated and cured with antibiotics. TB can develop resistance to antibiotics, so taking medicine, with the support of the DOTS program if needed, is very important. TB can develop resistance to antibiotics, so taking medicine, with the support of the DOTS program if needed, is very important.

38. 37 This presentation is produced by Aeras Global TB Vaccine Foundation SM in collaboration with the University of Cape Town and the South African Tuberculosis Vaccine Initiative. A special thanks to Professor Greg Hussey, Professor Maurice Kibel, Marie Buchanan, Hons.B.Soc.Sc., Marijke Geldenhuys, MSHS CRA, Dr. Sylvia Silver, D.A., and Jen Page, M.Ed. for their contributions and support for this presentation. Clinical Infectious Disease 1