WELCOME

EMERGING AND RE-EMERGING INFECTIOUS

DISEASES

CAPT SHAHARUL

INTRODUCTIONDespite remarkable advances in medical science and treatment during 20th century, infectious diseases remain the leading cause of death worldwide

Emergence of new infectious diseases, re-emergence of old infectious diseases and persistence of intractable infectious diseases.

During the last 20 years, at least 30 new diseases have emerged

These diseases are the leading cause of death worldwide, claiming at least 17 million lives every year. In the South-East Asia region, 7 million people die from diseases annually.

AIM

To introduce major concepts related to emerging and re-

emerging infectious diseases.

SCOPE

Emerging and Re-emerging infectious diseasesFactors contributing to emergeBasic concept of the infectious diseasesChallenges to prevent the emergenceRecommendation Conclusion

“Emerging” & “Re-Emerging”EmergingDiseases that have not occurred in humans before orthat occurred onlyin small numbersin isolated places.

Re-emerging Diseases that once were major health problems globally or in a particular country, and then declined dramatically, but are again becoming health problems for a significant proportion of the population.

Diseases thought to be adequately controlled making a “comeback” are “re-emerging”

CONT..

NEW DISEASE EMERGE&

OLD DISEASE RE-EMERGE

DRIVING FORCES TO ENERGE

Ecological disruption and human intrusion into new

ecological system increases the exposure of human to new

infectious agents.Usually tropical &

Developing countries are HOT SPOT of outbreak

of diseases

Climate change is another potential driver that shifts the

ecological niche or range of the diseases.

Long-term impact of global warming, some major climatic events caused disease outbreaks in the areas that have not experienced the disease

before.

Urbanization and Industrialization impact the

prevalence and scope of both infectious and chronic diseases.

High risked sexual practices, multiple sexual partners and use of substances directly transmit

the diseases

Overcrowding causes person to person rapid spreading of diseases.

Poor housing quality, poor sanitation and water supply infrastructure.

International trade of goods and services through international border facilitate the

spread of diseases by bringing pathogen to new geographical areas.

Travelers are exposed to variety of pathogen, many of them have never

encountered and no immunity to many diseases.

EVOLUTION OF THE INFECTIOUS AGENT

Mutations in bacterial genes that confer resistance to antibiotics – 20%Multidrug-resistant & extremely drug-resistant TB Multi drug resistant P.falciparum

REDUCED HUMAN IMMUNITY

Immunization failure (breakdowns in public health measures)

Increased number of

immunocompromised hosts.

War & Political conflict cuase

breakdown of public health

infrastructure has role in emergence

of diseases.

Poor primary health care services may not be equipped to

deal with some infectious outbreaks

Year recognized Disease Infectious agentNew viral strain

emerge periodicallyPandemic Influenza Influenza virus

1967 Murburg hemorrhagic fever

Marburg virus

Before 1976 Salmonellosis Salmonella entertidis1976 Ebola hemorrhagic

feverEbola virus

1983 AIDS Human Immuno-deficiency Virus

1983 Gastric ulcers Helicobacter pylori 1989 Hepatitis C Hepatitis C virus (HCV)1998 Nipah encephalitis Nipah encephalitis2002 VRSA infection Vancomycin resistant

S. aureus2003 SARS (severe acute

respiratory syndrome)

SARS-associated coronavirus

2015 Zika Zika virus

EMERGING DISEASES

RE-EMERGING DISEASESDISEASE AGENT

DENGUE FEVER Dengue virus

MALARIA Plasmodium species (protozoan)

MENINGITIS Group A Streptococcus (bacterium)

SCHISTOSOMIASIS Schistosoma species (helminth)

RABIES Rabies virus

CHOLERA Vibrio cholerae 0139 (bacterium)

POLIO Poliovirus

YELLOW FEVER Yellow fever virus

TUBERCULOSIS Mycobacterium tuberculosis (bacterium)

SARS: The First Emerging Infectious Disease Of The 21st

Century (China, 2003)

SARS(Severe Acute Respiratory Syndrome)

Total 8429 cases; 824 deaths30 countries in 7-8 months

in 2003

The 2014 Ebola outbreak is the largest in history.

Primarily affecting Guinea, Northern Liberia, and Sierra Leone.

Ebola virus disease (EVD), previous known as Ebola hemorrhagic fever

(Ebola HF)

Fatality rate of up to 90%

Transmitted by direct contact with the blood, body fluids and tissues of

infected animals or people

More than 11,000 deaths only in Africa

Tuberculosis or TB is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most

commonly affects the lungs.

In the 18th and 19th centuries, a tuberculosis epidemic rampaged

throughout Europe and North America.

In 1993 the World Health Organization (WHO) declared that TB was a Global Emergency; the

first time that a disease had been labeled as such.

TUBERCULOSIS

Approximately 390 million people worldwide infected with the dengue virus each year.

Since December

2014, swine flu has

claimed the lives of over 1,300 people

in India, making it the

worst outbreak of the virus in the country since 2009

SWINE FLU (H1N1 Virus)

Highly Pathogenic Avian Influenza (H5N1)

Epidermodysplasia Verruciformis(Tree Man)

GENETICSThe cause of this condition is an inactivating PH mutation in the EVER1 or EVER2 genes which are located adjacent

to one another on Chromosome 17

MALARIA

Infectious agent is Plasmodium species

Malaria is transmitted among humans by female mosquitoes of the genus

Anopheles.

LEPTOSPIROSIS

CHOLERA

Causative agent is Vibrio cholera

Water borne disease

Varying pathogenicity (mortality ranging from 21-80%).

Responsible for 1967 outbreak in Europe.

Outbreaks in 2000 in Democratic Republic of the Congo and 2005 in

Angola.

Currently no vaccine or treatment.

MURBURG VIRUS(Murburg Hemorrhagic Fever)

PNEUMONIC PLAGUE SEPTICEMIC PLAGUE

BUBONIC PLAGUETlea (Ceratophyllus faciatus)

EID IN SEA REGIONEID – a leading cause of death globally17 m die annually from ID – SEA accounts for 41% or 7 m deathsEID cause suffering & impose financial burden on societyPlague outbreak in 1994 cost India over 1.5 B USD due to loss in trade, employment & tourismIn Thailand cost of one AIDS patient more than 5000 USDOverall costs for India on account of AIDS estimataed at 11 b USDIncreasing or persistent poverty & poor living conditions continue to expose millions of people to the hazards of infectious diseases.The low priority & support given to public health services is most important factor.

MANAGEMENT OF EIDA proactive and planned approach to ensure the appropriate prevention and control of the spread of disease. Strategic planning should include:

Phase I (non-alert) is a routine, preparatory state;

Phase II (alert) is the detection, confirmation and declaration of changes identified during non-alert conditions;

Phase III (response) includes the ongoing assessment of information and the planning and implementation of an appropriate response, which includes the coordination and mobilization of resources to support intervention activities

Phase IV (follow-up) activities include re-evaluation, restructuring, reporting and continuing education, and redefining strategic parameters.

RECOMMENDATIONStrengthening epidemiological surveillance & laboratory capabilities and services .Establishment of a rapid response team.Monitoring antimicrobial resistance.Establishment of international disease surveillance. networking and advocacy.Screening on International travels and trades.Networks of laboratories that link countries and regions need to be established.Strong national and regional public health systems.

CONCLUSION

Thank You!!!