Presented by : Anil Kumar

M.Sc PHE 2nd yrVCRC (ICMR)2015-17

EMERGING & RE-EMERGINGVECTOR BORNE DISEASES

KALA-AZAR JAPANESE ENCEHALITIS EBOLA CHIKUNGUEA LEPTOSPIROSISWEST NILE VIRUS YELLOW FEVER HUNTA VIRUS AVIAN INFLUENZA

ZIKA AES CCHFTRICHENELLOSISPLAGUE KFD

H1N1 NIPAHCHANDIPURA VIRUS DENGUE

CONTENTSTerminologies

Introduction

Factors influencing E/RE VBDs

Evidences

IDSP, GOARN & IHR

Summary

References

Difficulties & Suggestion

Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. (source: WHO)

TERMINOLOGIES

Re-emerging infectious diseases are 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. (source: NIH)

An emerging diseases is one that has appeared in a population for the first time, or that may have existed previously but is rapidly increasing in incidence or geographic range. (Source: WHO)

INTRODUCTION• There had been a worldwide explosion of infectious diseases.• Emerging/Re-emerging diseases are becoming pandemic and

may lead to threat to the stability of nations worldwide.• As per WHO 2007, World Health Report, more than 40

infectious diseases have been discovered since 1970s.• Infectious diseases accounted for about 26 percent of 57 million

deaths worldwide in 2002. (source: World Health Report 2004, WHO)

• The driving factors for emergence/re-emergence of infectious diseases are complex and interrelated.

EMERGING VIRUSYEAR DISEASE COUNTRY1950 DHF Philipines and Thailand

1947 Zika Uganda

1998,1999 Nipah virus Malaysia,Bangladesh-India

1997 / 2004 Avian Influenza(H5N1) China / Thailand, Vietnam

2003 SARS Coronavirus China

2006 - Influenza H5N1- New Human Rhinovirus

- Egypt, Iraq- USA

2007 - LCM like Virus- Polyoma like virus- Nipah virus

- Australia- Australia - Bangladesh

2009 Influenza H1N1

1944/1969/ 2011 CCHF Crimea / Congo / India

RE-EMERGING DISEASES Plague West Nile Virus Yellow fever Japanese Encephalitis KFD Leptospirosis Scrub Typhus Chikungunya Ebola Marbug HE/HF Drug resistant malaria Rift valley fever

(Source: Morens D.M., et al. 2004. The Challenge of Emerging and Re-emerging Infectious diseases. Nature 430: 242-49)

FACTORS INFLUENCING EMERGING & RE-EMERGING VECTOR BORNE DISEASES Agent/

Pathogen

EnvironmentHost

Interventions:- Remove breeding sources- Improve sanitation

DISEASE

Factors: • toxicity, virulence, infectivity• Susceptibility to antibiotics

(mutation)• Ability to survive outside bodyInterventions:• Eradicate• Genetically modify

Factors:• Climate• Physical structures• Social structure• Population densityInterventions:• Housing quality• Sanitation, water• Preventive measures

Factors:• Age• Previous exposure• Susceptibility• Co-infection• Immune responseInterventions:• Treat, isolate• Immunize• Nutrition

Interventions:• Educate• Change in activities• Quarantine

Interventions:• Prevention• Educate• Immunize

CONTINUATION…

OTHER FACTORS INFLUENCING VECTOR BORNE EMERGING & RE-EMERGING DISEASES Extreme events - Disaster and Hazard - War

Travelling

Urbanization

Population migration

Change in human behavior

Ecological pressure (non vector becoming vector)

Bioterrorism

It involves interaction of multiple complex factors between the host and pathogen, each driven factor need to secure the success of the species in changing environments.

Adaptation of one partner to exploit new environmental changes will often stimulate the other to modify its characteristics to take advantage of the change .

The human encroachment into habitat especially in tropical regions and interface with wildlife can lead to creation of “hot spots” for emergence of new pathogens, with a potential for rapid spread among susceptible human populations, facilitated by rapid means of travel and wildlife trafficking.

HOST PATHOGEN RELATIONSHIP

The mutation can create the parasite , pathogen virulent strain, and non vector became vector as making it infectious to humans, is a common cause of new illnesses in humans.

CONTINUED…

EVIDENCES

Wor

ld P

opul

atio

n in

billi

ons

()

Days

to C

ircum

navig

ate

()

the

Glob

e

Year18500

400350300250200150100

50

20000

1900 1950

1

2

3

4

5

6

Speed of Global Travel in Relation toWorld Population Growth

(Source: Murphy and Nathanson. Semin. Virol. 5, 87, 1994)

Cases & death due to AES/JE

(source: NVBDCP)

DRUG RESISTANCE IN MALARIA

INTEGRATED DISEASE SURVEILLANCE PROJECT (IDSP) Launched as pilot project titled National Surveillance Program for

Communicable Diseases (NSPCD) in 1997 in 5 districts & was coordinated National Institute of Communicable Disease (NICD).

November, 2004: World Bank funded project titled “Integrated Disease Surveillance Project (IDSP)” was launched.

September, 2007: Weekly reporting of disease alerts/outbreaks through IDSP by states/UTs initiated.

Nov, 2007: Weekly compilation/summary of outbreak reports was introduced.

2007-08: IDSP as a part of NRHM.

Feb, 2008: 24X7, toll free call centre (1075)

PHASING OF THE IDSP Phase I (commencing from 2004-05)

Andhra Pradesh, Himachal Pradesh, Karnataka, Madhya Pradesh, Maharashtra, Uttaranchal, Tamil Nadu, Mizoram & Kerala

Phase II (commencing from 2005-06)Chhatisgarh, Goa, Gujarat, Haryana, Rajasthan, West Bengal, Manipur, Meghalaya, Orissa Tripura, Chandigarh, Pondicherry, Delhi

Phase III (commencing from 2006-07)Uttar Pradesh, Bihar, Jammu & Kashmir, Jharkhand, Punjab, Arunachal Pradesh, Assam, Nagaland, Sikkim, A & N Nicobar, D & N Haveli, Daman & Diu, Lakshdweep

OBJECTIVES OF IDSP To integrate, coordinate and decentralize surveillance activities

Undertake surveillance for limited number of health conditions and risk factors

To establish system for quality data collection, reporting, analysis and feedback using IT

To improve laboratory support for disease surveillance

To develop human resource for disease surveillance

To involve all stake holders including those in private sector and communities

ADMINISTRATIVE STRUCTURE OF IDSP

NATIONAL SURVEILLANCE COMMITTEE (CENTRAL SURVEILLANCE UNIT)

STATE SURVEILLANCE COMMITTEE (STATE SURVEILLANCE UNIT)

DISTRICT SURVEILLANCE COMMITTEE (DISTRICT SURVEILLANCE UNIT)

GLOBAL OUTBREAK ALEART & RESPONSE NETWORK (GOARN) Coordinated by WHO and was established in 2000.

Mechanism for combating international disease outbreaks Ensure rapid deployment of technical assistance, contribute to long-

term epidemic preparedness & capacity building

Surveillance at national, regional, global level - epidemiological - laboratory - ecological - anthropological

Investigation and early control measures

Implementation of preventive measures

Monitoring and evaluation

INTERNATIONAL HEALTH REGULATIONS (IHR)

This legally-binding agreement.It significantly contributes to global public health

security. providing a new framework for the coordination

of the management of events that may constitute a public health emergency of international concern.

improve the capacity of all countries to detect, assess, notify and respond to public health threats.

CONTINUED…PURPOSE: To prevent, control and protect against the international spread of

diseases. Restricted to public health risks, and avoid unnecessary

interference with international traffic and trade.

Aim: Strengthening national capacity for surveillance and control,

including in travel and transport. Prevention, alert and response to international public health

emergencies. Global partnership and international collaboration. Rights, obligations and procedures, and progress monitoring.

CONTINUED…Updates:

From three diseases to all public health threats.From preset measures to adapted response.From control of borders to, also, containment at source.Scope has been expanded from cholera, plague and yellow

fever to all public health emergencies of international concern (PHEIC)

Poor implementationPoor surveillance and monitoringLimited range of drugs and insecticidesInadequate dosage of drugs and insecticidesLack of treatment for some VBDsLack of dependable vaccine candidate for immunizationInadequate fundingInsecticide resistance/Drug resistanceInadequate skilled man powerLow community acceptanceDifficult to change human behaviorLack of political will

PROBLEMS LEAD TO FAILURE OF VBD CONTROL

PROGRAM

PREVENTION & CONTROL OF EMERGING INFECTIOUS DISEASES WILL REQUIRE ACTION IN EACH OF THESE AREAS Surveillance and Response

Ensure political support

Applied Research

Infrastructure and Training

Prevention and Control

Strict legislation

Increase global collaboration

continued…. Vaccination for all Enhanced communication with and within the Heath

department: locally, regionally, nationally and globally

Judicial use of antibiotics

strengthen IEC and BCC activities

REFERENCES Dikid, T. and et al. "Emerging and Re-emerging Infections in

India: An overview." INDIAN J RES MED 138 (JULY 2013): 19-31 Gupta, Sanjeev K and et al. "Emerging and Re-emerging

Infectious Diseases, Future Challenges and Strategy." Journal of Clinical and Diagnostic Research, Vol-6(6) (August, 2012): 1095-1100.

Jane, P. Messina and et al. "Global spread of dengue virus types: mapping the 70 year history." Trends in Microbiology (March 2014): Vol. 22, No. 3., pgg: 139-146.

Lim, Victor K E. "Emerging and Re-emerging infections." leJSME 7(Suppl 1) (2013): S51-56.

Morens, D M. and Folker, G K. “The Challenge of Emerging and Re-emerging Infectious Disease.” The Nature, 2004.

WHO. INTERNATIONAL HEALTH REGULATIONS . WHO Library Cataloguing-in-Publication Data, 2005

www.idsp.nic.in