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Emerging Re-emerging

Diseases

INTRODUCTION

• Disease burden is colossal

• Cause heavy mortality, disability and economic loss

• Result in widespread epidemics

• Immense suffering to the man kind

• Disturb International trade and economic development

DEFINITION

Emerging infectious diseases are “New diseases; new problem (New threats)”.

An emerging infectious disease is a one that is caused by a newly discovered infectious agent or by a newly identified variant of a known pathogen, which has emerged and whose incidence in humans has increased during the last two decades and is threatening to increase in the near future.

Cont….

• Re-emerging infectious diseases are “old diseases, new problem. (New threats)”.

• A re-emerging infectious disease is a one which was previously controlled but once again has risen to be a significant health problem. This term also refers to that disease which was formerly confined to one geographic area, has now spread to other areas.

Transmission of communicable diseases

Agent

of

Vector

Agents Human

Indir

ect

Direct contact

Contact

• Number of agents

• Characteristics of agents • Pathogenicity

• Defense mechanisms

• Immunity

• Personal characteristics

Host Reaction Infectious agents

Enter human host

Produces inapparent infection Host recovery

Mild disease Host fights or

with treatment

Severe disease with treatment

Disability

Death

The Factors Responsible

Improper planning of the township

Population explosion

Poor living conditions

Over crowding

Industrialization

Urbanization

Lack of health care services

Migration of population

Intense international travel

Globalization

Cont…• Indiscriminate use of antibiotics and

development of resistance

• Increase in contact with animals

• Insecticide resistance

• Alterations in micro-organisms

• Environmental degradation with changing weather pattern.

• Illiteracy and ignorance

• Natural disasters

Predisposing Factors for the Epidemic

• Before the on set of epidemic

– Earth quake (Gujarath-1993)

• During the epidemic

– Migration of the people

– Eruption of slums

– Collection of garbage

– Scarcity of antibiotics

Emerging Diseases in India and Global

• Diseases due to new agents (Eg.AIDS)

• Diseases due to new variants of known pathogens (Eg.Avian Flu)

• Diseases caused by an infectious agent but resulting in non-communicable diseases. (Eg.Hep.C results in liver cancer)

Global examples of emerging and re-emerging infectious diseases

Examples of new and Reemerging Diseases

Emerging Food borne water borne disease

• Accounts for 20 million cases in the world annually (T.D. Chugh-2008)

• Incidence is increasing

• Half of all known food borne pathogens discovered during the past 25 years

Cont…..Entero hemorrhagic Escherichia coli

– Causes no signs of illness

– Low infections dose in humans causes hemorrhagic colitis and hemolytic uraemic syndrome

– Consumption of undercooked beef and contaminated vegetables, fruits and water for vegetarians.

– Reported in 1.4% of stools from cases of bloody diarrhoea in Kolkata (Ministry of Health and Welfare 2006).

– Detection of potential pathogenic O157:H7 in river water (Ganges by Hamner et al 2007) is alarming.

Cont….Vibrio cholerae

• Cholera is one of the oldest recorded infectious diseases.

• John Snow demonstrated the spread by infected water

• Pacini in 1854, first described comma shaped bacteria

• Robert Koch in 1883, showed the causative agent V .Cholerae.

• Das and Gupta -2005 reported the diversity of V .Cholerae.

• Narang et al (2008) described the changing patterns of V .Cholerae.

Listeria monocytogenes

Listerosis is an emerging zoonotic disease

28% deaths due to food borne illnesses in USA

Organism is robust and survive food-processing and contaminated refrigerated meat and dairy products.

In India, Bhujwala et al in 1970 reported the presence of this organism in cervical secretions of 1.3-3% of cases with very bad obstetrical history.

Thomas et al (1981) in a prospective study of 1300 newborns found the pathogen in 2 cases

Campylobacter spp

Are significant zoonotic poultry pathogens

Leading cause of gastro enteritis in the world

Around 2.5 million human infections are reported annually in the United States.

In developing countries the presence of the organism was reported in 5-20% in child hood diarrhoea

Jain et al (2005) reported isolation of jejuni in 13.5% of the diarrhoea patients

Drug-resistant bacteria

• Antimicrobial resistance (AMR) in hospitals and community poses a public health problem (Moellering 2007).

• Reservoir for resistant genes is the fecal flora and upper respiratory tract

• Chugh (2008) reviewed the global status of AMR in

various pathogens.

• Woodford (2007) has identified the existence of multi resistant clones of common pathogens.

Cont…. Staphylococcus aureus is the “modern Ghengis

Khan” (Chugh 2007). the most frequently identified drug-resistant pathogen.

Singhal et al (2007)reported ciprofloxacin-resistant meningococci in an outbreak in Delhi.

Resistance of Salmonella typhi and S. paratyphi to chloramphenicol, ampicillin and cotrimoxazole is widespread.

AMR in Shigella resistance to azithromycin, ceftriaxon and ciprofloxacin on the increase

Rational use of antibacterial to contain AMR

Melioidosis • The causative pathogen is Burkholderia

pseudomallei

• It is an environmental saprophyte in rice paddies, wet soil, mud and pooled surface water.

• It causes suppurative chronic infection characterized by septicemia and focal abscesses in liver, spleen and other viscera.

Cont….

• Has been documented from Tamilnadu and Karnataka.

• The association of the disease with diabetes mellitus is high.

• Vidyalakshmi et al (2007) reviewed the disease in India

• The first culture proven case in India was a child in Maharashtra in 1990.

Chronic and Neoplastic Diseases

Microbe Disease Helicobacter pylori Peptic ulcer, gastric

carcinoma

Human papilloma virus Cervical, anal, vulvar carcinoma

Hepatitis B/C viruses Liver cirrhosis, hepatocellular carcinoma

Epstein –Bar Virus B-cell lymphoma, nasopharyngeal carcinoma

Human T lymphotropic virus type 1

Adult T-cell leukemia

Cont….Microbe Disease

Human herpes virus 8 Kaposi’s sarcoma

Borrelia burgdorferi Lyme arthritis

Tropheryma whippelii Whipple’s disease

Chlamydia pneumoniae

atherosclerosis

Cont…. • Ramakrishna (2006) discussed the high prevalence of

H. pylori infection in India.

• The high prevalence of resistance to metronidazole, clarithromycin and amoxicillin is the failure to eradicate H. pylori infection.

• The resistance is higher in south than north India.

• High rate of re infections in Indian subjects (60%).

• Chlamydia pneumoniae is associated with pathogenesis

of coronary artery disease. (Jha et al 2007).

Control of Emerging and Re-emerging Diseases

• Controlling the reservoir

• Interrupting the transmission

• Protecting the susceptible host

• Strengthening of the disease surveillance system

• Encouraging research initiations for treatmentregimens and diagnostics

• Encouraging research for new methods of control measures

• Establishment of drug resistance

Response to H5N1 avian influenza outbreak in Hong Kong. 

Emerging Infectious Diseases: a Research Approach

Benefits of Emerging Diseases Research

Emerging Diseases Funding (National Institute of Allergy and Infectious Diseases).

Role of Nurses in Prevention

Increase knowledge and skill

Encourage partnerships with consumers and other disciplines to identify needs, set priorities, develop strategies and evaluate progress

Support health care legislation

Involve in research

Encourage using multidisciplinary efforts.

Influence local and National economic and political options

Continue to advance nursing concern

Educate the public

Benefits of Community Prevention Programme

Opportunity to reach the masses and effect widespread changes in social norms

Increased public awareness of and commitment

Increased cost efficiency of group intervention

Ability of the programme to promote the development of an environment of social support

Opportunity of evaluate the effectiveness of health promotion programms

Enhanced approach toward promoting health in large population

Additional resources for information exchange and social support.

Role of Public Health Authorities

• National programme for prevention and control of vector borne diseases

• Legislations for elimination

• Communities awareness of the disease

• Minimizing transmission of infection: By – Risk communication to the family members

– Minimizing vector population

– Minimizing vector – individual contact

• Reporting to the nearest public health authority

Public health measures to prevent infectious diseases

• Safe water

• Sewage treatment and disposal

• Food safety programme

• Animal control programme

• Vaccination programme

• Public health organization

Response of the WHO

• Developing global and regional strategies

• Appointing Task Force

• Generous grant from WHO regular budget

• Support the World Bank grant

Conclusion • The true prevalence of many diseases is not

known. Since we live in a global village, we connot afford to be complacent about the tremendous economic, social and public health burden of these diseases. Effective surveillance is the key to their early containment.

• There is a need to develop epidemiology improved diagnostic facilities, a strong public health structure, effective risk communication, epidemic preparedness and rapid response.

Take Home Massage

• Community health is the pivot of Global health. Let us join our hands on creating an awareness to the individual family and community through effective risk communication.