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Infectious Diseases & Urbanization in Developing Countries
Opeyemi S. OdewalePhD Student
Walden UniversityPUBH
Instructor: Dr. Rubin HowardSpring 2011
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Overview
• Status of global waterborne infectious disease
• Waterborne pathogens
• Study focus: Hepatitis E Virus (HEV)
• Study focus: Developing countries ( India, Mexico & Nigeria)
• HEV health impact
• Need for concerns
• Prophylaxis & Vaccine
• Global Integration
• Reference (s)
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Status of global waterborne infectious disease
Per year more than 3.4 million people die as a result of water related diseases, making it the leading cause of disease and death around the world ( WHO, 2005)
Image by Berto Garcia
Image by Humanitarian and Development Partnership
Eliminating disease and death due to unclean water and poor sanitation would reap billions of dollars in health and productivity gains; estimation indicates that for every dollar spent, there would be an economic return of between $3 and $34 ( WHO, 2005)
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Waterborne pathogensStudy focus: Hepatitis E Virus (HEV)
Images CDC
Image World Hunger: Georgia State University
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Hepatitis E Virus (enteric transmitted non-A, non-B hepatitis) StatusMicrobiology
• 27-34 nm, non-enveloped virions
• Single-stranded RNA genome: approximately 7.2 Kb,
• positive polarity, with 5’-cap
• Genus Hepevirus
• Family Hepeviridae Genotypes
• – Gt 1, 2: Only human infection
• – Gt 3, 4: Both humans and animalsClinical Presentation
• Acute hepatitis
• Sporadic hepatitis Transmitted person-to-person fecal-oral route
CDC, 2010
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Hepatitis E Status
Genotype (Gt) geographical distribution :•Gt 1 and 2: epidemic strains causing human infection •Gt 3 and 4: zoonotic strains isolated from humans and a variety of animals
Pelosi & Clarke, 2008
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Hepatitis E Status - Outbreak
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Developing countries associated with HEV
• Study Focus:– India ( Asia)– Nigeria (Africa)– Mexico (North America)
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Statistics of HEV -India
•Population growth rate is 1.41% ranking 93rd in the world •29.5% population in urban setting • 1955-1956 30 000 cases were reported in New Delhi•1997- 52 000 cases were reported in Kashmir
WHO, 2010
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Statistics of Hepatitis E -Mexico
•Population growth rate is 1.1% ranking 106th in the world •77.2 % of population live in urban setting •1986 Genotype 2 outbreak•1988- 1989 4000 cases
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Statistics of HEV -Nigeria
•Population growth rate is 1.94% ranking 59th in the world •48.4 of population in urban setting•1986 Genotype 2 sporadic infection outbreak in Port Harcourt
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Health Impact – General Population
• Affects predominantly young adults
• Leading cause of acute viral hepatitis in South Asia, Africa, Middle East
• Mortality in general population 1-4%
• Causes substantial morbidity and mortality in older men
WHO, 2010
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Health impact of HEV- Pregnancy
• Mortality in pregnant women ~20%
• Hepatitis and mortality in pregnant women during epidemics (10-20%) in 3rd trimester
• Causes intrauterine infection, prenatal morbidity and mortality
• Maternal death can occur due to encephalopathy, haemorrhagic diathesis or renal failure
• Cope, 2010
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Health Impact -Global transportation
Image Craig Mackintosh
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Need for concern•Relatively new virus •Under diagnosed•Misdiagnosed •Globalization•Poor prognosis associated with pre-existing liver disease
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Prophylaxis & Vaccine
Recombinant HEV vaccine has shownefficacy tailored to women. It boostersresponse following 3 doses, which indicates development in immunological memory
Wai Kuo Shih (2010)
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Global Integration
Organization(s)
CDC
United Nation
UK- Health
Protection Agency
WHO
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Reference• Alirol, E. Getaz, L. Stoll, B Chappuis, F. Loutan, L (2011). Urbanisation and infectious diseases in a globalised world. The Lancet
Infectious Diseases, Volume 11, Issue 2, Pages 131 – 141
• CDC, (2010). Waterborne definition. www.cdc.gov/ncphi/disss/nndss/casedef/waterbornecurrent ( Retrieved 22-04-2011)
• Virginia Bioinformatics Institute(2011). Hepatitis E Virus. http://ci.vbi.vt.edu/pathinfo/pathogens/HEV.html (Retrieved 22-04-2011)
• Aggarwal, R. Nanda, C.S. Wiersma, S. (2010). Global Prevalence of Hepatitis E Virus Infection and Suceptibility: A Systematic
Review. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India and World
Health Organization, Geneva, Switzerland
• Cope, A. (2010). What Happened to Hepatitis E? Sheffield Teaching Hospitals
• Dalton, H.R. Bendall,R, Ijaz, S. BanKs, M (2008). Hepatitis E: an emerging infection in developed countries. The Lancet Infectious
Diseases, Volume 8, Issue 11, Pages 698 – 709
• Wai Kuo Shih, J. (2010). Efficacy, Immunogenicity and Safety of a Recombinant Hepatitis E Vaccine. National Institute of
Diagnostics and Vaccine Development infectious diseases, Xiamen University, Seoul, Korea
• Myint, K. S.A. ( 2008). Hepatitis E : a neglect threat. Department of Virology, Armed Forces Research Institute of Medical Sciences,
Trans R Soc Trop Med Hyg 102:211-2
• Pelosi, E. Clarke, I., (2008). Hepatitis E: a complex and global disease. Emerging Health Threats Journal
• World Health Organizations (2005 & 2011). WHO: Waterborne Disease is World's Leading Killer. http://www.voanews.com. Voice of
America (Retrieved 28-04-2011)