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Module: Public Health Disaster Planning for Districts Organization: East Africa HEALTH Alliance, 2009-2012 Author(s): Dr. Immaculate Nabukenya (MoH Uganda), Dr. Justine Lumaya (Yei Hospital), Ms. Christine Kanyandekwe (RALDA), Dr. Abdu Mohammed (MoH Ethiopia), Dr. Nlemba Mabela (MoH DRC), Dr. Julius Keyyu (Tanzania Wildlife Research Institute), Dr. Christina A.O. Othieno (Moi University), Dr. Terence Odoch (Makerere University), Dr. Robinson Mdegela (Sokoine University), Joel Buhinja (RALDA), Isaac Ntahobakulira (Rwanda) Resource Title: Session 1.2b: Epi-zoonotic Diseases of Importance in the Region License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution 3.0 License: http://creativecommons.org/licenses/by/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. 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To use this content you should do your own independent analysis to determine whether or not your use will be Fair. { Content the copyright holder, author, or law permits you to use, share and adapt. } { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } { Content Open.Michigan has used under a Fair Use determination. } Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Slide 3 Epi-zoonotic Diseases of Importance in the Region Compiled by the Eastern Africa Disaster Management Training Core Team Narrated by Dr. Roy William Mayega 10/10/20093Public Health Disaster Planning for Districts river seal, flickr ArranET,, flickr Anna Briggs,, flickr Slide 4 We are going to discuss the following Epi-zoonotic Diseases: 1. Rift Valley Fever 2. Influenza A Viruses 3. Anthrax 4. Rabies 5. Ebola 6. Plague 7. Trypanosomiasis 10/10/2009Public Health Disaster Planning for Districts4 CDC, Wikimedia Commons Slide 5 1. Rift Valley Fever An acute disease of domestic ruminants caused by a mosquito-borne virus characterized by liver disease, bleeding disorders and frequent abortions in animals Infection can cause severe disease in both animals and humans with many deaths Large outbreaks in animals occur especially after heavy rains The disease is typically distributed along but not limited to the Great Rift Valley 10/10/2009Public Health Disaster Planning for Districts5 Anna Briggs, flickr ArranET, flickr Slide 6 Transmission of RVF Spread among animals is through the bite of an infected mosquito (esp. Aedes); other biting flies can act as mechanical transmitters Susceptible Animals: Sheep, cattle, goats, camels Majority of human infections result from direct or indirect contact with blood and organs of infected animals People at highest risk: Butchers, Veterinarians, Animal handlers, herders, farmers Humans can also be infected directly by infected mosquitoes, skin cuts and inhalation 6Public Health Disaster Planning for Districts10/10/2009 Slide 7 Clinical Presentation of RVF Animals: Incubation period varies from 1 to 6 days Fever, low activity, salivation, diarrhoea, vomiting, nasal discharge, loss of appetite, low milk yield; Mortality of 10-70% especially calves Outbreaks manifest as a wave of unexplained abortions in livestock Humans: Influenza-like syndrome: Fever, headache, muscular pain, weakness, nausea, upper abdominal discomfort, fear of light; Recovery occurs within 4-7 days Complications: Eye complications, bleeding disorders, yellow eyes, meningitis-like illness and death 7Public Health Disaster Planning for Districts10/10/2009 Slide 8 Controlling RVF Animals Mass vaccination in affected and neighboring areas Restricting livestock movement may slow spread Control of mosquito populations Burn and bury dead and affected animals, abortion products Surveillance in animals provides early warning for epidemic in humans Humans Control of mosquitoes Personal protective measures for high risk groups Reducing consumption of raw blood, milk or animal tissue In epizootic regions, all animal products should be thoroughly cooked before eating Proper handling of specimens 8Public Health Disaster Planning for Districts10/10/2009 Slide 9 2. Influenza A highly contagious acute respiratory illness which affects humans and animals Influenza viruses are grouped into 3 types: Type A affects many animals (Pigs, Birds, Horses) and are of veterinary and public health importance Type B mainly affects humans; it causes seasonal influenza that is often mild Type C affects pigs and man 9Public Health Disaster Planning for Districts10/10/2009 Slide 10 Influenza Most Influenza A viruses are classified as low pathogenic strains Occasionally, low pathogenic Influenza A viruses mutate and become highly pathogenic, causing potentially devastating pandemics Examples: Highly Pathogenic Avian Influenza (HPAI) (H5N1) Influenza A (H1N1) also called Swine Flu 10/10/2009Public Health Disaster Planning for Districts10 NIH, Wikimedia Commons Slide 11 Pandemic Influenzas Worldwide, a pandemic has been occurring every 30 years: The Spanish flu (H1N1) caused 20-40 Million deaths in 1918 The Asian Flu (H2N2) caused 1 Million deaths in 1957 The Hongkong flu (H3N2) caused 1 Million deaths in 1968 The latest Flu (H1N1) occurred in 2009 and has caused over 3500 deaths 10/10/2009Public Health Disaster Planning for Districts11 Stephen & Claire Farnsworth, flickr Slide 12 Pandemic Influenzas Influenza A viruses cause pandemics as a result of the following: Change in the nature of the virus to a new strain Change in the nature of the virus so that it can infect humans e.g. a bird or pig virus changes so that it can infect humans Change in the nature of the virus so that it can be easily transmitted from person-to- person 10/10/2009Public Health Disaster Planning for Districts12 Source Unknown Slide 13 Phases of Pandemic Influenza 10/10/2009Public Health Disaster Planning for Districts13 Source Unknown Slide 14 Avian Influenza These are Influenza A viruses found chiefly in birds Occasionally, new strains are formed which cause mass epidemics in birds Risk is low to most people because the viruses do not easily infect humans However, since 1997, nearly 400 human cases have been reported in 23 countries The virus may change to a form that can cause a deadly pandemic 10/10/2009Public Health Disaster Planning for Districts14 river seal, flickr Bread for the World, flickr Slide 15 Symptoms of zoonotic flu Symptoms of zoonotic flu in animals Sudden massive deaths in animals (e.g. Birds), reduced egg production, bluish comb, swollen head, diarrhoea, lack of appetite Symptoms of zoonotic flu in humans Similar to seasonal flu: chills, fever, sore throat, muscle pains, severe headache, coughing, weakness, general discomfortchillsfeversore throatmuscle painsheadachecoughingweaknessgeneral discomfort However, unlike the seasonal flu, the new flues may cause severe disease and massive deaths High risk groups: Poultry and animal handlers, travelers to affected countries/zones, family and community contacts 15Public Health Disaster Planning for Districts10/10/2009 Slide 16 Control of Influenza in Animals Before the outbreak Protection in handling animals Do not mix different species Sensitize communities on how to recognize Train Rapid Response Teams Surveillance During the outbreak Farmers with affected flocks should report Immediate Notification and quarantine Rapid Response Teams should be activated Destruction and safe disposal of all affected flocks/animals Owners have to work with field teams Disinfecting animal houses, farm 10/10/2009Public Health Disaster Planning for Districts16 Jessica Reeder, flickr USFWS Mountain Prairie, flickr Slide 17 Control of Influenza in Humans Before the Outbreak Targeted Community sensitization on measures for control During the Outbreak Individual and Community Stay home if mildly or moderately sick Avoid close contact with people who are sick Nurse sick persons in separate area with personal protection Wash hands often and avoid touching eyes, nose and mouth Cover mouth or nose with a tissue when coughing or sneezing Keep up with health information in your own community Do not touch or eat affected animals Severely ill persons should be referred System Set up treatment centres for severely ill Call for immediate logistical support from the Ministry of Health Give Antiviral drugs if available Vaccinate high risk groups if vaccine is available Measures to ensure security and continuity of other services 17Public Health Disaster Planning for Districts10/10/2009 Slide 18 3. Anthrax An acute disease caused by Bacillus anthracis ; most forms of the disease are deadlyacutediseaseBacillus anthracis It most commonly occurs in cattle, sheep, goats, camels, wild-animals, and other herbivores Anthrax is most common in agricultural regions When it affects humans, it is usually due to an occupational exposure to infected animals or their products It is more common in developing countries or countries with poor veterinary public health programs It is also associated with the transition from drought to rains; occasionally during heavy rains 18Public Health Disaster Planning for Districts10/10/2009 Slide 19 Transmission of Anthrax Animals are infected by ingestion of the spores when grazing or drinking or inhalation of spores from dust Humans are infected by: Eating infected meat, water or food (Commonest form) Breathing in contaminated dust Through broken skin Humans can be infected from dead animals Anthrax does not usually spread from human-to- human, except when the dead are not handled carefully 19Public Health Disaster Planning for Districts10/10/2009 Slide 20 Clinical Signs of Anthrax Clinical signs in Animals Incubation period of 1 to 20 days May be sudden without showing signs or a short period of fever Blood discharge from the body openings in dead animals; the blood does not clot and the animal does not stiffen at death Pigs in particular only show swellings in the neck Clinical signs in Humans The skin form causes itching of the skin, a pimple and wound The lung form causes difficulty in breathing; may kill within a few hours The intestinal form causes fever, malaise, abdominal pain, diarrhoea, severe illness, chills, collapse and death 20Public Health Disaster Planning for Districts10/10/2009 Slide 21 Control of Anthrax Animals Treat the sick animals using high doses of penicillin Avoid opening suspect dead animals Isolate the sick and quarantine the suspected Disinfect the farm with standard disinfectants Vaccinate the animals in endemic areas Avoid contact with suspicious animal products Safe disposal (Burn or bury in deep hole with Lime; the dormant forms of the organisms stay for over 100 years!!!) Humans Notify immediately and admit them to a health facility Community education 21Public Health Disaster Planning for Districts10/10/2009 Slide 22 4. Rabies Rabies is a fatal zoonotic disease of all warm blooded animals caused by a virus and characterized abnormal behaviour as a result of its effects on the nervous system It occurs world wide, but especially where veterinary services are poor Related to poor handling of domestic animals (inability to feed them, none confinement and not vaccinating them) Over 95% of human deaths occur in the tropics 22Public Health Disaster Planning for Districts10/10/2009 Slide 23 Transmission of Rabies Virus is present in the saliva of clinically ill mammals and is transmitted through: Bite from an infected animal Contact with saliva through broken skin Through intact mucous membranes 30 to 60% of cases are children under 15 years Rabies is also present in wild animals (carnivores and bats) and is therefore difficult to control 23Public Health Disaster Planning for Districts10/10/2009 Slide 24 Clinical Signs of Rabies Animals Incubation period of this disease is about 10 days to 2 months and sometimes even longer The animal changes behaviour by becoming dangerously aggressive, salivating excessively, attacking other animals, people and objects, and may become paralyzed; it fears water- hydrophobia; abnormal appetite-may eat wood, stones, etc Humans: Exhibit the same symptoms Once symptoms of the disease develop, rabies is fatal Bark like dogs Almost always fatal NB: There is a mild form that is difficult to detect early 24Public Health Disaster Planning for Districts10/10/2009 Slide 25 Control of Rabies Animal Notify the authorities of any suspicious case Awareness creation Control dog populations; all un-confined animals may be killed Confine and observe suspect animal for 14 days; If it does not die, then it had no virus; DO NOT KILL THE ANIMAL IMMEDIATELY If it dies, take its head for laboratory confirmation Once signs and symptoms of rabies start, there is no treatment Mass vaccination of all domestic carnivores and keep vaccination records Maintain documentation of animal disposition and location Human Notify the authorities If bitten/scratched by an animal, clean the wound and seek medical advice Immunisation as soon as possible after suspect contact with an animal can prevent rabies in 100% of cases Once signs and symptoms of rabies start, there is no cure 25Public Health Disaster Planning for Districts10/10/2009 Slide 26 5. Ebola A highly virulent viral hemorrhagic fever that is often fatal in man and other primates Outbreaks occurred in DRC (1976, 1977, 1995, 2007, 2008), Sudan (1976, 1979), Kenya (1980), Cote dIvoire (1994, 1995), Gabon (1996), Uganda (2000, 2007) Source: Its natural reservoir still unclear; Monkeys and Chimpanzees are the common source; bats are the suspected as reservoir Other similar zoonotic viral hemorrhagic fevers include Marburg, Yellow Fever, Lassa fever, West-Nile Fever) Transmission Direct contact with the blood, body fluids and tissues of infected persons Handling, eating sick or dead infected wild animals (chimpanzees, gorillas, monkeys, forest antelope, fruit bats) 26Public Health Disaster Planning for Districts10/10/2009 Slide 27 Clinical signs of Ebola Clinical Signs Animal Infected animals are partially resistant and do not show the clinical signs Man Sudden onset of fever, intense weakness, muscle pain, headache and sore throat Followed by vomiting, diarrhoea, rash, kidney and liver failure In some cases, both internal and external bleeding (from external openings) Some get rash and bleeding under the skin 10/10/2009Public Health Disaster Planning for Districts27 Dr. Lyle Conrad, Wikimedia Commons Slide 28 Prevention and Control of Ebola in Animals Animals Most infected animals do not show signs Others are completely resistant Control in wild animals difficult Avoid contact with or eating wild primates Human Educate on special precautions with suspects No specific treatment or vaccine ; severe cases require intensive supportive care Isolate from other patients and use strict barrier nursing Trace and follow up people who may have been exposed Disinfect all items used around the patient Strict infection control practices by health workers Behaviour and cultural change in handling of patients Other VHFs: Insect and arthropod control 10/10/2009Public Health Disaster Planning for Districts28 CDC Slide 29 6. Plague An acute disease of animals and humans caused by a bacteria transmitted from small animals to humans by the bite of infected fleas Occurs world wide but with focal distribution depending on presence of rats and infected fleas in defined geographical areas In 2003, nine countries reported 2118 cases and 182 deaths 98.7% cases and 98.9% of deaths were reported from Africa Transmitted between animals and humans by the bite of infected fleas, direct contact, inhalation and rarely, ingestion of infective materials 29Public Health Disaster Planning for Districts10/10/2009 Slide 30 Clinical signs in man Plague can be a very severe disease with a case-fatality ratio of 30%-60% if untreated Incubation period of 3-7 days Infected persons usually start with flu-like symptoms They then experience sudden fever, chills, head and body- aches and weakness, vomiting and nausea Clinical plague manifests itself in three forms depending on the route of infection Bubonic: Swellings of lymph nodes in groin, neck, Generalized Blood infection: Spread is in the blood, with severe illness and fever Pneumonia: A severe lung infection 30Public Health Disaster Planning for Districts10/10/2009 Slide 31 Prevention and control of Plague Cases Early diagnosis Treatment Notification Isolation in the case of pneumonic plague Community level Flea control Rat Control Hygiene Surveillance Awareness creation Preventive antibiotic therapy 31Public Health Disaster Planning for Districts10/10/2009 Slide 32 7. Trypanosomiasis (Sleeping Sickness) A disease that affects the central nervous system of animals It occurs in the tsetse belt on either side of the equator 36 countries of sub-Saharan Africa affected Endemic in many foci in East Africa There are low levels of surveillance and control programmes Recently, major outbreaks occurred in Angola, the DRC, Sudan, Central African Republic, Chad, Congo, Cte dIvoire, Guinea, Malawi, Uganda and Tanzania Transmission is from the bite of an infected tse- tse fly 10/10/2009Public Health Disaster Planning for Districts32 ILRI, flickr Slide 33 Clinical Signs of Sleeping Sickness Animals Loss of appetite, weight loss, fever, anemia, rough hair coat, reduced milk production, some die Humans Incubation period Two stages Stage 1 (Early; in blood and lymph nodes): Painless skin swelling at site (Chancre), fever, swollen lymph nodes, face may be swollen, itchy rash Stage 2 (Late); Persistent headaches, change on behaviour, loss of appetite, weight loss, day-time sleepiness and failure to sleep at night; Confirmation by a Lumbar Puncture is mandatory to indicate stage of disease 33Public Health Disaster Planning for Districts10/10/2009 Slide 34 Prevention and Control of Sleeping Sickness Animals Diagnose and treat animals Give prophylaxis to animals in high risk areas Tsetse control (Insecticides, bush clearing, trypano-tolerant animals, tsetse targets) Surveillance Dipping or spraying with acaricides Humans Find, diagnose and treat cases Surveillance and Mass screening (Checking signs and lab tests) Diagnose as early as possible and before the neurological stage in order to avoid complicated, difficult and risky treatment Health education and awareness Participate in existing tsetse control programmes 34Public Health Disaster Planning for Districts10/10/2009 Slide 35 Other Important Zoonoses Other important zoonoses are not likely to cause epidemics include: Brucellosis, Bovine Tuberculosis and Cysticercosis 35Public Health Disaster Planning for Districts10/10/2009 Slide 36 Public Health Disaster Planning for Districts Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy Slide 3, Image 1: river seal, "chickens", flickr, http://www.flickr.com/photos/riverseal/22446062/, CC: BY-NC 2.0, http://creativecommons.org/licenses/by-nc/2.0/ Slide 3, Image 2: ArranET, "Pygora goat", flickr, http://www.flickr.com/photos/arran_edmonstone_photography/4995279544/, CC: BY 2.0, http://creativecommons.org/licenses/by/2.0/ Slide 3, Image 3: Anna Briggs, "Cow on Kegworth canal bridge", flickr, http://www.flickr.com/photos/anna-b/3160390295/, CC: BY-NC 2.0, http://creativecommons.org/licenses/by-nc/2.0/ Slide 4, Image 1: CDC, "Ebola outbreak in Gulu Municipal Hospital", Wikimedia Commons, http://commons.wikimedia.org/wiki/File:Ebola_outbreak_in_Gulu_Municipal_Hospital.jpg, PD-Gov, Public Domain - Government. Slide 5, Image 1: Anna Briggs, "Cow on Kegworth canal bridge", flickr, http://www.flickr.com/photos/anna-b/3160390295/, CC: BY-NC 2.0, http://creativecommons.org/licenses/by-nc/2.0/ Slide 5, Image 2: ArranET, "Pygora goat", flickr, http://www.flickr.com/photos/arran_edmonstone_photography/4995279544/, CC: BY 2.0, http://creativecommons.org/licenses/by/2.0/ Slide 10, Image 1: NIH, "Anigenic Shift", Wikimedia Commons, http://commons.wikimedia.org/wiki/File:AntigenicShift_HiRes.jpg, PD-GOV, Public Domain, Government Slide 11, Image 1: Stephen and Claire Farnsworth, "Piglets", flickr, http://www.flickr.com/photos/the_farnsworths/4720941033/, CC: BY-NC-SA 2.0, http://creativecommons.org/licenses/by-nc-sa/2.0/. Slide 14, Image 1: river seal, "chickens", flickr, http://www.flickr.com/photos/riverseal/22446062/, CC: BY-NC 2.0, http://creativecommons.org/licenses/by-nc/2.0/. Slide 14, Image 2: Bread for the World, "Uganda Chickens", flickr, http://www.flickr.com/photos/breadfortheworld/4995437199/, CC: BY-NC 2.0, http://creativecommons.org/licenses/by-nc/2.0/ Slide 16, Image 1: Jessica Reeder, "P1030638", flickr, http://www.flickr.com/photos/jessicareeder/3598192525/, CC: BY-SA 2.0, http://creativecommons.org/licenses/by-sa/2.0/ Slide 16, Image 2: USFWS Mountain Prairie, "Avian Influenza Sampling", flickr, http://www.flickr.com/photos/usfwsmtnprairie/5790548806/, CC: BY 2.0, http://creativecommons.org/licenses/by/2.0/ Slide 37 10/10/2009 Public Health Disaster Planning for Districts Additional Source Information for more information see: http://open.umich.edu/wiki/CitationPolicy Slide 27, Image 1: Dr. Lyle Conrad, "7042 lores-Ebola-Zaire-CDC Photo.jpg", Wikimedia Commons, http://commons.wikimedia.org/wiki/File:7042_lores-Ebola-Zaire-CDC_Photo.jpg, PD-Gov, Public Domain - Government Slide 28, Image 1: CDC, "Outbreak Investigation", http://blogs.cdc.gov/publichealthmatters/2011/09/outbreak-investigation-a-cheat-sheet/, Public Domain Government Slide 32, Image 1: ILRI, "A sleeping sickness patient in Soroti, Uganda", flickr, http://www.flickr.com/photos/ilri/5464379313/, CC: BY-NC-SA 2.0, http://creativecommons.org/licenses/by-nc-sa/2.0/