Emerging and Re-emerging Infections
Item
- Title
- Emerging and Re-emerging Infections
- Date
- 1998
- extracted text
-
EMERGING AND RE-EMERGING INFECTIONS
What are anerging/re-emerging infections .
In 1991, a committee appointed by Institute of Medicine, USA,
defined them as follows :
EMERGENCE
Spread of new agent
recognition of a previously unrecognised infection.
RE-EMERGENCE J.
Reappearance of previously known infection after a
period of decline
Is there a general phenomen of " emerging infections ' today?
witnessing a ’resurgence' of infectious diseases.
We would like to define
’Resuroenca'
Or are
resurgence ' as fallows :
is an exacerbation of an already prevalent infection.
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HISTORY OF THE IDEA OF EMERGENCE/RE—EMERGENCE OF INFECTIOUS DISEASES
1880-1920
— Sanitary legislation, safe handling of food and water,
environmental
sanitation
were
insituted
in
many
countries.
These were followed by control of diseases
due to faeco-oral or vector borne transmission,
wherever
these measures have been adopted.
1936
- Discovery of antibiotics
1955-1960
1960's
Polio vaccination and erradication of bolio from Europe
and America.
Small pox vaccination and erradication of small pox.
— Discovery of MRSA (Methicillin resistant S. Aureus)
Control of infectious diseases in most market economies
Increase in life expectancy, shift of morbidity to
degenerative diseases.
General perception that infectious diseases had been
conquered, accompanied by a decrease in funding of
infectious disease research.
environmental
Increasing
relations to health.
of
consciousness
and
of
its
HIV/AIDS.
1981
- Discovery
1980-=4}
- Spread of HIV pandemic world-wide
Description of a host of new pathogens related to HIV.
Appearance of several multidrug resistant
pathogens
(Pneumococcus. Enterococcus, TB).
Increasing concern about
emerging infections ’
among
scientific community.
1989
— Conference on emerging infectious diseases
Rockefeller University, National Institute of Allergy ?<
Infectious diseases, Fogarly International Centre.
1991
18 month study by committee apoointed by Institute of
Medicine, USA.
(Emerging microbial threats. to public health in USA)
April 1994 - WHO meeting of International Experts to consider global
emerging and re-emerging
strategy to deal with new,
infections.
1994
1995
1995
1997
— Supposed outbreak of ‘Plague’ in
people.
India
affecting
876
‘Emerging Infectious Diseases’, a new quarterly was
published by National Center for Infectious Diseases, and
CDC, Atlanta.
- Outbreak of Ebola Virus in Zaire with 315 deaths.
Theme
for
World Health Day
" Emerging Infections".
DISTRIBUTION OF DALY's LOSS BY CAUSE AND DEMOGRAPHIC REGION 1990
SUB-SAHARAN
AFRICA
ESTABLISHED
MARKET
ECONOMIES
WORLD
INDIAN
CHINA
5267
850
1134
510
798
Communicable
diseases
45.8
50.5
25.3
71.3
9. 7
TB
3.4
3.7
2.9
4.7
0.7
,TD & HIV
3.8
2. 7
1.7
8.8
3.4
Diarrhea
7.3
9.6
2. 1
10. 4
0.3
Vaccine preventable
childhood infection
5.0
6.7
0.9
9.6
0. 1
Malaria
2.6
0.3
Warm infections
1.8
0.9
3.4
1.8
Resp i ratory
infections
9.0
10.9
6. 4
10.8
Population
(mill ions)
DALYs =
10. 8
less than 0. 1
disability - adjusted life years
2.6
RESURGENCE OF INFECTIOUS DISEASE IN INDIA (BACTERIA)
EPIDEMIOLOGICAL INFORMATION
INFECTION
RESURGENCE
Plague
Re-emergence
2 out breaks in August-October
- Dismantling of plague surveill
1994 with 876 cases of presumotive
ance units among rodents.
plague (after a period of 26
- Poor environmental sanitation
years)
- Poor lab and epidemiological
support
Only 3 proven cases based on
histopathology. Data on outbreak
not convincing.
* Melioidosis
New agent
’Unrecognised problem
Handful of cases reoorted from
two centres 1991-1996
Extent of problem not known.
* Anthrax
’Resurgence
■’Unrecognised problem
Increase in nuitraer of cases
from 1970's
- Poor vetinary care of animals
- Poor lap support.
- Handling and ingestion of dead
animals
» Leotosoirosis
? Resurgence
? Unrecognised
proolem
Outbreaks of Leptosoirosus
Since 1980's in Tamilnauu.
Kerala and Andamans.
Leptospirosis wide soread
among animals.
- Poor lab support hence extent
of sroolem cannot be defined.
V.Cholera 0139
Old agent
New strain
8th pandemic of cholera
starting in South India in 1992
spreading all over India
and the whole world.
Poor environmental sanitation
ano lack of safe orinking
water.
New strain
Wide soread of this organism
since 1990's.
Overuse of Chloromycetin
MRSA (Methicillin
Resistant
Staohyiococcus
Aureusi
New strain
Widely prevalent in many hosoitals
in India since 1990's,
Over use of Penicillins in
hospitals.
Multi-drug
Resistant
M-Tuoerculosis
New strain
Multi-drug
Resistant typnoia
REASONS FOR RESURGENCE
Lack of infection control and
handwashing.
Extent of problem not defined but
likely to be large
» Inadeouate epidemiological data to state the extent of the problem.
Irregular theraoy
RESURGENCE OF INFECTIOUS DISEASES ITJ INDIA (VIRUSES)
INFECTION
HIV
ENERGENC/RESUR6ENCE
New Agent
EPIDEMIOLOGICAL INFORMATION
REASONS FOR RESURGENCE
First case detected in 1985
Presently number of cases
estimated to be 1.75-3 millions
Projection of 5-6 millions by
by 2000 A.D.
Low role of women in society
Widespread sex industry
Inaoeouate blood donor
screening
Inadequate governmental
resoonse
Poor education'
IV Drug use.
Dengue
Resurgence
Heoatitis E
Heoatitis C
Increasing urbanisation
Poor environmental sanitation
Inadequate lab. facilities for
diagnosis and knowledge about
treatment.
Soreau of vector to rural areas
(Ae. aegypt;)
Extent of problem not defined
* Jaoanese
B Enceohalitis
* Hepatitis B
Outbreaks known for one century
Since 1960's-DHF/DSS seen
Since last 10 years increasing
Freouency ano magnitude of
epidemics
Rural outbreaks
Heoatitis E i C
previously
unrecognised
infections
Hepatitis B-
Hepatitis E
toa.ior puolic Health problem
Poor environmental, sanitation
Heoatitis B
Inaoeouate blood supply
Professional blood bank/donors
Inaoeouate blood screening.
Heotitis E Commonest cause of eoicemic
eoicemic and sporaoic hepatitis
* Inaoeouate epioemiological data to state the extent of the oroblem.
RESURGENCE OF INFECTIOUS DISEASES IN INDIA (PROTOZOA/NEMATODES)
INFECTION
RESURGENCE
EPIDEMIOLOGICAL INFORMATION
REASONS FOR RESURGENCE
Kalaazar
Resurgence
Steady increase in no. of cases/
deaths from late 1970’s
Spread to non-enoemic areas
(1977 - No.of cases 18.742
1992 - No.of cases 75.523)
Withdrawal of DDT soray under
NMEP.
Builduo of sandfly population
Inadeouate public attention
Scarcity of funds for
diagnosis, treatment and
control.
Lack of monitoring systea.
Lymonatic filariasis
Resurgence
Enormous increase in cases over
over last 4 aecaoes
Microfilaria rates 10-227.
Disease rate 5-18 7.
Musauito infection rates 10-307.
Increased uroanisation
Musouitogenic condition
Improoer water drainage
Limitations of control
prograese
Non-availaoility of drugs
and anti-filarial measures
Malaria
Resurgence
Steady increases of cases
in 1990's
Increased P.Faicioaruta rate
Drug resistance
Eoicemic and focal outbreaks
Increase in uroan
Malaria
Urbanisation
Environmental degradation
Pooulation aoveeents
Drug resistance
Lack of residual spraying
Lack of availability of
drugs ano adequate diagnostic
facilities.
!
FACTORS RESULTING IN RESURGENCE OF INFECTIOUS DISEASES
1. URBANISATION;
- Increased population density
- Poor sanitation
- Poor quality of housing, water food and
healthcare
2. ENVIRONMENTAL/ECOLOGICAL CHANGES
Deforestation
Man-made reservoirs of water
Global warming
Changes in animal populations
and animal movements
Agriculture
3. ECONOMIC FACTORS
North - South Inequalities
Low income - decreased access to shelter, food. water, clothing
health care
Economic factors leading to urbanisation
Decreased governmental expenditure on health.
4. POLITICAL FACTORS:
'World Bank' Control of developing governments health policy.
'Panic reaction' to politically sensitive diseases
'Cover ud' of diseases for political reasons
Low government expenditure on health and social sector.
5. PUBLIC HEAL.TH SYSTEM :
Inadequacies in hospital and public health apparatus
EPIDEMIOLOGY AND MICROBIOLOGY SERVICES
Absence of surveillance apparatus and microDiology
reliably diagnose common and uncommon infections.
7. ANTIBIOTIC PRESCRIBING PRACTICES:
Irrational and overuse of antibiotics
a. NATURAL AND MAN-MADE DISASTERS : "
Earthquakes, tidal waves, war and civil strike.
9. POPULATION MOVEMENTS
Travel
Migration
Tourism
10. HUMAN BEHAVIOUR
IV drug use
Sexual practices
services
to
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