Emerging and re-emerging

infectious diseases

Hajer Elkout
Outlines of the lecture
 Definition of emerging & re-emerging
diseases.
 Factors contributing to emergence.
 Examples.
 Influenza.
 Strategies to reduce the risk of infection.
Infectious disease and the world history
◦ The Black Death in the Middle Ages killed 1/3 Europe’s population
◦ .
◦ Measles destroyed the South American Aztec civilization.

◦ Smallpox destroyed indigenous peoples of North and South

America, facilitating the conquest of the New World.
Definition of emerging and re-
emerging infectious diseases

 If the disease was unknown in the location

before, the disease is considered to be
emerging.

 If the disease had been present at the

location in the past and was considered
eradicated or controlled, the disease is
considered to be re-emerging.
 Infectious Disease- Trends
 Incidence reduced in the 20th century.
◦ Urban sanitation, improved housing, personal
hygiene, antisepsis & vaccination.
◦ Antibiotics further suppressed morbidity &
mortality.
Factors contributing to emergence
 AGENT
◦ Evolution of pathogenic infectious agents
(microbial adaptation & change).
◦ Development of resistance to drugs.
◦ Resistance of vectors to pesticides.
Drug resistance
 CAUSES:
◦ Wrong prescribing practices.
◦ non-adherence by patients.
◦ Use of anti-infective drugs in animals & plants.

 CONSEQUENCES:
◦ Prolonged hospital admissions.
◦ Higher death rates from infections.
◦ Requires more expensive, more toxic drugs.
◦ Higher health care costs.
Factors Contributing To Emergence

 HOST
◦ Human demographic change (inhabiting new
areas).
◦ Human behaviour (sexual & drug use, use of
child-care facilities).
◦ Human susceptibility to infection
(Immunosuppression due to medical treatments
or new diseases ).
◦ Poverty & social inequality.
Factors Contributing To Emergence
 ENVIRONMENT
◦ Climate & changing ecosystems.
◦ Economic development & Land use (urbanization,
deforestation).
◦ Technology & industry (food processing &
handling).
◦ International travel & commerce.
◦ War, unrest, natural disasters, overcrowding.
Source: NATURE; Vol 430; July 2004
Examples of recent emerging diseases
Examples
 Malaria
◦ Plasmodium falciparum was thought to be eradicated
because of the effective use of DDT insecticide
◦ But mosquito gain resistance
 Tuberculosis
◦ Isoniazid was initially effective to cure TB
◦ By 1980s, the era of HIV/AIDS, increased immune
deficiencies of people, increases the risk of latent M.
tuberculosis
◦ Also the fact that TB is a disease of poverty –
crowding, inadequate hygiene
 Dengue
◦ Aedes albopictus mosquito eggs in shipments of used tyres  dengue
fever
 Infectious causes of chronic
diseases
Disease Cause
Cervical cancer Human papilloma virus
Chronic hepatitis, liver cancer Hepatitis B and C viruses
Lyme disease (arthritis) Borrelia burgdorferi
Whipple’s disease Tropheryma whippelii
Bladder cancer Schistosoma haematobium
Stomach cancer Helicobacter pylori
Peptic ulcer disease Helicobacter pylori

Atherosclerosis (CHD) Chlamydiae pneumoniae

Diabetes mellitus, type 1 Enteroviruses (esp. Coxsackie)
Multiple sclerosis Epstein-Barr v, herpes vv?
Inflammatory bowel disease Mycobacterium avium sub-spp.
Paratuberculosis, Yersinia
Influenza Viruses
 Influenza, commonly called the flu is an
infectious disease caused by RNA virus.
 Classified into types A, B, and C
◦ Types A and B cause significant disease worldwide.
◦ Types B and C limited to humans.
◦ Type A viruses. More virulent and affect many
species.

 Reservoir
1. Domestic and wild birds.
2. Live animals.
3. Pigs.
Influenza
 Several influenza pandemics have occurred
throughout history. Best documented within the
last century.
◦ 1918 - Spanish flu (H1N1).
◦ 1957 - Asian flu (H2N2).
◦ 1968 - Hong Kong flu (H3N2).
◦ 2009 - Swine flu (H1N1).

 Spanish flu in 1918 was the most devastating,

causing an estimated 50 million deaths
worldwide.
Influenza

 The severity of infection depends on the viral

virulence and the host’s overall health.
 Virulence factor genes constantly mutating.
 H and N also mutating affecting immune
recognition
 These mutations influence virulence and mean
there is always the potential for increased virulence
in future strains.
Symptoms Complications
 Fever over 100 F (38  Pneumonia
C)  Bronchitis
 Aching muscles,  Asthma flare-ups
 Chills and sweats  Sinus infections
 Headache  Ear infections
 Dry cough  Pneumonia is the
 Fatigue and weakness most serious
 Nasal congestion complication.
Prevention
 Cover mouth and nose when sneezing.
 Wash hands frequently with soap and water or
alcohol.
 Avoid touching eyes, nose and mouth.
 Avoid contact with sick people.
 Avoid crowded congested environments.
 If sick stay home, don’t expose others.
 Get flu shot(s).
 Take antiviral drugs if physician recommends.
Strategies to reduce threats of
emerging and re-emerging infections
 IMPROVE GLOBAL SURVEILLANCE
◦ Improve diagnostic capacity (training,
regulations).
◦ Improve communication systems (web, e-mail
etc.) and sharing of surveillance data.
◦ Rapid data analysis.
◦ Develop innovative surveillance and analysis
strategies.
◦ Coordinate human and animal surveillance
Strategies to reduce threats
 USE OF VACCINES
◦ Increase coverage.
◦ New strategies for delivery (e.g., nasal spray
administration).
◦ Develop new vaccines.
◦ Decrease cost.
◦ Decrease dependency on “cold chain”.

 NEW DRUG DEVELOPMENT

Strategies to reduce threats
 Decrease inappropriate drug use
◦ Improve education of clinicians and public.
◦ Decrease antimicrobial use in agriculture and food
production.

 Improve vector and zoonotic control

◦ Develop new safe insecticides.
◦ Develop more non-chemical strategies e.g.
organic strategies.

 Better widespread health education (e.g.bed

nets, mosquito repellent).
Strategies to reduce threats
 Develop more feasible control strategies.
 Develop new strategies requiring low-cost
technology.
 Greater support for research.
 Reduce poverty and inequality.
Essential factors for disease eradication
 Knowledge of its epidemiology and transmission
patterns/mode.
 Availability of effective tools for diagnosis,
treatment and prevention.
 Knowledge of local cultural and political
characteristics.
 Community acceptance and mobilization.
 Political will and leadership.
 Adequate and sustained funding.
Targets
 Antimicrobial resistance
 Foodborne and waterborne diseases.
 Vector borne and zoonotic diseases.
 Diseases transmitted through blood transfusions
or blood products
 Chronic diseases caused by infectious agents.
 Vaccine development and use
 Diseases of persons with impaired host defenses
 Diseases of pregnant women and newborns
 Diseases of travelers, immigrants, and refugees
THANK YOU