Introduction

What is the Burden of Disease Caused by Communicable Diseases? What Public Health Tools are Available to Address the Burden of Communicable Diseases?

Introduction
How Can Barriers Against Disease Address the Burden of Communicable Diseases? How Can Immunization Be Used to Address the Burden of Communicable Diseases? How Can Screening and Case Finding Address the Burden of Communicable Diseases? How Can Public Health Efforts Maximize Effectiveness of Treatment and Prevent Resistance? How Can Public Health Strategies Eliminate Specific Communicable Diseases?

Introduction
Your dorm mate went to bed not feeling well one night and early the next morning you had trouble arousing her. She was rushed to the hospital just in time to be effectively diagnosed and treated for meningococcal meningitis. The health department recommends immediate antibiotic treatment for everyone in close contact with your roommate. They set up a process to watch for additional cases to be sure an outbreak is not in progress. Fortunately no more cases occur. You ask yourself should your college require that all freshman to have the meningococcal vaccine before they can register for classes?

Scenarios Communicable Diseases

As a health advisor to a worldwide HIV/AIDS foundation, you are asked to advise on ways to address the HIV and growing TB epidemic. You are asked to do some long range thinking and to come up with a list of potential approaches to control the epidemics. The first recommendation you make is forget about eradicating HIV/AIDS. How did you come to that conclusion?

Communicable Disease Burden

Tuberculosis One Billion deaths from 1700-1900

Many ppl today are carriers Genes, nutrition, reduced immunity produce activity P.H. movements such as Sanitariums, Vaccines, X-ray, Milk Pasteurization, worked to nearly eliminate incidence 1940s began medical treatment era of TB antibiotic treatments

Not so fast!
1980s saw resurgence in developed world Never ended pandemic in many underdeveloped regions Various reasonsHIV increases susceptibility, promotes spread Drug resistant TB on rise

Communicable Disease Burden

Increased presence of new infections such as Lyme Disease & West Nile Lost battle for control of global pandemics Malaria Chagas Measles HIV Influenza (H1N1 most recent)

Emergence of previously unknown infections

West Nile (U.S. presence in 1999) Dengue Fever (1960s) Mad Cow (1993)

How do we Eradicate?
Barrier, Protection Immunization Screening

Treatment
Maximize effectiveness and prevent resistance

Is Eradication Easy?
HIV/AIDS
Burden of Disease:
1.2 Million people living w/ HIV/AIDS Another 250,000 undiagnosed Half of 1.2 million people receive regular care 25% of 1.2 million are at undetectable viral load

Modes and Chance of Transmission of HIV and existing interventions

Route of transmission Estimated transmission rate per exposure
Range from 0.1% to 10% with unprotected receptive anal intercourse posing highest risk. Vaginal male to female greater than female to Male. Circumcision reduces risk by half. Other sexually transmitted diseases may increase risk.

Potential interventions

Sexual contact

Latex condom Circumcision Abstinence Serial monogamy reduces spread compared to two or more concurrent partners

Anal higher than vaginal, which is much higher than oral

Modes and Chance of Transmission of HIV and existing interventions

Route of transmission Estimated Transmission rate per exposure Contaminated blood over 90% chance of transmission; pooling of blood Dramatically increases infection Potential interventions

Blood transfusion Blood and blood products, such as pooled blood products previously used in U.S. by hemophiliacs

Screening of blood to detect HIV early

Use of individuals own blood for surgery

Modes and Chance of Transmission of HIV and existing interventions

Route of transmission Estimated transmission rate per exposure
15 to 40% Higher in developing countries Highest rate of transmission at time of vaginal delivery

Potential interventions

Mothertochild transmission

Cesarean delivery Drug treatment during pregnancy and at time of delivery for mother and child

Modes and Chance of Transmission of HIV and existing interventions

Route of transmission Estimated Transmission rate per exposure Potential interventions

Breast-feeding

Very low per exposure, Continuation of drug but up to 25% over year treatment reduces, but does or more of breast not eliminate transmission feeding

Modes and Chance of Transmission of HIV and existing interventions

Route of transmission Estimated transmission rate per exposure Potential interventions

Needlestick exposures: Health care occupational risk

Less than 0.5% of Postexposure HIV treatment with positive drugs established as needlesticks effective result in prevention transmission

Modes and Chance of Transmission of HIV and existing interventions

Route of transmission Estimated transmission rate per exposure Potential interventions

Injection drug use

Less than 1% per Needle exchange episode of needle programs sharing

Potential for Eradication of HIV/AIDS

HIV/AIDS
Disease is limited to humans, i.e., no animal reservoir? Limited persistence in the environment? Absence of long-term carrier state? Long-term immunity results from infection? NoAnimal reservoirs exist

NoMay persist on contaminated needles long enough for transmission NoCarrier state is constant Effective long-term immunity does not usually occur

Potential for Eradication of HIV/AIDS

HIV/AIDS
Vaccination confers long-term immunity? Herd immunity prevents perpetuation of an epidemic? NoNone currently available and will be difficult to achieve NoLarge number of previously-infected individuals increases the risk to the uninfected

Easily-diagnosed disease?
Vaccination effective postexposure?

NoRequires testing
NoNone currently available

Is Eradication Easy?
HIV/AIDS
Barrier, protection Isolation? Sexual protection?
Immunization Treatment but no vaccine Treatment slows progression, does not prevent spread Screening Stigma associated w/ screening creates barrier What are end results? Maximize effectiveness, prevent spread Yes, but how!

HIV/AIDS
New efforts to Maximize effectiveness of treatment to reduce incidence Compliance to treatment reduces viral load to undetectable levels

Creates new level of prevention via UVL Reduces risk of infection by 98%*
http://www.aidsmap.com/page/1429357/

PrEP Pre-Exposure Prophylaxis Reduces risk of infection by 44-75%*

http://www.cdc.gov/hiv/prep/

Eradication of Human Diseases: What Makes it Possible?

Smallpox
Disease is limited to humans, i.e., no animal reservoir? Limited persistence in the environment? Absence of long term carrier state? Yes

Polio
Yes

Measles
Yes

Yes

Yes

Yes

Yes

YesAbsent, but may occur in Immune Compromised individuals

YesAbsent, but may occur in immune Compromised individuals

Eradication of Human Diseases: What Makes it Possible?

Smallpox
Long-term immunity results from infection? Yes

Polio
YesBut may not be sustained in Immune Compromised individuals
YesBut may not be sustained in Immune Compromised Individuals Virus used for production of the live vaccine can produce polio-like illness and has potential to revert back to "wild type infection"

Measles
YesBut may not be sustained in immune Compromised individuals YesBut may not be sustained in immune Compromised individuals

Vaccination confers long-term immunity?

Yes

Eradication of Human Diseases: What Makes it Possible?

Smallpox
Herd immunity Prevents perpetuation of an epidemic?
Easily-diagnosed disease?

Polio
Yes

Measles
Yes

Yes

YesDisease easily identified

Yes/No Disease relatively easy to identify, but large number of Asymptomatic infections

No Disease may be confused with other diseases by those unfamiliar with measles

Vaccination effective postexposure?

Yes Postexposure Vaccination effective

No Postexposure vaccination not effective

No Postexposure vaccination not effective

So you see
Eradication of communicable disease isnt simple Controlling infection can be a P.H. Objective Public Health efforts must be long term and consistent Evidence-Based practice must be up to date for P.H. efforts to continue to work