Emerging Re-emerging

Diseases

.
 INTRODUCTION
Disease burden is colossal
Cause heavy mortality, disability and
economic loss
Result in widespread epidemics
Immense suffering to the man kind
Disturb International trade and economic
development
 DEFINITION

Emerging infectious diseases are New

diseases; new problem (New threats).

An emerging infectious disease is a one

that is caused by a newly discovered
infectious agent or by a newly identified
variant of a known pathogen, which has
emerged and whose incidence in
humans has increased during the last
two decades and is threatening to
increase in the near future.
Cont.
Re-emerging infectious diseases are old
diseases, new problem. (New threats).
A re-emerging infectious disease is a one
which was previously controlled but once
again has risen to be a significant health
problem. This term also refers to that
disease which was formerly confined to one
geographic area, has now spread to other
areas.
Transmission of communicable
diseases

Agent
of
Vector

Agents Direct contact Human

Number of agents Defense mechanisms

Characteristics of agents Immunity
Pathogenicity
Personal characteristics
 Host Reaction
Infectious agents

Enter human host

Produces inapparent infection Host recovery

Mild disease Host fights or

with treatment
Severe disease with treatment
Disability
Death
 The Factors Responsible
Improper planning of the township
Population explosion
Poor living conditions
Over crowding
Industrialization
Urbanization
Lack of health care services
Migration of population
Intense international travel
Globalization
Cont
Indiscriminate use of antibiotics and
development of resistance
Increase in contact with animals
Insecticide resistance
Alterations in micro-organisms
Environmental degradation with changing
weather pattern.
Illiteracy and ignorance
Natural disasters
 Predisposing Factors for the
Epidemic
Before the on set of
epidemic
Earth quake (Gujarath-1993)

During the epidemic

Migration of the people
Eruption of slums
Collection of garbage
Scarcity of antibiotics
 Emerging Diseases in India and
Global
Diseases due to new agents (Eg.AIDS)
Diseases due to new variants of known pathogens
(Eg.Avian Flu)
Diseases caused by an infectious agent but
resulting in non-communicable diseases.
(Eg.Hep.C results in liver cancer)
Global examples of emerging and
re-emerging infectious diseases
Examples of new and Reemerging
Diseases
Emerging Food borne water borne
disease
Accounts for 20 million cases in the world
annually (T.D. Chugh-2008)
Incidence is increasing
Half of all known food borne pathogens
discovered during the past 25 years
Cont..
Entero hemorrhagic Escherichia coli
Causes no signs of illness
Low infections dose in humans causes
hemorrhagic colitis and hemolytic uraemic
syndrome
Consumption of undercooked beef and
contaminated vegetables, fruits and water for
vegetarians.
Reported in 1.4% of stools from cases of bloody
diarrhoea in Kolkata (Ministry of Health and Welfare
2006).
Detection of potential pathogenic O157:H7 in river
water (Ganges by Hamner et al 2007) is alarming.
Cont.
Vibrio cholerae
Cholera is one of the oldest recorded infectious
diseases.
John Snow demonstrated the spread by infected water
Pacini in 1854, first described comma shaped bacteria
Robert Koch in 1883, showed the causative agent
V .Cholerae.
Das and Gupta -2005 reported the diversity of
V .Cholerae.
Narang et al (2008) described the changing patterns of
V .Cholerae.
Listeria monocytogenes
Listerosis is an emerging zoonotic disease
28% deaths due to food borne illnesses in USA
Organism is robust and survive food-processing and
contaminated refrigerated meat and dairy products.
In India, Bhujwala et al in 1970 reported the presence of
this organism in cervical secretions of 1.3-3% of cases
with very bad obstetrical history.
Thomas et al (1981) in a prospective study of 1300
newborns found the pathogen in 2 cases
Campylobacter spp
Are signicant zoonotic poultry pathogens
Leading cause of gastro enteritis in the world
Around 2.5 million human infections are
reported annually in the United States.
In developing countries the presence of the
organism was reported in 5-20% in child hood
diarrhoea
Jain et al (2005) reported isolation of jejuni in
13.5% of the diarrhoea patients
Drug-resistant bacteria
Antimicrobial resistance (AMR) in hospitals and
community poses a public health problem (Moellering
2007).
Reservoir for resistant genes is the fecal flora and upper
respiratory tract
Chugh (2008) reviewed the global status of AMR in
various pathogens.
Woodford (2007) has identied the existence of multi
resistant clones of common pathogens.
Cont.
Staphylococcus aureus is the modern Ghengis
Khan (Chugh 2007). the most frequently identied
drug-resistant pathogen.
Singhal et al (2007)reported ciprooxacin-resistant
meningococci in an outbreak in Delhi.
Resistance of Salmonella typhi and S. paratyphi
to chloramphenicol, ampicillin and cotrimoxazole is
widespread.
AMR in Shigella resistance to azithromycin,
ceftriaxon and ciprooxacin on the increase
Rational use of antibacterial to contain AMR
 Melioidosis
The causative pathogen is Burkholderia
pseudomallei
It is an environmental saprophyte in rice
paddies, wet soil, mud and pooled surface
water.
It causes suppurative chronic infection
characterized by septicemia and focal
abscesses in liver, spleen and other viscera.
Cont.
Has been documented from Tamilnadu and
Karnataka.
The association of the disease with
diabetes mellitus is high.
Vidyalakshmi et al (2007) reviewed the
disease in India
The first culture proven case in India was a
child in Maharashtra in 1990.
 Chronic and Neoplastic Diseases

Microbe Disease
Helicobacter pylori Peptic ulcer, gastric
carcinoma
Human papilloma virus Cervical, anal, vulvar
carcinoma
Hepatitis B/C viruses Liver cirrhosis,
hepatocellular carcinoma
Epstein Bar Virus B-cell lymphoma,
nasopharyngeal carcinoma
Human T lymphotropic Adult T-cell leukemia
virus type 1
Cont.
Microbe Disease

Human herpes virus 8 Kaposis sarcoma

Borrelia burgdorferi Lyme arthritis

Tropheryma whippelii Whipples disease

Chlamydia atherosclerosis
pneumoniae
Cont.
The high prevalence of resistance to metronidazole,
clarithromycin and amoxicillin is the failure to eradicate
H. pylori infection.
The resistance is higher in south than north India.
High rate of re infections in Indian subjects (60%).
Chlamydia pneumoniae is associated with pathogenesis
of coronary artery disease. (Jha et al 2007).
 Control of Emerging and
Re-emerging Diseases
Controlling the reservoir
Interrupting the transmission
Protecting the susceptible host
Strengthening of the disease surveillance
system
Encouraging research initiations for
treatmentregimens and diagnostics
Encouraging research for new methods of
control measures
Establishment of drug resistance
Response to H5N1 avian influenza
outbreak in Hong Kong.
Emerging Infectious Diseases:
a Research Approach
Benefits of Emerging Diseases
Research
 Emerging Diseases Funding (National
Institute of Allergy and Infectious Diseases).
 Role of Nurses in Prevention
Increase knowledge and skill
Encourage partnerships with consumers and other
disciplines to identify needs, set priorities, develop
strategies and evaluate progress
Support health care legislation
Involve in research
Encourage using multidisciplinary efforts.
Influence local and National economic and political
options
Continue to advance nursing concern
Educate the public
Benefits of Community Prevention
Programme
Opportunity to reach the masses and effect widespread
changes in social norms
Increased public awareness of and commitment
Increased cost efficiency of group intervention
Ability of the programme to promote the development of an
environment of social support
Opportunity of evaluate the effectiveness of health promotion
programms
Enhanced approach toward promoting health in large
population
Additional resources for information exchange and social
support.
 Role of Public Health Authorities
National programme for prevention and control
of vector borne diseases
Legislations for elimination
Communities awareness of the disease
Minimizing transmission of infection: By
Risk communication to the family members
Minimizing vector population
Minimizing vector individual contact

Reporting to the nearest public health authority

Public health measures to prevent
infectious diseases
Safe water
Sewage treatment and disposal
Food safety programme
Animal control programme
Vaccination programme
Public health organization
 Response of the WHO

Developing global and regional strategies

Appointing Task Force
Generous grant from WHO regular
budget
Support the World Bank grant
RE-EMERGING DISEASES
DISEASE AGENT
DENGUE FEVER - Dengue virus
MALARIA - Plasmodium species (protozoan)
MENINGITIS - Group A Streptococcus (bacterium)
SCHISTOSOMIASIS - Schistosoma species (helminth)
RABIES - Rabies virus
CHOLERA - Vibrio cholerae 0139 (bacterium)
POLIO - Poliovirus
YELLOW FEVER - Yellow fever virus
TUBERCULOSIS- Mycobacterium tuberculosis
SARS

The First Emerging Infectious Disease Of

The 21st Century (China, 2003)
SARS (Severe Acute Respiratory
Syndrome)
Total 8429 cases; 824 deaths 30
countries in 7-8 months in 2003
SARS

is a viral respiratory
disease of zoonotic origin caused by
the SARS coronavirus (SARS-CoV)
Signs and Symptoms

Initial symptoms are flu-like and may

include
Fever
myalgia
lethargy
Cough
sore throat
other nonspecific symptoms.
Signs and Symptoms

The only symptom common to all patients

appears to be a fever above 38 C (100 F).
SARS may eventually lead to
shortness of breath and/or
pneumonia; either direct viral pneumonia or
first bacterial pneumonia.
Diagnosis

SARS may be suspected in a patient who has:

Any of the symptoms, including a fever of 38 C (100 F)
or higher, and
Either a history of:
Contact (sexual or casual) with someone with a
diagnosis of SARS within the last 10 days OR
Travel to any of the regions identified by the World
Health Organization (WHO) as areas with recent local
transmission of SARS (affected regions as of 10 May
2003 were parts of China, Hong Kong, Singapore and
the town of Geraldton, Ontario, Canada).
Prevention

Handwashing
Disinfection of surfaces for fomites
Wearing a surgical mask
Avoiding contact with bodily fluids
Washing the personal items of someone with SARS in hot,
soapy water (eating utensils, dishes, bedding, etc.)
Keeping children with symptoms home from school
Treatment

Treatment of SARS is largely supportive

with antipyretics, supplemental oxygen
and mechanical ventilation as needed.
People with SARS must be isolated,
preferably in negative pressure rooms,
with complete barrier nursing precautions
taken for any necessary contact with
these patients.
EBOLA

The 2014 Ebola outbreak is the largest in

history. Primarily affecting Guinea, Northern
Liberia, and Sierra Leone.
Ebola virus disease (EVD), previous known
as Ebola hemorrhagic fever (Ebola HF)
Fatality rate of up to 90% Transmitted by
direct contact with the blood, body fluids and
tissues of infected animals or people
Signs and Symptoms

start between two days and three weeks after contracting the
virus with a
fever
sore throat
muscular pain
headaches
Then, vomiting, diarrhea and rash usually follow, along with
decreased function of the liver and kidneys At this time, some
people begin to bleed both internally and externally.[1] The
disease has a high risk of death, killing between 25 and 90
percent of those infected, with an average of about 50
percent.[1] This is often due to low blood pressure from fluid
Signs and Symptoms

At this time, some people begin to bleed both internally and

externally.
The disease has a high risk of death, killing between 25 and
90 percent of those infected, with an average of about 50
percent. This is often due to low blood pressure from fluid
loss, and typically follows six to sixteen days after symptoms
appear.
Mode of Transmission

The virus spreads by direct contact with body fluids, such

as blood, of an infected human or other animals.
This may also occur through contact with an item recently
contaminated with bodily fluids.
Spread of the disease through the air between primates,
including humans, has not been documented in either
laboratory or natural conditions.
Semen or breast milk of a person after recovery from EVD
may carry the virus for several weeks to months.
Fruit bats are believed to be the normal carrier in nature, able
to spread the virus without being affected by it.
Diagnosis

When EVD is suspected in a person, his or her travel and

work history, along with an exposure to wildlife, are important
factors to consider with respect to further diagnostic efforts.
The specific diagnosis of EVD is confirmed by isolating the
virus, detecting its RNA or proteins, or
detecting antibodies against the virus in a person's blood.
Isolating the virus by cell culture, detecting the viral RNA
by polymerase chain reaction (PCR)
Management

No specific treatment is currently

approved
Treatment is primarily supportive in
nature.
Prognosis

EVD has a high risk of death in those

infected which varies between 25 percent
and 90 percent of those infected.
Swine Flu

Since December 2014, swine flu has

claimed the lives of over 1,300 people in
India, making it the worst outbreak of the
virus in the country
 Swine influenza is an infection caused
by any one of several types of
swine influenza viruses
Swine influenza virus (SIV) or swine-
origin influenza virus (S-OIV) is any
strain of the influenza family of
viruses that is endemic in pigs
Signs and Symptoms

Fever Sneezing
Cough runny nose
sore throat Coughing
watery eyes Dizziness
body aches abdominal pain
shortness of breath lack of appetite
Headache fatigue
weight loss
Chills
Diagnosis

The CDC recommends real-time PCR as

the method of choice for diagnosing
H1N1.
The oral or nasal fluid collection and RNA
virus preserving filter paper card is
commercially available
Treatment

If a person becomes sick with swine flu,

antiviral drugs can make the illness
milder and make the patient feel better
faster. They may also prevent serious flu
complications. For treatment, antiviral
drugs work best if started soon after
getting sick (within two days of
symptoms).
Highly Pathogenic Avian
Influenza (H5N1)

Influenza A virus subtype H5N1, also

known as A(H5N1) or simply H5N1, is a
subtype of the influenza A virus which
can cause illness in humans and many
other animal species
Signs and Symptoms

fever
Cough
sore throat
muscle aches
conjunctivitis
and, in severe cases, breathing problems and pneumonia
Treatment

There is no highly effective treatment for

H5N1 flu
Zika Virus

is a member of the virus family Flaviviridae

It is spread by daytime-active Aedes mosquitoes, such as A.
aegypti and A. albopictus
Its name comes from the Ziika Forest of Uganda, where the
virus was first isolated in 1947
Zika virus is related to the dengue, yellow fever, Japanese
encephalitis, and West Nile viruses
Transmission

Mosquito
Sexual
Pregnancy
Blood transfusion
Result to a baby from a mother
infected with Zika:

microcephaly
severe brain malformations
and other birth defects