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
• Number of agents
• Characteristics of agents
• Pathogenicity
Human
• Defense mechanisms
• Immunity
• Personal characteristics
Host Reaction
Infectious agents
Enter human host
Produces
Mild disease
inapparent infection
Host recovery
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
hemorrhagic colitis and hemolytic
syndrome
causes
uraemic
– 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 significant 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 identified the existence of multi
resistant clones of common pathogens.
Cont….
 Staphylococcus aureus is the “modern Ghengis
Khan” (Chugh 2007). the most frequently identified
drug-resistant pathogen.
 Singhal et al (2007)reported ciprofloxacin-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 ciprofloxacin 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
Helicobacter pylori
Human papilloma virus
Hepatitis B/C viruses
Epstein –Bar Virus
Human T lymphotropic
virus type 1
Disease
Peptic ulcer, gastric
carcinoma
Cervical, anal, vulvar
carcinoma
Liver cirrhosis,
hepatocellular carcinoma
B-cell lymphoma,
nasopharyngeal carcinoma
Adult T-cell leukemia
Cont….
Microbe
Disease
Human herpes virus 8
Kaposi’s sarcoma
Borrelia burgdorferi
Lyme arthritis
Tropheryma whippelii
Whipple’s disease
Chlamydia
pneumoniae
atherosclerosis
Cont….
• Ramakrishna (2006) discussed the high prevalence of
H. pylori infection in India.
• 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
Conclusion
• The true prevalence of many diseases is not
known. Since we live in a global village, we connot
afford to be complacent about the tremendous
economic, social and public health burden of
these diseases. Effective surveillance is the key to
their early containment.
• There is a need to develop epidemiology
improved diagnostic facilities, a strong public
health structure, effective risk communication,
epidemic preparedness and rapid response.
Take Home Massage
• Community health is the pivot of Global
health. Let us join our hands on creating
an awareness to the individual family and
community
through
effective
risk
communication.