Emerging Infectious Diseases

Emerging Infectious Diseases Dorothy Cumbey, Ph.D., RN Director of Quality Management Health Services Jerry Dell Gimarc, MA Senior Planner South Carolina Department of Health and Environmental Control AHEC SOUTH CAROLINA Developed as part of an Enhanced AHEC Community Partnership for Health Professions Workforce and Educational Reform project funded by the Health Resource and Service Administration (HRSA) SOUTH CAROLINA AHEC At the completion of this module you will be able to   describe how the public health system can be mobilized to address emerging issues or threats to the public’s health identify roles and responsibilities of different components of the public health system in confronting health challenges SOUTH CAROLINA AHEC Objectives, Continued   describe the linkages needed within the public health system to effectively address these challenges discuss health care needs of individuals and communities in the future SOUTH CAROLINA AHEC OBJECTIVES    Describe the public health approach to emerging issues. Identify roles and responsibilities of public health system components. Describe linkages needed to address challenges. SOUTH CAROLINA AHEC What Are Emerging Infectious Diseases? These are human illnesses caused by microorganisms or their poisonous byproducts and having the potential for occurring in epidemic numbers. SOUTH CAROLINA AHEC Why are we concerned about Emerging Infectious Diseases?  These diseases:    Pose a threat to all persons regardless of age, sex, lifestyle, ethnic background, or socioeconomic status Cause suffering and death Impose a financial burden on society SOUTH CAROLINA AHEC Trends in Death Caused by Infectious Diseases in the United States, 1900-94 Click for larger picture SOUTH CAROLINA AHEC Economic and Societal Impact of Some Infectious Diseases Economic and Social Impact of Some Infectious Diseases Click for larger picture SOUTH CAROLINA AHEC Emerging Infectious Diseases include conditions that  emerge as a new infectious process re-emerge as drug resistant forms SOUTH CAROLINA  AHEC Microbial Adaptation    Mechanisms of genetic diversity Respond to changes in physical and social environment. Epidemiologic triangle    Host Environment Agent SOUTH CAROLINA AHEC New Emerging Infectious Diseases       Human Immunodeficiency Virus (AIDS) Lyme disease Ebola fever Hantavirus Pulmonary Syndrome West Nile encephalitis Legionnaire’s disease SOUTH CAROLINA AHEC Drug Resistant Diseases  Malaria Multiple drug resistant tuberculosis Bacterial pneumonias SOUTH CAROLINA   AHEC How Are Infectious Diseases Acquired? Inhalation  Ingestion   Food, water, soil Percutaneous inoculation  Mucous membranes  Blood and body fluids  SOUTH CAROLINA AHEC Origin of Emerging Infectious Diseases        Changes in environment (technology and industry) Economic development Population growth or migration Human behavior International travel and commerce Microbial adaptation Breakdown in public health measures SOUTH CAROLINA AHEC Discussion Time  Identify some changes that may contribute to the rise of infectious diseases. SOUTH CAROLINA AHEC Target Areas for Preventing Emerging Infectious Diseases       Drug resistance Food borne and water borne diseases Vectorborne and zoonotic diseases Diseases transmitted through exposure to blood and body fluids Chronic diseases caused by infectious agents Vaccine development and use SOUTH CAROLINA AHEC Drug Resistance The emergence of drug resistance in bacteria, parasites, viruses, and fungi is reversing medical advances of the previous 50 years. SOUTH CAROLINA AHEC Drug Resistant Diseases More Examples    S. aureus in Japan and UK, 1997 HIV endemic in NY Problems in South Carolina   Streptococccus pneumoniae Vancomycin resistant Enterrococcus SOUTH CAROLINA AHEC Examples of Multi-State Food-borne Outbreaks in the US 1994-1997 Year Organism 1994 Shigela flexneri 1994 Listeria monocytogenes #States Food Source 2 3 Green onions, probably contaminated in Mexico Milk, contaminated after pasteurization and shipped interstate. Ice cream premix hauled in trucks that had previously carried raw eggs. Raspberries from Guatemala, mode of contamination unclear SOUTH CAROLINA AHEC 1995 Salmonella enteriditis 41 1996 Cyclospora cayetanensis 20 Examples of Multi-state Food-borne Outbreaks in the US 1994-1997 1996 Escherichia coli O 157:H7 Norwalk virus Samonella infantis Cyclospora cayetanensis 3 Unpasteurized apple juice, probably contaminated during harvest. Oysters contaminated before harvest. Alfalfa sprouts, probably contaminated during sprouting. Raspberries imported from Guatemala, mesclun lettuce, and products containing basil. Strawberries from Mexico distributed through USDA Commodity program for use in school lunches SOUTH CAROLINA AHEC 1996 1997 5 2 1997 18 1997 Hepatitis A 4 Vectorborne and Zoonotic Diseases     Influenza Creutzfeldt-Jakob Disease “Mad Cow Disease” Lyme Disease Rabies SOUTH CAROLINA AHEC Vectorborne and Zoonotic Diseases     West Nile Viral Encephalitis Malaria Ebola fever Hantavirus pulmonary syndrome SOUTH CAROLINA AHEC Diseases Transmitted Through Exposure to Blood and Body Fluids   Human Immunodeficiency Virus Hepatitis    A, B, C, D, E NANE SEN-V  Bacterial pathogens SOUTH CAROLINA AHEC Other Target Areas for Prevention  Chronic Diseases Caused by Infectious Agents Vaccine Development and Use  SOUTH CAROLINA AHEC Populations Particularly at Risk  People with impaired host defenses Pregnant women and newborns Travelers, immigrants, refugees SOUTH CAROLINA   AHEC Bioterrorism as an Emerging Infectious Disease Threat  Intentional dissemination of disease Infectious and toxic agents   viruses, bacteria, toxins, fungi SOUTH CAROLINA AHEC Public Health Approach to Emerging Infectious Diseases  Surveillance Epidemiology for early diagnosis Early response to outbreaks and changing disease patterns SOUTH CAROLINA   AHEC Public Health Approach continued     Public Health Laboratory support for rapid and accurate diagnosis Rapid Communication links to private providers and hospitals Communication to public Education about prevention and/or early detection SOUTH CAROLINA AHEC CASE STUDY Foodborne Illness        Health care provider report Epidemiologic investigation: Epi Team Early Response: Consultation Laboratory support for diagnosis Rapid communication to health care provider/hospital Communication to public Education AHEC SOUTH CAROLINA DISCUSSION  What is your role in addressing emerging infectious diseases?  Prevention  Education Detection SOUTH CAROLINA  AHEC Your role in the prevention of emerging infectious diseases       Best practices Antibiotic use Food preparation Control exposure Awareness of risk Behavior change SOUTH CAROLINA AHEC Your role in education about emerging infectious diseases  Stay informed     CDC Web Pages MMWR on Web EID Journal  Educate patients/family/friends Know resources - who to call SOUTH CAROLINA AHEC Your role in detection of emerging infectious diseases     Participate in surveillance activities within your clinical setting Be alert for “clues”; assess risk Know your resources - who to call for consultation Report to local health department SOUTH CAROLINA AHEC Summary  Shifts in the environment, human behavior and microorganisms can cause new diseases to emerge We share responsibility to identify, minimize or avoid these situations SOUTH CAROLINA  AHEC