Welcome to Unit 6

1. Welcome to Unit 6 Communicable Diseases

2. APA Format When to cite in-text source citations • Any idea that is not your own • Data or information accessed from a source • Statistics (ie: prevalence, incidence, mortality, morbidity) • Tables/charts that includes data from other sources • Personal interviews/communications • Information learned from a video, seminar, conference etc

3. APA Format When to reference a source • Any source that is provided within a paper must be referenced with the exception of personal communications. • Information provided in tables and charts also need to be referenced

4. APA Format How to cite a personal communication: Personal communications (includes interviews, letters, memos, telephone conversations) (A. Dickerson, personal communication, April22, 2010) Or • Dickerson (personal communication, April 22, 2010) Personal communications are cited within the a paper, but are not referenced on the reference page.

5. APA Format Why would personal communications be used? For the purposes of this class, personal communications may be helpful to: • Obtain information from a local public health agency for a paper or assignment • Interview a person who has personal experience with an infectious disease.

6. APA Format How to reference sources in APA format • Journal articles with one author Geiger, H.N. (2009). The psychological effects of nicotine addiction. Journal of Professional Public Health Practictioners, 18(6): pp. 297-321.

7. APA Format Journal article with more than one author Geiger, H.N., Bennett, T.R., Dole, S., Raisin, V.N., & Tipper, G. (2010). Breaking the psychological addition. Journal of Drug Addictions, 6(21): pp. 322-337.

8. APA Format Referencing Journal Articles: Things to Remember • The first line of each reference begins at the margin and all other lines are indented 8 spaces. • Author’s last name, first and middle initials, in order as they appear in the article. • Only the first letter of the first word of the article title is capitalized and the first letter of the first word after a semicolon: (ie: Psychological addictions: How they are broken). • All sources on the reference page are doubled spaced • The name of the journal and the volume number are placed in Italics (ie: American Journal of Public Health, 16(5).

9. APA Format In-text citations of journal articles • Can appear several ways: to introduce information • After the information is presented. Example: According to Geiger et al (2010) the psychological addiction to nicotine takes much longer to overcome than physical addiction does. Or The psychological addiction to nicotine takes much longer to overcome than physical addiction does (Geiger, Glum, Daily & Jones, 2010).

10. APA Format Things to keep in mind when citing journal articles: • Authors and year of publication are cited (not name of the journal article). • If you quote information from a journal article, the page number is also provided, for example (Geiger, Glum, Daily & Jones, 2010, p. 59). • Authors are listed as they appear in the journal article • The citation is included within the sentence (.? ! Appear after the citation). • If no date is provided in the journal article, citation would appear: (Geiger, Glum, Daily & Jones, “n.d.”).

11. APA Format How to reference a web site: • Author’s last name appears first, year of publication, title of article, date retrieved, from, provide web site address. Example: Sherman, P.D. (2010). Emerging infectious diseases in the 21st century. Retrieved April 21, 2010, from http://www.cdc.gov/emerginginfectiousdiseases.

12. APA Format How to reference a web site article If there is not author or year of publication provided: Centers for Disease Control and Prevention. (2010). Emerging infectious diseases in the 21st century. Retrieved April 17, 2010, from http://www.cdc.gov/emerginginfectious.

13. APA Format Things to keep in mind when referencing web sites: • Author name (s) appear first, if no author, the name of the web site appears first. • Never use the initials of a web site in the reference (or in-text). (ie; CDC, WHO) • If no year of publication is provided, type, “n.d.” where the year of publication would appear. • Only the first letter of the first word of the article is capitalized and the first letter of the first word after a semicolon. • Always provide the full web site address, not just the home page of the web site (ie: http://www.cdc.gov )

14. APA Format How to cite a web site • Can be cited several ways: Before the information is provided, or after the information is provided: Example According to the Centers for Disease Control and Prevention (2010), there were many serious infectious diseases that emerged throughout the 21st century. Or There were many serious infectious diseases that emerged throughout the 21st century (Center for Disease Control and Prevention, 2010).

15. APA Format How to reference a book • Author (s) first (last name, first and middle initials) • Year of publication • Title of the book (italicized with only the first letter of the first word of the title capitalized and the first letter of the first word after a semicolon capitalized) • City and state of publication • Name of publisher Example: Riegelman, R. (2010). Public health 101: Healthy people – healthy populations. Sudbury, MA: Jones and Bartlett.

16. Communicable Diseases What is a communicable disease? “any condition which is transmitted directly or indirectly to a person from an infected person or animal through the agency of an intermediate animal, host, or vector, or through the inanimate environment”.

17. Helpful Terminology • Antibodies: infection fighting proteins produced by white blood cells that fight bacterial infections. • Antibiotics: medicines that help fight bacterial infections. • Immune system: body system for fighting infections.

18. Helpful Terminology • Immunization (vaccination): specific substance containing weakened or killed pathogens given to build resistance to A given infection. • Infection: condition caused by pathogenic material in the body. • Exposure: coming into contact with A pathogenic material.

19. Pathogens Disease causing agents includes bacteria ,viruses, fungus, protozoa, parasitic worms

20. Pathogens Virus smallest agent of disease can only grow and reproduce after infecting another cell not truly “living” Examples: cold, flu, polio, hepatitis, herpes, chicken pox, mumps, measles

21. Pathogens Bacteria living cells that can grow and reproduce on their own can live in & on the body without issue, when growing in the wrong place disease arises Examples: pneumonia, tuberculosis, cholera, plague, typhoid fever, gonorrhea

22. Pathogens Fungus – from the plant world…very long complicated definition…ex. Athlete’s foot Protozoa – single cell organism that can only divide in a host organism… ex. malaria Parasitic worms – yucky wormies ex. trichinella, tape worm

23. Diseases Plague – killed 130 million people in the Middle Ages (bacterium) Yellow Fever – 5000 people killed in Philadelphia in 1703 (viral - mosquitoes) Smallpox – brought by Spanish explorers to the Americas. Killed at least ½ of the ENTIRE North & South American Indian populations. Later eradicated from the earth through vaccine (virus)

24. Diseases Influenza – killed 40-60 million people worldwide in 1918, including US, deadliest disease event in human history

25. Diseases Why did the WHO decide to attempt to eradicate small pox? Reference Table 7-1 1. No known animal carriers 2. No chronic human carrier where disease lies dormant 3. Safe, effective vaccine is available

26. Modes of Transmission • Direct • Blood-borne or sexual – HIV, Hepatitis B,C • Inhalation – Tuberculosis, influenza, anthrax • Food-borne – E.coli, Salmonella, • Contaminated water- Cholera, rotavirus, Hepatitis A • Indirect • Vector-borne- malaria, onchocerciasis, trypanosomiasis • Formites • Zoonotic diseases – animal handling and feeding practices (Mad cow disease, Avian Influenza)

27. Burden of Disease What is meant by burden of disease in Public Health? This is the impact a disease has on a specific area or population

28. Tools to Address the Public Health’s Burden of Disease • Barrier protection including isolation and quarantine. • Immunizations • Screenings and Case findings • Treatment and Contact treatment • Efforts to maximize effectiveness of treatment and prevent resistance

29. Barrier Protections & Immunization

30. Screening for Disease Purpose of Screening for Disease • To test individuals who are asymptomatic (experiencing no symptoms) of a disease • To catch a disease early on in the disease process. • To reduce disability and deaths

31. Types of Communicable Disease Screening Programs • TB • Syphillis • Chlamydia • Gonorheaa

32. Four Criteria for Ideal Screening Program • The disease produces substantial death and/or disability • Early detection is possible and improves outcomes • There is a feasible testing strategy for screening • Screening is acceptable in terms of harms, costs and patient acceptance

33. Case Finding Screenings linked to: • Case Findings/Contact Tracing • & • Contact treatment

34. What Is Case Finding or Contact Tracing? • Identification of individuals that may have had contact with infected individual.

35. Contact Tracing • For Syphilis, HIV, and AIDS patients • Interviewed, counseled by trained Disease Intervention Specialists (DIS) • Partners are located and referred to the health department for testing, additional counseling, etc. • For other STDs, partner notification occurs by partner referral.

36. Who are Contacts? • Family • Friends • Students at school • Daycare children and workers • Co-workers • Sexual partners • Patients (for Healthcare workers) • Customers (for Food service workers)

37. TB Contact Tracing • April 1994 • Traveler-- multi-drug resistant TB • Honolulu Chicago Baltimore • Baltimore Chicago Honolulu

38. TB Contact Tracing • Health department identified contacts from passenger manifests on 4 flights • Questionnaire: TB risk factors • Skin testing (baseline then 12 weeks after exposure)

39. TB Contact Tracking • Of 760 passengers and crew members • 6 (0.8%) Conversions (all on Chicago to Honolulu flight) • Contacts seated within 2 rows of the index case were 8.5 times as likely to have a positive skin test or conversion than those in the rest of the cabin. • For conversions, preventive therapy offered and watch for signs of disease

40. TB • 2 billion people infected with microbes that cause TB. • Not everyone develops active disease • A person is infected every second globally • 22 countries account for 80% of TB cases. • >50% cases in Asia, 28% in Africa (which also has the highest per capita prevalence) • In 2005, there were 8.8 million new TB cases; 1.6 million deaths from TB (about 4400 a day) • Highly stigmatizing disease

41. TB • The number one single infectious disease killer • TB is not on the decline. • One third of the world's population is infected with TB • In 1999 TB caused 8,000 deaths/day • The most deaths from TB in history • 7- 8 million people become infected with TB/year • 5-10 % of these people will develop active TB • Between 1993 and 1996, TB increased 13 % • TB accounts for more than 1/4 of all preventable adult deaths the developing world. nfid.org/factsheets

42. TB • The number one single infectious disease killer • Someone is newly infected with TB every second! • TB is the leading killer of women • TB outranks all causes of maternal mortality • TB creates more orphans than any other infectious disease • TB is the leading cause of death among HIV-positive individuals nfid.org/factsheets

43. TB & HIV • A third of those living with HIV are co-infected with TB • About 200,000 people with HIV die annually from TB. • Most common opportunistic infection in Africa • 70% of TB patients are co-infected with HIV in some countries in Africa • Impact of HIV on TB • TB is harder to diagnose in HIV-positive people. • TB progresses faster in HIV-infected people. • TB in HIV-positive people is almost certain to be fatal if undiagnosed or left untreated. • TB occurs earlier in the course of HIV infection than many other opportunistic infections.

44. Human Security concerns • Potential magnitude and rapid spread of outbreaks/pandemics. e.g. SARS outbreak • No country or region can contain a full blown outbreak of Avian influenza • Bioterrorism and intentional outbreaks • Anthrax, Small pox

45. Interesting Exercise Find out and record what you have been vaccinated against. Include the following: vaccine given when (how old were you) fights against what disease

46. THANK YOU!!