Module for Infectious Disease

1. Module for Infectious Disease September 25-26, 2017

2. Welcome to our training! Boehringer Ingelheim Pharmaceuticals, a family-owned company founded in 1885 138 companies worldwide 41,300 employees Main business areas: • Human Pharmaceuticals • Animal Health

3. Why are we here? • Why are we here? • What is an infection? • What are the types? • Who gets infections? • Is everyone at equal risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

4. “Tamil Nadu registered 15deaths 2,896 cases” [of swine flu] August 2, 2017 http://www.livemint.com/Politics/R3Fu4VfrOqr5Btdeu9MSNI/Sudden-emergence-of-infectious-diseases-a-big-worry-for-Indi.html

5. A perspective of public health priorities! • Basic public health measures are lagging behind in India and pose a threat to future prosperity of its citizens. • Immunization rates (72%) • Access to improved sanitation facilities in India (36%) • But, under the Swacch Bharat Abhiyan - government has committed to providing toilets and improving sewage systems. *(as measured by diphtheria-tetanus-pertussis [DPT3]) World Bank. World Development Indicators. http://data.worldbank.org/indicator.

6. Historic Figures in Infectious Disease “Father of Handwashing” Made connection between handwashing and infection Discovered penicillin - 1928 “Father of Modern Microbiology” Louis Pasteur developed a rabies, anthrax, and chicken cholera vaccines “Father of Epidemiology” John Snow traced cholera to a water pump handle in 1854

7. Introduction to Infectious Diseases • The best practices in infection control are based on research, and should be adopted in order to help prevent or reduce avoidable infections and to control existing ones. • Our understanding of the infection process should lead to actions which help to protect the public. Good infection control techniques can assist in preventing or reducingavoidable infections. • The most important factors in the fight against potentially fatal infections, are: • Appropriate antibiotic use • Basic prevention and control measures* *Examples: clean hands, disposal of solid wastes, maintain sanitation and hygiene, chlorinate all water sources, and undertake fly control measures.

8. Pop Quiz! Test your infectious disease trivia…win a prize! 2. Florence Nightingale, the founder of modern nursing, is also known by which nickname? a. Lady Nurse b. Handwashing Queen c. Lady with the Lamp d. Nurse Ratched 2. 1. 1. The smallpox vaccine was developed from which disease? a. Chickenpox b. Measles c. Cowpox d. Smallpox 4. In which major U.S. city did "Typhoid Mary" reside? a. New York b. Boston c. Philadelphia d. Chicago 3. Which pest actually spread the Bubonic Plague (or Black Death)? a. Pigeons b. Ticks c. Mice d. Fleas 3. 4. 1. Cowpox, 2. Lady with the Lamp, 3. Fleas, 4. New York

9. What is an infection? • Why are we here? • What is an infection? • What are the types? • Who gets infections? • Is everyone at equal risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

10. What is Infectious Disease? • …a disease which is transmissible from one person to another is said to be infectious.* • Some infectious diseases can come from animals. • A disease is infectious due to a living organism, which can multiply in or about one person, and be released in or on another person. This is known as communicability. • The story of cholera • http://mdcurrent.in/patients/the-story-of-cholera/ If actual contact with the diseased person is necessary to convey it to another, the disease may be called contagious

11. Battle between Person & Parasite* • For Parasites to cause disease , two conditions are required : • 1- The Parasite must be able to mobilize and multiply • 2- The person’s (HOST) defense mechanisms must be sufficiently low for period while the Parasite mounts disease. *(e.g. of a infectious agent)

12. The cycle of infection • Essential measures should be taken to help prevent and controlthis cycle of infection, including: • limiting sources of infection, • preventing the routes of transmission, • minimizing portals of entry, and protecting susceptible patients. 4 3 5 2 6 1 • Portals of entry are the same as the portals of exit and are either natural or artificial. *Common vehicle: food, water, drugs, blood or other solutions

13. Acute infection • The local signs of inflammation* • What you • might experience • Happening • inside Increased blood flow Widening of blood vessels Fluid build-up Fluid pressure on nerves Large # of phagocyte cells in fluid • *Depending on the source of infection, this process can occur on skin or underneath skin or in mucous membranes. • When it occurs in deeper tissues or body compartments, some of the above may be absent or slightly different. • Phagocytic cells are of importance in the destruction of invading bacteria.

14. Despite the variety of viruses and bacteria, germs spread from person to person through a common series of events. Therefore, to prevent germs from infecting more people, we must break the chain of infection.

15. Who gets infections? • Why are we here? • What is an infection? • Who are the types? • Who gets infections? • Who is at risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection • What you can expect • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

16. Keys to remember about the host of a possible infection • Susceptible host determined by: • Age • Genetic predisposition • Nutritional status • Disease process • Stress levels • Hygiene habits Important public health issues* in the prevention and control of infection, also include living conditions(such as housing, water, and sanitation facilities). *These can impact the level of infectious disease in the community.

17. How do you recognize an infection in you or others? • What is an infection? • Who are the types? • Who gets infections? • Who is at risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection • What you can expect • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

18. When and where you should go if you suspect infection • Why are we here? • What is an infection? • Who are the types? • Who gets infections? • Who is at risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection? • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

19. Notifiable diseases Notifiable diseases Some infectious diseases must be notified to the Board of Health, and this should be done immediately the diagnosis is made!!!Responsibility for notifying falls both on the doctor in attendance and on the individual, but in practice, the notification of a doctor usually suffices. The notifiable diseases, which may change from time to time, and based on the country, include: small-pox, scarlet fever, cholera, diphtheria, membranous croup, eryispelas, typhus fever, enteric fever (including typhoid and paratyphod), measles, chicken-pox, relapsing fever, continued fever, puerperal fever, acute primary pneumonia, acute influenzal pneumonia, tuberculosis, ophthalmia neonatorum, cerebrospinal fever, plague, dysentery, malaria, and leprosy. http://www.tnhealth.org/dph/dphdb.php

20. After suspicion of exposure to a risky infectious agent… …immediate self-examination, seek information, visit doctor Pharmacist, Health Dept., Community Health Worker You! Doctor, PA/NP Doctor, PA/NP, Lab Technician Qualified healthcare professionals (e.g. doctor) can diagnose and treat infectious diseases PA – Physician’s Assistant, NP – Nurse Practitioner

21. Everyone plays a role in stopping the spread of infectious diseases …including You!

22. When and where you should go if you suspect infection • Why are we here? • What is an infection? • Who are the types? • Who gets infections? • Who is at risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

23. Antibiotics – one example of a treatment type Antibiotics don’t affect viruses, fungi, or parasites - they only affect BACTERIAL CELL. In fact, they specifically target bacteria rather than human cells. • When an antibiotic molecule sticks to its BACTERIAL CELL, and if enough of the antibiotic is present, the bacterial cell is crippled and either: • stops growing (bacterio-static effect) or • simply dies (bacteri-cidal effect). *different types of medicines are given for viral and other diseases

24. Examples of antibiotics and how they work Penicillin has been called a “wonder antibiotic” because it isn't toxic to humans at concentrations that can kill bacteria and it can kill a lot of different types of bacteria. So how does it work?   Penicillinweakens the bacterial wall by causing the bacteria to weaken its own cell wall and prevents the bacteria from being able to repair itself. Azithromycin is often used to treat a wide variety of infections; everything from pneumonia to STDs So how does it work? Azithromycin prevents the bacteria from multiplying by making it much easier for the immune system to handle the infection.

25. 6 Smart Facts About Antibiotic Use https://www.cdc.gov/features/antibioticuse/index.html

26. Antibiotic Resistance A growing list of infections are becoming harder to threat as antibiotics become less effective. The World Health Organization (WHO) has declared antibiotic resistance one of the biggest global health threats facing the world today! e.g. Methicillin-resistant Staphylococcus aureus (MRSA) and Multi drug-resistant Tuberculosis (MDRTB) are of great concern worldwide

27. National Program on Antimicrobial Surveillance (ICMR) The Indian Council of Medical Research has established a National Programme on Antimicrobial Surveillance in 10 laboratories based at academic centers and covering priority pathogens identified by the W.H.O. When complete, this network will focus on priority pathogens: diarrhea (e.g., Shigella, Vibrio cholerae), enteric fever (e.g., S. Typhi, S. Paratyphi), sepsis caused by Enterobacteriaceae (e.g., E. coli, K. pneumoniae), other Gram-negative organisms (e.g., Pseudomonas aeruginosa, A. baumannii), Gram-positive bacteria (e.g., MRSA and vancomycin-resistant enterococci [VRE]), fungal infections (e.g., Candida spp.), and respiratory pathogens (e.g., Streptococcus pneumoniae).

28. Prevention

29. Clean water & immunization • The two most important public health interventions, which have had the greatest impact on the world’s health, are the provision of clean drinking water and immunization. • Immunization has been shown to be one of the safest and most cost-effective interventions known.

30. When should we wash our hands?

31. What solution should we use to wash our hands? Soap can be used for eliminate germs from hands. However, bars of soap sitting in stagnant water should be avoided. Liquid soap dispensers are suitable but topping up of these dispensers should be avoided. If dispensers will be reused, they should be cleaned out frequently and thoroughly dried.

32. Hospital-acquired infections Hospital-acquired infections (HAIs), also known as nosocomial infections, are infections that were not present or incubating on admission of a patient to hospital. These infections can be readily diagnosed in patients who have appeared free of signs and symptoms of infection on admission and have then gone on to develop infection – for example, a surgical wound exuding pus.

33. Common childhood diseases

34. Poor hygiene and sanitation can lead to stunted growth in children

35. Lack of access to effective and affordable antibiotics still kills more children in India than does drug resistance Laxminarayan R, Matsoso P, Pant S, Brower C, Barter D, Klugman K, et al. Access to effective antimicrobials: a worldwide challenge. Lancet. 2015;387: 168–175. Published online Nov 18. pmid:26603918 Tamil Nadu at number 5: 7,000 die of brain fever in 5 years http://timesofindia.indiatimes.com/city/chennai/Tamil-Nadu-at-number-5-7000-die-of-brain-fever-in-5-years/articleshow/47291331.cms

36. Why this matters? • What is an infection? • Who are the types? • Who gets infections? • Who is at risk? • How do you recognize an infection in you or others? • When and where you should go if you suspect infection • What you can expect • How do you treat and prevent an infection? • Hygiene • Medicine • Why this matters?

37. Why this matters... Communicable Diseases Rise 32% In 5 Years; Spending Up 7% http://zeenews.india.com/health/rains-playing-spoil-sport-for-your-health-heres-your-guide-to-tackle-infections-head-on-2045635 “Be the change you want to see in the world.” ~Mahatma Gandhi http://www.indiaspend.com/cover-story/communicable-diseases-rise-32-in-5-years-spending-up-7-81669

38. Back-up Resources

39. Growing trends of antibiotic use in India, 2000-2010 Fig 1. Trends in antibiotic consumption in India, 2000–2010. The data used to create this figure can be accessed at the Center for Disease Dynamics, Economics & Policy (CDDEP) Resistance Map website at http://resistancemap.cddep.org/resmap/c/in/India. 

40. Antibiotic Resistance (cont.) Education of patients and community is important in the developing world Some types of infection are less severe, others and do not need antibiotics Ensure understanding of unnecessary use of antibiotics, which kills their body’s normal flora, and reduces their immunity – which could put them at future risk of harm About 700,000 people around the world die annually due to drug-resistant infections and, if no action is taken, it has been estimated that such infections will kill 10m people a year by 2050. https://www.theguardian.com/society/2017/feb/27/world-health-organisation-12-antibiotic-resistant-bacteria-threat-human-health

41. http://www.tnhealth.org/dph/dphdb.php

42. Control for Communicable Diseases : • The control of communicable diseases is one of the major programs under the Primary Health Care services, especially for the disease occurring in epidemic forms. • Acute Diarrheal Diseases and suspected cholera are common among the water borne diseases. Tamil Nadu is endemic for Acute Diarrheal Diseases with sporadic outbreak of cholera in most of the districts throughout the year, and in epidemic proportions during the rainy seasons and peak summer periods. • All the District Level officials and executive authorities of local bodies take necessary preventive measures including proper disposal of solid wastes and maintain sanitation and hygiene chlorinate all water sources and undertake fly control measures. http://www.tnhealth.org/dph/dphdb.php

43. “India’s fourth Zika case and the first one from Tamil Nadu is a 27-year-old tailor with no history of travel to the affected regions, officials confirmed…. Zikavirus is transmitted to people through the bite of an infected mosquito from the Aedes genus… This is the same mosquito that transmits dengue, chikungunya and yellow fever.”

44. Break the Chain of Infection To emphasize that everyone plays a role in infection prevention, APIC has created this infographic to reinforce that everyone can prevent healthcare-associated infections. This infographic shows what patients and their families can do to stay healthy while receiving healthcare. AIPC.org/professionals

45. Viruses or Bacteria – what’s got you sick? https://www.cdc.gov/getsmart/community/materials-references/print-materials/everyone/viruses-bacteria-chart.pdf

46. Videos and useful links http://mdcurrent.in/patients/how-to-build-a-tippy-tap-handwashing-station-to-save-lives/ http://study.com/academy/lesson/types-of-global-health-issues.html https://www.forbes.com/sites/judystone/2016/08/25/without-success-in-india-well-never-control-drug-resistant-tuberculosis-anywhere/#87c9e2f773b8 https://www.youtube.com/watch?v=COXXJtk76So&lc=z134ulmqprq1tbynl225hpe5mxzldzk2n https://www.youtube.com/watch?v=COXXJtk76So&lc=z134ulmqprq1tbynl225hpe5mxzldzk2n https://www.youtube.com/watch?v=zQGOcOUBi6s Presentation title, date, author

47. Videos and useful links http://mdcurrent.in/patients/the-story-of-cholera/ https://www.youtube.com/watch?v=CDBSyt748YY https://www.theguardian.com/society/2017/feb/27/world-health-organisation-12-antibiotic-resistant-bacteria-threat-human-health http://mdcurrent.in/patients/managing-non-healing-wounds-in-rural-areas/ http://mdcurrent.in/patients/management-fever-rural-areas/ http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001974 https://www.youtube.com/watch?v=mlBgtSesnco https://www.theguardian.com/global-development/2014/aug/28/toilets-india-health-rural-women-safety