Health threats in the 21 st Century

1. Health threats in the 21st Century Sam Stebbins, MD, MPH San Mateo County Health Department

3. Disease Investigation…. ….And Reporting

5. Masks and Isolation Procedure • 2 types of Respiratory Isolation • Airborne via droplet nuclei (2-5 micron size). • Remain suspended in air for hours. Particles inhaled. • Use N95 mask • Use Negative Pressure Room • Indication: TB, varicella, measles, SARS • Droplet (large, visible particles). No spread beyond 3-6 feet. Requires close contact. Droplets spread from contact to mucous membranes of eye, nose or mouth • Use surgical mask • Use Private Room. Do not need negative pressure room. • Indication: meningococcal infection, influenza, small pox, pneumonic plague

6. Which Mask Should I Use? Standard Surgical Mask (no fit-test) N95 Respirator (must be fit-tested*) Use for R/O Meningococcal meningitis, pneumonic plague, and other diseases spread by the droplet route, PPE for body fluid Use for R/O TB, R/O SARS

7. If You Have a Cough • Please ask the receptionist for a mask or box of tissues • Wash your hands or use an alcohol-based hand rub • to clean your hands

8. SARS HIV/AIDS Avian Influenza (two types) Mad Cow Disease Hoof and Mouth Disease Newcastle Disease West Nile Virus Tuberculosis Anthrax, Plague, Smallpox, Botulism, Ricin Emerging Diseases

9. Avian Influenza, Exotic Newcastle Disease

10. Avian Influenza • Numerous Kinds H5N1 (2003-2004) • Wiped out chicken and duck flocks in 8 Asian countries • 34 confirmed human cases with 23 deaths in 2 Asian countries • Resistant to older flu drugs • Previous outbreak in Hong Kong 1997 • Not known to be efficiently transmitted between humans (at present)

11. 1999 2000 2001 2002

12. West Nile Virus • RESERVOIR HOSTS: Wild Birds • VECTORS: Mosquitoes • INCIDENTAL HOSTS: Humans, horses, other mammals

15. Birds that commonly carry WNV: • Crows • Ravens • Magpies • Jays • Raptors • Sparrows • Finches • Blackbirds

16. Courtesy of Robert McLean, USDA

17. San Mateo County Mosquito Abatement District • Located in Burlingame • Covers most of the County • Extensive mosquito-control activities already underway • Surveillance of various kinds • Call 344-8592 • For Advice • To report Mosquito infestations • To obtain free mosquito fish

18. Global TB Burden • Every Day: • 25,000 people develop active TB • 5,000 people die from TB • In the next 20 years: • Nearly one billion new TB infections • 200 million new cases of active disease • 35 million deaths • HIV and TB form a lethal combination

19. 2002 World TB Rates (WHO) 2002 World TB Rates (WHO)

20. 2002 World prevalence HIV and TB co-infection 2002 World prevalence HIV and TB co-infection

21. 2002 Implementation of DOTS (WHO) 2002 Implementation of DOTS (WHO)

23. TB EpidemiologyInfection and Disease in California

24. g f g f h f g a a f f f g f m l

26. Primary Tuberculosis

29. Post-Primary Tuberculosis

32. Healed Tuberculosis

35. Electron Micrograph SARS Coronavirus

36. Bioterrorism: The use of living microorganisms (bacteria, viruses and fungi) or toxins to produce death or disease in humans, animals and plants that is designed to cause panic and social disruption.

37. Cutaneous Anthrax Photo: CDC

38. Man with smallpox. Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice

40. 1796 – Edward Jenner Infected James Phipps, age 8 with cowpox No illness when deliberately exposed to smallpox Experiment repeated on other children, including his own son. Findings published in 1798 Concept spread rapidly Smallpox: Vaccination

42. Plague

43. DETECTION CAPABILITIES

44. DECONTAMINATION

46. Human Immunodeficiency Virus

47. Illness Antibiotic usually needed? Cold No Flu No Chest Cold (in healthy children and adults) No Sore Throats (except strep) No Bronchitis (in healthy children and adults) No Runny Nose (with green or yellow mucus) No Fluid in the Middle Ear (otitis with effusion) No