Emerging Infectious Diseases

1. 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

2. Developed as part of an Enhanced AHEC CommunityPartnership for Health Professions Workforce and Educational Reform project funded by the Health Resource and Service Administration (HRSA)

3. 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

4. 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

5. OBJECTIVES • Describe the public health approach to emerging issues. • Identify roles and responsibilities of public health system components. • Describe linkages needed to address challenges.

6. What Are EmergingInfectious Diseases? These are human illnesses caused by microorganisms or their poisonous byproducts and having the potential for occurring in epidemic numbers.

7. 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

8. Trends in Death Caused by Infectious Diseases in the United States, 1900-94 Click for larger picture

9. Economic and Societal Impact of Some Infectious Diseases Economic and Social Impact of Some Infectious Diseases Click for larger picture

10. Emerging Infectious Diseases include conditions that • emerge as a new infectious process • re-emerge as drug resistant forms

11. Microbial Adaptation • Mechanisms of genetic diversity • Respond to changes in physical and social environment. • Epidemiologic triangle • Host • Environment • Agent

12. New EmergingInfectious Diseases • Human Immunodeficiency Virus (AIDS) • Lyme disease • Ebola fever • Hantavirus Pulmonary Syndrome • West Nile encephalitis • Legionnaire’s disease

13. Drug Resistant Diseases • Malaria • Multiple drug resistant tuberculosis • Bacterial pneumonias

14. How Are Infectious Diseases Acquired? • Inhalation • Ingestion • Food, water, soil • Percutaneous inoculation • Mucous membranes • Blood and body fluids

15. Origin of EmergingInfectious 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

16. Discussion Time • Identify some changes that may contribute to the rise of infectious diseases.

17. 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

18. Drug Resistance The emergence of drug resistance in bacteria, parasites, viruses, and fungi is reversing medical advances of the previous 50 years.

19. Drug Resistant DiseasesMore Examples • S. aureus in Japan and UK, 1997 • HIV endemic in NY • Problems in South Carolina • Streptococccus pneumoniae • Vancomycin resistant Enterrococcus

20. Examples of Multi-State Food-borne Outbreaks in the US 1994-1997

21. Examples of Multi-state Food-borne Outbreaks in the US 1994-1997

22. Influenza Creutzfeldt-Jakob Disease “Mad Cow Disease” Lyme Disease Rabies Vectorborne and Zoonotic Diseases

23. West Nile Viral Encephalitis Malaria Ebola fever Hantavirus pulmonary syndrome Vectorborne and Zoonotic Diseases

24. Diseases Transmitted Through Exposure to Blood and Body Fluids • Human Immunodeficiency Virus • Hepatitis • A, B, C, D, E • NANE • SEN-V • Bacterial pathogens

25. Other Target Areas for Prevention • Chronic Diseases Caused by Infectious Agents • Vaccine Development and Use

26. Populations Particularlyat Risk • People with impaired host defenses • Pregnant women and newborns • Travelers, immigrants, refugees

27. Bioterrorism as an Emerging Infectious Disease Threat • Intentional dissemination of disease • Infectious and toxic agents • viruses, bacteria, toxins, fungi

28. Public Health Approach to Emerging Infectious Diseases • Surveillance • Epidemiology for early diagnosis • Early response to outbreaks and changing disease patterns

29. Public Health Approach continued • PublicHealth 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

30. CASE STUDYFoodborne 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

31. DISCUSSION • What is your role in addressing emerging infectious diseases? • Prevention • Education • Detection

32. Your role in the prevention of emerging infectious diseases • Best practices • Antibiotic use • Food preparation • Control exposure • Awareness of risk • Behavior change

33. 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

34. Your role in detection of emerging infectious diseases • Participate in surveillance activitieswithin yourclinical setting • Be alert for “clues”; assess risk • Know your resources - who to call for consultation • Report to local health department

35. 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