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Infectious Diseases & Urbanization in Developing Countries

Infectious Diseases & Urbanization in Developing Countries . Opeyemi S. Odewale PhD Student Walden University PUBH Instructor: Dr. Rubin Howard Spring 2011. Overview. Status of global waterborne infectious disease Waterborne pathogens Study focus: Hepatitis E Virus (HEV)

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Infectious Diseases & Urbanization in Developing Countries

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  1. Infectious Diseases & Urbanization in Developing Countries Opeyemi S. OdewalePhD Student Walden UniversityPUBH Instructor: Dr. Rubin HowardSpring 2011

  2. Overview • Status of global waterborne infectious disease • Waterborne pathogens • Study focus: Hepatitis E Virus (HEV) • Study focus: Developing countries ( India, Mexico & Nigeria) • HEV health impact • Need for concerns • Prophylaxis & Vaccine • Global Integration • Reference (s)

  3. Status of global waterborne infectious disease Per year more than 3.4 million people die as a result of water related diseases, making it the leading cause of disease and death around the world ( WHO, 2005) Image by Berto Garcia Eliminating disease and death due to unclean water and poor sanitation would reap billions of dollars in health and productivity gains; estimation indicates that for every dollar spent, there would be an economic return of between $3 and $34 ( WHO, 2005) Image by Humanitarian and Development Partnership

  4. Waterborne pathogensStudy focus: Hepatitis E Virus (HEV) Images CDC Image World Hunger: Georgia State University

  5. Hepatitis E Virus (enteric transmitted non-A, non-B hepatitis) Status Microbiology • 27-34 nm, non-enveloped virions • Single-stranded RNA genome: approximately 7.2 Kb, • positive polarity, with 5’-cap • Genus Hepevirus • Family Hepeviridae Genotypes • – Gt 1, 2: Only human infection • – Gt 3, 4: Both humans and animals Clinical Presentation • Acute hepatitis • Sporadic hepatitis Transmitted person-to-person fecal-oral route CDC, 2010

  6. Hepatitis E Status • Genotype (Gt) geographical distribution : • Gt 1 and 2: epidemic strains causing human infection • Gt 3 and 4: zoonotic strains isolated from humans and a variety of animals • Pelosi & Clarke, 2008

  7. Hepatitis E Status - Outbreak

  8. Study Focus: India ( Asia) Nigeria (Africa) Mexico (North America) Developing countries associated with HEV

  9. Statistics of HEV -India • Population growth rate is 1.41% ranking 93rd in the world • 29.5% population in urban setting • 1955-1956 30 000 cases were reported in New Delhi • 1997- 52 000 cases were reported in Kashmir • WHO, 2010

  10. Statistics of Hepatitis E -Mexico • Population growth rate is 1.1% ranking 106thin the world • 77.2 % of population live in urban setting  • 1986 Genotype 2 outbreak • 1988- 1989 4000 cases

  11. Statistics of HEV -Nigeria • Population growth rate is 1.94% ranking 59th in the world • 48.4 of population in urban setting • 1986 Genotype 2 sporadic infection outbreak in Port Harcourt

  12. Health Impact – General Population • Affects predominantly young adults • Leading cause of acute viral hepatitis in South Asia, Africa, Middle East • Mortality in general population 1-4% • Causes substantial morbidity and mortality in older men WHO, 2010

  13. Health impact of HEV- Pregnancy • Mortality in pregnant women ~20% • Hepatitis and mortality in pregnant women during epidemics (10-20%) in 3rd trimester • Causes intrauterine infection, prenatal morbidity and mortality • Maternal death can occur due to encephalopathy, haemorrhagic diathesis or renal failure • Cope, 2010

  14. Health Impact -Global transportation Image Craig Mackintosh

  15. Need for concern • Relatively new virus • Under diagnosed • Misdiagnosed • Globalization • Poor prognosis associated with pre-existing liver disease

  16. Prophylaxis & Vaccine Recombinant HEV vaccine has shown efficacy tailored to women. It boosters response following 3 doses, which indicates development in immunological memory WaiKuo Shih (2010)

  17. Global Integration

  18. Reference • Alirol, E. Getaz, L. Stoll, B Chappuis, F.  Loutan, L (2011). Urbanisation and infectious diseases in a globalised world. The Lancet Infectious Diseases, Volume 11, Issue 2, Pages 131 – 141 • CDC, (2010). Waterborne definition. www.cdc.gov/ncphi/disss/nndss/casedef/waterbornecurrent ( Retrieved 22-04-2011) • Virginia Bioinformatics Institute(2011). Hepatitis E Virus. http://ci.vbi.vt.edu/pathinfo/pathogens/HEV.html (Retrieved 22-04-2011) • Aggarwal, R. Nanda, C.S. Wiersma, S. (2010). Global Prevalence of Hepatitis E Virus Infection and Suceptibility: A Systematic Review. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India and World Health Organization, Geneva, Switzerland   • Cope, A. (2010). What Happened to Hepatitis E? Sheffield Teaching Hospitals • Dalton, H.R. Bendall,R, Ijaz, S. BanKs, M (2008). Hepatitis E: an emerging infection in developed countries. The Lancet Infectious Diseases, Volume 8, Issue 11, Pages 698 – 709 • WaiKuo Shih, J. (2010). Efficacy, Immunogenicity and Safety of a Recombinant Hepatitis E Vaccine. National Institute of Diagnostics and Vaccine Development infectious diseases, Xiamen University, Seoul, Korea • Myint, K. S.A. ( 2008). Hepatitis E : a neglect threat. Department of Virology, Armed Forces Research Institute of Medical Sciences, Trans R Soc Trop Med Hyg 102:211-2 • Pelosi, E. Clarke, I., (2008). Hepatitis E: a complex and global disease. Emerging Health Threats Journal • World Health Organizations (2005 & 2011). WHO: Waterborne Disease is World's Leading Killer. http://www.voanews.com. Voice of America (Retrieved 28-04-2011)

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