Analyze issues of public health, infectious diseases, & bioterrorism.

1. Infectious Diseases Unit-F • Analyze issues of public health, infectious diseases, & bioterrorism.

2. They remain the leading cause of death!

3. Public Health can be improved with biomedical research! How?? Read on….

4. Nature of infectious diseases 1. Pathogens- Microorganisms that are capable of causing disease. 2. Infection- results when a pathogen invades and begins growing within the host. 3. Disease- results only if and when tissue function is impaired (I.e. burns, skin lesions) Guinea Worms!

5. 4. The body has defense mechanisms to prevent infection – normal flora, physical attributes (nasal passages) 5. In order to cause a disease, pathogens must be able to enter; adhere; invade and colonize; then inflictdamage. 6. Entrance to the host -- mouth, eyes, genital openings, wounds.

7. 7. Growth of pathogens or the production of toxins/enzymes cause disease (impairment of tissue function). 8. Some normal flora prevents disease

8. Infectious Disease Process *Sequelae - A pathological condition resulting from a disease

9. 1.Bacteria- i.e. Salmonella typhi, Staphylococcus aureus (may lead to MRSA) Clostridium tetani – This microorganism's reservoir is typically soil. (tetanus) 2. Viruses - apart from the host cell, have no metabolism and cannot reproduce. 3. Fungi- form spores (i.e. ringworm, athletes foot) 4. Protozoa- acquired through contaminated food or water, or bite of an arthropod (mosquito) *** Occurs more in tropical environment!!!! ***

10. 5. Helminths - simple, invertebrate animals, some infectious parasites- symptoms: abdominal pain and diarrhea 6. Prions- i.e. Creutzfeldt-Jakob disease – causes holes in brain Helminths example-Trichinella spiralis – Fatal cases due to respiratory paralysis. Caused by undercooked pork!

11. Epidemiology- study of the occurrence of disease in populations http://www.ph.ucla.edu/epi/snow/fatherofepidemiology.html 2.Disease reservoirs- where the infectious agent survives (humans, rodents) example= yersiniapestiscauses plague! 3. Modes of transmission (direct contact, airborne, etc).

12. 1. Nonspecific mechanisms are the body’s defenses against disease- anatomical barriers, physiological deterrents and presence of normal flora (skin, low Ph and high salinity) 2. Specific mechanisms - immunity 3. Vaccination- produces immunity

13. What symptoms might a patient exhibit if they developed the infectious disease previously recognized prior to 1983 as being noninfectious. Gastric ulcers caused by H-pylori (bacterium) have symptoms of abdominal pain and indigestion. How does biomedical research help the population?

14. What is the role of public health in the prevention of infectious disease?

15. Safe water- US water is purified through settling, filtration, and chlorination

16. 2. Sewage treatment and disposal is mandated by the federal government. This is a public health concern!!!! After a hurricane the safety of the water supply is often in jeopardy.

17. Settling • Filtration • Chlorination

18. 3. Food Safety- US has many standards, inspection plans and regulations dealing food preparation, handling, and distribution. Pasteurizing milk & dating it for sale demonstrates food safety.

19. 4. Animal control programs - Domestic herds are inspected, rabid animals are destroyed, rat control programs in place in urban areas. i.e. Rabies primarily spread by direct contact.

20. 5. Vaccination programs mandate that children be vaccinated prior to school. The reason vaccinations work, is a pathogen cannot reproduce itself enough to maintain disease in population.

21. 6. Pesticides to block vectorborne disease- those carried by mosquitoes. Mosquitoe spraying kills the insect with pesticides therefore decreasing / eliminating vectorborne disease i.e. malaria

22. 1. National Institutes of Health (NIH) - supports health-related research

23. 2. Centers for Disease Control (CDC) - investigates disease outbreaks, publishes reports, sponsors education/research, reference labs

24. 3. Food and Drug Administration (FDA)- monitors safety of food, medicines and other products

25. 4. World Health Organization (WHO) - provides global surveillance and control of diseases.

26. FDA • NIH • CDC

27. New research techniques- has lead way to rapid identification. HIV protease inhibitors Vaccine research Identification of better preventative measures.

28. What is the treatment for infectious diseases?

29. 1. Penicillin’s / cephalosporin's interfere with certain layers of cell wall synthesis.

30. 2. Chloramphenicol, tetracyclines, and erythromycins- may be toxic when used in high doses or prolonged periods of time.

31. 3. Rifampin- used for treatment of Tuberculosis. (TB)…is considered re-emerging because of antibiotic resistance.

32. 1. Antiviral drugs target virus - specific enzymes. 2. Acyclovir- used in treatment of genital herpes 3. Amantadine- used to prevent or moderate influenza. 4. AZT- inhibit replication of HIV genome.

33. 1. Penicillin resistance noted as early as 1943. • 2. Mycobacterium tuberculosis - some strains resistant to all drugs. • 3. Resistance to antibiotics - result of changes in genetic information of bacteria. • 4. Indiscriminate (random) use of antibiotics increases drug resistance.

34. Emerging infectious diseases • Have not occurred in humans before, • Have occurred previously but affected only small numbers, • Or have occurred throughout human history, but only recently recognized as disease due to infectious agent (i.e. H. Pylori)

35. Once were major health problems globally or in a particular country, then declined dramatically, but are again becoming health problems for a significant proportion of the population An infectious disease is considered to be Re-emerging once occurred, greatly declined, then increases in incidence.

36. What about bioterrorism???

37. 1. Bacterial - Anthrax and Plague

38. 2. Viral- Smallpox 3. Toxins -Botulism and Ricin (Saddam used it to “practice” bioterrorism in his own country)

39. Isolation practices • Patient placement • Patient transport - limited to movement that is essential • Cleaning, disinfection and sterilization of equipment and environment - follow standard precautions • Discharge management – lots of teaching before going home.

40. 6. Post-mortem care - should you tell the funeral director what the pt died of if it is from an infectious disease? Yes to ensure it is not spread! 7. Do you know how to wash your hand? The best water temperature to use is warm.

41. Terrorism is defined in the United States code, Title 18, section 2331 (18 USC 2331) as: Violent acts or acts dangerous to human life that…appear to be intended

42. 1. Healthcare facilities would group affected victims together in the same facility if there were a large scale bioterrorism attack. 2. If we were in a foreign country we would be kept there until we were noninfectious. 3. Victims least symptomatic will be sent home and instructed on barrier precautions, handwashing, and cleaning.

43. Purpose of bioterrorism… • To intimidate or coerce a civilian population. • To influence the policy of a government by intimidation or coercion; or • To affect the conduct of a government by assassination or kidnapping.

44. Biological weapons used in bioterrorism are living microorganisms such as bacteria, viruses, fungi, that can kill or incapacitate.

45. Funeral director would need to know the cause of death from a bioterrorist attack because special post-mortem precautions must be taken.

46. Health care facilities may be the initial site of recognition and response to bioterrorism activity. Because of this, the names and telephone numbers for internal and external departments or agencies that need to be contacted should be kept by each facility in its bioterrorism readiness plan.

47. By following standard precautions the general public could protect themselves from bioterrorism agents. • The guideline recommends wearing gloves when collecting or handling blood and body fluids contaminated with blood and wearing face shields when there is danger of blood splashing on mucous membranes and when disposing of all needles and sharp objects in puncture-resistant containers.

48. Internal reporting requirements (within a facility): a. Infection control personnel b. Epidemiologist (local and state) c. Administration (health care facility and health department) d. Office of public affairs in the health facility

49. a. Local health department b. State Health Department c. FBI d. CDC e. Local police f. EMS

50. a. Bacterial- Anthrax and Plague b. Viral- Small Pox c. Toxins- Botulism and Ricin