Dr. M.S. BASAVARAJ. MD Deputy chief medical officer UNIVERSITY HEALTH CENTRE UNIVERSITY OF MYSORE MYSORE

1. Emerging diseases - a social perspective Dr. M.S. BASAVARAJ. MD Deputy chief medical officer UNIVERSITY HEALTH CENTRE UNIVERSITY OF MYSORE MYSORE

2. “I became involved, not only on a professional level, but also on a very personal level, following personal exposure to the impact of HIV/AIDS, Influenza, Dengue in MY CLINICAL PRACTICE • My involvement in HIV/AIDS really was an outgrowth of travels in the villages” • Casual behaviour of the youth • Youth in hurry to show, that they are Masculine

3. Definition • Emerging diseases • An emerging disease is one that has appeared in a population for the first time, or • that may have existed previously but is rapidly increasing in incidence or geographic range.

4. Classification • Non communicable diseases • Diabetes • Heart ailments • Accidents • Drug abuse • Communicable diseases; • HIV / AIDS • Dengue / chikungunya • Influenza

5. NON-COMMUNICABLE DISEASEStomorrow's pandemics • Levels of risk for NCDs involve people's patterns of behaviour, determined by the interplay between • personal characteristics, • social interactions and • many environmental factors. • Individual behaviour is only part of the problem. • Communication strategies and action are required as core components of any effective health initiative.

6. World health report • The WHR points out that • poverty, • violence, • rapid social and economic changes, • lack of education, • inadequate or total absence of health services contribute as much to the increasing cases of NCDs as they do to AIDS, malaria and tuberculosis. • This shift reflects a significant change in • diet habits, • physical activity levels, and • tobacco consumption • worldwide as a result of industrialisation, urbanisation, economic development and food market globalisation.

7. RISK • Risk, • is a probability of an adverse outcome, or • a factor that raises this probability.

8. Risk factors • Un modifiable • Genetic predisposition • Age

9. Partially avoidable Stress

10. Totally modifiable • Smoking • Alcohol • Physical inactivity • Unhealthy foods / under nutrition • Risky behaviour • Neglecting present diseases

11. TOBACCO CONSUMPTION • Tobacco use kills 4.2 million people every year. • This figure has nearly doubled in the last ten years (these are the ones who started smoking 10 -20 years ago) and • it is estimated to reach 8.4 million by 2020 if action is not taken now to curb the tobacco epidemic. • 479 deaths per hour, or one every 8 seconds, are from cardiovascular disease, chronic respiratory disease, cancer and other diseases caused by tobacco consumption.

12. ALCOHOL CONSUMPTION • Alcohol causes 1.7 million deaths and 56 million disability-adjusted life years lost a year. It is estimated that alcohol causes • 20-30% of oesophageal cancer, • liver cancer, • cirrhosis of the liver, • homicide, • epilepsy, • motor vehicle accidents

13. Physical activity • OBESITY/OVERWEIGHT • Balance between calorie input & outputOverweight and obesity raise the risk of Cardiovascular Disease, as well as diabetes and many cancers. • Obesity has also been associated with asthma and impaired lung function.

14. Thrifty gene hypothesis • Increasing incidence of diabetes • Decreasing physical activity • Increasing stress levels • Change in food habits • From scarcity to surplus • Even children are not an exception • Lost in TV & junk foods

15. UNDERNUTRITION • Underweight and malnutrition is one of the 10 highest risk factors for death in both high and low mortality developing countries • Iron deficiency affects an estimated 2 billion people, and causes almost a million deaths a year. Young children and their mothers are the most commonly and severely affected.

16. HIGH BLOOD PRESSURE & CHOLESTEROL • There are about 600 million people with high blood pressure in the world. • Most of them are unaware and undiagnosed. • High blood pressure and cholesterol are major risk factors of cardiovascular disease (CVD).

17. Effect of cholesterol • Cardiovascular disease & Stroke • Animations of CVD, angioplasty, CABG

18. PREVENTION /// SUMMARY • QUIT SMOKING • MODERATE ALCOHOL • BE PHYSICALLY ACTIVE • PLENTY OF FRUITS & VEGETABLES • REDUCE USE OF FATS / OILS • CONSIDER THE LONG TERM EFFECTS • SUPPLEMENT TRACE ELEMENTS

19. Emerging infectious diseases

20. DIFFERENCE • AFTER ONSET OF DISEASE SYMPTOMS --- • CURE WITH DRUGS ----- • TYPHOID, MALARIA • BEFORE EXPOSURE TO THE DISEASE PRODUCING AGENT ---- • VACCINE PREVENTABLE ------ • POLIO, TETANUS, MUMPS, MEASLES • AFTER EXPOSURE TO THE DISEASE PRODUCING AGENT -- • VACCINE PREVENTABLE --- • RABIES • HIV –AIDS -- ????????? • Influenza • SARS • Dengue

21. World on the verge of elimination of some diseases • At the same time – entry of new diseases • Corona – SARS • Ebola • H1N1 • HIV • Dengue, Chikungunya

22. UNSAFE WATER, SANITATION, AND HYGIENE • About 1.7 million deaths a year worldwide are attributed to unsafe water, sanitation and hygiene, mainly through infectious diarrhoea. 9 out of 10 such deaths are in children, and virtually all of the deaths are in developing countries.

23. An emerging infectious disease (EID) is an infectious disease whose incidence has increased in the past 20 years and threatens to increase in the near future. • EIDs include diseases caused by a • newly identified microorganism or newly identified strain of a known microorganism (e.g. SARS, AIDS) • new infections resulting from change or evolution of an existing organism (e.g. influenza), H haemagglutinin, N -neuraminidase • a known infection which spreads to a new geographic area or population (e.g. West Nile virus), • newly recognized infection in an area undergoing ecologic transformation (e.g. Lyme disease), • and pre-existing and recognized infections reemerging due to drug resistance of their agent or to a breakdown in public health (e.g. tuberculosis).

24. Mechanisms of emergence and reemergence • Microbial adaption; e.g. genetic drift and genetic shift in Influenza A • Changing human susceptibility; e.g. mass immunocompromisation with HIV/AIDS • Climate and weather; e.g. diseases with zoonotic vectors such as West Nile Disease (transmitted by mosquitoes) are moving further from the tropics as the climate warms • Change in human demographics and trade; e.g. rapid travel enabled SARS to rapidly propagate around the globe • Economic development; e.g. use of antibiotics to increase meat yield of farmed cows leads to antibiotic resistance • Breakdown of public health; e.g. the current situation in Zimbabwe • Poverty and social inequality; e.g. tuberculosis is primarily a problem in low-income areas • War and famine • Bioterrorism; e.g. 2001 Anthrax attacks • Dam and irrigation system construction; e.g. malaria and other mosquito borne diseases

25. 4 IMPORTANT NEW / RECENT EIDs • Swine flu • Dengue • Chikungunya • HIV / AIDS • Delhi superbug – Staph. aureus

26. Novel Influenza – A - H1 N1 2009 Dr. M.S. BASAVARAJ. MD Deputy chief medical officer UNIVERSITY HEALTH CENTRE UNIVERSITY OF MYSORE

27. The reported number of fatal cases is an under representation of the actual numbers as many deaths are never tested or recognized as influenza related

28. Pearl Buck • If you want to understand today, you have to search yesterday

37. DENGUE Key facts • Dengue is a mosquito-borne infection that causes a severe flu-like illness, and sometimes a potentially lethal complication called dengue haemorrhagic fever. • Global incidence of dengue has grown dramatically in recent decades. • Dengue haemorrhagic fever is a leading cause of serious illness and death among children in some Asian countries. • There is no specific treatment for dengue, but appropriate medical care frequently saves the lives of patients with the more serious dengue haemorrhagic fever. • The only way to prevent dengue virus transmission is to combat the disease-carrying mosquitoes. - breeding places

38. How to reduce your risk of dengue infection: • There is no vaccine available against dengue, and there are no specific medications to treat a dengue infection. • This makes prevention the most important step, and prevention means avoiding mosquito bites if you live in or travel to an endemic area. • The best way to reduce mosquitoes is to eliminate the places where the mosquito lays her eggs, like artificial containers that hold water in and around the home. • Outdoors, clean water containers like pet and animal watering containers, flower planter dishes or cover water storage barrels.  • Look for standing water indoors such as in vases with fresh flowers and clean at least once a week. • The adult mosquitoes like to bite inside as well as around homes, during the day and at night when the lights are on. • To protect yourself, use repellent on your skin while indoors or out. When possible, wear long sleeves and pants for additional protection.   Also, make sure window and door screens are secure and without holes. If available, use air-conditioning. • If someone in your house is ill with dengue, take extra precautions to prevent mosquitoes from biting the patient and going on to bite others in the household.  • Sleep under a mosquito bed net, eliminate mosquitoes you find indoors and wear repellent!

39. Aedesaegypti / albopictus

40. Chikungunya Key facts • Chikungunya is a viral disease that is spread by mosquitoes. • Mosquito – aedes, day biting, breeds in artificial collections of water • It causes fever and severe joint pain. Other symptoms include muscle pain, headache, nausea, fatigue and rash. • The disease shares some clinical signs with dengue, and can be misdiagnosed in areas where dengue is common. • There is no cure for the disease. • Treatment is focused on relieving the symptoms. • The proximity of mosquito breeding sites to human habitation is a significant risk factor for chikungunya. • The disease occurs in Africa, Asia and the Indian subcontinent. In recent decades mosquito vectors of chikungunya have spread to Europe and the Americas. • In 2007, disease transmission was reported for the first time in Europe, in a localized outbreak in north-eastern Italy.

41. Prevention • The proximity of mosquito vector breeding sites to human habitation is a significant risk factor for chikungunya as well as for other diseases that these species transmit. Prevention and control relies heavily on reducing the number of natural and artificial water-filled container habitats that support breeding of the mosquitoes • The most effective means of prevention are protection against contact with the disease-carrying mosquitoes and mosquito control. • These include using insect repellents with substances like DEET (N,N-Diethyl-meta-toluamide; icaridin (also known as picaridin and KBR3023), PMD (p-menthane-3,8-diol, a substance derived from the lemon eucalyptus tree), or IR3535.

42. AIDS / HIVTHE EPIDEMIC TURNS 30

43. PERSONAL EXPERIENCE • 2004 • MANIPUR BOY • SON DONATING BLOOD TO MOTHER • 2006 • POST MORTEM OF PARENTS & SON • 2009 • HANUMANTHA, A 4 YEAR OLD BABY

45. A I D S is: ACQUIRED - must do something to contract IMMUNE- ability to fight off infectious agents DEFICIENCY- lack of SYNDROME- cluster of symptoms that are characteristic for a disease H I V is : HUMAN- isolated to the human species IMUNO- DEFICIENCY- lacking the ability to fight off infectious agents VIRUS- a disease causing agent

46. AIDS Lifecycle Stage 1

49. NO TREATMENT FOR COMPLETE CURE TREATMENT IS ONLY TO PROLONG LIFE BY SUPRESSING VIRUS REPLICATION