Mad Cows & Brits with holes in their brains (& other infectious diseases)

1. Mad Cows & Brits with holes in their brains(& other infectious diseases) Lecture 3 Dulai - FIB - 2008

2. Comeback Diseases • Infectious diseases such as • Cholera • Rheumatic fever • Plague though still quite rare, are on the rise and are threats to be reckoned with. • For example, cholera, Vibrio comma , is turning up in the shellfish population, mainly on the U.S. Gulf Coast. • It's usually transmitted to humans when they eat undercooked shellfish. Vibrio comma

3. Revisiting! • Likewise, outbreaks of such maladies of yesteryear as • Measles • Mumps • Diphtheria • Tuberculosis • Syphilis • are on the rise.

4. Why? • Lax use of drugs by patients • Because parents, doctors and public health authorities have failed to mount the effort needed to make sure everyone susceptible to preventable diseases, regardless of economic status, is vaccinated. • Even people who have been properly immunized are being stricken. • Population Growth and overcrowding

5. What next? • It is common knowledge amongst scientists that IT IS NOT IF, BUT WHEN, the next major pandemic will be coming. • Millions, if not hundreds of millions, may die! • What will it be? • Influenza • Ebola • TB • MSRA • Prions

6. Lets quickly consider these examples…

7. Influenza • Agent: Virus which attacks our cells. • What can the stupid flu do to me? • I am healthy and strong • I live in a country with a lot of wealth • I have nothing to fear… …or so you think!

8. Influenza - learn from history • Flu pandemics tend to occur on a regular basis • 1918 • 1957 • 1968 • ?2008-9 • The disease bears little resemblance to the the ‘flu’ - except at the molecular level • The virus gets its start when one of the many strains which constantly circulates in wild and domestic birds evolves into a form that infects humans

9. Hybrid strain • The bird strain then exchanges genes with the native human flu strain to produce a novel germ - that is highly contagious! • Some of these strains are mild • Others, which mutate faster than the immune system can defend against, cause severe and/or fatal illness • It is predicted that the next pandemic has the potential to claim more lives in a single year than AIDS has in the last 25 years!…

10. Warnings • Epidemiologists have warned that the next pandemic could sicken 1/3 people on the planet • Killing 10,000,000 to 100,000,000 people • It would spare no nation, no race, no income group • There will be no way to avoid it!

11. My government will have a vaccine for me. So I will be just fine. …will you?

12. Asian Bird Flu is doing the rounds • Hard to predict when it will come • Conditions are ripe at this time • There is a fierce strain of avian flu killing people in Asia, and infecting birds in a rapid westward lunge towards Europe • Influenza A (H5N1) does not pass readily from person to person - not yet!!!! • The virus is evolving and the birds are beginning their migrations… • What can we do?

13. Defense • Our best bets • Surveillance • Vaccines • Containment • Medications

14. Remember the Alamo Katrina • The government had a great plan for a hurricane hitting the Texas coast • It failed to implement properly • It has a great plan for the ‘bird flu’ too • Can they stick to their plans if the same workers are downed by the flu?

15. Case in point… Jakarta, Indonesia They HAD a plan too…

16. FLU Strain H5N1 • Late June - In a wealthy suburb of Jakarta, a 8-year old daughter of government auditor falls ill. • She gets antibiotics, but gets worse • June 28th - She is hospitalized • July 4th - Her father and sister fall ill too • July 9th - Sister dies • July 12th - Father dies

17. H5N1 continued • July 13th - doctors alert US Navy medical base • July 14th - the girl dies • July 14th - techs isolate and ID H5N1 form blood samples • July 22nd - Government acknowledges that there is a problem. • Hospitals prepare for an outbreak. • - Over 30 days elapsed - containment window would have closed. • Luckily - This time it was a false alarm.

18. Use Vaccines to Control Flu • Vaccines have worked to almost eradicate smallpox and polio • BUT, this tactic will not work with influenza (unless we have a major advance in vaccine technology) • Why? • It takes about 6 months to make vials of vaccine • One will need two injects of vaccine 4 weeks apart - primer and booster • Add it up and it would take about 8 months to get immunity from the start of the pandemic

19. Vaccines - Who will get them? • There is capacity to make about 300 million doses per year • More capacity on the way but still have other problems too • Make flu vaccine or pandemic vaccine - cannot make both at the same facility • Delays and shortages will abound • Who will get them first? • Government works • Police • Health works • Teachers • Elderly & infants • Ill people Will YOU?

21. EBOLA The new “jungle fever”

22. Ebola • Ebola is both the common term used to describe a group of viruses • …and the common name for the disease which they cause, Ebola fever • Thought to be transmitted by the fruit bat • Ebola hemorrhagic fever • Vomiting, diarrhea, general body pain, internal and external bleeding, and fever. • Mortality rates are generally high, ranging from 50% - 90%, with the cause of death usually due to shock or organ failure - one of the most virulent viral diseases known to humankind

23. Ebola - Infectious • Among humans, the virus is transmitted by direct contact with infected body fluids - sex • or to a lesser extent, skin or mucus membrane contact • The incubation period can be anywhere from 2 to 21 days, but is generally between 5 and 10 days • Monkeys - seems to be airborne, not humans- yet! • Transmission of the Ebola virus has also occurred by handling ill or dead infected chimpanzees. (Did we not blame them for giving us HIV/AIDS too!)

24. Tuberculosis TB for tubercle bacillus

25. Chest X-ray of Patient

26. TB - ‘The comeback kid’ • Today about 5000 people die of this once thought conquered disease! • It is caused by a bacteria • Primarily attacks the lungs, although it can also attack a number of other locations - nerves, blood, lymph, genitals, skin, etc. • Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks.

27. TB - ‘The comeback kid’ • Over 20% of the cases are now drug resistant in many countries • With a further 4% requiring 2nd line treatments • Will it be the next ‘BIG ONE’?

28. MRSA Methicillin-resistant Staphylococcus aureus

29. MRSA • MRSA is characterized by antibiotic resistance to all penicillins • including methicillin and other narrow-spectrum penicillin antibiotics. • MRSA was discovered for the first time in 1961 in the UK, but it is now widespread in the hospital setting. • MRSA is commonly termed a superbug. • MRSA infection can be fatal.

30. Natural flora • Staphylococcus bacteria are normally found on the skin or in the nose of about one-third of the population • If you have staph on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected with MRSA • Healthy people can be colonized with MRSA and have no ill effects, however, they can pass the germ to others.

31. MRSA… • Enters through • Nose • Cuts • IV sites • Urinary tract • Infections • About 5 times the risk of dying over those that do not get it. • Costs more to treat too, as you have to spend about 3X longer in the hospital.

32. Common place • Cases are now being reported outside the hospital setting - in communities • This has huge implications for us. • Will we reach a point where we will have no further antibiotics left to treat this infection - the bacteria is evolving very fast!

33. Finally… HELLO I’M BACK! WATCH ME…

34. Prions “ATTACK OF THE KILLER PROTEINS” In pure At a slaughter house near you…

35. MAD COW DISEASE • BSE - Bovine Spongiform Encephalitis • Spongy Brain Disease • Makes cows mad • Known as Creutzfeldt-Jakob disease (CJD) in man

36. proteinaceous infectious particle

37. Watch and learn Whilst watching the video answer the following questions please: • How old was the first patient? • What did the natives of Papua New Guinea eat that caused them to get ‘kuru”? • How did it get into cows? • What is the cause of BSE? • What happens to the patients brain?

38. Group Questions

39. Group Questions • If you were a health worker, how would you change your habits after today's lecture? • Do you believe that killer diseases are inevitable? • As we become more and more parasitic on other species, what could be some of the outcomes? Discuss and then outline at least three possibilities. • Some say that the best way to control the human population is to allow these diseases to run their course. What do you think? • Downer Cattle & the meat factory in the news in California. Now do you understand why downer cattle are not allowed into the human foodchain.