EID Intro

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Information about EID Intro
Travel-Nature

Published on March 31, 2008

Author: Ulisse

Source: authorstream.com

Slide1:  Medical Microbiology and Immunology 554 Bioterrorism and Emerging Infectious Diseases Slide2:  Time We Will Start on Time at 12:05 and officially end at 12:55 (we will try to end a couple of minutes early) Attendance We expect you to attend class and participate in discussion when provided with the opportunity. This will be almost 7% of the grade this year. Grading :  Grading Participation is 40 points: -6 online chat topics (1 pt first and 2 pt for counter) -Attendance is 22 points. Sign in at each lecture (1pt each) plus 2 enrichment lectures (3pts each). Participation points can be made up by attending discussion groups at the end of each month. We’ll pick an evening. Short answer, short essay mid-term examine on October 11th. This is 110 points Longer answer and longer essay final examine, 170 points. Total is 320 points with participation 12.5% Were on the Web:  Were on the Web Almost all lectures (not from some guest speakers) will be posted on our website a couple of days before the lecture date, so you can download the powerpoint slides and look at them or print them before class to take notes on. From the Medical Microbiology and Immunology site, click on Undergraduate Program, on the left side there is an area called MMI undergraduate courses. http://www.medmicro.wisc.edu/Undergraduate/Courses/554/index.html No Required Text Book but…:  No Required Text Book but… There will be articles to read from some speakers Microbial Threats to Health: Emergence, Detection, and Response (2003) From the Board on Global Health (BGH), Institute of Medicine (IOM) http://www.nap.edu/books/030908864X/html/ Educational Objectives: Questions to keep asking yourself:  What is the problem? Why do we have this problem? What can we do about it? Because EID and bioterrorism situations are always changing and unpredictable, we are only going to give you disease examples so you can learn to think through new situations as they arise. Educational Objectives: Questions to keep asking yourself Slide7:  Infections in the Pre-antibiotic Era Infections were the major cause of death and disabilities in the U.S. until mid-20th century Smallpox, tuberculosis, diphtheria, cholera, plague, polio, mumps, measles, typhoid, scarlet, and rheumatic fever Life expectancy in the U.S. with birth in 1900: -45 years male -47 years female Elderly population (65+) was 3-4% of the total population Slide8:  Changes Brought by Pasteur’s Germ Theory Antisepsis Antibiotics Immunization Sanitation Public Health Slide9:  Impact of Germ Theory Reduced childhood mortality Life expectancy in the U.S. with birth in 2000: -74 years male -79 years female Elderly population (65+) is 13% of the population (36 million) Life expectancy at 65+ and 75+ 65+ 75+ males 15 yrs 9 yrs females 19 yrs 14 yrs Slide10:  Current Top Causes for Death in the U.S. Heart Disease Cancer Stroke Pneumonia However…worldwide infections account for 30-35% of all deaths for example TB infects 30% of the world population Slide11:  Costs of common infectious diseases can be broken into: -direct costs such as treatment -indirect costs like lost work due to death or disability Disease Estimated Costs Intestinal infections $23 billion total Food Borne diseases $5-6 billion total S.T.Ds. (excluding AIDS) $5 billion in direct costs Influenza $5 billion in direct costs + $12 billion in indirect costs Antibiotic Resistant bacteria $ 4 billion in direct costs Costs of Infectious Diseases in the US What do you think a Definition of Emerging Infectious Diseases is?:  What do you think a Definition of Emerging Infectious Diseases is? Slide14:  Definition of Emerging Infections: New, re-emerging, or drug resistant infections whose incidence in humans has increased within the past two decades or whose incidence threatens to increase in the near future. -Institute of Medicine, 1992 What are the factors that you think lead to an infectious disease emerging?:  What are the factors that you think lead to an infectious disease emerging? Factors of Emergence::  Board on Global Health (BGH) and the Institute of Medicine (IOM) Microbial adaptation and change Human Demographics and Behavior International Travel and Commerce Economic Development and Land Use Technology and Industry Breakdown of public health measures Human susceptibility to infection Climate and weather Changing ecosystems Poverty and social inequality War and famine Lack of political will Intent to harm Factors of Emergence: Microbial Adaptation and Change:  A number of microbes utilizing different genetic mechanisms -genome sequences show that lateral transfer is common -high mutation rates in RNA viruses-rapid adaptation -quick reproduction so rare mutations build up rapidly Antimicrobials for livestock growth enhancement and over prescription of antimicrobials by Drs. (convenience) -evolve modifying enzymes and “drug pumps” Superbugs Streptococcus and penicillin, Staphylococcus and vancomycin Tuberculosis and isoniazid Malaria and chloroquine. Microbial Adaptation and Change Human Demographics and Behavior:  Increases in the human population, even in the U.S. Urbanization-more people concentrated in cities-often without adequate infrastructure Increases in the elderly populations Increases in children in daycare: working woman with kids under 5 was 30% in 1970, is 75% in 2000. Fast paced Lifestyles- increase in convenience items and more stress High-risk behavior- Drug use and unprotected sex Human Demographics and Behavior International Travel and Commerce:  365 days to circumnavigate the globe…now it takes 36 hours -used to quarantine ships, but 36 h faster than disease incubation 400 million people per year travel internationally increased incidence of both Tuberculosis and Influenza transmission on long flights Transportation of products is an increased concern -rapid transport of disease harboring fresh produce -transport of livestock facilitates movements of viruses and arthropods (especially ticks) Increases in Cruise ship travel International Travel and Commerce Economic Development and Land Use:  Consumption of natural resources, deforestation, and dam building Logging in the rain forest has exposed people to new viruses Historic example -emergence of Yellow Fever when humans entered the Central American jungle to build the Panama Canal New standing water from dam building, canalization, and irrigation Historic example -the Aswan high dam increases rates of Schistosomiasis in Egypt Reforestation in some parts of North America has caused the emergence of Lyme disease in those areas Economic Development and Land Use Technology and Industry:  Advances in Technology-most changes are positive but… Medical technology -people living longer but have weaker immune systems -blood transfusions and organ transplants save lives but can cause infections (implanting parts causes biofilm growth) Transportation technology -the ability to rapidly move people and goods. Industrial Changes- Mass production of food …now we all get our water and food from the same sources. Industrial Pollution-increases incidence of TB Technology and Industry Breakdown of Public Health:  World-wide breakdown of public health measures (such as adequate sanitation, immunizations, tb control) have dramatically increased EID. Late 1970’s- IMF and World Bank forced reductions in public sector investment, especially in Latin America and Africa. Debate over whether this had a negative impact on public health. -The bank has shown that these countries are economically better off. -The other side says, the reduction in public health sector caused immunization levels, nutrition, and medical supplies to drop. A similar reduction in public health funding occurred in the US. -reduction in programs for disease prevention and surveillance Lack of diagnosis and treatment in many areas of the world. -In Kikwit, the Ebola outbreak went with high mortality for a while before there help sent. Breakdown of Public Health Human Susceptibility to Infection:  Human Susceptibility to Infection Impaired Host Immunity -AIDS -Increases in the older population Genetic Polymorphisms Malnutrition-host susceptibility is aggravated Climate and Weather:  Climate and Weather Global warming-climatologists project temps to increase up to 5.8°C by 2100 Elevated rainfall -creates new breeding habitats for mosquitoes “ “-decreases salinity which can increase toxic bact. “ “-increases vegetation which increases rodents (1993 Hanta virus outbreak) “ “-increases runoff into drinking reservoirs (1993 Cryptosporidiosis outbreak) Higher ocean temps increase Vibrio parahaemolyticus (shellfish) Some soil pathogens carried by dry dusty winds (Coccidiodes) Changing Ecosystems:  Changing Ecosystems Ecological changes can increase the risk of infection by altering human exposure or pathogen distribution. Rainforest destruction -forests reduce while cropping increases humidity Urban development increases atmospheric particles and increases air temperatures Of the 10 EID targeted by WHO, 7 have arthropod vectors Poverty and Social Inequality:  Poverty and Social Inequality Mortality from infectious diseases more closely than ever correlates with income. -developing and former communist bloc countries Factors: malnutrition, lack of clean water and sanitation, poor housing, ignorance of risky behaviors (including absence of social agencies to teach), lack of transportation, lack of funds for out-of-pocket expenses. Population of the poorest is increasing the fastest War and Famine:  War and Famine War refugees are a full 1% of the global population War refuges are forced onto new areas where they are exposed to new microbes from vectors and people. War and famine are closely linked. In 2001, tracking 16 countries with “food emergencies”, showed that 9 were because of civil unrest. Famine is also caused by social, economic, and political forces. Weather and HIV/AIDS Lack of Political Will:  Lack of Political Will A global political commitment is rather vague -Who will be the parties in a global social contract? -How is their will determined? -How can the liberties of individual coutnries be balanced against collective responsibility? Is there collective responsibility? Must have commitment from 4 groups: donors, health care professionals, country authorities, and patients Developing world diseases don’t matter to politicians here. Intent to Harm:  Intent to Harm Even before 2001, some recognized the threat. 1972- the Biological Weapons Convention (BWC) treaty- prohibited the possession, stockpiling, and use, BUT…it had nothing for monitoring, inspection, or enforcement. The US abandoned its biological warfare program is 1969, BUT The Soviet Union kept its program up after signing the BWC, we did not find this out until the mid-1990s Aum Shinrikyo had also experimented with botulin, anthrax, and sent teams to Zaire for Ebola. Six Priority Areas of the CDC:  Six Priority Areas of the CDC International Outbreak Assistance (emergency response, epidemology) Global Approach to Disease Surveillance (global early warning networks) Applied Research on Diseases of Global Importance (lots into flu now) Application of Proven Public Health Tools (bed nets, vaccines, etc) Global Initiatives for Disease Control (the big three and vaccines) Public Health Training and Capacity Building (International Emerging Infections Programs) Slide31:  The Big Three for ID Disease Microbe Cases (Annual) Cases (Total) Deaths (Annual) Malaria Tuberculosis AIDS Plasmodium M. tuberculosis HIV 5 million 8 million 300-500 million 300-500 million 1 million 2 million 3.1 million 40 million 2 billion Factors of Emergence::  Board on Global Health (BGH) and the Institute of Medicine (IOM) Microbial adaptation and change Human Demographics and Behavior International Travel and Commerce Economic Development and Land Use Technology and Industry Breakdown of public health measures Human susceptibility to infection Climate and weather Changing ecosystems Poverty and social inequality War and famine Lack of political will Intent to harm Factors of Emergence:

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