Population Health Curriculum for Health Professionals

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Emerging Infectious Diseases
Dorothy Cumbey, Ph.D., RN Director of Quality
Management Health Services Jerry Dell Gimarc,
MA Senior Planner South Carolina Department of
Health and Environmental Control
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Developed as part of an Enhanced AHEC Community
Partnership for Health Professions Workforce and
Educational Reform project funded by the Health
Resource and Service Administration (HRSA)
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At the completion of this module you will be able
to

• describe how the public health system can be
  mobilized to address emerging issues or threats
  to the publics health
• identify roles and responsibilities of different
  components of the public health system in
  confronting health challenges

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Objectives, Continued

• describe the linkages needed within the public
  health system to effectively address these
  challenges
• discuss health care needs of individuals and
  communities in the future

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OBJECTIVES

• Describe the public health approach to emerging
  issues.
• Identify roles and responsibilities of public
  health system components.
• Describe linkages needed to address challenges.

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What Are EmergingInfectious Diseases?

• These are human illnesses caused by
  microorganisms or their poisonous byproducts and
  having the potential for occurring in epidemic
  numbers.

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Why are we concerned about Emerging Infectious
Diseases?

• These diseases
• Pose a threat to all persons regardless of age,
  sex, lifestyle, ethnic background, or
  socioeconomic status
• Cause suffering and death
• Impose a financial burden on society

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Trends in Death Caused by Infectious Diseases in
the United States, 1900-94
Click for larger picture
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Economic and Social Impact of Some Infectious
Diseases
Economic and Societal Impact of Some Infectious
Diseases
Click for larger picture
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Emerging Infectious Diseases include conditions
that

• emerge as a new infectious process
• re-emerge as drug resistant forms

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Microbial Adaptation

• Mechanisms of genetic diversity
• Respond to changes in physical and social
  environment.
• Epidemiologic triangle
• Host
• Environment
• Agent

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New EmergingInfectious Diseases

• Human Immunodeficiency Virus (AIDS)
• Lyme disease
• Ebola fever
• Hantavirus Pulmonary Syndrome
• West Nile encephalitis
• Legionnaires disease

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Drug Resistant Diseases

• Malaria
• Multiple drug resistant tuberculosis
• Bacterial pneumonias

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How Are Infectious Diseases Acquired?

• Inhalation
• Ingestion
• Food, water, soil
• Percutaneous inoculation
• Mucous membranes
• Blood and body fluids

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Origin of EmergingInfectious Diseases

• Changes in environment (technology and industry)
• Economic development
• Population growth or migration
• Human behavior
• International travel and commerce
• Microbial adaptation
• Breakdown in public health measures

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Discussion Time

• Identify some changes that may contribute to the
  rise of infectious diseases.

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Target Areas for Preventing Emerging Infectious
Diseases

• Drug resistance
• Food borne and water borne diseases
• Vectorborne and zoonotic diseases
• Diseases transmitted through exposure to blood
  and body fluids
• Chronic diseases caused by infectious agents
• Vaccine development and use

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Drug Resistance

• The emergence of drug resistance in bacteria,
  parasites, viruses, and fungi is reversing
  medical advances of the previous 50 years.

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Drug Resistant DiseasesMore Examples

• S. aureus in Japan and UK, 1997
• HIV endemic in NY
• Problems in South Carolina
• Streptococccus pneumoniae
• Vancomycin resistant Enterrococcus

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Examples of Multi-State Food-borne Outbreaks in
the US 1994-1997
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Examples of Multi-state Food-borne Outbreaks in
the US 1994-1997
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Vectorborne and Zoonotic Diseases

• Influenza
• Creutzfeldt-Jakob Disease
• Mad Cow Disease
• Lyme Disease
• Rabies

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Vectorborne and Zoonotic Diseases

• West Nile Viral Encephalitis
• Malaria
• Ebola fever
• Hantavirus pulmonary syndrome

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Diseases Transmitted Through Exposure to Blood
and Body Fluids

• Human Immunodeficiency Virus
• Hepatitis
• A, B, C, D, E
• NANE
• SEN-V
• Bacterial pathogens

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Other Target Areas for Prevention

• Chronic Diseases Caused by Infectious Agents
• Vaccine Development and Use

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Populations Particularlyat Risk

• People with impaired host defenses
• Pregnant women and newborns
• Travelers, immigrants, refugees

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Bioterrorism as an Emerging Infectious Disease
Threat

• Intentional dissemination of disease
• Infectious and toxic agents
• viruses, bacteria, toxins, fungi

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Public Health Approach to Emerging Infectious
Diseases

• Surveillance
• Epidemiology for early diagnosis
• Early response to outbreaks and changing disease
  patterns

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Public Health Approach continued

• Public Health Laboratory support for rapid and
  accurate diagnosis
• Rapid Communication links to private providers
  and hospitals
• Communication to public
• Education about prevention and/or early detection

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CASE STUDYFoodborne Illness

• Health care provider report
• Epidemiologic investigation Epi Team
• Early Response Consultation
• Laboratory support for diagnosis
• Rapid communication to health care
  provider/hospital
• Communication to public
• Education

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DISCUSSION

• What is your role in addressing emerging
  infectious diseases?
• Prevention
• Education
• Detection

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Your role in the prevention of emerging
infectious diseases

• Best practices
• Antibiotic use
• Food preparation
• Control exposure
• Awareness of risk
• Behavior change

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Your role in education about emerging infectious
diseases

• Stay informed
• CDC Web Pages
• MMWR on Web
• EID Journal
• Educate patients/family/friends
• Know resources - who to call

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Your role in detection of emerging infectious
diseases

• Participate in surveillance activities within
  your clinical setting
• Be alert for clues assess risk
• Know your resources - who to call for
  consultation
• Report to local health department

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Summary

• Shifts in the environment, human behavior and
  microorganisms can cause new diseases to emerge
• We share responsibility to identify, minimize or
  avoid these situations