Emerging, Re-emerging Infectious Diseases and Employee Health

1
??? ???? ?????? ??????
Emerging Reemerging Infectious diseases Shahid
Beheshti University of medical sciences,
2008 By Hatami H. MD. MPH
2
Ebola
??????? ????? ?? ???? ???? ?? ??? 1976 ???? 88
???????? ?? ?? ????? ?????? ???
3
Hepatitis C
??????? ?????? C ?? ??? ???? ???? ?????? ??? ??
170 ?????? ??? ? ????? ???? ?? ?????? ?? ????
?????? ???
4
Avian Influenza
??????? ?????????? ??????? ?? ??? 2004 ????
?????? ? ?????? ????????? ?????? ?????? ????? ???
????? ? ??? ??? ?? 70 ???? ??? ??? ??? ??????
???????? (???? ???? ??? 1388) ??? ?????? ?? ????
???? ?? ??? ???? ???? ????
5
??????? ?????????? H5N1 ?? ????? ?? 14/8/1388
1382 1383 1384 1385 1386 1387 1388
????? ?????
????? ???
?? ????? 442 ????? ??? 262 (60)
18 ???? ?????? ? 6 ???? ??? 1376
6
Nipah Encephalitis
??????? ???????? ???? ?? ????? ???? ?? ????? ??
??? 99-1998 ??? ????? ?? ????? ? ??? ?? 40 ????
?? ?? ??? ??? ??? ???? ???
7
Diphtheria (USSR)
???????? ?????? ?? ????? ???? ?? ??????? 95-1990
???? ?????? ??? ?? 125000 ??? ? ??? ???? 4000
????? ?????? ???
8
HIV/AIDS
??????? ? ???????? HIV/AIDS ???? ?????? ??? ?? 70
?????? ??? ?? ???? ???? ? ??? ??? ?? 28 ??????
??? ???? ??? ???
9
?? ?????13040
10
SARS
??????? SARS ?? ??? 2002 ? ???????? ???? ?? ??
???? ?????? ??? ?? 8 ???? ??? ?? ???? ???? ? ???
??? ?? 900 ??? ???? ?????? ???
? ?????? ?? ???????? ??? ?? ?? ??? ???????
????????? ?????? ?????? ???? ???
11
(No Transcript)
12
Hepatitis - E
??????? ?????? E ?? ??? 70-1369 ???? ???? ??????
???? ??? ?? ???? ???????? ? ??? ????? ??? ?? ????
???? ??????? ?????? ???
13
Diphtheria (Khoozestan)
???????? ?????? ?? ??????? 68-1367 ?? ???????
???? ?????? ??? ????? ?? ?????? ? ????????? ? ???
??? ??? ?? ???? ??? ???
14
?????? ??
Estimates For Next Pandemic of Influenza in U.S.
Alone

• 200 million will be infected
• 40 - 100 million will be clinically ill
• 18 - 45 million will require outpatient care
• 300,000 - 800,000 will be hospitalized
• 88,000 - 300,000 will die
• Economic losses of 71 - 166 billion

15
Definitions
16
Emerging infectious diseases

• Not previously emerged anywhere (SARS, Avian
  flue)
• In a new country or area (Fascioliasis in
  Kermanshah)
• Occurred for a long time, but recently
  recognised (Hepatitis E)
• Drug resistant organisms (MDR TB)

17
Re-Emerging infectious diseases

• Decreased and are increasing again (TB,
  Diphtheria in USSR )

18
Disappearing Infectious Diseases

• Eradicated (Smallpox)
• Candidate to eradication (poliomyelitis)

19
????? ???? ?? ??????? ? ????????

• Ecological Changes
• Human Demographics and Behavior
• International Travel and Commerce
• Technology and Industry
• Microbial Adaptation and Change
• Breakdown in Public Health Infrastructure
• Human Susceptibility to Infection
• Economic Development and Land Use
• Climate and Weather
• War and Famine
• Poverty and Social Inequality
• Bioterrorism

20
Emerging InfectionsEcological changes

• Engineering projects like dam-building
• Increased vectorborne zoonotic diseases

21
Emerging InfectionsHuman Demographics,
Behavior, Vulnerability

• More people, more crowding
• Changing sexual mores (HIV, STIs)
• Injection drug use (HIV, Hepatitis C)
• Changing eating habits out more, more produce
  (foodborne infections)
• More populations with weakened immune system
  elderly, HIV/AIDS, cancer patients and survivors,
  persons taking antibiotics and other drugs

22
Emerging InfectionsTechnology and Industry

• Mass food production (Campylobacter, E.coli
  O157H7, etc)
• Use of antibiotics in food animals
  (antibiotic-resistant bacteria)
• More organ transplants and blood transfusions
  (Hepatitis C, )
• New drugs for humans (prolonging
  immunosuppression)

23
Emerging InfectionsInternational Travel and
Commerce

• SARS, VHF,
• Foods from other countries imported routinely
  (Cyclospora,.)
• Vectors hitchhiking on imported products

24
Emerging InfectionsMicrobial Adaptation and
Change

• Increased antibiotic resistance with increased
  use of antibiotics in humans and food animals
  (VRE, VRSA)
• Increase virulence (Group A Strep?)
• Jumping species from animals to humans (avian
  influenza, SARS?)

25
Emerging InfectionsPoverty, Social Inequality,
Breakdown of Public Health Measures

• Lack of basic hygienic infrastructure (safe
  water, safe foods, etc.)
• Inadequate vaccinations (measles, diphtheria)
• Discontinued mosquito control efforts (dengue,
  malaria)
• Lack of monitoring and reporting (SARS in China)

26
Emerging InfectionsBioterrorism

• Bioterrorism Anthrax in US 2001
• Bio-Crimes Salmonella in OR, Shigella in TX.
• Potential agents Smallpox, Botulism , Plague,
  Tularemia, .

27
????? ?? ?? ????? El Nino
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
???? ???? ?????? ??? ?????? ? ???????
??? ? ?? ??? ????? ????????? ? ? ?? ??? ?????
????????? ? ? ?? ??? ????? ? ? ?? ??? ????? ? ???
?????? ?? ? ?? ??? ???? ???? ?? ????? ???? ???? ?
? ?? ??? ????? ?????? ? ? ?? ??? ??? ?? ???? ????
??????? ? ? ?? ??? ??????? ???? ?? ?? ??????
????? ????
32
???? ???? ?????? ??? ?????? ? ???????

• ??? ? ?? ??? ????? ?????????

33
?????????? ????? ?????? ?? ?????

• 1 ? HIV/AIDS (1365 - ?????)
• 2 ? ?????? E (70-1369 - ????????)
• 3 ? ??????? ????? ?? ??? ???? (1376 ????? ????)
• 4 ? ??????????? ?????? (1379 ????????)
• 5 ? ????????? ????? ?? ??? ???? . . .
• 6 ? CCHF
• 7 ? ???????? (????? ????????? ??? 1382)

34
?????????? ????? ??????? ?? ?????
1 ? ?????? (???????? ????? ???) 2 ? ????
(???????? ????? ???) 3 ? ?? ???????? (??? ?????
????? ???) 4 ? ??????????? ?????? (????? ?????
??? 68-1367)
35
?????????? ????? ?????? ?? ?????
1 ? ???? (????? ???? ?? ??? 1351 ?? ?????) 2 ?
?????????????? (??? 1375) 3 ? ???? (????? ???) 4
? ?????????? (????? ???) 5 ? ?????? B
(??????????? ?????? ?? 15 ??? ???)
36
???? ???? ?????? ??? ?????? ? ???????
? ? ?? ??? ????? ????????? 1 ? ????????
(?????????? ?????? ?????? HTLVIII? ???? AIDS?
????? ?????? E ? C ? ???? ?????? ??????? ?????
?????????? ??????? ????? ? ????? ???? ???? 8?
????? ?????????? ???????? ????? SARS? ????
?????? . . . ) 2 ? ????????? (????????
????????????? ??????????? ????? ????? ???????
??????? ???? O157H7? ?????? ???? ???????
?????????? ??????? ??????????? O139 . . .) 3 ?
??????? (zygomycetes, phaeohyphomycetes, Fusarium
sp, Trichosporon sp . . . ) 4 ? ???????
(??????????????? ?????????? ???????? ????? 5 ?
???????? (???? ???? ? vCJD)
37
???? ???? ?????? ??? ?????? ? ???????
? ? ?? ??? ????? 1 ? ??????? (????????) 2 ? ????
(???????) 3 ? ????? (HIV/AIDS)
38
???? ???? ?????? ??? ?????? ? ???????
? ? ?? ??? ????? ? ??? ?????? 1 ? ?? (???????????
?????? ?????? O139 . . . 2 ? ??? (??????? ????
O157H7 ? ?????????????? . . . 3 ? ??? (SARS?
?????????? ??????? ??????? 1997 ? 2004? ?????????
4 ? ???? ???? (?????????? ??????? HIV/AIDS . .
. ) 5 ? ??????? (?????? ????????? ??????????
??????? ???? . . . )
39
???? ???? ?????? ??? ?????? ? ???????

• ?? ? ?? ??? ???? ????

1973 Rotavirus Enteritis/Diarrhea 1976 Cryptos
poridium Enteritis/Diarrhea 1977 Ebola
virus VHF 1977 Legionella Legionnaires
dz 1977 Hantaan virus VHF w/ renal
flr 1977 Campylobacter Enteritis/Diarrhea 1980
HTLV-1 Lymphoma 1981 Toxin prod.
S.aureus Toxic Shock Synd. 1982 E.coli
0157H7 HUS 1982 HTLV-II Leukemia 1982 Borrel
ia burgdorferi Lyme disease
40
???? ???? ?????? ??? ?????? ? ???????

• ?? ? ?? ??? ???? ????

1983 HIV AIDS 1983 Helicobacter
pylori Peptic ulcer dz 1988 Hepatitis
E Hepatitis 1989 Hepatitis C
Hepatitis 1990 Guanarito virus VHF
1991 Encephalitozoon Disseminated
dz 1992 Vibrio cholerae O139 Cholera 1992 Barton
ella henselae Cat scratch dz
41
???? ???? ?????? ??? ?????? ? ???????

• ?? ? ?? ??? ???? ????

1993 Sin Nombre virus Hanta Pulm.
Synd. 1994 Sabia virus VHF 1994 Hendra
virus Respiratory dz 1995 Hepatitis G
Hepatitis ???? 1995 H Herpesvirus-8 Kaposi
sarcoma 1996 vCJD prion Variant CJD 19972006
Avian influenza (H5N1) Influenza 1999 Nipah
virus Encephalitis 1999 West Nile
virus Encephalitis 2001 BT Bacillus
anthracis Anthrax 2003 Monkeypox Pox 2003 SARS
-CoV SARS
42
???? ???? ?????? ??? ?????? ? ???????

• ? ? ?? ??? ????? ??????

1 ? ???? ?????? ??? ???? ?????? (????? SARS . . .
) 2 ? ?????? ??????? ???? ??? ???? ????? ??? ???
???? ????? ?? ????? ??????? ??? ??? (?????? E . .
. ) 3 ? ???? ??? ???? ????? ??? ????? ?????
?????? ???? ??? (??????????? ?????? ?? ??????
???????? ????? . . . )
43
???? ???? ?????? ??? ?????? ? ???????
 

• ? ? ?? ??? ??? ?? ???? ???? ???????

1 ? ?????????? ??? ????? (???? ????? ?????? ?
???????) 2 ? ?????????? ???? (????????) ???? ??
????? ??????
44
???? ?? ????? ??? ?? ????? ?????? ??? ????? ??????
45
Prevention of Emerging Infectious Diseases Will
Require Action in Each of These Areas

• Surveillance and Response
• Applied Research
• Training
• Prevention and Control

46
Preventing EmergingInfectious Diseases

• Surveillance and Response
• Detect, investigate, and monitor emerging
  pathogens, the diseases they cause, and the
  factors influencing their emergence, and respond
  to problems as they are identified.

47
Preventing EmergingInfectious Diseases

• Applied Research
• Integrate laboratory science and epidemiology to
  increase the effectiveness of public health
  practice

48
Preventing EmergingInfectious Diseases

• Infrastructure and Training
• Strengthen public health infrastructures to
  support surveillance, response, and research and
  to implement prevention and control programs.
• Provide the public health work force with the
  knowledge and tools it needs.

49
Preventing EmergingInfectious Diseases

• Prevention and Control
• Ensure prompt implementation of prevention
  strategies and enhance communication of public
  health information about emerging diseases.

50
??????? ? ???????? ????????? ? ????? ????????
?????

• ???? ???? ?????????
• ?? ???? ???????? ????? ??????
• http//www.elib.hbi.ir/persian/library.htm

51
Sources

• Duc J. Vugia,Emerging and Re-emerging Infectious
  Diseases 2003
• McKinley Thomas , Epidemiology of Emerging
  Infectious Diseases An Examination of Global
  Threats From a Public Health Education
  Perspective
• Jutta B.U. Tebje-Kelly BSc Hons BVSc , Emerging
  diseases
• History of Public Health and Its Role in
  Addressing Emerging Disease Threats MMI 554
  September 14, 2004
• http//www.who.int/csr/disease/avian_influenza/cou
  ntry/en/ (2008)
• ???? ??????? ? ???????? ???????? ? ????? ????????
  ?????? ????? ???? ???? ????? ? ???????
  http//www.elib.hbi.ir/persian/EMERGING_EBOOK/EMER
  GING_INDEX.htm