Emerging and Re-emerging

Infectious Disease
 Introduction
• Despite remarkable advances in medical science and
treatment during 20th century, infectious disease
remain the leading cause of death world wide.

• Emergence of new infectious diseases, re-emergence

of old infectious diseases and persistence of
intractable infectious diseases.
 Introduction
• During the last 30 years, at least 30 new diseases
have emerged.
• These diseases are the leading cause of death
worldwide, claiming at least 17 million lives every
year.
• In the south-east asia region, 7 million people die
from diseases annually.
 Emerging disease
• are those whose incidence in humans has
increased during the last two decades or
which threaten to increase in the near future.
• These are the disease that haven’t occurred in
human before or that occurred only in small
number in isolated places.
 Emerging disease
• Also refers to newly-appearing infectious
diseases, or diseases that are spreading to
new geographical areas - such as cholera in
South America and yellow fever in Kenya
 Factors responsible
Agents
• Evolution of pathogenic infectious agents
(microbial adaptation & change)
• Development of resistance to drugs
• Resistance of vectors to pesticides
 Factors responsible
Host
• Human demographic change (inhabiting new
areas)
• Human behaviour (sexual & drug use)
• Human susceptibility to infection
(Immunosuppression)
• Poverty & social inequality
 Factors responsible
Environment
• Climate & changing ecosystems
• Economic development & Land use (urbanization,
deforestation)
• Technology & industry (food processing & handling)
• International travel & commerce
• Breakdown of public health measure (war, unrest,
overcrowding)
• Deterioration in surveillance systems (lack of political
will)
List of emerging diseases in Nepal
• Dengue fever
• Japanese encephalitis
• Visceral Leishmaniasis
• Rotavirus infection
• Cholera
• Leptospirosis
• Influenza virus infection
 CDC’s Plan to Prevent Emerging
Infectious Diseases
‘’Preventing Emerging Infectious Diseases: A Strategy for the
21st Century”
Goals of CDC Plan
• Surveillance and Response
• Applied research
• Infrastructure and Training
• Prevention and control
 Surveillance and Response
Objectives
• Strengthen infectious disease surveillance and
response.
• Improve methods for gathering and evaluating
surveillance data.
• Ensure the use of surveillance data to improve
public health practice and medical treatment.
• Strengthen global capacity to monitor and
respond to emerging infectious diseases
 Applied research
Objectives
• Develop, evaluate, and disseminate tools for
identifying and understanding emerging
infectious diseases.
• Identify the behaviors, environments, and host
factors that put persons at increased risk for
infectious diseases and their sequelae.
• Conduct research to develop and evaluate
prevention and control strategies in the target
areas
 Infrastructure and Training

 Objectives
• Enhance epidemiologic and laboratory capacity.
• Improve CDC’s ability to communicate electronically
with state and local health departments, health-care
professionals, and others.
• Enhance the nation’s capacity to respond to complex
infectious disease threats internationally, including
outbreaks that may result from bioterrorism.
• Provide training opportunities in infectious disease
epidemiology and diagnosis throughout the world
 Prevention and Control
Objectives
• Implement, support, and evaluate programs
for the prevention and control of emerging
infectious diseases.
• Develop, evaluate, and promote strategies to
help health-care providers and other person’s
behaviors that facilitate disease transmission.
• Support and promote disease control and
prevention internationally
 Target Areas
• Antimicrobial resistance
• Foodborne and waterborne diseases
• Vector borne and zoonotic diseases
• Diseases transmitted through blood transfusions
or blood products
• Chronic diseases caused by infectious agents
• Vaccine development and use
• Diseases of persons with impaired host defenses
• Diseases of pregnant women and newborns
• Diseases of travelers, immigrants, and refugees
 Re-emerging diseases
• refers to the diseases which were previously
easily controlled by chemotherapy and
antibiotics, but now they have developed
antimicrobial resistance and are often
appearing in epidemic form.
 Factors responsible
• Increasing use of antimicrobial in sub-
therapeutic dose
• Change in lifestyle, behaviour, culture and
social values. (eg. Syphilis)
• Increase in number of sexual partners (eg.HIV)
• Travel and tourism
Antibiotic Resistance
 Antibiotic resistance
• occurs when bacteria lose their sensitivity to
antibiotics.
• develops when a bacteria mutates or acquires
a resistance gene.
• Resistant bacteria are able to withstand attack
by antibiotics, so that standard treatments
become ineffective and infections persist and
may spread to other people
 Antibiotic resistance
• used by too many people to treat the wrong
kind of infection, in the wrong dosage and for
the wrong period of time.
• deadly impact on the control of diseases such
as tuberculosis, malaria, cholera, dysentery
and pneumonia.
 Mechanism of Antibiotic Resistance
• Enzymatic degradation of antibacterial drugs
• Alteration of bacterial proteins that are
antimicrobial agents
• Changes in membrane permeability to
antibiotics
 Example of bacterial resistance
• MDR TB and XDR TB
• Chloroquine resistant malaria
• Penicillin resistant bacteria
– B-lactamase producing
– N. gonorrhoeae
Prevention and control: Re-emerging
diseases
• Early diagnosis and prompt treatment
• Vector control measures &Prevention of
epidemics, for malaria
• DOTS - for tuberculosis
• Research initiatives for treatment regimens and
improved diagnostics, drugs and vaccines
• Strengthening epidemiological surveillance and
drug-resistance surveillance mechanisms and
procedures with appropriate laboratory support
for early detection, confirmation and
communication