Emerging And Re-emerging Disease In Nepal 484f52

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, , 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. • 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 subtherapeutic 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 for early detection, confirmation and communication