Emerging Re-emerging

Diseases
BY
K.HEMA ANANDHY,
M.Sc Nursing

INTRODUCTION
Disease burden is colossal
Cause heavy mortality, disability and
economic loss
Result in widespread epidemics
Immense suffering to the man kind
Disturb International trade and economic
development

DEFINITION
Emerging infectious diseases are New
diseases; new problem (New threats).
An emerging infectious disease is a one
that is caused by a newly discovered
infectious agent or by a newly identified
variant of a known pathogen, which has
emerged and whose incidence in
humans has increased during the last
two decades and is threatening to
increase in the near future.

Cont.
Re-emerging infectious diseases are old
diseases, new problem. (New threats).
A re-emerging infectious disease is a one
which was previously controlled but once
again has risen to be a significant health
problem. This term also refers to that
disease which was formerly confined to one
geographic area, has now spread to other
areas.

Transmission of communicable
diseases

ac
nt
t

Agents

t
c
e

Co

In

r
i
d

Agent
of
Vector

Direct contact

Number of agents

Characteristics of agents
Pathogenicity

Human

Defense mechanisms
Immunity
Personal
characteristics

Host Reaction
Infectious agents
Enter human host
Produces
Mild disease

inapparent infection

Host recovery

Host fights or
with treatment

Severe disease with treatment

Disability
Death

The Factors Responsible

Improper planning of the township
Population explosion
Poor living conditions
Over crowding
Industrialization
Urbanization
Lack of health care services
Migration of population
Intense international travel
Globalization

Cont
Indiscriminate use of antibiotics and
development of resistance
Increase in contact with animals
Insecticide resistance
Alterations in micro-organisms
Environmental degradation with changing
weather pattern.
Illiteracy and ignorance
Natural disasters

Predisposing Factors for the

Epidemic
Before the on set of
epidemic
Earth quake (Gujarath-1993)

During the epidemic

Migration of the people
Eruption of slums
Collection of garbage
Scarcity of antibiotics

Emerging Diseases in India and

Global
Diseases due to new agents (Eg.AIDS)
Diseases due to new variants of known pathogens
(Eg.Avian Flu)
Diseases caused by an infectious agent but
resulting
in
non-communicable
diseases.
(Eg.Hep.C results in liver cancer)

Global examples of emerging and

re-emerging infectious diseases

Examples of new and Reemerging

Diseases

Emerging Food borne water borne

disease
Accounts for 20 million cases in the world
annually (T.D. Chugh-2008)
Incidence is increasing
Half of all known food borne pathogens
discovered during the past 25 years

Cont..
Entero hemorrhagic Escherichia coli
Causes no signs of illness
Low infections dose in humans causes
hemorrhagic colitis and hemolytic uraemic
syndrome
Consumption
of
undercooked
beef
and
contaminated vegetables, fruits and water for
vegetarians.
Reported in 1.4% of stools from cases of bloody
diarrhoea in Kolkata (Ministry of Health and Welfare
2006).

Detection of potential pathogenic O157:H7 in river

water (Ganges by Hamner et al 2007) is alarming.

Cont.
Vibrio cholerae
Cholera is one of the oldest recorded infectious
diseases.
John Snow demonstrated the spread by infected water
Pacini in 1854, first described comma shaped bacteria
Robert Koch in 1883, showed the causative agent
V .Cholerae.
Das and Gupta -2005 reported the diversity of V
.Cholerae.
Narang et al (2008) described the changing patterns of
V .Cholerae.

Listeria monocytogenes
Listerosis is an emerging zoonotic disease
28% deaths due to food borne illnesses in USA
Organism is robust and survive food-processing and
contaminated refrigerated meat and dairy products.
In India, Bhujwala et al in 1970 reported the presence of
this organism in cervical secretions of 1.3-3% of cases
with very bad obstetrical history.
Thomas et al (1981) in a prospective study of 1300
newborns found the pathogen in 2 cases

Campylobacter spp
Are signicant zoonotic poultry pathogens
Leading cause of gastro enteritis in the world
Around 2.5 million human infections are
reported annually in the United States.
In developing countries the presence of the
organism was reported in 5-20% in child hood
diarrhoea
Jain et al (2005) reported isolation of jejuni in
13.5% of the diarrhoea patients

Drug-resistant bacteria
Antimicrobial resistance (AMR) in hospitals and
community poses a public health problem (Moellering
2007).
Reservoir for resistant genes is the fecal flora and upper
respiratory tract
Chugh (2008) reviewed the global status of AMR in
various pathogens.
Woodford (2007) has identied the existence of multi
resistant clones of common pathogens.

Cont.
Staphylococcus aureus is the modern Ghengis
Khan (Chugh 2007). the most frequently identied
drug-resistant pathogen.
Singhal et al (2007)reported ciprooxacin-resistant
meningococci in an outbreak in Delhi.
Resistance of Salmonella typhi and S. paratyphi
to chloramphenicol, ampicillin and cotrimoxazole is
widespread.
AMR in Shigella resistance to azithromycin,
ceftriaxon and ciprooxacin on the increase
Rational use of antibacterial to contain AMR

Melioidosis
The causative pathogen is Burkholderia
pseudomallei
It is an environmental saprophyte in rice
paddies, wet soil, mud and pooled surface
water.
It causes suppurative chronic infection
characterized by septicemia and focal
abscesses in liver, spleen and other viscera.

Cont.
Has been documented from Tamilnadu and
Karnataka.
The association of the disease with
diabetes mellitus is high.
Vidyalakshmi et al (2007) reviewed the
disease in India
The first culture proven case in India was a
child in Maharashtra in 1990.

Chronic and Neoplastic Diseases

Microbe

Disease

Helicobacter pylori

Peptic ulcer, gastric

carcinoma

Human papilloma virus

Cervical, anal, vulvar

carcinoma

Hepatitis B/C viruses

Liver cirrhosis,
hepatocellular carcinoma

Epstein Bar Virus

B-cell lymphoma,
nasopharyngeal carcinoma

Human T lymphotropic
virus type 1

Adult T-cell leukemia

Cont.
Microbe

Disease

Human herpes virus 8

Kaposis sarcoma

Borrelia burgdorferi

Lyme arthritis

Tropheryma whippelii

Whipples disease

Chlamydia
pneumoniae

atherosclerosis

Cont.
Ramakrishna (2006) discussed the high prevalence of
H. pylori infection in India.
The high prevalence of resistance to metronidazole,
clarithromycin and amoxicillin is the failure to eradicate
H. pylori infection.
The resistance is higher in south than north India.
High rate of re infections in Indian subjects (60%).
Chlamydia pneumoniae is associated with pathogenesis
of coronary artery disease. (Jha et al 2007).

Control of Emerging and

Re-emerging Diseases
Controlling the reservoir
Interrupting the transmission
Protecting the susceptible host
Strengthening of the disease surveillance
system
Encouraging research initiations for
treatmentregimens and diagnostics
Encouraging research for new methods of
control measures
Establishment of drug resistance

Response to H5N1 avian influenza

outbreak in Hong Kong.

Emerging Infectious Diseases:

a Research Approach

Benefits of Emerging Diseases

Research

Emerging Diseases Funding (National

Institute of Allergy and Infectious Diseases).

Role of Nurses in Prevention

Increase knowledge and skill
Encourage partnerships with consumers and other
disciplines to identify needs, set priorities, develop
strategies and evaluate progress
Support health care legislation
Involve in research
Encourage using multidisciplinary efforts.
Influence local and National economic and political
options
Continue to advance nursing concern
Educate the public

Benefits of Community Prevention

Programme
Opportunity to reach the masses and effect widespread
changes in social norms
Increased public awareness of and commitment
Increased cost efficiency of group intervention
Ability of the programme to promote the development of an
environment of social support
Opportunity of evaluate the effectiveness of health promotion
programms
Enhanced approach toward promoting health in large
population
Additional resources for information exchange and social
support.

Role of Public Health Authorities

National programme for prevention and control
of vector borne diseases
Legislations for elimination
Communities awareness of the disease
Minimizing transmission of infection: By
Risk communication to the family members
Minimizing vector population
Minimizing vector individual contact

Reporting to the nearest public health authority

Public health measures to prevent

infectious diseases
Safe water
Sewage treatment and disposal
Food safety programme
Animal control programme
Vaccination programme
Public health organization

Response of the WHO

Developing global and regional strategies
Appointing Task Force
Generous grant from WHO regular
budget
Support the World Bank grant

Conclusion
The true prevalence of many diseases is not
known. Since we live in a global village, we
connot afford
to be complacent about the
tremendous economic, social and public health
burden of these diseases. Effective surveillance is
the key to their early containment.
There is a need to develop epidemiology
improved diagnostic facilities, a strong public
health structure, effective risk communication,
epidemic preparedness and rapid response.

Take Home Massage

Community health is the pivot of Global
health. Let us join our hands on creating
an awareness to the individual family and
community
through
effective
risk
communication.