Infectious Diseases: Surveillance and Control Infectious Diseases: - - PowerPoint PPT Presentation

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Infectious Diseases: Surveillance and Control Infectious Diseases: - - PowerPoint PPT Presentation

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International Conference on Science and Technology for Sustainability 2007 ility 2007 International Conference on Science and Technology for Sustainab International Cooperation for Development International Cooperation for Development

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International Conference on Science and Technology for Sustainab International Conference on Science and Technology for Sustainability 2007 ility 2007 International Cooperation for Development International Cooperation for Development

Infectious Diseases: Surveillance and Control Infectious Diseases: Surveillance and Control

Emerging and Re Emerging and Re-

  • emerging Infectious Diseases

emerging Infectious Diseases Nobuhiko OKABE, MD, PhD Nobuhiko OKABE, MD, PhD

Infectious Disease Surveillance Infectious Disease Surveillance Center Center National Institute of Infectious Diseases, Japan National Institute of Infectious Diseases, Japan Sept Sept 15 15, , 2007 2007, , Tokyo Tokyo

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Infectious disease is caused by transmission of micro Infectious disease is caused by transmission of micro-

  • rganisms.
  • rganisms.

It is spread widely among human, if nothing taken. It is spread widely among human, if nothing taken.

Prevention of Infectious Diseases Prevention of Infectious Diseases

not contact with infected patients (isolation) to clean materials contaminated (disinfection)

  • to keep healthy and clean condition
  • to give immunity (vaccination), if available
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disinfection disinfection

isolation isolation

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Immunization was introduced at 1796. Immunization was introduced at 1796.

Small pox (variolla)

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鍋島邸（佐賀藩）における わが国初めての種痘 1849 Ｉｎｔｒｏｄｕｃｅｄ Ｉｍｍｕｎｉｚａｔｉｏｎ first in Japan (Saga Han, Kyushu) at 1849

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Measles in Japan Measles in Japan at 1800`s at 1800`s

Every 20 Every 20-

  • 40 years, big

40 years, big

  • utbreak of measles
  • utbreak of measles
  • ccurred
  • ccurred

Many people both young Many people both young children and adults were children and adults were suffered by this fatal suffered by this fatal disease disease The could only prayed The could only prayed not to be suffered by not to be suffered by measles measles

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2000 4000 6000

Number of Reported Polio by Year in Japan (1947 Number of Reported Polio by Year in Japan (1947-

  • 2006)

2006)

Urgent introduction of OPV imported from USSR and Canada Legal use of OPV as a routine immunization with 2 doses with 2 doses 1964- 1950 1960 1970 1980 1990

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Last case of wild Last case of wild-

  • polio in the Region

polio in the Region

Americas Region Luis Fermin Tenorio Peru 1991 European Region Melik Minas Turkey 1998

Polio Eradication

Western Pacific Region Mum Chanty Cambodia 1997

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A region where no children suffer from……

Polio Measles Hepatitis B Neonatal Tetanus and diphtheria, pertussis & infant tuberculosis

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WHO Regional Measles WHO Regional Measles Elimination Targets Elimination Targets

2 0 0 0 2 0 0 0 2 0 0 7 2 0 0 7 2 0 1 0 2 0 1 0

2012 2012

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June 4, 2003 World Health Organization June 4, 2003 World Health Organization

Microbes are unpredictable!

WHO WHO-

  • facilitated outbreak responses

facilitated outbreak responses in the field, 1998 in the field, 1998– –2003 2003

World Health Organization World Health Organization

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Emerging Infectious Diseases

EID are those due to newly identified and previously unknown infections which cause public health problems either locally or Internationally.

Re-emerging Infectious Diseases

REID are those due to the reappearance and increase of infections which are known, but had formerly fallen to levels so low that they were no longer considered a public health problem.

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The HIV/AIDS pandemic A new virus recognized in the early 1980s

July 2007

  • 39.5 M HIV infected
  • 2.9 M deaths in 2006
  • Drug-Resistance
  • No vaccine

A new virus recognized in the early 1980s

July 2007

  • 39.5 M HIV infected
  • 2.9 M deaths in 2006
  • Drug-Resistance
  • No vaccine
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Index case: Index case: from Guandon, China from Guandon, China

Hotel M

Canada Canada USA USA

Irland Irland

Germany Germany

Hanoi Hanoi Bangkok Bangkok Singapore Singapore

ＳＡＲＳ ｉｎ ２００３

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  • 2005. Marburg disease

In Angola 374（ death 328: FTR 88%)

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The malaria challenge The malaria challenge

(R.Carter,1999)

Annual deaths from malaria (millions) 1.0 2.0

Africa World

1950 1970 1990 2000

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Anti Anti-

  • malarial drug resistance to

malarial drug resistance to treatment worldwide, 2001 treatment worldwide, 2001

Chloroquine Chloroquine resistance resistance S/ P resistance S/ P resistance Multi Multi-

  • drug resistance

drug resistance

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Multidrug Multidrug-

  • resistant TB (MDR

resistant TB (MDR-

  • TB), 2001

TB), 2001

hyperendemic

  • utbreaks

Cost of treating multidrug-resistant TB:

US$ 250 000 per patient in industrialized countries, US$ 1 000 –$ 10 000 in developing countries

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Dengue/Dengue fever Dengue/Dengue fever Dengue/Dengue fever

200,000 400,000 600,000 800,000 1,000,000

1950s 1960s 1970s 1980s 1990s 2000s*

Average annual number of DF/DHF cases reported to WHO

454 15,547 122,174 295,591 492,820 877,888

* 2000-2003, provisional data

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DF/DHF DF/DHF DF/DHF

1970-1979 1950-1969

2004 reported

2000>

2005 reported

1980-1999

1999 reported 1996 reported 1998 reported

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Leading causes of mortality, 2001 Leading causes of mortality, 2001

48% 18% 19% 10% 3% 2%

Infectious

Injuries Non-communicable Perinatal Maternal Nutritional

45% 35% 11% 6% 1% 2%

Low-income nations (South-East Asia & Africa) Premature mortality (worldwide, 0–44 years)

Total = 53.9 million Total = 53.9 million

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Leading infectious causes of Leading infectious causes of mortality, 2001 estimates mortality, 2001 estimates

3.5

Deaths (millions) < 5 years old > 5 years old 0.5 1.0 1.5 2.0 2.5 3.0 3.5 ARI AIDS Diarrhoea TB Malaria Measles

2.3 2.2 1.5 1.1 0.9

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Why infectious disease, again. Why infectious disease, again. A Changing World ! A Changing World !

  • Collapse of public health

Collapse of public health infrastructure infrastructure

  • Poverty, urbanisation and

Poverty, urbanisation and population displacement population displacement

  • Environmental exploitation

Environmental exploitation and degradation and degradation

  • Complex and natural

Complex and natural disasters disasters

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A Changing World ! A Changing World !

  • Development of antimicrobial

Development of antimicrobial resistance resistance

  • Animal diseases crossing into

Animal diseases crossing into human populations human populations

  • Globalisation of travel and trade

Globalisation of travel and trade (great benefits but new threats !) (great benefits but new threats !)

  • Inappropriate social, political and

Inappropriate social, political and economic responses to economic responses to

  • utbreaks
  • utbreaks
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Ricketsial infections

Typhus Rocky Mountain

spotted fever Virus infections

Arbovirus Filoviruws

Small pox

Bacterial infections

Plague

Anthrax

Tularaemia

Fungal infections

Coccidioidomycosis

Additoinal Situation on Infectious Diseases: Bioterolism

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Infectious Diseases Control Infectious Diseases Control

Prevention

Hygiene (personal, public) Immunization

Diagnosis

Clinical Diagnosis Microbiological Diagnosis

Treatment

Surveillance

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10 20 30 40 50 60 70 80 90 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

Delayed Response

DAY CASES

Opportunity for control

Late Detection First Case

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10 20 30 40 50 60 70 80 90 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39

Rapid Response

CASES

Early Detection

Opportunity for Control

DAY

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Backbone of Surveillance Backbone of Surveillance

To collect information To analysis information To disseminate information

  • regularly, timely and rapidly
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Infectious diseases do not respect international

borders.

Global and regional partnerships and the rapid

sharing of data and other information enhance preparedness and evidence-based control strategies.

Strengthening surveillance system and networks is

recognized as one of the most important tool to dissolve these issues. It is necessary to improve and to strengthen surveillance with regard to health crises.

It is necessary to keep track of outbreak trends of

basic infectious diseases on a daily basis, and to detect any abnormalities as early as possible.

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Furthermore, it is necessary to pass on this information

in an appropriate and easy-to-understand manner and to enhance provision of information.

Sometimes crises caused by false rumors and

misinformation result in more direct damage．

Fair disclosure of information and easy-to-understand

explanations provided to public from a scientific standpoint are increasingly required as measures to manage health crises.

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Response to Outbreak of Infectious Diseases through Information Network

Pr e f . De p . He a l t h Pu b l i c He a l t h I n s t . Pu b l i c He a l t h Ct r . Lo c a l Me d . A s s .

NI I D

Lo c a l Co m m i t t e e Ce n t r a l Co m m i t t e e Ja p . Me d . A s s . Cl i n i c / Ho s p i t a l Qu a r a n t i n e St . W HO, CDC, PHLS, e t c Co m m u n i t y

F ie ld E p id e m i o lo g is t

MHW

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Global health protection Global health protection -

  • the challenges

the challenges

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Ｌｅｔ｀ｓ Ｌｅｔ｀ｓ ｓｔｒｕｇｇｌｅ ｓｔｒｕｇｇｌｅ ａｇａｉｎｓｔ ａｇａｉｎｓｔ ｉｎｆｅｃｔｉｏｕｓ ｉｎｆｅｃｔｉｏｕｓ ｄｉｓｅａｓｅｓ ｄｉｓｅａｓｅｓ ｗｉｔｈ ｗｉｔｈ Ｓｃｉｅｎｃｅ Ｓｃｉｅｎｃｅ, , Ｔｅｃｈｎｏｌｏｇｙ Ｔｅｃｈｎｏｌｏｇｙ and and International Cooperation. International Cooperation.

Thank you ! Thank you !

Ａｒｉｇａｔｏｕ Ａｒｉｇａｔｏｕ gozai gozai mashita mashita

ありがとうございました ありがとうございました

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Leading Causes of Death in Japan Leading Causes of Death in Japan

1950

1.TB 2.Brain vascular disease 3.Pneumonia 4.Gastro-enteritis

  • 5. Malignant diseases

2001

  • 1. Malignant diseases
  • 2. Brain vascular disease
  • 3. Cardiovascular diseases
  • 4. Pneumonia
  • 5. Accident
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Sakai Sakai

  • utbreak
  • utbreak

July,1996 July,1996 The The Education Education Minister Minister visited sick visited sick children children

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Nipah virus infection

1999 Malaysia Human encephalitis ↑ Pig pneumonia, encephalitis ↑ Fruit Bat no illness 2005 Bangladesh 2007 India

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Treatm ent of Poliom yelitis: 1 9 4 0 ’s USA

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TB trends in Eastern Europe and Africa

1980 1985 1990 1995 2000

50 100 150 200 250 (cases per 100 000)

Africa Eastern Europe

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Spread of wild polio virus 2004 Spread of wild polio virus 2004-

  • 2005

2005

In HQ as of 4 May 2005

Case or outbreak following importation Endemic countries Wild virus type 1 Wild virus type 3 Re-established transmission countries

16 polio-free countries had importations from Nigeria. Polio was 're-established' in 5 of these polio-free countries.