Emerging & Re

emerging infectious
Diseases
 Learning objectives
• What is emerging and re emerging infections
• Factors responsible for emergence and re-emergence of infections
• Factors contributing to the emergence
• Examples of Emerging and Re emerging Infectious Diseases
• Emerging Food borne & water borne disease
• Antibiotic resistance
• Bioterrorism
• Control of Emerging and Re-emerging Diseases
• Role of Doctors in Prevention
• Role of Public Health Authorities
• Public health measures to prevent infectious diseases
Emerging Infectious Diseases:
• 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 pathogen, which has emerged and whose
incidence in humans has increased during the last 2 decades and is
threatening to increase in the near future.
Re-emerging Infectious Diseases:
• 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.
Factors contributing to the
emergence of infectious diseases:
1. Human demographics and behaviour
2. Technology and industry
3. Economic development and land use
4. International travel and commerce
5. Microbial adaptation and change
6. Breakdown of public health measures
7. Human susceptibility to infection
Factors contributing to the
emergence of infectious diseases:
8. Climate and weather
9. Changing ecosystems
10. Poverty and social inequality
11. War and famine
12. Lack of political will
13. Intent to harm
Factors contributing to the
emergence
• AGENT
• HOST
• ENVIRONMENT
 AGENT
• Evolution of pathogenic infectious agents (microbial adaptation & change)
• Development of resistance to drugs:
Wrong prescribing practices
Non-adherence by patients
Counterfeit drugs
Use of anti-infective drugs in animals & plants
• Resistance of vectors to pesticides
 HOST
• Human demographic change (inhabiting new areas)
• Human behaviour:
1. Unsafe sexual practices (HIV, Gonorrhoea, Syphilis)
2. Changes in agricultural & food production patterns- food
borne infectious agents (E. coli)
3. Increased international travel (Influenza)
• Human susceptibility to infection (Immunosuppression)
• Poverty & social inequality
 ENVIRONMENT
• Climate & changing ecosystems:
Deforestation forces animals into closer human contact- increased
possibility for agents to breach species barrier between animals & humans
EL Nino- Triggers natural disasters & related outbreaks of infectious diseases
(Malaria, Cholera)
Global warming- spread of Malaria, Dengue, Leishmaniasis, Filariasis
• Economic development & Land use (urbanization, deforestation)
• Technology & industry (food processing & handling)
• International travel & commerce
• Deterioration in surveillance systems (lack of political will)
 ENVIRONMENT
• Breakdown of public health measure (war, unrest, overcrowding):
Poor populations- major reservoir & source of continued transmission
Poverty- Malnutrition- Severe infectious disease cycle
Lack of funding, Poor prioritization of health funds, Misplaced in curative
rather than preventive infrastructure, failure to develop adequate health
delivery systems
• Uncontrolled Urbanization & Population Displacement:
Growth of densely populated cities- substandard housing, unsafe water, poor
sanitation, overcrowding, indoor air pollution (>10% preventable ill health)
Problem of refugees & displaced persons
Diarrhoeal & Intestinal parasitic diseases, ARI
 Examples of Emerging Infectious
Diseases
• 1993: Hantavirus pulmonary syndrome (United States)
• 1994: Plague (India)
• 1995: Ebola fever (Democratic Republic of Congo)
• 1996: New variant Creutzfeldt-Jakob disease (United Kingdom)
• 1997: H5N1 influenza (Hong Kong);
• 1998: Nipah virus encephalitis (Malaysia, Singapore)
• 1999: West Nile virus encephalitis (Russia, United States)
• 2000: Rift Valley fever (Kenya, Saudi Arabia, Yemen); Ebola fever(Uganda)
• 2001: Anthrax (United States); foot-and-mouth disease(United Kingdom)
• 2002: Vancomycin-resistant Staphylococcus aureus (United States)
• 2003: Severe acute respiratory syndrome (SARS) (multiple countries); monkeypox (USA)
 Examples of Emerging Infectious
Diseases
• Hepatitis C- First identified in 1989
In mid 1990s estimated global prevalence 3%
• Hepatitis B- Identified several decades earlier
Upward trend in all countries
Prevalence >90% in high-risk population
• Zoonoses- 1,415 microbes are infectious for human
Of these, 868 (61%) considered zoonotic
70% of newly recognized pathogens are zoonoses
Emerging Influenza infections in Humans associated with Chickens, Pigs
 Highly Pathogenic Avian Influenza
(H5N1)
• Since Nov 2003, avian influenza H5N1 in birds affected 60 countries across Asia,
Europe, Middle-East &Africa

• >220 million birds killed by this virus or culled to prevent further spread

• Majority of human H5N1 infection due to direct contact with birds infected with
virus
 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

• Most common associated organisms are: Entero hemorrhagic Escherichia coli,

Vibrio cholerae, Campylobacter sp.
 Ebola
• Ebola was first discovered in 1976 near the Ebola River. Since then, outbreaks
have appeared sporadically in Africa.
• Ebola Hemorrhagic Fever Outbreak:
• 2000-2001: Uganda
• 2002-2003: Gabon and Democratic Republic of the Congo (DRC)
• 2004: South Sudan
• 2007: DRC, Uganda.
• 2011-2012: Uganda, DRC
• 2014-2016: West Africa
 Examples of Re-Emerging Infectious
Diseases
• Diphtheria- Early 1990s epidemic in Eastern Europe(1980- 1% cases; 1994- 90%
cases)

• Cholera- 100% increase worldwide in 1998 (new strain eltor, 0139)

• Human Plague- India (1994) after 15-30 years absence.

• Dengue/ DHF- Over past 40 years, 20-fold increase to nearly 0.5 million (between
1990-98)
 Antibiotic resistance
• Emerge in environment due to inappropriate use of antibiotic

• WHO estimates that 10 million people are dying of infectious diseases related to
antibiotic resistance.

• Proper antibiotic guidelines needed to prevent the drug resistance.

 Multi-resistant pathogens
• Staphylococcus aureus is the most frequently identified drug-resistant pathogen.

• Singhal et al (2007)reported ciprofloxacin-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, ceftriaxone and ciprofloxacin on the
increase
• Methicillin/oxacillin-resistant Staphylococcus aureus (MRSA)
 Multi-resistant pathogens
• Vancomycin-resistant enterococci (VRE);
• Extended-spectrum beta-lactamases (which are resistant to cephalosporins &
monobactams) (ESBLs);
• Penicillin-resistant Streptococcus pneumoniae (PRSP);
• Multi-drug resistant tuberculosis (MDR-TB);
• CRKP- Carbapenem Resistant Klebsiella Pneumoniae
• S. typhimurium - DT104 (resistant to five antibiotics: ampicillin, chloramphenicol,
streptomycin, sufonamides and tetracycline)
 Bioterrorism
• Possible deliberate release of infectious agents by dissident individuals or
terrorist groups

• Biological agents are attractive instruments of terror- easy to produce, mass

casualties, difficult to detect, widespread panic & civil disruption

• Highest potential- B. anthracis, C. botulinum toxin, Y. pestis, Variola virus, Viral

haemorrhagic fever viruses

• Likeliest route- aerosol dissemination

 References
• Public Health and Preventive Medicine. MAXY-ROSENMAN-LAST, 15th edition.
• Oxford textbook of Public Health 6th edition.
• Park text Book of Preventive & Social Medicine. 23rd edition • EMERGING INFECTIOUS
DISEASES IN SEAR. WHO1998.
• WHO GLOBAL STRATEGY FOR CONTAINMENT OF ANTIMICROBIAL RESISTANCE. Executive
summary.2001.
• CDC website: https://www.cdc.gov/vhf/ebola/about.html
• Preventing Emerging Infectious Diseases: A Strategy for the 21st Century. Overview of
the Updated CDC Plan
• Review of the emerging infectious disease problem And strengthening of epidemiological
surveillance. Forty fourth meeting of the regional director within WHO representative, New
Delhi, 1995.
• Forty-fifth Meeting of the Regional Director with the WHO Representatives, New Delhi 4 to 13
November 1996 SEA/WR45/5. Emerging and re-emerging diseases, including tuberculosis and malaria.