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Infectious Disease Control

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Title: Infectious Disease Control


1
Infectious Disease Control
Milestones in Public Health Chapter 4
Lectures for Undergraduate Education
January 2011
2
Learning Objectives
  • Describe the 150-year history of world efforts to
    control infectious disease
  • Discuss Darwins concept of adaptation as applied
    to infectious diseases
  • Describe the roles of federal agencies and
    advocacy organizations
  • Review the CDCs OPLAN for Avian Influenza

3
Learning Objectives
  • List the sources of infection
  • Describe how organisms gain entry into the body
  • Describe how infectious agents spread within the
    body
  • Discuss when infection occurs

4
Lecture Outline
  1. Historical Perspective
  2. The Milestone and its Impact on Public Health
  3. Aspects of Biology, Behavior and Science of
    Infectious Diseases
  4. Systems, Policies and Programs
  5. Looking Ahead
  6. Wrap-Up
  7. References and Resources

5
Infectious Disease Control
  • Historical Perspective

6
Historical Perspective Infectious Disease
Control
  • The War is Over! In 1967, the U.S. Surgeon
    General William Stewart supposedly stated
  • It is time to close the book on infectious
    diseases, and declare the war against pestilence
    won.

FAQs (2004)
7
Historical Perspective (Cont.)
  • To tell the real war story, the current one,
    we need to go back to 1859 to Charles Darwins
    Theory of Natural Selection as the explanation of
    the functional designs of organisms.

Neese and Williams (1996)
8
The Concept of Adaptation by Natural Selection
  • Adaptations by which we combat pathogens
  • Adaptations of pathogens that counter our
    adaptations
  • Maladaptive but necessary costs of our adaptations

Neese and Williams (1996)
9
New Take on Darwinian Medicine
  • Bacteria and viruses seen as sophisticated
    opponents in an endlessly escalating arms race
  • These pests have evolved ways to overcome our
    defenses or even use them to their own benefit
  • Explains why we cannot eradicate all infections

Neese and Williams (1996)
10
New Take on Darwinian Medicine(Cont.)
  • From time of Darwin to those premature
    declarations of the end of the war against
    infectious disease, there is a rich history of
    our increasing understanding of infectious
    diseases and of our efforts to control them.

Neese and Williams (1996)
11
Stern and Markel (2004)
  • Identified three eras of international
    approaches to controlling infectious diseases
  • 1851-1881 Setting the stage The first
    International Sanitary Conference
  • 1881-1945 Advent of germ theory and rise of
    bacteriology
  • 1945-2004 The WHO A new definition of health
    to the present

12
Growth in Understanding the Spread of Disease
from Person-to-Person
  • Since microbes are invisible to humans, nothing
    was known about them until the 1600s
  • Microorganisms seen under microscopes of Robert
    Hooke (1664) and Anton Van Leeuwenhoek (1684) had
    to be definitively linked to disease, which was
    accomplished by Robert Koch in 1891

Stern and Markel (2004) and Black (2008)
13
Kochs Postulates of 1891 The Germ Theory of
Disease
  • Four fundamental concerns
  • 1. Microbe must be present in every case of
    the disease
  • 2. Microbe must be isolated from the
    diseased host and grown in culture
  • 3. Disease must be reproduced when a pure
    culture is introduced into a non- diseased
    susceptible host
  • 4. Microbe must be recoverable from an
    experimentally infected host

Fredricks and Relman (1996)
14
Infectious Disease Control
  • The Milestone and Its Impact on Public Health

15
Top 10 Causes of Death (Due to Infectious
Disease)by Broad Income Group
High-Income Middle-Income Low-Income
Lower Respiratory Infections 4th (Diarrheal Diseases, HIV/AIDS, TB, and Malaria not in top 10) Lower Respiratory Infections 4th - Tuberculosis 9th (Diarrheal Diseases, HIV/AIDS, and Malaria not in top 10) Lower Respiratory Infections 1st Diarrheal Diseases 3rd HIV/AIDS 4th Tuberculosis 7th Malaria 9th
WHO (2007)
16
Populations at Risk
  • In the developed world, old people are most at
    risk of infectious diseases, while in the
    developing world, infants and young children
    remain most at risk
  • Other vulnerable populations to hazards of
    infection include immunocompromised persons and
    those on steroid therapy for chronic diseases

Milestones (2006)
17
Why Are Infectious Diseases Still Among the
Leading Causes of Death Worldwide?
  • Emergence of new infectious diseases
  • Re-emergence of old infectious diseases
  • Persistence of intractable infectious diseases

Milestones (2006))
18
Infectious Disease Control
  • Aspects of Biology, Behavior and Science of
    Infectious Diseases

19
Aspects of Biology, Behavior, and Science of
Infectious Diseases
  • Occurrence and Spread of Infection
  • Infection occurs when micro-organisms invade
    sterile body tissues
  • An infectious disease occurs when infection is
    associated with clinically manifested tissue
    damage

Black (2008)
20
Sources of Infection
  • Microorganisms enter the body through
  • Air
  • Food
  • Water
  • Contact with skin
  • Contact with vectors

Black (2008)
21
Sources of Infection (Cont.)
  • Commensal organisms (organisms that normally
    live in the body without causing harm)
  • Become pathologic because of change in host
    environment
  • Examples
  • Another disease results in immunosuppression
  • Natural barriers breached by injury or invasive
    pathological processes (ulceration or malignancy)

Black (2008)
22
Sources of Infection (Cont.)
  • Air-borne diseases
  • Many kinds of organisms enter respiratory system
    by inhalation of air-borne droplets
  • Cause infection of respiratory tract
  • Can also cause main impact elsewhere after spread

Black (2008)
23
Sources of Infection (Cont.)
  • Food-borne diseases
  • Contracted from any food not preserved or
    isolated from potential sources of contamination
  • Not only cooking properly, but handling properly
    is important
  • Food handlers hygiene (infected or carriers)

Black (2008)
24
Sources of Infection (Cont.)
  • Water-borne diseases
  • Usually spread by fecal-oral route
  • Common in less-developed countries
  • Also from food sources

Black (2008)
25
Sources of Infection (Cont.)
  • Body fluids
  • Organisms can be secreted in body fluids of
    infected person and spread by direct contact with
    those fluids
  • Mechanism of spread for sexually-transmitted
    diseases
  • Blood and blood products present risk

Black (2008)
26
How Do Organisms Gain Entry to the Body?
  • Examples of sites of entry
  • Avenues and methods used by infectious agents to
    get into tissues
  • Signs and symptoms may point to a particular site
    or organ system

27
Sites of Entry
  • Ingestion into gastrointestinal tract
  • Caused by microorganisms contaminating food or
    water
  • Salmonella, Vibrio cholera
  • Experience abdominal pain, nausea, vomiting,
    diarrhea
  • Inhalation into respiratory tract
  • Caused by microorganisms in air
  • Experience cough, chest pain, shortness of
    breath, coughing blood

Black (2008)
28
Sites of Entry (Cont.)
  • Ascension into urinary tract
  • Caused by microorganisms that enter bladder
    through urethra or catheter
  • Experience painful urination, blood in urine,
    pelvic pain, flank pain
  • Ascension into biliary tree
  • Caused by microorganisms entering common bile
    duct from GI tract
  • Experience abdominal pain, jaundice

Uehilng, Johnson, Hopkins (1999) and Clincea,
Chalasani, Gaddipati (2002)
29
Sites of Entry (Cont.)
  • Crossing of mucosal surfaces
  • Caused by microorganisms that penetrate oral,
    anal, genital, or conjunctival linings
  • Human papillomavirus, HIV, herpes simplex virus,
    Neisseria gonorrhea
  • Experience local irritation, ulceration, pain,
    redness
  • Entrance through wound sites
  • Direct inoculation of micro-organisms leads to
    direct spread

Black (2008)
30
Spread of Infectious Agents In Body
  • Travel via the bloodstream
  • Septicemia
  • Travel via the lymphatic system
  • Enlarged tender lymph nodes suggest possible
    infection at site
  • Travel via the body cavity
  • Can spread in cerebrospinal fluid, peritoneal
    fluid, joint space
  • Crossing of the placenta to fetus
  • Basis for congenital infection

Black (2008)
31
When Does Infection Occur?
  • Colonization the presence of organisms on a body
    surface or in a lumen, but not producing disease
  • All persons have bacteria (and some fungi) on
    skin surfaces or in the oral cavity
  • Invasion organisms have moved into tissues to
    cause disease

Black (2008)
32
When Does Infection Occur? (Cont.)
  • Virulence the ability of an organism to cause
    infectious disease
  • Some organisms are unlikely to cause disease
  • Some organisms, like Vibrio cholera, Salmonella
    typhi, Mycobacterium tuberculosis or Yersinia
    pestis (plague) are highly virulent and
    potentially fatal

Black (2008)
33
When Does Infection Occur? (Cont.)
  • Resistance the ability of the host to prevent
    infection from occurring infectious disease
    from developing
  • Resistance is normally aided by
  • Barriers to infection intact, functional
    epithelial surfaces (respiratory tract, gastric
    acid, antibacterial action of bladder secretions
    and saliva of oral cavity)
  • Immune system

Black (2008)
34
When Does Infection Occur? (Cont.)
  • Resistance is diminished by
  • Debilitation from malnutrition (poor diet,
    alcoholism)
  • Cancer
  • Poorly functioning immune system (congenital or
    acquired)
  • Drug therapy corticosteroids, antibiotics
  • Previously damaged or abnormal anatomical
    structure

Black (2008)
35
Infectious Disease Control
  • Systems, Policies and Programs

36
Human and Microbial Factors in Emergence of New
Infectious Diseases
  • Human demographics
  • International travel
  • Technology
  • Industry
  • Climate change
  • Poverty
  • War
  • Intent to harm
  • Breakdown in public health measures
  • Microbial adaptation, changes and counter defenses

Milestones (2006)
37
Antibiotic Resistance
  • Our use/misuse/overuse of antibiotics in
    human and veterinary medicine and in animal feed
    has resulted in large amounts of antibiotics in
    our pantries and environments.

Milestones (2006)
38
Federal Agencies and Advocacy Organizations
  • Various organizations have provided
    regulations and guidance, creating much
    controversy about correct ways to handle growing
    problem of antibiotic resistance
  • Federal agencies
  • Centers for Disease Control and Prevention (CDC),
    US Department of Agriculture (USDA),
    Environmental Protection Agency (EPA), Food and
    Drug Administration (FDA) and National Institutes
    of Health (NIH)
  • Advocacy organizations
  • American Public Health Association (APHA) and
    American College of Physicians (ACP)


Milestones (2006)
39
Federal Agencies
  • CDCViews antibiotic resistance as one of its
    top concerns
  • USDA- Concerned with labeling and
  • claims on meat packages- 70 of antibiotic
    use is an
  • additive to animal feed, not to
  • treat disease

Milestones (2006)
40
Federal Agencies (Cont.)
  • EPAHas jurisdiction and authority
  • over water pollutants that enter environment
  • NIHConducts research, develops
  • solutions and educates public
  • about emerging problem

Milestones (2006)
41
Federal Agencies (Cont.)
  • FDA
  • Has authority to restrict use of
  • antibiotics in animals based on
  • the potential risk to human health
  • Controversy has surrounded use in animals due to
    strong evidence that practice of giving livestock
    antibiotics results in inability to treat some
    human illness

Crawford (2003), Milestones (2006), Pyrek
(2003), and Taraporewala (2008)
42
Federal Agencies (Cont.)
  • In 1998, the FDA began to
  • restructure drug-approval system
  • for use of antibiotics in food producing animals
  • In 2003, the FDA took action in the campaign
    against resistance in issuing new labeling
    regulations for human use the intention was to
    reduce the inappropriate prescription of
    antibiotics for common ailments such as ear
    infections and common coughs

Crawford (2003), Milestones (2006), Pyrek
(2003), and Taraporewala (2008)
43
Federal Agencies (Cont.)
  • In 2005, the agency withdrew a
  • livestock antibiotic based on its
  • growing concerns about resistance being
    transmitted from food animals to humans
  • FDA has variety of regulatory tools to help
    developers of antimicrobial drugs, including an
    accelerated approval process for drugs that
  • treat illnesses
  • show meaningful benefit over existing drugs to
    control disease

Crawford (2003), Milestones (2006), Pyrek
(2003), and Taraporewala (2008)
44
Federal Agencies (Cont.)
  • Guidance document issued
  • targeting pharmaceutical
  • industry which develops veterinary drugs for
    widespread agricultural use
  • FDAs National Center for Toxicological Research
    has studied mechanisms of resistance to
    antibiological agents in human GI tract

Crawford (2003), Milestones (2006), Pyrek
(2003), and Taraporewala (2008)
45
Advocacy Organizations
  • The American Public Health Association (APHA)
    has prepared a fact sheet on antibiotic
    resistance, supporting
  • Education programs for providers and patients in
    the appropriate use of antibiotics
  • Improved surveillance programs at local and
    national level, with feedback to policy makers,
    health officials and providers

APHA (2003)
46
Advocacy Organizations(Cont.)
  • Withdrawal of all antibiotics given to healthy
    animals for economic reasons when those
    antibiotics are also used for people

APHA (2003)
47
Advocacy Organizations(Cont.)
  • The American College of Physicians (ACP) has
    issued guidelines for patients, multiple levels
    of health care providers, and others in support
    of
  • Adequate funding for state surveillance efforts
    to study antibiotic resistance and other diseases
  • In-state surveillance programs for diseases that
    are nationally-notifiable, and subsequent
    reporting of such information to the CDC

Milestones (2006)
48
Infectious Disease Control
  • Looking Ahead

49
Looking Ahead
  • Major infectious disease threats currently
    facing the U.S. and world
  • Every important bacterium has become resistant in
    some way to antibiotics
  • The spread of avian influenza (H5N1) viruses
    among birds continues to cause human disease with
    high mortality and to pose threat of a pandemic
  • One-stop access to U.S. government avian and
    pandemic flu information at http//www.pandemicflu
    .gov/

Milestones (2006)
50
Mission of CDC
  • To immediately detect onset of outbreaks with
    influenza pandemic potential
  • To assist with containment of such outbreaks
  • To delay introduction and transmission of
    pandemic viruses in the U.S.
  • To assist state, local, territorial, and tribal
    health authorities in management of influenza
    pandemic event

Milestones (2006) and CDC (2008)
51
THE CDC OPLAN (January 11, 2008)
  • Operation plan delineates how CDC (under HHS)
    will prepare for and fight a potentially
    devastating outbreak and disease from a new
    influenza strain, Influenza A (H5N1)
  • Designed to allow planners, at every level within
    CDC, to gain insights into what actions need to
    be taken in preparing for an influenza epidemic

CDC (2008) and Update on H5N1 (2008)
52
Infectious Disease Control
  • Wrap-up

53
Wrap-Up
  • Germ theory
  • Great strides have been made to control and
    decrease infectious disease, yet still among the
    leading cause of death worldwide
  • Various surveillance systems exist, yet
    infectious disease is difficult to monitor due to
    multiple sources of causation and different sites
    of entry
  • Emergence of new infectious diseases and
    re-emergence of existing infectious diseases
  • Various agencies, policies, and programs exist to
    help control infectious disease

54
Resources and References
  1. American Public Health Association. (2003).
    Antibiotic Resistance Fact Sheet. Retrieved from
    http//www.apha.org/advocacy/reports/facts/advocac
    yfactantibiotic.htm
  2. Aschengrau, A., G. R. Seage III. (2009).
    Essentials of Epidemiology in Public Health.
    Boston Jones and Bartlett Publishers.
  3. Black, J.G. (2008). Microbiology Principles and
    Explorations (7th ed.). Hoboken, NJ J. Wiley
    Sons.
  4. Centers for Disease Control and Prevention.
    (January 11, 2008). Influenza Pandemic OPLAN.
    Retrieved from http//www.cdc.gov/flu/pandemic/cdc
    plan.htm
  5. Centers for Disease Control and Prevention.
    (January 25, 2010). National Notifiable Diseases
    Surveillance System. Retrieved from
    http//www.cdc.gov/ncphi/disss/nndss/nndsshis.htm
  6. Clincea, R., Chalasani, H.G., Gaddipati, K.V.
    (2002). Infections of the Biliary Tree.
    Hospital Physician Infectious Diseases Board
    Review Manual. 8(4), 1-2.
  7. Crawford, L.M. (2003). Testimony Regulatory
    Program of the Food and Drug Administration
    before the sub-committee on Conservation, Credit,
    Rural Development and Research Committee on
    Agriculture, United states of Representatives.
    HHS. June 17, 2003. Washington, D.C. U.S.
    Department of Health Human Services. Retrieved
    from http//www.hhs.gov/asl/testify/t030617a.html

55
Resources and References
  1. Fauci, A.S. (2004, October). Emerging Infectious
    Diseases. A Clear and Present Danger to Humanity.
    JAMA. 292(15), 1887-1888.
  2. Fauci, A. (2007). NIAID Investment, Research Make
    Strides For Improving Health Globally. U.S.
    Medicine.NIAID. Retrieved from http//www.usmedici
    ne.com/column.cfm?columnID243issueID95
  3. FAQs. (2004). The Office of Public Health Service
    History. NIH. Retrieved August 29, 2008 from
    http//lhncbc.nlm.nih.gov/apdb/phsHistory/faqs.htm
    l
  4. Fredericks, D., Relman, D. (1996).
    Sequence-based identification of microbial
    pathogens A reconsideration of Koch's
    postulates. Clinical Microbiology Reviews, 9(1),
    18-33.
  5. Jhung, M.A, Banerjee, S.N., Fridkin, S., Tenover,
    F.C., McDonald, L.C., (2008) Enhanced Detection
    of Staphylococcus aureus-related
    Hospitalizations Using Administrative Databases,
    United States-1999-2005 Slide Presentation.
    Atlanta, GA Centers for Disease Control and
    Prevention. Retrieved from http//www.cdc.gov/ncid
    od/dhqp/SHEA_EnhanDetecS_aureus_textonly.html
  6. Pfizer Inc. (2006). Milestones in public health
    Accomplishments in public health over the last
    100 years. New York, NY Pfizer Inc.

56
Resources and References
  1. Neese, R. Williams, G. (1996). Why we get sick
    The new science of Darwinian medicine. New York
    Vintage Books.
  2. National Institute of Allergy and Infectious
    Diseases (n.d.). Emerging and Re-Emerging
    Infectious Diseases Research at NIAID. Retrieved
    from http//www.niaid.nih.gov/topics/emerging/Page
    s/Default.aspx
  3. Pyrek, K.M. (2003). Reducing Resistance FDA
    Adopts New Antibiotic Regulations. Infection
    Control Today. Retrieved from www.infectioncontrol
    today.com/articles/406/406_341feat1.html
  4. Stern, A.M., Markel, H. (2004). International
    Efforts to Control Infectious Diseases, 1851 to
    Present. JAMA. 292(12), 1474-1479.
  5. Taraporewala, I.B. (2008). The Growing Problem of
    Antibiotic Resistance Medical, Legislative, and
    Legal Implications. Update (2), 6-11.
  6. Uehling, D.T., Johnson, D.B., Hopkins, W.J.
    (1999). The Urinary Tract Response to Entry of
    Pathogens. World Journal of Urology. 17(6),
    351-8.
  7. Update on avian influenza A (H5N1) virus
    infection in humans. (2008). New England Journal
    of Medicine, 358(3), 261-273. Retrieved from
    http//dx.doi.org.proxygw.wrlc.org/10.1056/NEJMra0
    707279
  8. World Health Organization. (2007). The top 10
    causes of death. Retrieved from
    www.who.int/mediacentre/factsheets/fs310/en/index.
    html
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