Title: Scourges Old and New: The Burden of Infectious Diseases in the 21st Century
1Scourges Old and New The Burden of Infectious
Diseases in the 21st Century
- Joel G. Breman, MD, DTPH
- Fogarty International Center
- National Institutes of Health
- University of Pennsylvania
- November 1, 2002
2Global Infectious Diseases Objectives
- Problem
- Determinants
- Diseases
- Control and eradication
- Triumphs
- Tribulations
3Global Infectious Diseases Objectives
- Problem
- Determinants
- Diseases
- Control and eradication
- Triumphs
- Tribulations
4(No Transcript)
5(No Transcript)
6(No Transcript)
7(No Transcript)
8(No Transcript)
9(No Transcript)
10Infectious Disease Mortality in the United
States, 1980-1996
80
70
60
Deaths per 100,000 population
50
Crude ID Mortality Rate
40
30
20
10
0
Year
Source JAMA 1996275189-193 and unpublished CDC
data
11Global Infectious Diseases Objectives
- Problem
- Determinants
- Diseases
- Control and eradication
- Triumphs
- Tribulations
12Determinants of Emergence of Infectious Diseases
- Population growth and density (measles,
chickenpox, influenza) - Migration and transhumance (cholera, sexually
transmitted infections) - Urbanization (plague, water-borne diseases,
respiratory diseases) - Human behavior and lifestyles (STIs, HIV/AIDS)
- Contact with animal populations (salmonella,
anthrax, monkeypox, Ebola/Marburg) - International travel and commerce (malaria,
cholera, food-borne diseases)
13Determinants of Emergence of Infectious Diseases
(2)
- Technology and industry (toxic shock syndrome,
nosocomial infections) - Microbial adaptation and change (Staphylococcus
aureus, influenza, HIV/AIDS, malaria) - Breakdown of public health measures
(tuberculosis, diphtheria, pertussis, meningitis) - Global warming (malaria, dengue, yellow fever,
cholera) - Bioterrorism (smallpox, anthrax, plague,
tularemia, botulinum toxin, hemorrhagic fevers)
14(No Transcript)
15Antimicrobial Resistance
- Worldwide problem
- Dramatic increase in antimicrobial-resistant
community-acquired and nosocomial pathogens - Major risk factors
- Antimicrobial use (misuse)
- Infection control practices (noncompliance)
16Evolution of Antimicrobial Resistance
Penicillin ? 1950s
Methicillin ? 1980s
Penicillin-resistant S. aureus
Methicillin-resistant S. aureus (MRSA)
S. aureus
Vancomycin
1997
1990s
Vancomycin-resistant enterococcus (VRE)
Vancomycin (glycopeptide) - intermediate resistant
S. aureus
Vancomycin- Resistant S. aureus
?
17(No Transcript)
18Global Infectious Diseases Objectives
- Problem
- Determinants
- Diseases
- Control and eradication
- Triumphs
- Tribulations
19(No Transcript)
20(No Transcript)
21(No Transcript)
22(No Transcript)
23(No Transcript)
24(No Transcript)
25(No Transcript)
26(No Transcript)
27(No Transcript)
28(No Transcript)
29(No Transcript)
30(No Transcript)
31(No Transcript)
32(No Transcript)
33(No Transcript)
34(No Transcript)
35 Label, 2002
36Blood Safety
- Units donated in the U.S. are routinely tested
for evidence of seven infectious agents - HTLV I and II
- HIV 1 and 2
- Treponema pallidum
- Hepatitis B and C viruses