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Infectious Disease Control


Milestones in Public Health: Chapter 4 Lectures for Medical and Clinical Education January 2011 * * * * * * * * * * * * * * * * * * * * * * * * 1851-1881 Technical ... – PowerPoint PPT presentation

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Title: Infectious Disease Control

Infectious Disease Control
Milestones in Public Health Chapter 4
Lectures for Medical and Clinical Education
January 2011
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

Learning Objectives
  • Distinguish between emerging and re-emerging
  • Summarize human and microbial factors in the
    emergence of new infectious diseases
  • Describe human behaviors which play a role in
    re-emerging infectious diseases

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

Infectious Disease Control
  • Historical Perspective

Historical Perspective Infectious Disease
  • 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

FAQs (2004)
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)
The Concept of Adaptation by Natural Selection
  • Adaptations by which we combat pathogens
  • Adaptations of pathogens that counter our
  • Maladaptive but necessary costs of our adaptations

Neese and Williams (1996)
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)
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)
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
  • 1945-2004 The WHO A new definition of health
    to the present

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)
Kochs Postulates of 1891 The Germ Theory of
  • 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)
Infectious Disease Control
  • The Milestone and Its Impact on Public Health

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)
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)
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))
Infectious Disease Control
  • Aspects of Biology, Behavior and Science of
    Infectious Diseases

Infectious Disease Realities
  • Emergence of new infectious diseases
  • Re-emergence of old infectious diseases
  • Persistence of intractable infectious diseases

Emerging Infectious Diseases
  • Include outbreaks of previously unknown diseases
    or known diseases whose incidence in humans has
    significantly increased in past two decades
  • Innovative research and improved diagnostic
    methods have revealed a number of previously
    unknown human pathogens

Fauci (2004) and NIAID
National Institute of Allergy and Infectious
Diseases (NIAID) Categories Group 1
  • Some pathogens newly recognized in past two
  • Two new hepatitis viruses
  • Three new herpes viruses
  • Helicobactor pylori
  • Borrelia burgdorferi

Status of New Infectious Diseases
  • New infectious diseases evolve and emerge due
  • Changes in human demographics, behaviors, and
    land use
  • People are in closer and more frequent contact
    with animal or arthropod carriers of disease
  • Increasing trade in exotic animals for pets or
    food service
  • Contributes to rise in opportunity for pathogens
    to jump from animal reservoirs to humans

Re-Emerging Diseases
  • Diseases in which natural genetic variations,
    recombinations, and adaptations allow new strains
    of known pathogens to appear to which immune
    system has not been previously exposed and is
    therefore not primed to recognize

Re-Emerging Diseases (Cont.)
  • Role of Human Behaviors
  • Increased and occasional imprudent use of
    antimicrobial drugs and pesticides has led to
    development of resistant pathogens allowing many
    diseases that were formerly treatable to return
  • Malaria, TB, nosocomial, food-borne infections
  • Decreased compliance to vaccination policy has
    led to re-emerging diseases that were under
  • Measles and pertussis
  • Increased use of deadly pathogens as agents of
  • Anthrax or smallpox

Re-Emerging Diseases (Cont.)
  • Current infectious diseases that have posed
    ongoing health problems in developing countries
    are re-emerging in the U.S.
  • For example
  • Food and water-borne infections
  • Dengue
  • West Nile virus

NIAID Research Plans and Priorities
  • Pandemic influenza
  • Emerging and re-emerging infectious diseases such
    as TB, malaria and tropical disease
  • Immune-mediated diseases

Fauci (2007)
Infectious Disease Control
  • Systems, Policies and Programs

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

Milestones (2006)
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)
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)
Federal Agencies
  • CDC Views 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)
Federal Agencies (Cont.)
  • EPA Has jurisdiction and authority
  • over water pollutants that enter environment
  • NIH Conducts research, develops
  • solutions and educates public
  • about emerging problem

Milestones (2006)
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)
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)
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)
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)
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)
Advocacy Organizations (Cont.)
  • Withdrawal of all antibiotics given to healthy
    animals for economic reasons when those
    antibiotics are also used for people

APHA (2003)
Advocacy Organizations (Cont.)
  • The American College of Physicians (ACP) has
    issued guidelines for patients, multiple levels
    of health care providers, and others in support
  • 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)
Infectious Disease Control
  • Looking Ahead

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

Milestones (2006)
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)
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)
Infectious Disease Control
  • 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

Resources and References
  1. American Public Health Association. (2003).
    Antibiotic Resistance Fact Sheet. Retrieved from
  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
  4. Centers for Disease Control and Prevention.
    (January 11, 2008). Influenza Pandemic OPLAN.
    Retrieved from http//
  5. Centers for Disease Control and Prevention.
    (January 25, 2010). National Notifiable Diseases
    Surveillance System. Retrieved from
  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//

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
  3. FAQs. (2004). The Office of Public Health Service
    History. NIH. Retrieved August 29, 2008 from
  4. Fredericks, D., Relman, D. (1996).
    Sequence-based identification of microbial
    pathogens A reconsideration of Koch's
    postulates. Clinical Microbiology Reviews, 9(1),
  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//
  6. Pfizer Inc. (2006). Milestones in public health
    Accomplishments in public health over the last
    100 years. New York, NY Pfizer Inc.

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//
  3. Pyrek, K.M. (2003). Reducing Resistance FDA
    Adopts New Antibiotic Regulations. Infection
    Control Today. Retrieved from www.infectioncontrol
  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),
  7. Update on avian influenza A (H5N1) virus
    infection in humans. (2008). New England Journal
    of Medicine, 358(3), 261-273. Retrieved from
  8. World Health Organization. (2007). The top 10
    causes of death. Retrieved from