Epidemiological types of infectious

diseases
Epidemics

(Emerging and re-emerging infections)

Definition
 EMERGING INFECTIOUS DISEASE

1.Newly identified & previously

unknown infectious agents that cause
public health problems either locally
or internationally
Definition
 RE-EMERGING INFECTIOUS DISEASE

1. Infectious agents that have been known for

some time,
2. had fallen to such low levels that they were
no longer considered public health problems &
3. are now showing upward trends in incidence
or prevalence worldwide.
 Why Do Diseases Emerge?
•Diseases can emerge when humans come
into contact with infected animals;
pathogens become resistant to existing
drugs; or people lack appropriate
immunizations.
•The increased frequency of international travel
and a global food supply can enable emerging
diseases to spread very quickly.
 Infectious Disease- Trends
Receded in Western countries
20 thcentury due
to:
 Urban sanitation, improved housing,
personal hygiene, antisepsis & vaccination
 Antibiotics further suppressed morbidity &
mortality.
 Infectious Disease- Trends
Since last quarter of 20th century- New & Ressurgent
infectious diseases
 Unusually large number- Rotavirus,
Cryptosporidiosis, HIV/AIDS, Hantaviraus, Lyme
disease, Legionellosis,
Hepatitis C……
…Ebola and …….Now SARS-Cov-2 (Covid -19)
 Infectious Diseases: A World in Transition
AIDS UP
Avian Influenza
Ebola
Marburg

?
DOWN
Cholera
Rift Valley Fever
Typhoid Guinea worm, Smallpox
Tuberculosis Yaws (A type of STD)
Leptospirosis Poliomyelitis
Malaria
Measles
Chikungunya
Dengue Leprosy
JE Neonatal tetanus
Antimicrobial resistance
CORONA -2020
 Factors Contributing To Emergence
AGENT

 Evolution of pathogenic infectious agents

(microbial adaptation & change)
 Development of resistance to drugs

 Resistance of vectors to pesticides

 Factors Contributing To Emergence
HOST
 Human demographic change (inhabiting new areas)

 Human behaviour (sexual & drug, alcohol Abuse )

 Human susceptibility to infection (Immunosuppression)

 Poverty & social behaviours and inequality
 Factors Contributing To Emergence
ENVIRONMENT

 Climate & changing ecosystems

 Economic development & Land use (urbanization,

deforestation)
 Technology & industry (food processing &

handling)
ENVIRONMENT - CONTD.

 International travel & commerce

(Importation of substandard good)
 Breakdown of public health measure (war,

unrest, overcrowding, limited resources)

 Deterioration in surveillance systems (lack
of political will) Dr. KANUPRIYA CHATURVEDI
 Transmission of Infectious Agent from
Animals to Humans

 >2/3rd emerging infections originate from animals-

(wild & domestic)=Zoonotic
 Emerging Influenza infections in Humans associated with
Geese, Chickens & Pigs
 Animal displacement in search of food after
deforestation/ climate change (Lassa fever)
 Humans themselves penetrate/ modify unpopulated
regions - come closer to animal reservoirs/ vectors
(Yellow fever, Malaria)=Human wildlife conflicts
 Climate & Environmental Changes

 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.
 Poverty, Neglect & Weakening of
Health Infrastructure
 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
Lyme disease (B. burgdorferi)- Changes in ecology,
increasing deer populations, suburban migration of
population.
 Human Behaviour

 Unsafe sexual practices (HIV, Gonorrhoea,

Syphilis, Pubic lice)
 Changes in agricultural & food production
patterns- food-borne infectious agents (E. coli)
 Increased international travel (Influenza)

 Increased Outdoor activity (Corona)

 Antimicrobial Drug Resistance

 Causes:
• Wrong prescribing practices
• Non-adherence/Compliance by patients
• Counterfeit drugs –National control policies (M
& E units E.g. here in Somaliland)
• Use of anti-infective drugs in animals & plants
 Antimicrobial Drug Resistance CONTD.

• Loss of effectiveness:
• Community-acquired (TB, Pneumococcal) &
Hospital-acquired (Enterococcal,
Staphylococcal
 Antiviral (HIV), Antiprotozoal (Malaria),
Antifungal
 Antimicrobial Drug Resistance

Consequences
 Prolonged hospital admissions
 Higher death rates from infections
 Requires more expensive, more toxic drugs
 Eventual Higher health care costs.
 Reduced quality of life

 Retrogressive health care delivery(No progress)

 ENVIRONMENT

Climate change Mega-cities

Vector
Pollution Migration
proliferation
Exploitation
Population
Antibiotics HUMAN Growth
Vector
resistance

Food
production
ANIMALS VECTORS

Intensive farming

Transmission
Examples of recent emerging diseases

Source: NATURE; Vol 430; July 2004; www.nature.com/nature

 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
CONTD.

 Zoonoses- 1,415 microbes are infectious for human

Of these, 868 (61%) considered zoonotic
70% of newly recognized pathogens are zoonoses.

Implications :
-Direct and
-Indirect)
 Implications (Direct and Indirect)
Direct implications are defined as the
consequences for human health in
terms of morbidity and mortality.
Indirect implications are defined as
the effect of the influence of emerging
zoonotic disease on two groups of
people, namely: health professionals
and the general public.
 Impact of Neglected Zoonotic Diseases
The impact of NZDs on health services and
economies is most severe on poor households
in developing countries, as most of the
populations living in rural areas are still largely
dependent on animals for
1. feed,
2. transport and
3. farm work.
Populations from urban slums are also affected.
 Emerging Zoonoses: Human-
animal interface

Avian influenza Ebola virus

virus Bats: Nipah virus
Marburg virus

Deer tick (Ixodes

Borrelia burgdorferi: Lyme Hantavirus Pulmonary Syndrome
scapularis)
Mostomys rodent: Lassa fever
 SARS: The First Emerging Infectious Disease Of The
21st Century
No infectious disease has spread so fast and far as
SARS did in 2003
SARS Cases Total: 8,439 cases, 812 deaths,
19 February to 5 July 2003 30 countries in 7-8 months

Europe: Russian Fed. (1)

Canada (243) 10 countries (38)
Mongolia (9)
Korea Rep. (3)
USA (72) China (5326)
Macao (1)
Kuwait (1)
Hong Kong (1755) Taiwan (698)
India (3)
Colombia (1) Viet Nam (63) Malaysia (5)
Indonesia (2)
Singapore (206)
Brazil (3) Philippines (14)

Thailand (9)
South Africa (1)
(
Australia (5)
New Zealand (1)

Source: www.who.int.csr/sars
 Lesson learnt from SARS

 An infectious disease in one country is a threat

to all.
 Important role of air travel in international
spread
 Tremendous negative economic impact on
trade, travel and tourism, estimated loss of $
30 to $150 billion
 CONTD.

 High level commitment is crucial for rapid

containment
 WHO can play a critical role in catalyzing
international cooperation and support
 Global partnerships & rapid sharing of
data/information enhances preparedness
and response
 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 AI virus or culled to
prevent further spread
 Majority of human H5N1 infection due to direct
contact with birds infected with virus
 Novel Swine origin Influenza A (H1N1)

 Swine flu causes respiratory disease in pigs – high

level of illness, low death rates.
 Pigs can get infected by human, avian and swine
influenza virus.
 Occasional human swine infection reported

 In US from December 2005 to February 2009, 12

cases of human infection with swine flu reported.
 Swine Flu
Influenza A (H1N1)

 March 18 2009 – ILI outbreak reported in Mexico

 April 15th CDC identifies H1N1 (swine flu)

 April 25th WHO declares public health emergency

 April 27
th Pandemic alert raised to phase 4

 April 29th Pandemic alert raised to phase 5

 Influenza A (H1N1)

 By May 5th more than 1000 cases confirmed in 21

countries
 Screening at airports for flu like symptoms (especially
passengers coming from affected area)
 Schools closed in many states in USA
 May 16th India reports first confirmed case
 Stockpiling of antiviral drugs and preparations to
make a new effective vaccine.
 37
Dr. KANUPRIYA CHATURVEDI
 Pandemic HINI (Swine flu)
 Worldwide- 162,380 cases
1154 deaths

 India- 558 cases

1 death
Examples of Re-Emerging Infectious Diseases

 Diphtheria- Early 1990s epidemic in Eastern Europe

Currently in Yemen(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)
Dr. KANUPRIYA CHATURVEDI
 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.
 CONTD.
 Highest potential- B. anthracis, C. botulinum
toxin, F. tularensis, Y. pestis, Variola virus,
Viral haemorrhagic fever viruses.
 SEE NEXT TWO SLIDES FOR REFERENCE

 Likeliest route- aerosol dissemination

 Viral Hemorrhagic Fevers
Summary of Agents
Virus Family Virus/Syndrome Geographic Reservoir or Human-human
occurrence Vector transmission?
Junin (Argentine HF) S.America Rodents Lassa Fever – yes, via
Arenaviridae body fluids; others –
Machupo (Bolivian HF) S.America not usually

Guanarito (Brazilian HF) S.America

Sabia (Venezuelan HF) S.America

Lassa (Lassa Fever) West Africa

Yellow Fever Tropical Africa,Latin Mosquitoes Yellow Fever – blood

Flaviridae America infective up to 5d of
illness;
Dengue Fever Tropical areas Others - No

Kyanasur Forest Disease India Ticks

Omsk HF Siberia
 Viral Hemorrhagic Fevers
Summary of Agents
Virus Family Virus/Syndrome Geographic Reservoir or Human-human
occurrence Vector transmission?
Congo-Crimean HF Crimea, parts of Africa, Ticks Congo-Crimean
Bunyaviridae Europe & Asia Hemorrhagic Fever – yes,
through body fluids;
Rift Valley Fever,
Rift Valley Fever Africa Mosquitoes
Hantaviruses – no

Hantaviruses (Hemorrhagic Diverse Rodents

Renal Syndrome/
Hantavirus Pulmonary
Syndrome)

Ebola HF Africa Unknown Yes, body fluid

Filoviridae transmission
Marburg HF Africa
 Key Tasks in Dealing with Emerging
Diseases

 Surveillance at national, regional, global level

 epidemiological,
 laboratory
 ecological
 anthropological

 Investigation and early control measures

 Implement prevention measures
 behavioural, political, environmental

 Monitoring, evaluation(Diseases burdens,District resistance level

 National surveillance : current situation
Somaliland

 Independent vertical control programmes

 Surveillance gaps for important diseases

 Limited capacity in field epidemiology,

laboratory diagnostic testing, rapid field
investigations
 Inappropriate case definitions.
 National surveillance : current situation
Somaliland CONTD….
 Delays in reporting, poor analysis of data
and information at all levels
 No feedback to periphery

 Insufficient preparedness to control

epidemics
 No evaluation
 Possible Solutions (Somaliland)

Public health surveillance & response systems

 Rapidly detect unusual, unexpected, unexplained disease
patterns
 Track & exchange information in real time (Need to capacity

build)
 Response effort that can quickly become global (Requires

advanced infrastructure)
 Contain transmission swiftly & decisively.
 GOARN
Global Outbreak Alert & Response Network
 Coordinated by WHO.

 Mechanism for combating international disease

outbreaks.
 Ensure rapid deployment of technical assistance,
contribute to long-term epidemic preparedness &
capacity building.
 Sharing Outbreak-related Information
• with Public Health Professionals
• with Public

Dr. KANUPRIYA CHATURVEDI

 Solutions

 Internet-based information technologies

 Improve disease reporting
 Facilitate emergency communications &
 Dissemination of information
 Human Genome Project

 Role of human genetics in disease susceptibility,

progression & host response
 Possible Solutions
 Microbial genetics.
Methods for disease detection, control & prevention
 Improved diagnostic techniques & new vaccines.

 Geographic Imaging Systems

Monitor environmental changes that influence

disease emergence & transmission.
Key tasks - carried out by whom?

Global
Regional
Synergy

National

Dr. KANUPRIYA CHATURVEDI

What skills are needed?

Public
Infectious Health
Telecom. &
diseases
Informatics

International Laboratory
Epidemio- field
Information
logy experience
management

Multiple expertise needed !

 Global Disease Intelligence:
A world on the alert.
Collection

Verification Distribution

Response
 The Best Defense (Multi-factorial)

 Coordinated, well-prepared, well-equipped

PH systems
 Partnerships- clinicians, laboratory techs &
PH agencies
 Improved methods for detection &
surveillance
CONTD.
 Effective preventive & therapeutic
technologies
 Strengthened response capacity

 Political commitment & adequate resources

to address underlying socio-economic
factors
 International collaboration &
communication