Global (Public) health problem II:

Emerging Infectious Disease (EID)

and Travel Health
MEDF1120 Public Health
May PS YEUNG
School of Public Health & Primary Care
The Chinese University of Hong Kong
Content
Objectives
I. Introduce the major concepts of emerging infectious diseases (EID) and infectious
diseases (ID).

II. Demonstrate the major concepts of EID using examples Zika virus and Ebola.

III. Identify individual risks that will affect safety and health during travel, familiarise with the
preparation prior travel and know about related health service.

Learning Outcomes
• Describe the characteristics of EIDs and demonstrate by examples.

• Illustrate with example some infection control measures in Hong Kong

• Able to use appropriate resources to find the latest up-to-date information on travel health
risks in a specific country.
Part I
EID AND ID CONCEPTS
Reference:
Farmer R, Lawrenson R. Lecture Notes on
Epidemiology and Public Health Medicine, 5th
edition. Chapter 14, Control of Infectious
Diseases, p.103-111, Blackwell Science; 2004.
(online ebook at CUHK Library)
Definition
Infectious diseases (ID) are caused by pathogenic
microorganisms, such as bacteria, viruses, parasites
or fungi; the diseases can be spread, directly or
indirectly, from one person to another.
(WHO)

Emerging infectious diseases (EID) are those that

have newly appeared in a population or have existed
but are rapidly increasing in incidence or geographic
range.* WHO
http://www.who.int/topics/infectious_diseases/en/

Re-emerging infectious diseases (Re-EID) are

diseases that once were major health problems
globally or in a particular country and then declined
dramatically, but are again becoming health problems
for a significant proportion of the population.
(CDC)

*Geraint Lewis, Jessica Sheringham, Jamie Lopez Bernal, Tim Crayford. Mastering Public Health: A Postgraduate Guide to
Examinations and Revalidation, First Edition, 2008,CRC Press. (p.265)
Driving Forces
1. Emergence and Re-emergence: underlying factors

2. Amplification: Human to human transmission

⚫ Urbanisation, population density; agricultural intensification; technology and industry; vector
distribution and densities, transmission in healthcare centers
3. Global Spread: Globalisation
⚫ Global travel: people, animals, vectors
⚫ Global trade: animal and their products, vaccines, medical products etc
Morens DM, Fauci AS (2013) Emerging Infectious Diseases: Threats to Human Health and Global Stability. PLoS Pathog 9(7): e1003467. doi:10.1371/journal.ppat.1003467
http://127.0.0.1:8081/plospathogens/article?id=info:doi/10.1371/journal.ppat.1003467
Bernadette Abela-Ridder, WHO Food Safety and Zoonoses Pierre Formenty, Global Alert and Response. Health Security and Environment ClusterFrom Forecasting to
Control of Zoonotic Diseases: Linking Animal and Human Systems. Paris, France, 24 February 2011. http://www.oie.int/fileadmin/Home/eng/Conferences_Events/sites/WILDLIFE_ACTES_2011/Presentations/S3_1_BernadetteAbela-Ridder.pdf
 Causative Agents of EID and Re-EID
(1990-2013)

Causative Agents highlighted by the black box are selected emergences emerged in that location after 2010

Kristi L. Koenig and Carl H. Schultz. The 2014 Ebola Virus Outbreak and Other Emerging Infectious Diseases
https://www.acep.org/uploadedFiles/ACEP/practiceResources/issuesByCategory/publichealth/The%202014%20Ebola%20Virus%20Outbreak.pdf
Slide courtesy of Prof. Herb Harwell
 Epidemiologic Triad (HEA)

Farmer R, Lawrenson R. Lecture Notes on Epidemiology and Public Health Medicine, 5th edition. Chapter 14, Control of Infectious Diseases,
p.103-111, Blackwell Science; 2004
 Prevention

Surveillance
• Active and passive
Containment surveillance of
reservoir vector
• Isolation
• Human reporting
• Disinfection
system in clinic /
•
•
Quarantine
Immunization
Control of hospital /
community of cases
•
•
Contact tracing
Treatment Infectious • Surveillance result
reporting)
• Port Health
Diseases

Investigation
Detection
• Questionnaire
• Clinical or laboratory
confirmation
• Field visit

Slide courtesy of Prof. Herb Harwell

Farmer R, Lawrenson R. Lecture Notes on Epidemiology and Public Health Medicine, 5th edition. Chapter 14, Control of Infectious Diseases,
p.103-111, Blackwell Science; 2004
Organisations of Infectious Disease
Surveillance and Response

Mainland & International

Health Authorities

Department of Health

Academics

Hospital
Authority Government Departments
Private & Community Institutions
Sector
Slide courtesy of Prof. SH LEE
International Health Regulations (2005)
• International law which helps countries work together to save lives and livelihoods
caused by the international spread of diseases and other health risks.

• All cases of the following four diseases must be automatically notified to WHO:
– smallpox;
– poliomyelitis due to wild-type poliovirus;
– SARS;
– cases of human influenza caused by a new subtype.

In addition the IHR (2005) requires States to notify WHO of all events that may constitute
a public health emergency of international concern and to respond to requests for
verification of information regarding such events.

• Agreement between 196 countries including all WHO Member States to work
together for global health security.

• Aims to prevent, protect against, control and respond to the international spread of
disease while avoiding unnecessary interference with international traffic and trade.

• Previous IHR of 1969 and had limited scope and only required the reporting to WHO
of three main diseases: cholera, yellow fever and plague.

• Enforced since 15th June 2007

Health Knowledge. Public Health Action Support Team (PHAST). WHOs International Health Regulations (IHR).
http://www.healthknowledge.org.uk/public-health-textbook/disease-causation-diagnostic/2g-communicable-disease/cdcontrol

WHO. International Health Regulations (2005) Second edition. http://www.who.int/ihr/publications/9789241596664/en/

Part 2
CHARACTERISTICS OF EID
1. Zika virus
2. Ebola
ZIKA VIRUS
Agent: Zika virus
Host: Nonhuman primates, human
Environment: 86 countries and territories since 2007
Transmission: Vector-borne (mosquito: Aedes)
Mortality & Morbidity: >2000 reported microcephaly and/ or CNS
malformation cases
WHO Zika virus - http://www.who.int/mediacentre/infographic/zika-virus/What-is-zika.pdf
Prevention
Surveillance
Surveillance of HK & Global Situation

CHP Flu Express http://www.chp.gov.hk/files/pdf/fluexpress_web_week38_22_9_2016_eng.pdf

Detection
• Laboratory investigation

• Field visits
 Prevention
• Personal advise in avoiding mosquito bites
• Travel advice especially for pregnancy women
• Identify / clean mosquito reservoir

Containment Surveillance
• Isolation • Active and passive
• Disinfection surveillance of
• Contact tracing mosquito (e.g. ovitrap)
• Treatment • Human reporting
• Port Health system in clinic /
(travellers who Control of hospital / community
return from affected of cases
areas should apply
insect repellent for
Infectious • Surveillance result
reporting to public
14 days after arrival
in Hong Kong)
Diseases

Detection
Investigation • Questionnaire
Explore new source of reservoirs
• Clinical or laboratory
and vehicles of infection, analysis
confirmation
of data collected, formulate of a
• Field visit
causal hypothesis
• Screening for healthy
individuals or high risk groups

Farmer R, Lawrenson R. Lecture Notes on Epidemiology and Public Health Medicine, 5th edition. Chapter 14, Control of Infectious Diseases,
p.103-111, Blackwell Science; 2004
Countries Where The Zika Virus Is Spreading

WHO https://www.who.int/emergencies/zika-virus/timeline/en/
EBOLA (2014– 2016)
Agent: Ebola virus
Host: Human
Environment: West Africa (Guinea, Liberia, Sierra Leone)
Transmission: Droplet
Morbidity & Mortality: Infected 28,616 cases, 11,310 deaths (40%)
Youtube https://www.youtube.com/watch?v=F5nkkEwPaEA
WHO Ebola R&D

WHO Ebola R&D - News on vaccines, therapies, diagnostics. http://www.who.int/medicines/ebola-treatment/en/.

Impacts
Social
• No Work (non-essential workers stay at home)
• No School
• No Clinic or Hospital
• No Social gathering
• Food and commodities doubled or even more
• Transport becomes expensive
• Change in culture (no hand-shaking, no hugging etc)
• News and media flooded with Ebola news

Community / Family
• Death of friends and relatives
• Trust

Personal
• Physical, social, mental, work etc

New Internationalist magazine

http://newint.org/features/web-exclusive/2014/10/23/ebola-lost-generation/
TRAVEL HEALTH
Pre-travel Health Related Questions
1. When and where are you traveling, and how long will you
be at each location?
2. What vaccinations have you had previously?
– Yellow fever, hepatitis A and B, measles–mumps–rubella (MMR)
3. Do you have any allergies (e.g. vaccine, medications,
foods, or environmental)?
4. What is your medical history and current health status
(e.g. past illnesses and surgeries, chronic health
problems, or other underlying medical conditions)?
5. What drugs are you going to take with you?
6. Where you can seek medical care during your trip? Is it
covered by insurance?
Travel Health Service

e.g. Med 5 Elective training in

Africa

• Pre-travel consultation, health

risk assessment

• Health education / advice

• Vaccinations and medications

– Malaria chemoprophylaxis, yellow
fever vaccination

• Visit Department of Health or

US CDC Travel Health
webpage

• Prepare travel health kits

Travel Health Kits
• Original containers: All medications should be carried in their
original containers with clear labels of generic name of drug
and dosage
• Physician notes: For controlled substances and injectable
medications, travelers are advised to carry a note from the
prescribing physician on letterhead stationery
• Availability: It should be carried with the traveler at all times
(e.g., in a carry-on bag).
• Types:
– Destination-related: antimalarial drug, treat high-altitude illness
– Pain or fever: acetaminophen, ibuprofen
– Stomach upset or diarrhea: antacid, antidiarrheal
– Respiratory symptoms: anti-histaminje, cough suppressant, throat
lozenges
– Basic first-aid: bandages, antiseptic, gauze, gloves, mask
– Other: insect repellent, sunscreen, antibacterial hand wipes
RECAP
• Emerging infectious diseases (EID) are those that have
newly appeared in a population or have existed but are rapidly
increasing in incidence or geographic range.

• The propagation of an epidemic involves 3 factors: Agent

(pathogen), Host and Environment. Preventive measures
should address all three factors.

• Control of ID: Prevention, Surveillance, Detection, Investigation,

and Containment.

• Travellers have to plan for health issues prior travel: assess

health risk, schedule medical consultation, consider
vaccinations and medications, and prepare travel health kits
Thank you!

© Faculty of Medicine The Chinese University of Hong Kong