‘The Textbook of finvronmenta Sudles and Distr Many, he Types of Epidemic Diseases The epidemic diseases are of three main {yPes ! F 1) Point Source : It is the kind of epidemic in which all the cases are infectey by Single source at the same time, h 1) Continuous Source : An epidemic in which a causal agent Such a8 contaming ‘ater and the food is infecting people over a long period of time is know, Continuous source. 5 i i) Person-to-Person : It is the type of epidemic in which the causative, transmitted from one person to the other allowing the epidemic to spreaq Notable Examples of Epidemic Diseases The Third Cholera (1852-1860): The third cholera is the largest cholera ou. known to the world. It originated in India and later on spread beyond the Indian boundarig The Asian Flu (1957): It broke out in China and took the lives of one toy. million people. ‘Bent ig SARS (Severe Acute Respiratory Syndrome, 2003): [tis a respiratory tract illness caused by the corona virus. It is believed to be transmitted from animals and 1OOk the lives of many people. ‘ Ebola (2014): It is arare occurring deadly virus that causes body ache, fever, and diarrhoea. It was transmitted from wild animals. It Proved to be fatal for a large numb of populations. HIV/AIDS (1960s-present): This disease is believed to have spread from chimpanzees to humans in the 1920s. The virus attacks the immune system and reduce; its efficiency. This disease is estimated to have taken the lives of 25 million People. Effects of Epidemics ') Social and political disruption due to tension and law and order problems, ii) Economic loss arising from lack of strength, Scarcity of food and water leading to malnutrition and starvation. iv) Worsening of already poor sanitary conditions result epidemics. Pandemic The World Health Organization (WHO) declares a Pandemic when a diseases growth is exponential. This means the growth rate skyrockets, and each day cases grow more than the day prior. It means a virus covers a wide area, affecting several countries and populations Pandemic refers to the outbreak of an infectious disease occurring over vast geographical area and is of high prevalence, It is also a type of epidemic, which occus cover the course of months and years, A pandemic is a larger version of an epidemic, In goes out of control, it is known as a pandemic. If an ting in aggravation of other words, when an epidemié epidemic covers many counts ide,223 Public Heath continents, i the term used eration troughs itis likely to be a pandemic. Pandemic is the 10 describe the rapid spread of a transmissible infectious/communicable disease Over feveral continents or worldwide. Once an epidemic becomes global and affects a large percent of the population it becomes known as a pandemic. COVID19 is one of the best examples forthe most destructive global pandemics in history. Features of pandemic Affects a wider geographical area, often global Infects a very large number of people Caused by a new virus or a new strain of a virus that has been dormant for many years, Spreads quickly in humans as there is very little existing immunity . Can cause a high number of deaths Because of the need to control the spread of the disease, there is often social disruption, unrest and economic loss _ Epidemic to Pandemic The World Health Organization (WHO) will declare a Pandemic when a disease shown exponential growth - dramatically increasing rate of growth, each day g many more cases than the previous day. A current example of this is Virus Disease (COVID-19). On 31 December 2019, a cluster of cases of nia of unknown cause, in the city of Wuhan, Hubei province in China, was d to the WHO. This was subsequently identified as a new virus in January nd over the following months, the number of cases continued to rise but were d to China and showed exponential growth worldwide. Due to the rapid rise in cases, this was declared a pandemic on 11 March 2021. es of a Pandemic : The WHO has identified six phases that it follows claring a pandemic. Phase 1 represents a low risk and phase 6 is a full- pe , you can see the phases below: 1 - a virus is seen in animals but has not been shown to infections in - a known animal virus has caused an infection in humans scattered or isolated incidence of cases occurring in humans; possible suman-to-human transmission but not at a level to cause community-ans is now evident © Phase 5 - the spread of the disease between hum ™ ma countries: feast one additional County in at . Phase 6 - community-level outbreaks are ion is then Once Phase 6 is réached preparation 19 : i it ne pandemic. Each phase has @ ist of actions oe es an transparency and the education of health organ! Prevention of Pandemic or. It is important to try to prevent an pre fea Beene as ae This requires organizations and nations to act early eo a ft of poi to try to limit the spread of an infectious agent beyond the initial individual cq cd cralt claslenk ot RSH ion ate erred ttairitecte iiexe Src Sere] easy that have proven effective in the control and containment of viruses: * Controls : application of border controls to limit/prevent movement individuals to and from affected areas . Identify cases : educate the public on the symptoms and risk factors, provi easy access to testing, flag potential cases in any healthcare encounters, tra contact with infected individuals © Trace contacts : tracks an infected individual’s movements from the mom of infection to identify all individuals who have been potentially infected. + Quarantine : separate an individual suspected of infection from contact wi others for a certain period of time that covers the period of incubation for disease . Isolate : separate an infected individual from contact with others . Protect ; use appropriate equipment (PPE) to protect healthcare workers cannot avoid contact with infected individuals. Managing Pandemic Once pandemic is identified it is important to take the appropriate meas to contain, manage and reduce the spread of the virus. The key message at this s is to reduce the transmission rate - the number of individuals infected by each si infected individual. If the transmission rate is g it will continue to increase. s Once a significant level of infection is this rate of spread becomes vital. Actions are termed Mitigation and involves i) institutions, work from home etc.),“The Textbook of Environmental Studies and Disaster Mange, © Phase - the apresd of the disease between hramansusinow evident in countries i in at least one additional ¢, * Phase 6 - community-level outbreaks are in a cunt on is then made for a full blown 9), ¢ that need to be followed to faci. tions and members of the py, Once Phase 6 is réached preparati pandemic. Each phase has a list of actions tha transparency and the education of health organiza Prevention of Pandemic an epidemic from developing into a panden; It is important to try to prevent y (OR pared. A set of pofg This requires organizations and nations to act early and be pr‘ eet to try to limit the spread of an infectious agent beyond the initial individual cay and small clusters of infection are termed containment. There ere several measuy that have proven effective in the control and containment of viruses . Controls : application of border controls to limit/prevent movement individuals to and from affected areas . Identify cases : educate the public on the symptoms and risk factors, provi easy access to testing, flag potential cases in any healthcare encounters, tra contact with infected individuals ° Trace contacts : tracks an infected individual’s movements from the mor of infection to identify all individuals who have been potentially infected. . Quarantine : separate an individual suspected of infection from contact wi others for a certain period of time that covers the period of incubation for disease . Isolate : separate an infected individual from contact with others . Protect : use appropriate equipment (PPE) to protect healthcare workers cannot avoid contact with infected individuals. Managing Pandemic Once pandemic is identified it is important to take the appropriate meas! to contain, manage and reduce the spread of the virus, The key message at this s! is to reduce the transmission rate - the number of individuals infected by each si infected individual. If the transmission rate is greater than the number of cases it will continue to increase. Once a significant level of infection is present within a population then this rate of spread becomes vital. Actions targeted the transmissi are termed Mitigation and involves i) Social distancing (cancel events, “l institutions, work from home ete.), ii) Edwe Tan, as hand washing and avoiding groups etc., iii) Economic measures - to p jef to individuals and businesses . ARtry All these aes aim to limit the population exposed to infection alo, ‘ the transmission rate between them. This results in a flattening of the “ily ‘al ~ afcases over time and so reducing the peak in the number of cases needing up gre. This maintains the ability of the healthcare system to provide quality cg * affected and reduce the mortality rate as fa a possible, The greater the ‘onthe healthcare system the higher the likely mortality Tate, as resources are ut den jo meet the demand and healthcare workers themselves exceed their capacit Oli, provide care Case, Difference between Epidemic and Pandemic a utes Epidemic Pandemic [ /Anepidemic isan outbreak of disease that | Pandemic isa larger epidemic. Apandemic FN of eets many in a Population and begins | covers several countries or spreads from one o spread rapidly. continent to another. TOVide ‘outbreak of disease is considered an} In Pandemic outbreaks, the number of| track demic if it affects a certain number of | people affected or killed doesn’t matter as within a short period of time, | much as the rate of spread and how far it ly within 2 weeks. has spread, oment ; ed. NON-COMMUNICABLE DISEASES t with The environment in which man lives affects his health. But it is unfortunate that or the § exploited and polluted its environment to satisfy his own needs and greed, even fy his own whims and fancy. Health is a quality of life. Due to constant and | deterioration of environment and its effects on health, man has realized the rtance of clean environment. ho 4 : Ee cable diseases (NCDs), also known as chronic diseases are not person to person. They are of long duration and generally progress slowly. have a long asymptomatic period. The common types of non-communicable isures cardio-vascular diseases, cancer, diabetes, hypertension, and obesity, stage ingle -CARDIO-VASCULAR DISEASES (CVD) sins s then cular disease (heart disease) refers to A group of diseases that affect ind blood vessels of the body. These diseases can affect one or ‘many parts of ood vessels. A person may be symptomatic (physically experience the ucing Aa atic (not feel anything at all). Cardiovascular disease is the a eA death ! the world, Cardiac disease or heart disease includes osit sponsible for flawed regular cardiac functions. These diseases aref Studies and Disaster Mao, 226 ‘The Textbook o! : ease : Ischaemic heart disease (THD) inclugs t of oxygen to the those disorders which result due to inadequate mee Aaa “ the he muscle compared to its needs or caused bY eT 5 a Y vessels of yp heart by a blood clot or thrombus The first sign of Man ‘cae esr symptoms of unbearable chest pain, This is not at a ee he Followed RN myocardial infraction caused due to damaged heart muse! a lowing lack oxygen supply. It is very fatal and Jeads to heart failure or sudd len cardiac atte About 25% to 30% of death in the industrialized countries is due to the tp ced due to hypertension or high boy disorder. One of the major causes vironmental ©® Coronary or Ischaemic heart dis (ii) Hypertensive heart disease : This is aus pressure. It is predominantly a circulatory : of this disorder is atherosclerosis, in which the cholesterol is deposited Inside the lumen of the arteries leading to the hardening of the artery with reduced lumen The lack of elasticity of the artery and its narrow lumen reduces the blood floy, Infective/Rheumatic heart disease (RHD) : A person after repeated attack op rheumatic fever may suffer from Rheumatic Heart Disease. The poisonous substances accumulated during rheumatic fever affects the functioning of hear valves. Due to incomplete closing of valves, there is leakage of blood between the chambers of the heart. The heart sounds are changed into heart murmur. Idiopathic heart disease : Such diseases include cardiac myopathy in which ihe electrical conduction in the heart muscle is improper leading to irregular contractions and expansions of the heart. The cause may be genetic or addiction to drugs. Heart disease includes heart or blood vessel problems : (iii) @) * Abnormal heart rhythms. . Heart valve disease. . Narrowing of the blood vessels in your heart, other organs or throughout y body with plaque. . Heart squeezing and relaxation difficulties. . Heart and blood vessel problems that you’re born with. . Problems with your heart’s outer lining, ‘Types of cardiovascular diseases : Arrhythmia: Problem with the electrical conduction system of your heart Wh! can lead to abnormal heart rhythms or heart rates, Valve'disease: Problem with your heart valves (structures that allow blood flow from one chamber to another chamber or blood vessel), such as ¥*! tightening or leaking, Coronary artery disease: Problem with the blockages. ai ee ie28 he Textbook of Environmental Studies and Disaster ya, The Text Se 4 What are the symptoms of heart disease ? ; Paice 5 Heart disease symptoms can vary depending on »SYMPLong abnormal heart rhythms may include: * Pounding or racing heart (palpitations). * Chest pain, * Sweating, * Lightheadedness. * Shortness of breath. Symptoms of heart valve disease may include : * Dizziness. *. Tiredness. © Chest pain, © © Heart murmur. * Shortness of breath. Symptoms of blockages in the blood vessels in your heart, other organs o throughout your body may include: * Pain in your chest or upper body. © Neck pain. © Heartburn or indigestion. * Exhaustion. © Shortness of breath. © Nausea or vomiting. * Dizziness. Symptoms of heart pumping difficulties include : © Swelling in your lower body. © Exhaustion. © Shortness of breath. Y Heart problems you’re born with may haye symptoms that include: . Heart murmur. § ve ¢ Inability to handle exercise. Shortness of breath. i Problems with your heart’s lining may give y Chest pain, typically sharp and wors ¢ Exhaustion. a ttea x of Environmental Studies The Textbool Avoiding all tobacco products. * Managing other health conditions, such as diabetes, high cholesterol or high, a Pressure, * Achieving and maintaining a healthy weight. . Eating a diet low in saturated fat and sodium. * Exercising at least 30 to 60 minutes per day on most days. * Reducing and managing stress. Seek emergency medical attention if you experience sudden: > Chest pain, * Syncope (fainting). * Severe shortness of breath, especially if new or progressive. Pain or numbness in your arms/legs. Ripping or tearing back pain. CANCER Itis regarded as the dreadful killer of the 21st century. In the developed countries, it is next to cardiac diseases, as far as the virulence is concerned. It accounts for 9% of the total mortality throughout the world. By the end of 20th century, out of 50 millon deaths in the world per year, 5 million was due to cancer. The most common cancer in human males is oral and throat cancer while in females it is the cervical and breast cancer. Cancer can be regarded as a group of disease. It is characterized by: (i) abnormal rate of division of cell, (ii) ability of these divided cells to invade adjacent tissues or even distant organs, (iii) eventual death due to the failure in interrupting this rapid division of cells etc. A tumour (mass of dividing cells) is either benign or malignant. A benign growth is localized and never spreads to any other part of the body. It is malignant when it spreads to other tissues (metastasis). This metastatic phase results in increasing interference in metabolic activities of normal cells, which leads to progressive deterioration Major categories of cancer are as follows (i) Carcinoma- rapid division of epithelial cells, (ii) Sarcoma~ rapid division of mesodermal cells, (iii) Lymphoma- when cells of bone-marrow are affected a if Carcinoma ar Initial Symptoms of Caret itil alia ie (i) A lump or hard area at unusual site, ' aenvironmental Studies and 22 ‘The Textbook of E ny Causes of Cancer to 90% of the total cases of Canoe Leite, 5 Ane 80% : (Environmental factors account for 80% 1, air pollution etc. are some of the Smoking of tobacco, consumption of aleohol important factors. or of cancer. Consumption of smoked fish ma, ause bowel cancer, consump, ion f consumption of fibrous fo, Gi) Diet is also a very important fact lead to stomach cancer, Consumption of beef may ¢ of high fat diet may cause breast cancer, Excess 0! (leafy vegetables, legumes etc.) prevents colon cancer. (iii) Occupational factors like exposure to X-ray, cadmium, may also cause cancer. (iv) Some cancers are caused as a result of viral infection. Virus causing Hodkin, disease, T-Cell leukaemia virus and human papilloma virus (HPV) are the common examples. arsenic and chromiym (¥) Cancers like retinoblastoma and leukaemia are genetical in origin. Mongols are more prone to leukaemia. Diagnosis of Cancer Early detection of cancer is the most effective way to fight this killer disease. Proper diagnosis of cancer can be made by: (i) examination of the affected tissues by histological method, (ii) endoscopy of gastrointestinal tract to detect ulceration and tumors, (iii) application of immunodetection method and tumor markers to detect cancerous tissues, (iv) use of DNA probes and (v) use of scanners. Treatment Several innovative treatments have been developed to cure cancer. Most effective treatment is the surgical removal of the affected tissue before metastasis. Chemotherapy and radiation therapy are the other two common methods of treatment to arrest mitosis of the affected cells. However, an early detection makes the disease 100% curable, but in case of late detection after metastasis, chances of survival are almost nil. Hormone therapy has been used for treatment of breast cancer. Several drugs such as BEACOPP, BEAM., Bendamustine (Levact), Bevacizumab (Avastin), Bexarotene (Targretin), Bicalutamide (Casodex), Bleomycin., Bleomycin, etoposide and platinum (BEP). Recent!y Gene therapy has also been introduced for treatment of skin cancer. Genetically developed tumour cells carry a protein called Interleukin-2. This protein, when injected into the affected skin afeas, activates the leukocytes to attack and kill the cancer cells- Immunotherapy is often used as a last resort, once other therapies have reached the end. OBESITY Obesity refers to being fat or having excess fatty tissues (more than required for optimal functioning).Most of us do not consider it asa serious disorder, rather consiuaa tram the point of view of body appearance, while others may think only in a etuced work capacity or inability for aetive participation in sports or other . However, data gathered by Life Insurance € ‘orporation shows that an vidual has shorter life expectancy than the individual having normal weight. vials are more at risk of developing heart disenses, and diabetes mellitus cases ae the main cause of death in obese persons ' Obesity is due to the accumulation of excess fit in t is or she weighs 20 per cent above the ideal body weight ( a anal jg As ky arn he weighs $5 ky ic, higher than 20 percent of his ideal body weight, ), Very often people use another term “overweight” a iynonym for , there is a clear cut distinction between the two terms. The term applied only to persons who weigh 10 per cent to 20 per cent more than the ideal weight, , Risk factors: Obesity is invariably a product of energy imbalance in the imbalance refers to imbalance between energy intake and energy output ‘consume more food (i.e. take in more energy) and do lesser work (ie. spend ~ energy) it would result in energy imbalance in the body. There are several factors ter __asrisk factor as given below. Overeating: Eating too much is a habit with many people. [fone isin the habit “eating more food in general or consuming energy: rich foods like butter, cakes, * pastries, jam, jellies, wafers and other rich snacks and dessert etc, one is likely to ‘weight. Some people prefer to eat less during the meal time, but keep on munching cks in between meals, Total intake of calories goes up in this way and it increases the ossibility ot “Sedentary life-style: Besides food intake another factor which influences the balance of the body is activity pattern. In urban areas, especially the affluent or people tend to have a sedentary lifestyle, Housewives are equipped with ets like vacuum cleaner, mixer, washing machine, etc, to make work. simpler Such people tend to spend or use very litle of calories they have consumed as od. The result is energy imbalance and consequent weight’ gain. pological factors: Some people tend to eat more if they are tense or bored or situations, food becomes the focus of their attention and a means or of tension and boredom. Such people also have a tendency to gain obesity results from an interaction gain and environmental234 The Textbook of Environmental Studies and Disaster Manage = a population. If both the parents are Obese which explain body weight variations in the es the chances that children will be obese rises up t0 80 pet Dietary Management of Obesity : Dietary Dee nace the dietary measures or steps to be taken for the treatment OF a <8 etary management of any disorder/disease has three steps: i) Defining the principles of dietary management ii) Working out nutritional needs (modifications in RDIs) according to the effect o¢ disease on the body and major principles of treatment iii) Dietary management i.e. modifying day’s diet based on changes in RDIs, Principles of Treatment of Obesity : The main principles are- i) _ slow and gradual reduction of body weight. It is closer to ideal body weight ii) maintenance of weight loss achieved iii) prevention of complications like heart disease or diabetes mellitus. iv) _ modifications needed in the amount of energy, protein, carbohydrate, fat, vitamins and minerals for obese persons. Dietary modifications: Energy: Obesity is the result of energy imbalance in the body. So modifications in energy (calorie) needs are important. This modification in energy is not the same in every individual. One has to cut down 500 to 1000 Keal from a day’s diet depending on the individual requirements. In general, a restriction of 500 Keal per day results in a loss of about 450 g (1 pound) a week and 1000 Keal leads to a loss of about 900 g (or 2 pounds)-a week. Protein : Care should be taken to include enough protein-rich foods in the diet. Around 1 g protein/kg body weight can be eaten. Fat : Total fat intake in the form of visible fats needs to be restricted. Saturated fats and cholesterol-rich foods should be avoided, as obese individuals are more at risk of developing heart disease, Vitamins and minerals : Diet should provide vitamin and minerals in adequate amount according to recommended dietary intakes. Restrict total food intake: For the purpose of restriction of total food intake, make a note of foods one (obese individual) eats daily as parts of meals, Don’t forget © count the foods one eats in between meals like biscuits, pastries, a piece of sweet, toffees or chocolates. Calculate the total energy intake. Compare total intake with RDIs. Find out’ the extent of energy restriction required for weight reduction. Start reducing 200- 300 Kcal per day and slowly more restriction can be achieved.The Textbook of Environmental Studies and Disaster Maree me betes and hypertension at lower BMI ranges than those fOF Non-Asian gy, due to predominance of central fat distribution. Consequently, the WHO has supa lower eutoft points for consideration of therapeutic intervention in Asians: a jy 18'S 1023 kwim'represents acceptable risk, 23 to.27.5 kg/m'confers increased risk 27-5 kg/m’or higher represents high ris ang Fat Distribution ‘Central Obesity: In addition toan increase in total body wq sere tonally greater amount of fat in the abdomen or trunk compared withthe hi. ann! lower extremities has been associated with increased risk for type 2 diabetes meljzy ‘hypertension, and heart disease in both men and women. Abdominal obesity is Commonly Teboried as a waist-to-hip ratio. Thus, an overweight person with predominanj, bdominal fat accumulation would be considered “high risk for these diseases. Wor have higher obesity rates than men. DIABETES Diabetes mellitus is a metabolic disorder characterized by an elevation of bloog Sugar (glucose) level. The main factor behind this condition is lack of a hormone calleg insulin. The disease can develop if insulin is present in the body but itis not functional, or if insulin is present but in lesser amounts than that is required by the body, or if there is total lack of insulin in the body. Insulin is secreted by the beta cells of Islets of ‘Langerhans of pancreas. It plays 2 major role in utilization of glucose in the body. If there is deficiency of insulin in the body, glucose cannot be oxidized properly in the body cells. This result in increase in levels of glucose in the blood called hyperglycemia. If accumulation of glucose in the blood is beyond the levels the kidney can retain, it can lead to passage of glucose in the urine called glucosuria. Deficiency of insulin also affects fat and protein metabolism. In ‘such a condition, fat formation in the body decreases and breakdown increases. This leads to accumulation of byproducts of fat metabolism called ketone bodies in the blood, known as Ketosis. As energy is not available from carbohydrates, tissue proteins are also broken down to supply energy to the body. ‘The disease can be divided into two types depending on the insulin status of the body: Type I and Type 11, lerized by absolute e process, Though st for the first time and polyphagia, rapidly followed by dehydration and : The patient requires daily insulin twi insulin for more than 24 hours?Daa ‘The Textbook of Environmental studies and Disaster Manager, e i ikes of prot Structure ; Corona viruses are spherical en Bea tase is 4 spikes help the virus bind to and infect healthy cells Reis emt the ed allow the immune system to identify the virus: Bits of the a RIP specter ly produce antibodies against the virus. These are named for ti e Pe conn ce: their spikes; when seen under a powerful microscope, the sPIKES ee | is the Latin for ‘crown’), Beneath these spikes is @ layer of mem! a ei mh ri can be disrupted by detergents and alcohols. That is why soap, WA's» h sanitizer gels are effective against the virus. Nucleocapsid protein "+ Envelope slycoprotein () RNA spike protein (5) sMiembrane glycoprotein (M) Fig- 4.1 Structure of Covid 19 Inside the membrane is the virus genetic material — its genome. While the of viruses like chickenpox and smallpox are made of DNA, those of corona viruses made of the RNA. RNA viruses have small genomes which are subject to change. These changes, called mutations help the virus adapt to and infect new species. It is thought that the new COVID-19 likely originated from bats but it is known whether mutations allowed this jump from animals to humans. Corona vi are minute, 65-125 nm in diameter and contain a single-stranded RNA as nucleic mat size ranging from 26 to 32kbs in length. ‘The subgroups of corona viruses family are alpha (a), beta (B), gamma (j) delta (6) corona virus. The severe acute respiratory syndrome corona virus (S. \V), HSNI influenza A, HIN 2009 and Middle East respiratory syndrome corona (MERS-CoV) cause acute lung injury (ALI) and acute respiratory distress (ARDS) which leads to pulmonary failure and result in fatality. Current Situation of SARS-CoV-2 Epidemic y In December 2019, the World Health Org. ‘an outbreak of pneumonia in Wuhan, H250, ‘The Textbook of Environmental Studies and Disaster Manageme Causes Influenza viruses travel through the a in droplets when someone with the inf, coughs, sneezes or talks, One can inhale the droplets directly, or pick up the germs, an object — such as a telephone or computer keyboard — and then transfer then eyes, nose or mouth, People with the virus are likely contagious from about a day bef symptoms appear until about five days after they begin. Children and people weakened immune systems may be contagious for a slightly longer time. Influenza is an acute infectious disease of the respiratory tract of man, J incubation period being 1-3 days. These are mostly spherical viruses and multiply, nucleus and cytoplasm. witht PB1, PB3, PA (RNA Polymerase) a HA (Hemagitinin Neuraminidase Lipid Envelope Nuclear Export Protein -NP (Nucleocapsid Protein) Single Stranded-RNA Fig- 4.3 Influenza Virus Types of Influenza Viruses There are four types of influenza viruses: A, B, C and D, Human influenza A and B viruses cause seasonal epidemics of disease (known as flu season) almost every winter. Influenza A viruses are the only influenza viruses known to cause flu pandemics, i.e., global epidemics of flu disease. Influenza C virus infections generally cause mild illness and are not thought to cause human epidemics. Influenza D viruses primarily affect cattle and are not known to infect people. Influenza Viruses” graphic for a visual depiction of classification Influenza viruses are constantly changing, with new strains appearing regularly. If you’ve had influenza in the past, your body has already made antibodies to fight that specific strain of the virus. If future influenza viruses are similar to those you've encountered before, either by having the disease or by getting vaccinated, those antibodies may prevent infection or lessen its severity. Also, antibodies against influenza viruses ‘one has encountered in the past may not protect from new influenza strains that can be very different viruses. Saidies and Disaster Ma, of Environmental Stud The Textbook Asthma flare-ups * Heart problems © Ear infections * Acute respiratory distress syndrome Pneumonia is one of the most serious Com) with a chronic illness, pneumonia can be deadly. plications. For older adults and pe le Prevention revention (CDC) recommends 1, fhe flu vaccine can reduce the Tisk of g serious illness from the fly i. The Centers for Disease Control and P vaccination for everyone age 6 months or older. Th the flu and its severity and lower the risk of havin needing to stay in the hospital. ortant this season because the flu and coron, lar symptoms. Flu vaccination could reduce e caused by COVID-19. Preventing the fly so lessen the numb Flu vaccination is especially imp’ virus disease 2019 (COVID-19) cause simil: symptoms that might be confused with thos and reducing the severity of flu illness and hospitalizations could al of people needing to stay in the hospital. This year’s seasonal flu vaccine provides protection from the four influenza viruses that are expected to be the most common during the year’s flu season. The vaccine will be available as an injection and as a nasa spray. ‘The nasal spray isn’t recommended for some groups, such as: Children under 2 years, adults 50 and older, pregnant women, and people with weakened immune systens. Controlling the spread of infection The influenza vaccine isn’t 100% effective, so it’s also important to take several measures to reduce the spread of infection, including: Wash your hands. Washing your hands often with soap and water for at least 20 seconds is an effective way to prevent many common infections. Or use alcohol- based hand sanitizers if soap and water aren’t available. . Avoid touching your face. Avoid touching your eyes, nose and mouth. . Cover your coughs and sneezes. Cough or sneeze into a tissue or your elbow. Then wash your hands. © Clean surfaces. Regularly clean often-touched surfaces to prevent spread of infection from touching a surface with the virus on it and then your face. ° Avoid crowds, The flu spreads easily wherever people gather — in child c=" centers, schools, office buildings, auditoriums and public transportation. 8! avoiding crowds during peak flu season, you reduce your chances of infetio™id Di 254 Tre Texbook of Environmental Studies and Disaster Mansgene, Hepa is D irus It is one of the severe liver diseases that are caused by @ virus Hepatiti, 1 poh Nt in conjunction.” spreads from infected blood or wound. Sometimes it might occur In conjunction With Hepatitis B, Hepatitis E This isa waterborne disease spread by the said virus. It ee circulated throug, food, water, and contaminated blood. It could be either acute or chronic. Dietary Recommendations for Viral Hepatitis eased carbohydrate, protein and moderate fat diet is advised in the case of viral hepatitis with vitamin and mineral supplementation. Carbohydrates: Liberal ini, of CHO is advised (300-400 g). This is to prevent endogenous breakdown of pro thus leaving a protein sparing effect, increase the (intra hepatic) glycogen stores ; improve the functioning and protect the liver against infecting agents. Proteins: Moder. Protein intake in the diet is required for the following reasons: - to prevent nezative y» balance, which may lead to hypoproteinemia, - for adequate tissue regeneration especialy of parenchymal cells; and - prevent fatty infiltration of liver cells. Fats: Fats should no. be severely restricted, about 20% of the total calories should be from Fat. Vitamin Supplementation of B complex, vitamin and C should be given. Minerals: Sodium restriction is required only if there is fluidretention. Potassium supplements are necessary with diuretic therapy. Iron supplementation is néeded only if there is anaemia. Bacterial hepatitis Bacterial infection of the liver commonly results in pyogenic liver abscesses, acute hepatitis, or granulomatous (or chronic) liver disease. . to Pyogenic abscesses commonly involve enteric bacteria such as Escherichia coli and Klebsiella pneumoniae . Acute hepatitis is caused by Neisseria meningitidis, Neisseria gonorrhoeae, Bartonella henselae, Borrelia burgdorferi, salmonella species, brucella species and campylobacter species. Chronic or granulomatous hepatitis is seen with infection from mycobacteria species, Tropheryma whipplei, Treponema pallidum, Coxiella burnetii and rickettsia species. Metabolic/Alcoholic hepatitis Excessive alcohol consumption is a significant cause of hepatitis and is the most common cause of cirrhosis in the U.S. Alcoholic hepatitis is within the spect of aleohoi liver disease, This rangesin order of severity and reversibility rom alsi* steatosis (least severe, most reversible), alcoh m (most severe, least reversible) Hepatitis usu= “The ‘Textbook of Environmental Studies and Disaster Man ‘occurrence and spread of tuberculosis. Infact, tuberculosis began to decline in the world long before the advent of chemotherapeutic drugs. This has been attribute Improvements in the quality of life. ; The control of Tuberculosis: The control of any infectious disease has thy.) components namely prevention, promotion and curative. The preventive componeny is the BCG vaccination. However, the preventive component becomes successful jn end unless it combined with the promotion component that targets the social factor, improving the quality of life. The third component, the curative aspect includes prop. case finding through standardized diagnostic pattern and treating. Diagnosis : The symptoms of tuberculosis are = a) persistent cough of about 3 or 4 weeks b) continuous fever ©) chest pain 4) haemoptysis (expectoration of blood or bloody mucus). Any person who voluntarily attends any health centre with these symptoms should be taken for a sputum-smear examination. The sputum culture examination will yield the results that reveal the status of the patient and if tested tuberculosis positive, chemotherapy is administered with anti-tuberculosis drugs. Patient compliance is critically important; the patient must take the correct drugs at the correct dosage for the correct! length of time. Incomplete treatment puts the patient at the risk of relapse and development of bacterial resistance and, the community at risk of infection with resi: organisms. ‘Treatment Major Health Problems: Combating tuberculosis in India has long been at forefront of the global battle against tuberculosis. Communicable and Directly ‘Treatment Short-Course (DOTS) is a five-point strategy. DOTS, if implemented correctly can prevent multi-drug resistance. DOTS is also effective among infected patients. challenge in the years ahead is to maintain the pace and quality of the programme achieving national coverage so that tuberculosis is no longer a. significant public problem in India. In Pioneering studies at the Tuberculosis Research Centre, and the National Tuberculosis Institute, Bangalore established the principles tuberculosis control, which are followed even to this day the world over. These princi288 The Textbook of Environmental Studies and Disaster Many, ey . ; ; al envelop is Sapsid. It is further covered by a loose viral membrane. The v IS made y, {0 glycoproteins called GP 120 and GP 41. These glycoprotein units on the sitet “tts, gives the typical horse-chestnut image to the virus when viewed from the Outs The outer surface appears to be spiked with dots. HTV belongs to the family ret, 1% Ns genetic material is RNA. The HIV has an enzyme called reverse transcriptase Which 'S capable of synthesizing DNA from the RNA in the cell. Modes of ‘Transmission HIV remains in blood, sexual secretions and other body fluids of infected Persone The main modes of transmission of HIV from one person to other are by (i) g, Kua intercourse, it) blood transfusion, blood products and contamination of equipmen ang (iii) through infected mother to child. (Sexual Intercourse: About 75% of the total HIV infection is through sexuay "ntercourse, Usually transmission occurs through semen, vaginal fluid and ceryica) secretions. (i) “Transmis sion through blood t rans fus ion, blood product s and contaminated equipment : HIV enters the body of a healthy person through contaminated blood, blood products or through unsterilised needles. Contaminated needles and syringes are the most common source of infection among drug addicts. (iii) Infected mother to Child : One third of world’s AIDS patients are infants ‘Transmission of HIV from pregnant mother to child may occur before, during or after birth. It can also occur through breast milk. Life Cycle of HIV Infection of HIV begins with contact between the viral particle envelope and the cell membrane of the new host cell. The viral RNA (chromosome) enters into the new host cell. By the action of the enzyme reverse transcriptase a DNA strand complementary to viral RNA is synthesized resulting in the formation of a RNA/DNA hybrid. This mechanism is called reverse transcription. The reverse transcriptase possesses RNAas? activity by which it degrades the RNA strand of the RNA/DNA hybrid. Another enzyme called DNA polymerase synthesizes a complementary DNA strand from the single new DNA strand, Thus, a double stranded DNA is formed. This double stranded DNA is then linearly integrated into the host chromosome. Now it is named as provirus. The provirus can be replicated along. with the host chromosome through many somatic cell generations, The provirus by transcription forms (i) viral RNA chromosome and (ii) viral messenger RNA. The viral messenger bY translation forms viral envelope, The viral RNA chromosome and viral envelope integrate t anew HIV which now attacks new host cells. i :pic Health Management HIV Life Cyde 1 binding Fig- 4.5 The Life Cycle of HIV Pathogenicity ‘The HIV is pathogenic in humans but notin other animals, The virus can’t survive for more than one minute outside the human body. The most dangerous characteristic of HIV provirus is that it may remain inactive for a long duration without showing any clinical symptom of its presence. This period is called incubation period which may range from several months to several years, The HIV does not, by itself, produce any pathogenicity in human beings. The virus attacks the immune system leading to depletion of T lymphocytes, resulting in Immuno-deficiency. Some of the T lymphocytes have a membrane protein called CD4. Lymphocytes with CD4 membrane protein are called CD4 positive T cells. CD4 positive T cells make up the major lymphocytic population. Healthy human beings have about 1000 such CD4 positive T cells in every cubic millimeter of blood. In HIV infected individuals this number declines by an average of about 40 to 80 every year. Basing on CD4 positive T cell count, the Centre for Disease Control (CDS) has classified HIV induced infection into the following four categories. First Phase: This stage is known as sero conversion illness which starts 15 to 30 days after infection by HIV, The symptoms are flu-like ilness with fever, headache, nightsweats etc, Commonly this phase passes unnoticed by the infected person. ‘Second Phase: This phase i also known as immune- depletion stage, The number of CD4 positive T cells is reduced to about 500 per eubie millimeter of blood. The persons look healthy and may not be aware ofcarying HIV. But they are capableCCC _—_—— i id Di =" a of Environmental Studies and Disaster a, the covering of peripheray ,, sontinue for a few years, of infecting others, At this stage, damage t0 Paralysis of cranial nerves occur which may eontiny depleti (il) Third Phase: This phase is known as intermediate ae as = Stage The CD4 positive T cell count drops down from 400 to rh, be I ned foe blood. The patients develop painful sores an "eh sweat, weight loss and diarrhoea. ; (ix) Fourth Phase: This phase is known as advanced immune depletion sia, CD4 positive T cell count falls below 200 per cubic millimeter of bloc, Patiem develops chronic diarrhoea, respiratory infection Problem and cent, nervous system toxoplasmosis due to brain infection. The major sign for case definition of AIDS in adult are : (a) weight loss greater than 10% of weight, (b) prolonged fever for more than one month, (c) chronic diarrhie, . ‘more than one month, (d) persistent cough for more than ane month, () ,,, irritation and itching, (1) swelling of lymph glands etc. Diagnosis Enzyme Linked Immuno Sorbent Assay (ELISA) test is conducted for diagno, of HIV— infected persons. However, Western Blot Test is the confirmative test for AIDS, Treatment Zidovudine delays the progress of AIDS, but can’t cure it. It inhibits the action of reverse transcriptase which helps in the multiplication of the virus. Prevention of HIV Infection : Since there is no treatment for HIV, prevention is the only means to keep away from AIDS and the following precautions may be taken. ) Sterilization, disinfection of syringes and other medical instruments should be done before use. Blood banks should test the blood for HIV before it is given toa Patient. The transfused blood should be HIV free. (ii) HIV infected females should avoid to become ‘mother, because their children would have a high risk of HIV infection, (iii) The most common and dominant mode of HIV infection in India is by heterosexual intercourse, Therefore, adolescent boys and girls should be given proper sex education and should adhere to “No sex” before Marriage, Monogamy after marriage is the best way for safe sex. To achieve the objective in AIDS control, Government of India has constituted National AIDS Control Board (NACB), National AIDS Committee (NAC), National AIDS Control oO ion (NACO) etc, To combat against this killer virus the AIDS it of every December to ereree aa gee ee264 The Textbook of Macrophages : These have the system. They release certain signals as cytokines infections, la ory to recruit other cells at the Site of Mast Cells : These are important for healing wounds and defence against infection, Neutrophils : These contain granules that are toxic in nature and Kill any pathos, that comes in contact Eosinophils : These contain highly toxic prov 1m contact Basophils: These attack multicellular paras histamine. A Natural Killer Cells: These stop the spread of infections by destroying the infeciog host cells. Dendritic Cells: These are located in the tissues for initial infections. These cel, Sense the infection’ and send the message to the rest of the immune system by antigen presentation. Acquired Immunity ins that kill any bacteria or pari, ites. Like the mast cells, these rele. The ability of the immune system to adapt itself to disease and to generate pathogen. specific immunity is termed as acquired immunity. It is also known as adaptive immunity Acquired immunity is the immunity that the body acquires or gains over time; not present at birth. An individual acquires the immunity after the birth, hence is called as the acquired immunity. It is specific and mediated by antibodies or lymphocytes which make the antigen harmless. The main function of acquired immunity is to relieve the victim of the infectious disease and also prevent its attack in future. It mainly consists of an advanced lymphatic defense system which functions by recognizing the own body cells and not reacting to them. The immune system of body identifies the pathogens which it has encountered in the past. When a person comes in contact with the pathogen or its antigen, the body starts producing antibodies to engulf the pathogen and destroy its antigen. When it encounters for the first time, it is called a primary response. Once a body gets used to these pathogens, antibodies are ready to attack them for the second time and are known as naturally acquired immunity. Features of Acquired Immunity Specificity: Our body has the ability to differentiate between different types of pathogens, and devise ways to destroy them, “Diversity: Body can detect vast varieties of pathogens, ee om protczos viruses. Differentiate between self and pppoe = a differentiate between its own cells and foreign cells. It o foreign celin the body. . :tat Studies and Disaster Manager, yer it 266 The Textbook of Environ Passive Immunity the antibodies attained from Passive immunity involves the imm it encounters is a} outside the boy The nary response by the body (08 ease PTE iscase 55 a little harsh on the body. While active immunity ™aY re body could begin its ata, lifetime passive immunity develops immediately so that ck oon the pathogen right away. There are two types of passive immunity + . Natural Passive Immunity wane response BY * Artificial Passive Immunity Auto-Immunity Sometimes the immune system attacks its foreign agents. This is called autoimmunity. Type! disease. Herd Immunity Herd immunity, also known as ‘population immunity’, or community immunity or mass immunity is the indirect protection from an infectious disease that happens when a population is immune either through vaccination or immunity developed throu; previous infection. The WHO supports achieving ‘herd immunity’ through vaccination, not by allowing a disease to spread through any segment of the population, as this would result in unnecessary cases and deaths. Achieving herd immunity with safe and effective vaccines makes diseases rarer and saves lives. Herd immunity is the indirect protection from a contagious infectious disease that happens when a population is immune either through vaccination or immunity developed through previous infection. This means that even people who aren’t vaccinated, or in whom the vaccine doesn’t trigger immunity, are protected because people around them who are immune can act as buffers between them and an infected person. Once herd immunity has been established for a while, and the ability of the disease to spread is hindered, the disease can eventually be eliminated. This is how the world eradicated smallpox. Challenges in creating herd immunity The more infectious a disease, the greater the population immunity needed to ensure herd immunity. For example, measles is highly contagious and one person with measles can infect up to 18 other people, This means that around 95% of people need to be immune in order for the wider group to have herd immunity. The new corona virus has a lower infection rate than measles, with each infected person passing it on to two or three new people, on a immunity should be achieved when around 60% of the pr COVID-19. ‘own tissues and organs instead of the diabetes is an example of autoimmune —268 book of Environmental Studies and Disaster Managem, = ‘The Textboo! to 28 days, depending on the paras, ic incubation period of that parasite Ita he extrinsic incubation period, then she for development in the mosquito ranges from a species and the temperature. This is the extrinsi female mosquito does not survive longer than t will not be able to transmit any malaria parasites. «the parasite to a human body via a bite, But ifa mosquito suecessfully transfers the pa esis ine” the parasite starts developing. The time between thi fe atiinsc incu, human and the development of the first symptoms of malar Es period. PREVENTION OF EPIDEMIC AND PANDEMIC DISEASES PREVENTING MEASURES lon, Quarantine Quarantine is the separation and restriction of movement of people Who have Potentially been exposed to a contagious disease, to limit the spread of the disease This differs from isolation, which applies to people who have been pigemosed With the disease, although the terms are sometimes used interchangeably. Particularly during the early stages of outbreak of a new infectious disease, quarantine is applied to large numbers of people. The early stages of the COVID 19 outbreak in the year 2020 have already witnessed the quarantining of entire India. Thousands of Indians were asked to enter quarantine at home or in government facilities upon return to foreign countries. Entry of foreign nation nationals was totally banned at that time. Quarantine protocol One of the major factors affecting adherence to quarantine is knowledge about the infection and the quarantine protocol. Parents who understood what they were meant todo during the quarantine period for infectious disease had significantly higher adherence to quarantine. Social norms and cultural values play an important part in adherence to quarantine protocols. Many individuals quarantined during the COVID 19 outbreak reported social pressure from others to adhere to quarantine. Residents also acknowledged a respect for the collective commitment to protect the community against the disease. However, social norms can also reduce adherence to quarantine, As rumors spread that others were breaking quarantine rule, those affected also declined to follow quarantine protocols themselves. Benefit of quarantine People who perceive a benefit of quarantine are example, as residents began to notice a slowing. changed and adherence to quarantine protocol happened. People became relaxed, careless. no longer observed the rules. More likely to adhere to it. Forss and Disaster Ma = “The Textbook of Environmental Studies 3 a Ordinary breathing and speech generate a large amount aa - ete aerosols. The particle generated during human exhalation a eee Sneezing and breathing are two floating droplets emerging from Whe OWN And/or nose The rate of particle emission during normal human speech is up to 50 particles. Furth, the velocity, number, and size distribution of the infectious droplet play an importn, role in virus transmission, Natural human breathing and talking produce a jet velocity of 4.5 mvs. Coughing Produces 10-100 times lesser droplets than sneezing. The cough droplets travel with , lesser velocity of approximately 10 m/s. The average diameter of a corona virus is 65 125 nm. The respiratory droplets are in the size of > 5-10 pm ie., one small vir, droplet carrier can hold around 77 Corona viruses. These airborne viruses contaminate the atmosphere and settle on surfaces. This indirectly hints at the capacity of the infecteg Surface in spreading the virus. Since salivary droplets take longer time to evaporate than Water droplets, caution must be taken about the viral spread from droplet. Sanitization has so far played an important role in containing the spread and in Testoring everyday life albeit on a smaller scale. The overall sanitizing action is to weaken the virus by depleting the lipid membrane using a disinfectant and remove it from the Surface. The mechanism involved in sanitization uses either one or both of these steps (@ mechanical or thermal treatment and/or (ii) use of virucidal /anti-microbial agents to decontaminate the body part, object or surfaces. The following figure explains the transmission routes along with the categories of sanitization. Figure 4.7 gives a detailed list of methods used for sanitization and disinfection of COVID-19 infected people, objects and spaces. Individual Space Object Sanitization || Sanitization || Sanitization Fig- 4.7 Objects of Sanitization Individual Sanitization Reon lp Sanitization is a practical approach to tackle: sil ination. Individual sanitization helps jental studies and Dissster Manage, nt rr rnd the strain ofthe virus. It is repo, type of surface, relative humidity, temperature "ste for up t0 72 hours, Whit that viruses on plastics and stainless surfaces cOUIMBE YE ive coy gous ‘on copper and cardboard surface, the virus is less eee teal within a mi ¥ and 24h, respectively, The contaminated surfaces can Pe 71% ethanol, 0.5% hydr, me using common surface disinfection procedures with 62°77) * a ec peroxide, or 0.1% sodium hypochlorite, The ee naa ee for sanitizing surfaces: (i) mops, (ii) sprays. and (iii) UV Wet Mops Chemical disinfectants applied to floors, doorknobs, table surfaces and surfaces in domestic and office use can be used to deactivate the corona ye me ee Moist mopping is superior to all other methods. Wet mops, moistened wit y isin fect : Ee Perform the dual role of mechanical removal and disinfection due to inactivation of the virus be Jets and Sprays ui Surfaces that are not accessible for mopping can be cleaned using jets and sprays, An acrosol created using disinfectant and the base fluid combination can be used to spray the inaccessible areas. The nanometer-sized corona embedded in micron sized cough droplets can easily reach inaccessible areas when an infected person coughs or sneezes. So.a proper use of spray and jet should be employed to disinfect such inaccessible surfaces. UV LED-Based Treatment For disinfecting N95 masks ultraviolent irradiation is one of the best options to disinfect and decontaminate surfaces and inanimate objects, like clothes, utensils, medical instruments Fumigation 8 Fumigants have been traditionally employed for a long time for their germicidal tendencies. The sporicidal and virucidal tendencies of fumigants have also been observed. Fumigation using ozone gas and chlorine dioxide have been found to be effective for the influenza virus. Human noroviruses (HuNoV) which also transmits through human contact and contaminated surface’ can be disinfected using hydrogen peroxide fumigant. . Paraformaldehyde has also been used for highly pathogenic viruses. It is advisable 10 properly ventilate the surrounding and renew the air before human use. Clean high touch surfaces at least once a day or as often as determined is necessary. Examples of high-touch surfaces include pens, counters, shopping carts, tables, doorknobs, light switches, handles, stair rails, elevator buttons, desks, keyboards, phones, tiles, fauce and sinks. cnnmtgee ae