The Resurgence of Infectious Diseases

COMMUNITY AND PUBLIC HEALTH 2022

• RESURGENCE: increase or revival after period of little activity or occurrence

1. HIV (HUMAN IMMUNODEFICIENCY VIRUS)/AIDS (ACQUIRED IMMUNODEFICIENCY SYNDROME)

❖ Retrovirus (RNA): uses RNA as its genetic material instead of the more usual DNA.
o Have long been known to cause cancer in animals and further studied that causes
human cancer.
o Infect cells by copying their RNA into the DNA of the cell, penetrating the genetic
material.
o May take over control of the cells machinery causing the uncontrolled reproduction
typical of cancer.
❖ CD4-T lymphocyte (T4 Cells): target cell of HIV, a white blood cell.
▪ Activated when the body recognizes foreign invader such as bacterium or virus.
▪ ROLE: divide and reproduce itself in response to such an invasion and to attack the
invader.
▪ T4 CELL THAT IS INFECTED WITH HIV: activation of the cell activates the virus also, which
then reproduce thousand of copies of itself in a process that kills T4 cells
▪ Destruction of the T4 cells disrupts the entire immune system.

❖ ACUTE INFECTION:
▪ Large amount of the virus is being produced in your body.
▪ Many, but not all people develop flu-like symptoms often describes as the “worst flu ever”
❖ CLINICAL LATENCY:
▪ During this stage, HIV reproduce at very low levels, although it is still active
▪ You may not have symptoms. With proper HIV treatment, people may live with clinical
latency for several decades.
▪ Without treatment, this period lasts an average of 10 years but some people may progress
through this stage faster

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❖ 1985 (LICENSING OF SCREENING TEST)
o Major step forward in the fight against HIV
o Relatively fast and inexpensive, sensitive, giving the first indication that the individual
may be HIV positive.
o PURPOSES:
❖ Diagnosing individuals at risk to determine whether they are infected So that
they may be appropriately counseled, if necessary, treated
❖ Monitoring the spread of HIV In various populations via epidemiologic studies
❖ Screening donated blood or organs to ensure that they do not transmit HIV to
a recipient of transfusion or transplant.
o WINDOW PERIOD: major drawback of the antibody screening test; absence of
antibodies in the 3-6 weeks period after infection.

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 oMEASUREMENT OF VIRAL LOAD:
▪ Test the direct measure of virus in the blood,
▪ Concentraton of virus in the blood
▪ Valuable tool for evaluating the effectiveness of therapeutic drugs.
❖ TREATMENT/DRUG FOR HIV

o HAART- HIGHLY ACTIVE ANTIRETROVIRAL THERAPY: Reduce viral load to undetectable levels
in the blood and body fluids
o COMBIVIR (protease inhibitor): interfere with the ability of newly formed viruses to mature
and become infectious.
❖ THE MOST EFFECTIVE WAY TO FIGHT AIDS IS TO “PREVENT TRANSMISSION”

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2. EBOLA

❖ 1976, before AIDS, silently spreading into African cities caused by unidentified Ebola virus.
Several hundred people and up to 90% of the victims died. The disease spread rapidly from 1
person to other affecting family members and hospital workers who had cared for patients. In
Africa, people have developed Ebola after handling infected animals found ill or dead, including
chimpanzees, gorillas, fruit bats, monkeys, forest antelope, and porcupines; 800 Africans have
died since 1995.
❖ 1989 Philippines to United States: a large number of monkeys imported from Philippines to US,
died of the viral infection.
❖ Outbreaks in human have been preceded by the discovery of dead animals near villages where
outbreak occur. It is highly contagious and infects humans and monkeys.
❖ Declines population of Gorillas and Chimpanzees.
❖ Former name: Ebola Hemorrhagic Fever
❖ Family: Filoviridae
❖ Ebola is considered a zoonotic virus, meaning that it originated in animals and then spread to
humans. There is currently no vaccine available for Ebola, although several are in development.
❖ Mode of transmission: close contact with the blood, secretions, organs or other body fluids of
infected animals (human-to-human transmission)
❖ Incubation period (appearance of signs and symptoms after the exposure): It ranges from 2 to
21 days.
❖ Signs and Symptoms: fever, headache, joint and muscle aches, weakness, diarrhea, vomiting,
stomach pain, lack of appetite
❖ Laboratory Tests: low white blood cell and platelet counts and elevated liver enzymes.

3. MONKEYPOX
❖ May and June 2003: Received report of a disease similar to smallpox among people who had
direct contact with prairie dogs.
❖ From Africa.
❖ Primary host: RODENTS
❖ Raised alarms about EXOTIC PETS.
❖ Not highly contagious in human and less severe disease than smallpox. No one died in the
outbreak
❖ The illness was traced back through PET STORES and ANIMAL DISTRIBUTORS.
❖ Source: Rainforest countries of central and west Africa
❖ The disease was discovered in laboratory monkeys in 1958.
❖ Causative Agent: Monkeypox is caused by Monkeypox virus, which belongs to the
orthopoxvirus.
❖ Signs and Symptoms: Similar to smallpox, except that enlargement of lymph node.
❖ Mode of Transmission: animal bite or direct contact with the animal's lesions or body fluids
❖ Treatment: No treatment, vaccine for smallpox may reduce the risk.

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4. HANTAVIRUS PULMONARY SYNDROME (HPS)

❖ Caused by Hantavirus, a virus carried by DEER MICE (white-footed mice); named after the
Hantaan River in Korea, the hantavirus was responsible for kidney disease among thousands of
American soldiers in Korea during the 1950s. It also causes respiratory disease in humans.
❖ 1993-2011 (New Mexico):
o CDC was called when in when 2 healthy young New Mexico residents living in the same
household died suddenly within a few days of each other of acute respiratory distress,
their lungs filled with fluid.
❖ 587 cases in 34 states (1/3 have died in a matter of hours)
❖ Adding HPS in the list of notifiable disease will help medical workers to recognize it more rapidly
because there was this incident in Rhode Island, college students have contacted with a rodent
while making a film at his father’s warehouse, the hospital did not recognize that he was
seriously ill and sent him home from the emergency room the first time he appeared there, 2
days later he turned much sicker, and he died 5 hours after being hospitalize.
❖ Mode of Transmission: Airborne, Person-to-person: The rodents shed the virus in their urine,
droppings, and saliva; The virus is mainly transmitted to people when they breathe in air
contaminated with the virus.
❖ Signs and Symptoms: fatigue, fever and muscle aches, especially in the large muscle groups—
thighs, hips, back, and sometimes shoulders.
❖ Incubation Period: 1 and 8 weeks
❖ Diagnosis and Treatment: There is no specific treatment, cure, or vaccine for hantavirus
infection
5. WEST NILE VIRUS
❖ Encephalitis: an inflammation in the brain
❖ The disease was suspected to be St. Louis Encephalitis (a mosquito borne disease that is
endemic in southern US). West Nile virus (WNV) is the leading cause of mosquito-borne (fed on
infected birds) disease in the continental United States. The great number of dead CROWS were
being found in the area, and there are reported deaths in Zoo’s exotic bird but St. Louis
Encephalitis was not known to infect birds.
❖ The diagnosis was supported by the patients reports that they had been outdoors in the evening
during peak mosquito hours.
❖ Well-known in Africa, West Asia, and The Middle East.
❖ Mode of Transmission: Vector-borne
❖ Signs and Symptoms: don't develop signs or symptoms.
o Some people develop a life-threatening illness that includes inflammation of the spinal
cord or brain.
o Some people also develop fever and mild headache.
❖ Incubation Period: 2-14 days
❖ Diagnosis and Treatment: No treatment, only to increase immune system

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6. HEMORRHAGIC FEVER WITH RODENTS AS CARRIER
❖ Bolivian Hemorrhagic Fever (Machupo Virus):
▪ Causative Agent: Machupo mammarenavirus
▪ Signs and Symptoms: Slow onset with fever, malaise, headache and myalgia (muscle pain),
very similar to Malaria symptoms.
▪ Prevention: Rodent interaction
▪ Treatment: No specific treatment

❖ Argentine Hemorrhagic Fever (Junin Virus):

▪ Incubation Period: 10-12 days
▪ Causative Agent: Junin Virus
▪ Signs and Symptoms: fever, headaches, weakness, loss of appetite

❖ Lassa Fever
▪ Incubation Period: 7-21 days
▪ Causative Agent: Lassa Virus
▪ Signs and Symptoms: 80% of those who are infected little or no symptoms occur
o Mild symptoms may include fever, tiredness, weakness, and headache.
o 20% of people more severe symptoms such as bleeding gums, breathing problems,
vomiting, chest pain, or dangerously low blood pressure may occur.
o Long term: Deafness

7. MOSQUITO-BORNE DISEASES

❖ Yellow Fever

▪ Flavivirus, family: Flaviviridae

▪ Transmitted through mosquito bite.
▪ Fever and jaundice (eyes and skin).
▪ Found in Africa and South America.
▪ Incurable, prevented by vaccine.

❖ Eastern Equine Encephalitis:

▪ Approximately 30% of people with EEE die and many survivors have ongoing neurologic
problems.
▪ Prevention: Prevent mosquito bites
▪ Causative Agent: genus Alphavirus, family Togaviridae
▪ Incubation Period: 4 to 10 days.
▪ Signs and Symptoms: febrile illness or neurologic disease
▪ Treatment: No treatment

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 ❖ Dengue Fever

▪ Area: tropical and subtropical areas of the world

▪ Causative Agent (Mosquito): Aedes aegypti (Zika, Chikunggunya)
▪ Types: Dengue 1, 2, 3, 4
▪ Transmission: Mosquito bite, Mother to child (pregnant)

8. INFLUENZA

❖ 1918-1919: killed 20-40 million worldwide; 196,000 (US in October)

❖ 1957: ASIAN FLU (70, 000 died)
❖ 1968: HONGKONG FLU
❖ 1976: SWINE FLU (China)
❖ 1997: 3-year-old Hong Kong boy died from influenza that normally infected chickens.
▪ 24 became sick and 12 died.
▪ 1.5 million chickens in the territory be killed.
❖ 2010: AH1N1 (influenza A virus subtype H1N1)
❖ Animal Reservoirs: Pigs and birds; common in China, living in close proximity to humans
❖ Influenza or Flu may seem like an old familiar infectious disease. However, it can be a different
disease from 1 year to the next and has the capacity to turn into a major killer.
❖ Vaccination: effective and must be changed annually against new strain.
❖ RNA Virus; constant changing its appearance and adapt at eluding recognizing by the human
immune system.

9. NEW BACTERIAL THREATS

❖ ANTIBIOTIC RESISTANCE: Bacteria, which in a few decades ago seemed easily controllable
because of the power of antibiotics to wipe them out. Some ordinary bacterial infections have
turned unexpectedly lethal, a great cause for concern is the development of RESISTANCE to
drugs
❖ LEGIONNAIRES’ DISEASE: (Legionella) flourish in water towers used for “Air Conditioning”.
o Severe form of pneumonia.
o Lung inflammation usually caused by infection.
o Incubation period: 2-10 days
o Signs and Symptoms: Headache, Muscle aches, Fever that may be 104 F (40 C) or higher
o Severe: Gastrointestinal symptoms, such as nausea, vomiting and diarrhea, Confusion or
other mental changes
o Mild Form: PONTIAC FEVER

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 ❖ LYME DISEASE: spirochete that is spread by bite of infected deer tick.
o RESERVOIR: White-footed mice
o Tick-borne disease
o Causative Agent: Borrelia burgdorferi and Borrelia mayonii (United States)
o Borrelia afzelii and Borrelia garinii (Europe and Asia)
o Signs and Symptoms: EARLY STAGE: Rash, fever, chills
LATER STAGE: Joint Pain, Neurological problem
o Carrier: DEER TICKS
o Attached: 36-48 hours
o Prevention: Early removal of ticks
❖ GROUP A STREPTOCOCCI: “flesh-eating bacteria” that infect the wounds to the extent of
amputation or even death; Group A Streptococci: Streptococcus pyogenes

10. PRIONS

❖ Contain protein but no nucleic acid; abnormal, pathogenic agents that are transmissible and are
able to induce abnormal folding of specific normal cellular proteins called prion proteins
❖ Found most abundantly in the brain.
❖ Abnormal folding of the prion proteins leads to brain damage and the characteristic signs and
symptoms of the disease
❖ Prion diseases are usually rapidly progressive and always fatal.
❖ Not Bacteria nor Virus, Not living but very dangerous.
❖ CREUTZFELDT-JAKOB DISEASE (CJD) 1990s
o Rapid progressive disease and always fatal. It destroys brain cells, and it causes tiny
holes in the brain.
o It has no cure
o After appearance of signs and symptoms, a maximum life expectant is 1 year.
o Incubation Period is long, and can take up to 40 years.
o Signs and Symptoms: dementia, or spasmodic involuntary movement of muscle groups,
mood and behavior changes
o Cause: Mutation in the egg or sperm cell, Acquired: Organ transplant
o brain becomes spongy on autopsy
o Caused by Prions (contain protein but no nucleic acid); discovered by Stanley Prusiner in
1997.
❖ BOVINE SPONGIFORM ENCEPHALOPATHY (BSE) 1996
o “Mad-cow disease”
o The disease was spread by the practice of grinding up discarded animal parts and adding
them to feed for other cattle
o It killed 160, 000 cattle in Britain. The British government ordered the mass slaughter of
all at-risk cattle to prevent the possibility of human exposure to infected beef.
o Transmission: Food consumption (Cow)
o Infects: Cattle, Humans, Cats
o Symptoms: damages brain tissue and causes the characteristic symptoms of CJD.
o 2009 (217 cases had been reported)

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PUBLIC HEALTH RESPONSE TO EMERGING INFECTIONS

❖ Institute of Medicine: undertaken several studies to address the environmental, demographic,

social, and other factors (factors leading to the emergence or re-emergence of infectious
disease)

❖ CONCLUSION: Most of the emerging infectious disease events have been caused by “zoonotic
disease pathogens” (those infectious agents that are transmitted from animals to human)

❖ FACTORS THAT CONTRIBUTE TO THE RISK OF ANIMAL TO HUMAN TRANSMISSION:

▪ Human population growth.

▪ Changing patterns of human-animal contact.
▪ Increased demand for animal protein.
▪ Increased wealth and mobility.
▪ Environmental changes.
▪ Human encroachment on farmland and previously undisturbed wildlife habitat.

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