Emerging and re-

emerging disease
1.Discuss the infectious diseases in
global, in Western Pacific region and
in Malaysia and their trend in recent
years.
List of infectious diseases that • Hepatits A
occur globally : • Hepatits E
• Lassa fever • Soil-transmitted helminthes
infection
• Tuberculosis • Foodborne tremodiases
• Measles • Ebola virus disease
• Hepatits C
• Meningococcal meningitis • Yellow fever
• Chikugunya • Dengue and sever
dengue
• Malaria
• Trachoma
• Plague • Chagas disease (
• HIV/AIDS American
trypanosomiasis)
• Pneumonia • Lymphatic filariasis
• Rubella • Onchocerciasis
• Trypanosomiasis ( sleeping
• Poliomyelitis sicknesss)
• Rabies • Dracunculiasis(guinea-
• Hepatits B worm disease)
• Echinococcosis
 Vector-borne diseases
 Avian influenza
 Influenza (seasonal)
 Cholera
 Yaws
 Leprosy
 Leishmaniasis
 Diarrhoeal diseases
 Taeniasis/cycticecrosis
 Crimean-congo haemorrhagic fever
 Marburg haemorrhagic fever
 Monkeypox
 Rift Valley fever
 smallpox
Tuberculosis
 Tuberculosis (TB) is a top infectious disease causing death.
 In 2014, 9.6 million people fell ill with TB and 1.5 million died from the
disease.
 Over 95% of TB deaths occur in low- and middle-income countries,
and it is among the top 5 causes of death for women aged 15 to
44.
 In 2014, an estimated 1 million children became ill with TB and 140
000 children died of TB.
 Tuberculosis (TB) is caused by bacteria (Mycobacterium
tuberculosis) that most often affect the lungs. Tuberculosis is curable
and preventable.
 TB is spread from person to person through the air.

 Common symptoms
cough with sputum
blood at times, chest pains,
weakness, weight loss, fever and night sweats.
HIV/AIDS
 HIV continues to be a major global public health issue, having
claimed more than 35 million lives so far. In 2015, 1.1 (940 000–
1.3 million) million people died from HIV-related causes
globally.
 There is no cure for HIV infection. However, effective
antiretroviral (ARV) drugs can control the virus and help
prevent transmission so that people with HIV, and those at
substantial risk, can have healthy and productive lives.
Measles
 Measles is one of the leading causes of death
among young children even though a safe and
cost-effective vaccine is available.
 In 2014, there were 114 000 measles deaths
globally – about 314 deaths every day or 13
deaths every hour.
 During 2000-2014, measles vaccination prevented
an estimated 17.1 million deaths making measles
vaccine one of the best buys in public health.
Malaria

• Malaria is a life-threatening disease caused by parasites that

are transmitted to people through the bites of infected female
Anopheles mosquitoes
• In 2015, 95 countries had ongoing Malaria transmission
• About 3.2 billion people(almost half of the world’s population
are at risk of Malaria
Cholera
 Cholera is an acute diarrhoeal disease that can kill within hours
if left untreated.
 Researchers have estimated that there are 1.4 to 4.3 million
cases and 28 000 to 142 000 deaths worldwide due to cholera
every year
 Up to 80% of cases can be successfully treated with oral
rehydration salts
 Provision of safe water and sanitation is critical to control
cholera and other waterborne diseases
 Oral cholera vaccines are an additional way to control
cholera but should not replace conventional control measures
 Cholera remains a global threat to public health and a key
indicator of lack of social development.
Ebola
 Ebola virus disease formerly known as Ebola
haemorrhagic fever is a severe often fatal illness in
humans
 The virus is transmitted to people from wild animals and
spreads in the human population through human-
human transmission
 The average EVD case fatality rate is around 50%. Case
fatality rates have varied from 25% to 90% in past
outbreaks.
Avian influenza
 Avian influenza , commonly called as bird flu is
an infectious disease of birds
 Most Avian influenza viruses do not infect
humans however some such as A(H5N1) and
A(H7N9) have caused serious infection among
people
Japanese Encephalitis
 Japanese encephalitis virus(JEV) is a flavivirus related to
dengue, yellow fever and is spread by mosquitoes
 JEV is the main cause of viral encephalitis in many countries
of Asia with an estimated 68 000 clinical cases every year
 Although symptomatic JE is rare, case fatality rate can be
high as 30%
 24 countries in WHO South-East Asia and Western Pacific
regions have endemic JEV transmission exposing more than
3billion people to risks of infection
 Major outbreaks of JE occur every 2-15 years. JE transmission
intensifies during the rainy season, during which vector
populations increase
 Western Pacific region
 Communicable diseases continue to be among the most
serious public health problems in the Western Pacific Region.
 The challenges arise from diseases such as malaria, measles
and leprosy to more recent infections, including HIV, and re-
emerging diseases such as dengue.

 The Western Pacific Region bears a significant proportion of

the global burden of many communicable diseases,
including cholera, hepatitis B and tuberculosis.
Infectious Diseases in Malaysia

 The top five notifiable diseases were dengue

fever, tuberculosis, food poisoning, hand, foot
and mouth disease (HFMD) and HIV/AIDS.

 Malaysia has been classified by WHO as an

intermediate-TB-burden country.

 Leptospirosis is endemic in Malaysia and has

been resurgent in recent years. the incidence
of leptospirosis to have risen from 2 per 100 000
population in 2006 to 5 per 100 000 in 2009.
Dengue fever

Since the year 2000, Malaysia has been

experiencing an increased number of dengue
cases being reported annually.
 Define emerging/re-
emerging diseases
 Emerging disease (by WHO)

An emerging disease is one that has appeared

in a population for the first time, or that may
have existed previously but is rapidly increasing
in incidence or geographic range

 Re-emerging diseases (by WHO)

Disease in which its incidence had significantly

declined in the past, but has now reappeared
2.Briefly explain their
terminology
 Emerging and Re-emerging
 New infections
• newly recognized
• newly evolved
• Known infections
• rapidly increasing in incidence,
• spreading to new geographic areas or populations
3.Discuss the examples of emerging
diseases.
(At least 5 emerging diseases)
 HIV/AIDS

 virus from one primate host to another (chimpanzees to humans) and

due to subsequent complex social and demographic factors, it spread
readily within the human population.
 AIDS was not recognized as a distinct entity until 1981, after its initial
detection among certain risk groups:
 men who have sex with men,
 blood transfusion,
 intravenous drug abuser
 Heterosexual transmission
Rapid spread are due to:
 human movement along truck routes accompanied by a high level of
commercial sex work, inadequate public health infrastructures, poverty,
and social inequality.
 Estimated 2.3M cases occur every year worldwide
 Agent: HIV-1 and HIV-2 RNA retrovirus
 Reservoir: once infected, virus remains in the body life-long
 The time from acute HIV infection to development of AIDS varies from months
to years, with a median latency period of 10 years.
 Source: Blood, semen, CSF
 Low concentration in tears, saliva, breast milk, urine, cervical and vaginal secretions

 Host:
 Age: Most in sexually active person (20-49 y/o)
 High risk: heterosexual partners (include prostitutes), “MSM”, IV drug abusers,
blood transfusion

Mode of transmission
 Sexual transmission: spread via vaginal/anal/oral sex.
 Blood contact
 Mother to child: through placenta during delivery or breast-feeding (20-
25%)
 Nipah Virus
 Nipah virus (NiV) emerged from bats and caused an epizootic in herds
of intensively bred pigs, which in turn served as the animal reservoir
from which the virus was passed on to humans.
 It is zoonotic virus, leads to severe and rapidly progressive encephalitis
in humans.
 First identified during outbreak in Kampung Sungai Nipah, Malaysia
1998.
 In Malaysia, this infection was associated with close contact with
infected pigs.
 Natural host: fruit bat
 Intermediate host: pigs
 Transmission: direct contact with infected bats, pigs or
people; ingestion of contaminated date palm sap.
 Incubation period: 5-14 days
 Clinical features: high fever and myalgias, encephalitis with
drowsiness, disorientation, convulsions
 Lab diagnosis:
 Throat or nasal swab, CSF, urine, blood
 PCR, virus isolation, ELISA
 Hand-Foot-Mouth Disease (HFMD)
 Agent: Enterovirus 71 (more severe), coxsackievirus A16 (usually full
recovery), A5, A9, A10, B2, B5

 EV71 can associated with brain stem encephalitis

and pulmonary edema. First such epidemic in
Malaysia was in Sarawak in 1997.
 Incubation period: 4-6 days
 Transmission: direct contact with nose and throat discharges, saliva,
fluids from blister, stool.
 Clinical features: vesicular eruptions on hands, feet, within mouth,
fever (>39⁰C longer than 3 days), malaise, headache, diarrhea
 Agent: Ebola virus
 Transmission:
 direct contact with infected person
 blood or body fluids of infected one
 Contaminated objects
 Infected fruit bats or primates
 IP: 8-10 days (2-21 days)
 Clinical Features: fever, severe headache, muscle pain,
weakness and fatigue, unexplained hemorrhage
 Recovery depends on good supportive care.
SARS
 Emerged from bats (natural reservoir) and spread into
humans first by person-to-person transmission in
confined spaces, then within hospitals, and finally by
human movement between international air hubs.
 Agent: Coronavirus
 Incubation period: 2-7 (commonly 3-5 days)
 Mode of Transmission: direct or indirect contact of
mucous membrane with respiratory droplets or
fomites.
4.Discuss the examples of re-
emerging diseases.
(At least 5 re-emerging
diseases)
 Dengue

 Two fifth of world’s population in tropical and subtropical countries are

at risk.
 About 50M infections worldwide annually
 Those who have not been infected have higher infection rate (40-50%)
 Agent: DENV-1, DENV-2, DENV-3, DENV-4 (lifelong immunity if
infected by that particular serotype)
 Vector: Aedes aegypti, Aedes albopictus
 Transmission: Mosquito become infective by feeding on
infected patient, it remains infective lifetime.
 Incubation period: 8-10 days
 Environment: survive best between 16-30⁰C and humidity of 60-
80%; breeds in container and around the house; it bites more
because of dehydration (warmer temperature)
Clinical features :
 Acute febrile, headache, rash, myalgia, retro-orbit pain,
leucopenia (WBC < 5000), thrombocytopenia (platelet <
150,000), raised hematocrit (5-10%)
 Virus isolated from serum, CSF, autopsy
Chikungunya
 Agent: Chikungunya virus (CHIKV; Alphavirus)
 Vector: Aedes aegypti and Aedes albopictus
 Incubation period: 3-12 days
 Transmission: mosquito bites
 Diphtheria
 Agent: C. diptheriae
 Reservoir: only humans
 Transmission: droplet or direct contact with nasopharyngeal
secretions
 Incubation period: 2-5 days or longer
 In Malaysia: 18 recorded case, 3 death
 Susceptibility and Resistance:
 Infants born of immune mothers are relatively immune, passive
protection usually lost before 6 months
 Lifelong immunity usually acquired after disease
 Prolonged active immunity via vaccination
 Rabies

 Rapidly progressive, acute infectious disease of CNS in humans and

animals.
 Endemic on all continents except Antarctica, with highest incidence
in Asia and Africa (threatened over 3billion people)
 Affects poor, low-resource communities, particularly children <15 y/o
(4 out of 10 death)
 Forms:
 Urban: from wild life to domestic dogs to human
 Wild life: unidentified
 Bat: vampire bats (host and vector for rabies)
 Agent: Rabies Virus (Lyssavirus)
 Host: all warm blooded animals include man (dead-end infection in
man, no survival value for virus)
 Reservoir: canines and bats (mostly dogs)
 Source of infection: Saliva of rabid animals in man. Virus present in
saliva of dogs and cats for 2-3 days before onset of symptom
 Incubation period: 2weeks - 1 year (3-8weeks)
 Mode of transmission: Bites from rabid dog, licks on abraded skin and
mucosa
 Clinical features: fever, anorexia, change of sensation at bite site,
increase salivation, delirium, seizure, hydrophobia, paralysis, coma.
 Post exposure Prophylaxis:
 Start immediately after exposure
 Wound site: immediate thorough cleansing of wounds with soap and
water; tetanus prophylaxis; antibiotics
 Human Rabies Immunoglobulin (RIG): 20 IU/kg
 Rabies vaccine: IM 1ml in deltoid on 0,3,7,14,28
 Vaccines available in Malaysia
 Human diploid cel vaccine (HDCV): IM only
 Human Rabies Immunoglobulin (HRIG)
 Leptospirosis

 Agent: Leptospira interrogans (spirochete bacteria)

 Natural carrier: Rodents (renal tubules), wild and domestic animals
 Mode of transmission: contact through skin, mucosa with urine-
contaminated water or soil, occasionally via ingestion contaminated
water
 Incubation period: 10 days (2-30days)
 Seasonal disease; usually starts at the onset of rainy season; sporadic
throughout the year and outbreak associated with extreme changing
weather events (heavy rainfall and flooding)
5. Describe the determinants (factors
contributing) of emergence and re-
emergence of diseases.
 Ecological changes (including those due to economic
development and land use)
 Human demographics, behavior
 International travel commerce
 Technology and industry
 Microbial adaptation and change
 Breakdown in public health measures
Ecological changes

 Agriculture
 Dams : changes in water ecosystems
eg: Outbreaks of Rift valley fever in Africa associated with
dam building
 Deforestation/ Reforestation
eg: Reforestation : emergence of lyme disease in US and
Europe due to increased population of deer and deer tick
 Flood/ drought
eg: JE is associated with flooding of fields for rice growing
 Famine : causes reduced immune capacity
 Climate changes : Cause changes in geographical
distribution of vectors and agents
Changes in Human
demographics and behavior
 Population growth and migration (movement from
rural areas to cities)
 War or civil conflict
 Urban decay ; eg: rain filled tires/ plastic bottles are
breeding grounds for mosquitoes
 Sexual behavior ; eg: STI
 Intravenous drug use ; eg: STI
 Use of high density facilities ; eg: day care centers or
prisons
International travel
commerce
 Worldwide movement of goods and people
 Air travel
Technology and Industry

 Globalization of food supplies

 Changes in food processing and packaging
eg: Increase chances of accidental contamination and
amplify the effects of contamination
 Organ or tissue transplantation
 Drugs causing immunosuppression
 Widespread use of antibiotics
Microbial adaptation and
change
 Microbial evolution, response to selection in
environment
eg: emergence of antibiotic resistant bacteria
 Inappropriate use of antimicrobial drugs
Breakdown in public health
measures
 Curtailment or reduction in prevention programs
 Inadequate sanitation and vector control measures
6. State public health responses
(Prevention and control) of
emerging and re-emerging diseases.
Specific steps can be taken to ensure that a
global plan is established to combat emerging
infectious diseases.

1) strengthening of global surveillance of infectious diseases –

 this includes making certain that national surveillance networks

are in place, that they are associated with diagnostic laboratories
capable of identifying common pathogens, and that information
is rapidly exchanged nationally, regionally and internationally; to
this end, greater use of WHO collaborating centres is encouraged
2) Establishment of national and international infrastructure to
recognize, report and respond to new disease threats –

specific examples of tasks are:

- strengthening of national, regional and international laboratory
capabilities to include measures to ensure that international
reference centres are available and prepared to assist in difficult
diagnoses;
- encouraging the provision of training opportunities and technology
transfer among collaborating and reference centres; and
streamlining communications among collaborating centres and
health resources
3) Further development of applied research –

- focus on practical problems of public health such as diagnosis,

epidemiology and prevention of infectious diseases that are
increasing or threaten to do so; -
- specific tasks could include support for development of inexpensive
diagnostic tests suitable for global use, encouragement for
establishment and maintenance of quality assurance programmes,
and evaluation of standards for basic public health action focused
on disease prevention;
4) Strengthening of international capacity for infectious disease
prevention and control –

 specific guidelines for prevention and control of newly emerging

or re-emerging diseases should be prepared, evaluated,
distributed and implemented; recommendations could be
developed and implemented to reduce the effects of
antimicrobial resistance to a minimum, and improve methods of
communication and dissemination of information to ensure that
guidelines reach the appropriate target groups.
 Role of public health

 Surveillance and early response(detect, investigate, initiate action

and monitor)
 Assessment of health status, risks and services available to a
community
 Development of health policy
 Assurance of quality services(discourage inappropriate use of
antibiotics)
 Laboratory identification
cont.

 Rapid communication with medical providers and

hospital
 Communication with the media
 Public and health care provider education(role in
transmission, modification of lifestyle to avoid disease
etc)
 Environmental assessment and remeditation, eg. Food
inspection, water supply inspection, vector control)
 Roles of WHO

 Plays a key role in keeping countries informed

 Providing the necessary technical and logistical assistance to control
the spread of diseases
 For WHO to be able to respond rapidly, it is important that surveillance
data is reported quickly to WHO by Member Countries
 Carry out several border meetings among countries-resulted in
development of strategies for prevention and control of the spread of
diseases
 Revise the International Health Regulations(IHR)-facilitate the free flow
of information on disease occurence without the affected countries
having to fear the imposition of totally unjustified restrictions on travel
and trade.
The Asia Pacific Strategy for
Emerging Diseases (APSED)
 Developed by the Western Pacific and South-East Asia
Regional Offices of the WHO
 To ensure that countries have the core capacities to
undertake effective preparedness planning,
prevention, prompt detection, characterization,
containment and control of emerging infectious
diseases which could threaten national, regional and
global security
7. Discuss epidemiology of Ebola virus
disease and prevention of control
measures of
Ebola virus
 Epidemiology of Ebola Virus
disease
 Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever,
is a severe, often fatal illness in humans.
 Ebola can cause disease in humans and nonhuman primates (monkeys,
gorillas, and chimpanzees).
family – Filoviridae
Genus – Ebolavirus
5 identified Ebola virus species:
Ebola virus (Zaire ebolavirus)
Sudan virus (Sudan ebolavirus)
Taï Forest virus (Taï Forest ebolavirus, formerly
Côte d’Ivoire ebolavirus)
Bundibugyo virus (Bundibugyo ebolavirus)
Reston virus (Reston ebolavirus), has caused
disease in nonhuman primates, but not in
humans.
Natural reservoir host – unknown
However, on the basis of evidence and the
 Transmission

 People get Ebola through direct contact (through broken skin or mucous
membranes in, for example, the eyes, nose, or mouth) with:
- blood or body fluids (including but not limited to urine, saliva, sweat, faeces,
vomit, breast milk, and semen) of a person who is sick with or has died from
Ebola
- objects (like needles and syringes) that have been contaminated with body
fluids from a person who is sick with Ebola or the body of a person who has
died from Ebola,
- infected fruit bats or primates (apes and monkeys), and
- possibly from contact with semen from a man who has recovered from
Ebola (for example, by having oral, vaginal, or anal sex)
 Background

 Ebola virus disease first appeared in 1976 in 2 simultaneous outbreaks, one

in what is now, Nzara, South Sudan, and the other in Yambuku,
Democratic Republic of Congo.
 The latter occurred in a village near the Ebola River, from which the
disease takes its name.

 The 2014–2016 outbreak in West Africa was the largest and most complex
Ebola outbreak since the virus was first discovered in 1976.
 There were more cases and deaths in this outbreak than all others
combined.
 It also spread between countries, starting in Guinea then moving across
land borders to Sierra Leone and Liberia.
 Prevention and control

 Reducing the risk of wildlife-to-human transmission

 Avoid direct contact with infected fruit bats or monkeys/apes.
Animals should be handled with gloves and other appropriate
protective clothing.
 Avoid consumption of their raw meat. Animal products (blood
and meat) should be thoroughly cooked before consumption.

 Reducing the risk of human-to-human transmission

 Avoid direct or close contact with people with Ebola
symptoms, particularly with their bodily fluids.
 Gloves and appropriate personal protective equipment should
be worn when taking care of ill patients at home.
 Regular hand washing is required after visiting patients in
hospital, as well as after taking care of patients at home.
 Reducing the risk of possible sexual transmission
 WHO recommends that male survivors of Ebola virus
disease practice safe sex and hygiene for 12 months from
onset of symptoms or until their semen tests negative
twice for Ebola virus.
 Contact with body fluids should be avoided and washing
with soap and water is recommended.
 WHO does not recommend isolation of male or female
convalescent patients whose blood has been tested
negative for Ebola virus.

 Outbreak containment measures

 including prompt and safe burial of the dead
 identifying people who may have been in contact with
someone infected with Ebola and monitoring their health
 Controlling infection in health-care
settings
 Health-care workers should always take standard precautions when caring for patients,
regardless of their presumed diagnosis.
- basic hand hygiene
- respiratory hygiene
- use of personal protective equipment (to block splashes or other contact with infected
materials)
- safe injection practices
- safe burial practices.

 Health-care workers caring for patients with suspected or confirmed Ebola virus should apply
extra infection control measures to prevent contact with the patient’s blood and body fluids
and contaminated surfaces or materials such as clothing and bedding.
- When in close contact (within 1 metre) of patients with EBV
- wear face protection (a face shield or a medical mask and goggles)
- a clean, non-sterile long-sleeved gown
- gloves (sterile gloves for some procedures).

 Laboratory workers are also at risk. Samples taken from humans and animals for investigation
of Ebola infection should be handled by trained staff and processed in suitably equipped
laboratories.
THANK YOU