YEKATIT 12 HOSPITAL MEDICAL COLLEGE

DEPARTMENT OF GENERAL PUBLIC HEALTH

GLOBAL HEALTH
SEMINAR ON
EMERGING AND RE-EMERGING INFECTIOUS DISEASES

PREPARED BY GROUP-2
SUBMITED TO Dr. Getabalew E (MPH, Ph.D)

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GROUP 2 MEMBERS
1. Dr. Anteneh Bizuneh....... 034/15
2. Betelihem Alemayehu..... 037/15
3. Dr.Dereje Abite................ 040/15
4. Irko Menigstu.................. 047/15
5. Dr. Maraki Mehari.......... 049/15
6. Wasihun Chanie............... 055/15

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 Out lines
• Learning objectives
• Definition
• Epidemiology of emerging and Re-emerging infectious diseases
• Classification
• Contributing factors
• Public Health Importance of EIDs and REIDs
• Measures to Address EIDs and REIDs
• Conclusion
• References

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Learning objectives

At the end of the chapter the learners will be able to:

 Define emerging and Re-emerging infectious diseases
 Describe the Epidemiology of emerging and Re-emerging
infectious diseases
 Describe Classification of EIDs and REIDs
 Identify the Contributing factors of EIDs and REIDs
 Describe the Public Health Importance and Measures to Address of
EIDs and REIDs

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Definition
Emerging infectious diseases:
 Are diseases that have not occurred in humans before
or that occurred only in small numbers in isolated places.
OR
Newly identified & previously unknown infectious
agents that cause public health problems either
locally or internationally

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Definition..
Re-emerging infectious diseases
 Are diseases that once were major health problems globally or in
a particular country and then declined dramatically, but are again
becoming health problems for a significant proportion of the
population.

 The re-emergence of some diseases can be explained by

evolution of the infectious agent (for example, mutations in
bacterial genes that confer resistance to antibiotics used to treat
the diseases).
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Epidemiology
 Infectious diseases are periodically emerging and re-emerging in
nearly every corner of earth, many with the potential to cause
pandemic.

 In 1992 a completely new strain of cholera, O139, appeared in

southeastern India (spread to China, Thailand, and South-East
Asia)

 Since 1997, AI (H5N1) having emerged in Hong Kong spread

rapidly to Cambodia, Indonesia, Thailand, and Viet Nam.
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Epidemiology..
• The new SARS coronavirus after emerging from Guangdong Province of
China in November 2002
 Spread rapidly to 30 countries across Asia, the Americas, and Europe,
with a total of 8439 cases and 812 deaths in less than a year.

• Ebola Virus Disease (Ebola hemorrhagic fever)

 1976: Appearing for the first time in Sudan and Democratic Republic of
Congo
 March 2014 : The current outbreak in West Africa, (is the largest and
most complex Ebola outbreak

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• It has also spread between countries
• starting in Guinea then spreading across land borders to Sierra Leone and
Liberia,
• by air (1 traveller) to Nigeria and USA (1 traveller), and by land to Senegal (1
traveller) and Mali (2 travellers).
• EVD in West Africa was first reported during early March 2014 in Guinea's 3
southeastern prefectures which share borders with Liberia and Sierra Leone.
• It then rapidly spread through most parts of Guinea and then to Liberia and
Sierra Leone, causing the largest EVD epidemic ever.
• Till November 1, 2015, West Africa had reported more than 28,000 EVD
cases, of which over 3800 (including greater than 2500 deaths) were reported
from Guinea alone.

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Epidemiology..
H1N1 influenza virus
• 1918 H1N1(Spanish Flu pandemic) 1st - World War I,
 Responsible for the deaths of an estimated 50 million people worldwide.

• 2009 H1N1(Swine flue), March 2009

 First reported in Mexico, which then spread to the United States and finally to
rest of the world including India.

 By the next 6 months, almost all countries had reported H1N1 virus to the
WHO, with more than 18,000 deaths, 67% of that in the USA alone.

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Zika virus, a mosquito-borne flavi virus
• Was first identified in Uganda in 1947 in monkeys.
• 1952, identified in humans: Uganda and the United Republic of Tanzania.
• Outbreaks of Zika virus disease were recorded in Africa, the Americas, Asia,
and the Pacific.

• From the 1960s to 1980s: across Africa and Asia, typically accompanied by
mild illness.

• 2007, the first large outbreak of disease: Island of Yap (Federated States of
Micronesia).
• 2015: Brazil reported an association between Zika virus infection and
Guillain–Barré syndrome(GBS) and microcephaly

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Epidemiology..
COVID-19
 Has been a significant topic of interest since the first
reported cases in December 2019.

As of October 2021, (WHO report)

 Globally: confirmed cases is estimated to be over 233
million
 More than 4.78 million deaths

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Classification
Based on time and how humans were involved in the emergence
1. Newly emerging infectious diseases
• Diseases that were not previously described in humans
2. Re-emerging infectious diseases
• Diseases that have spread to new places or which previous treatments no
longer control
3. Deliberately emerging infectious diseases
• Diseases created by humans for bioterrorism
4. Accidentally emerging infectious diseases
• Diseases created or spread unintentionally by humans, such as
vaccine-derived poliovirus
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Contributing factors
1. Microbial adaptation and change
2. Human susceptibility to infection
3. Climate and weather
4. Changing ecosystems
5. Human demographics and behavior
6. Economic development and land use
7. International travel and commerce
8. Technology and industry
9. Breakdown of public health measures
10. Poverty and social inequality
11. War and famine
12. Lack of political will
13. Intent to harm
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The following table gives examples for different factors:
Factor of emergence
Microbial adaption
Changing human susceptibility
Climate change
Changes in human
demographics and travel
facilitating rapid global spread
Economic development
War and famine
Inadequate public health
services
Poverty and social inequality
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Examples
Genetic drift and genetic shift in Influenza A
Mass immunocompromization with HIV/AIDS
Diseases transmitted by animal vectors such as mosquitoes (e.g. West
Nile fever) are moving further from the tropics as the climate warms
SARS-related coronaviruses
Use of antibiotics to increase meat yield of farmed cows leads to
antibiotic resistance
Clearing of animal habitats that increase the range of diseases such as
Ebola
Tuberculosis is primarily a problem in low-income areas
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The following table gives examples for different factors :
Factor of emergence Examples
Bioterrorism 2001 Anthrax attacks
Land use • Dam construction and irrigation systems can encourage malaria and other
mosquito-borne diseases
• Use of indiscriminate pesticides in industrial farming reduces/eliminates
biological controls (e.g. dragonflies, amphibians, insectivorous birds,
spiders) of known disease vectors (e.g. mosquito, tick, biting midge)

Anti-vaccination or Vaccine Re-emergence of measles

hesitancy
Wildlife trade • Has been linked to zoonotic emergence and spread of new infectious
diseases in humans, including Nipah virus.
• Crowded and unhygienic wet markets and wildlife farms have been
implicated in animal-human transmission of emergent viruses, including
novel coronaviruses and influenza viruses.
• Complex issues surrounding the commerce and consumption of bush meat
are also of particular concern

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WHO list of most important emerging infectious diseases

 In December 2015, the WHO held a workshop on

prioritization of pathogens:
For accelerated R&D for severe emerging diseases with
potential to generate a public health emergency, and

For which no, or insufficient, preventive and curative

solutions exist.

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The WHO workshop on prioritization of pathogens resulted in a list of six
diseases that require accelerated R&D efforts:
1. Ebola virus disease
A severe and often fatal illness caused by infection with the Ebola virus, which can
spread rapidly in healthcare settings.

2. Crimean-Congo haemorrhagic fever

A viral disease transmitted to humans through ticks, causing severe fever, bleeding,
and organ failure, with high fatality rates.

3. Lassa fever
A viral hemorrhagic fever caused by the Lassa virus, transmitted to humans through
contact with infected rodents, leading to severe illness and death.

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Cont..
4. Middle East respiratory syndrome coronavirus (MERS-CoV)
• A viral respiratory illness caused by the MERS coronavirus, transmitted
from animals to humans, with high fatality rates.

5. Nipah virus disease

• A viral disease transmitted to humans from animals, causing severe
brain inflammation and high mortality rates.

6. Rift Valley fever

• A viral disease affecting humans and animals, transmitted through
mosquito bites, causing liver damage and complications in pregnant
women.
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Recently emerged infectious diseases : COVID-19 (Coronavirus Disease
2019):

 The COVID-19 pandemic, caused by the novel coronavirus

SARS-CoV-2,
Emerged in late 2019 and quickly spread globally, leading to
widespread illness, mortality, and significant disruptions to
economies and societies.

 The disease has posed unusual challenges to healthcare systems

and has prompted extensive research into vaccines, treatments,
and public health measures.

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These were selected based on the following measures:
1. Human transmissibility (including population immunity,
behavioral factors, etc.)
2. Severity or case fatality rate
3. Spillover potential
4. Evolutionary potential
5. Available countermeasures
6. Difficulty of detection or control
7. Public health context of the affected area(s)
8. Potential scope of outbreak (risk of international spread)
9. Potential societal impacts

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Some examples of re-emerging infectious diseases worldwide include:

1. Tuberculosis (TB)

 Despite being a preventable and curable disease, TB has re-emerged as a

major public health concern due to:
Rise of drug-resistant strains
Weak health systems
HIV/AIDS epidemic.

 According WHO, 2019

Estimated 10 million new cases
1.4 million TB-related deaths
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Re-emerging..

2. Malaria
• Despite significant efforts to control and eliminate malaria, the disease
has re-emerged in several regions, including parts of Africa, Asia, and
South America.

• The WHO, 2020

241 million cases of malaria
627,000 malaria-related deaths

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3. Dengue Fever

 Dengue fever is a mosquito-borne viral infection caused by any of the

four dengue virus serotypes.

 The disease has re-emerged in many countries

Particularly in the tropical and subtropical regions,
Due to rapid urbanization, climate change, and increased
international travel.

 According to the WHO, 2029

~390 million dengue infections
 22,000 dengue-related deaths
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4. Chikungunya
• It is a viral disease transmitted by Aedes mosquitoes,
• Which often causes high fever, joint pain, and muscle pain.

• In many countries, (the Americas and Asia): due to the spread

of the vector, Aedes aegypti.

• The WHO, 2019

• 1.6 million cases
• 210 Chikungunya-related deaths

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Public Health Importance of EIDs and REIDs

Key areas:
1. Mortality and Morbidity:
• EIDs and REIDs can cause severe illness and death, leading to increased mortality
rates and a higher disease burden on the affected populations.
2. Economic Impact:
• These diseases can have significant economic consequences, as they can lead to loss
of productivity, increased healthcare costs, and decreased tourism revenue.
3. Global Health Security:
• EIDs and REIDs have the potential to spread rapidly across borders, posing a threat
to global health security.
• The rapid spread of diseases such as COVID-19 has emphasized the need for
international cooperation in addressing these threats.

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Key areas..
4. Antimicrobial Resistance:
• The emergence of antimicrobial-resistant pathogens is a significant concern, as
it can lead to the failure of treatment options and increased disease severity.

5. Vulnerable Populations:
• EIDs and REIDs can disproportionately affect vulnerable populations, such as
the elderly, young children, and with comorbidities, leading to increased
health disparities.

6. Research and Development:

• The identification and monitoring of EIDs and REIDs require ongoing research
and development efforts to identify new diagnostic tools, treatments, and
vaccines.
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Key Tasks in Dealing with Emerging Diseases
 Surveillance at national, regional, global level
Epidemiological,
Laboratory
Ecological
 Investigation and early control measures
 Implement prevention measures
 Behavioral, political, environmental
 Monitoring, evaluation

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 What skills are needed

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Measures to Address EIDs and REIDs

To address the public health importance of EIDs and REIDs, several

measures can be taken:

1. Surveillance and Monitoring:

• Establishing surveillance systems to detect and monitor the emergence
and re-emergence of infectious diseases is essential for early detection
and intervention.

2. Research and Development:

• Investing in research and development to identify new diagnostic tools,
treatments, and vaccines is crucial to combating these diseases.

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Measures..
3. Public Health Preparedness:
• Strengthening public health systems and preparedness plans to respond to EIDs and
REIDs is vital to minimize the impact of these diseases on affected populations.

4. Education and Awareness:

• Raising awareness about EIDs and REIDs among the public and healthcare
professionals is essential to promote early detection and appropriate management of
these diseases.

5. International Cooperation:
• Collaborating with international organizations and other countries to share
information, resources, and best practices is essential to address global health threats.

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Conclusion
• The true prevalence of many diseases is not known. Effective
surveillance is the key to their early containment.

• There is a need to develop epidemiology improved diagnostic

facilities, a strong public health structure, effective risk
communication, epidemic preparedness and rapid response.

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References
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Responding to Emerging Infectious Disease Threats". Annals of Internal Medicine. 167 (11): 805–811.
doi:10.7326/M17-2496. ISSN 0003-4819. PMID 29132162. S2CID 36800971.
2. "Emerging Infectious Diseases - NIOSH Workplace Safety and Health Topic". www.cdc.gov. Centers for
Disease Control and Prevention. 17 October 2018. Archived from the original on 18 April 2020.
3. Morens DM, Fauci AS (2020-09-03). "Emerging Pandemic Diseases: How We Got to COVID-19". Cell. 182
(5): 1077–1092. doi:10.1016/j.cell.2020.08.021. ISSN 0092-8674. PMC 7428724. PMID 32846157.
4. "Global outbreak alert and response" (PDF). WHO. Geneva, Switzerland. 26–28 April 2000.
hdl:10665/66750. Retrieved 10 September 2020.
5. Morens DM, Fauci AS (2013). "Emerging infectious diseases: threats to human health and global stability".
PLOS Pathogens. 9 (7): e1003467. doi:10.1371/journal.ppat.1003467. PMC 3701702. PMID 23853589.
6. Jones K (2008). "Global trends in emerging infectious diseases". Nature. 451 (7181): 990–993.
Bibcode:2008Natur.451..990J. doi:10.1038/nature06536. PMC 5960580. PMID 18288193.
7. Ndow G, Ambe JR, Tomori O (2019-03-20). "Emerging Infectious Diseases: A Historical and
Scientific Review". Socio-cultural Dimensions of Emerging Infectious Diseases in Africa. pp. 31–
40. doi:10.1007/978-3-030-17474-3_3. ISBN 978-3-030-17473-6. PMC 7123112.
8. Internate

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 Thank you!!

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