????????????????????? (Emerging Infectious diseases: EID):

1
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2
????????????????????? (Emerging Infectious
diseases EID)
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??????????????? 20 ??????????? ??????????????????
?????????????????????????????????????????
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3
???????????????????? (Re-emerging Infectious
diseases
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4



FIGURE 1. Crude death rate for infectious
diseases - United States, 1900 - 1996.
FIGURE 1. Crude death rate for infectious
diseases - United States,
1900 - 1996.
5
In 1918-9, Influenza pandemic killed more than 20
million people world wide, including over
500,000 people in the US.
Following World War II, Humans were winning the
war against infectious microbes. Life
threatening diseases such as tuberculosis and
typhoid fever could be treated with antibiotics,
and dreaded childhood diseases (polio, whooping
cough, diptheria) could be conquered with
vaccination. Coupled with improvements in urban
sanitation and water quality, vaccines and
antibiotics dramatically reduced the incidence of
infectious diseases.
6
EMERGING INFECTIOUS DISEASES SINCE 1973

• 1973 - Rotavirus
• 1975 - Parvovirus B-19
• 1976 - Cryptosporidium
• 1977 - Ebola
• 1977 - L. pneumophilia
• 1977- Hantaan virus
• 1977 - C. jejuni

7
EMERGING INFECTIOUS DISEASES SINCE 1973
1980 - HTLV-1 1981 - S. aureus - Toxic Shock 1982
- E. coli O157H7 1982 - HTLV-2 1982 - B.
burgdorferi 1983 - HIV 1983 - H. pylori
8
EMERGING INFECTIOUS DISEASES SINCE 1973
1986 - Cyclospora cayatanensis 1988 - HHV-6 1988
- Hepatitis E 1989 - Erlichia chafeensis 1989 -
Hepatitis C 1991 - Guanarito virus 1991 - Babesia
species
9
EMERGING INFECTIOUS DISEASES SINCE 1973
1992 - Vibrio cholerae O139 1992 - Bartonella
henselae 1993 - Sin nombre virus 1993 -
Encephalitozoon cuniculi - Hanta pulmonary
syndrome 1994 - Plague (India) 1995 - HHV-8
10
EMERGING INFECTIOUS DISEASES 1995-2004

• 1995 Ebola (Zaire)
• 1996 variant CJD (United Kingdom)
• 1997 H5N1 influenza virus, Vancomycin resistant
  SA, EV71
• (Hong Kong Japan, USA Malaysia)
• 1998 EV71, Nipah virus (Taiwan, Malaysia,
  Singapore)
• 1999 West Nile (Russia, USA)
• 2000 Rift Valley Fever, Ebola
• (Kenya, Saudi Arabia, Yemen, Uganda)
• 2001 Anthrax, Foot and mouth disease (USA UK)
• 2002 Vancomycin resistant SA (USA)
• 2003 Ebola, SARS, Monkey pox
• (Republic of Congo global USA)
• 2004 H5N1 Viet Nam, Thailand, etc.
• Nipah virus Bangladesh

11
EMERGING INFECTIOUS DISEASES
Between 1980 and 2004, The increase in drug
resistance in strains of bacteria forced the US
to return to the pre-antibiotic era in the
battle against many common organisms, at the
same time that new bacterial and viral pathogens
were appearing
12
Resistance to antimalarial drugs
1940
1950
1960
1970
1980
1990
13
Preventing HIV infections in Thailand
????????????????????????
14
(No Transcript)
15
(No Transcript)
16
Avian Influenza Infections in Humans
1997 In Hong Kong, avian influenza A (H5N1)
infected both chickens and humans 18 people were
hospitalized and 6 of them died. 1999 In Hong
Kong, avian influenza A H9N2 confirmed in 2
children, recovered possibility of
person-to-person transmission open ? 2003 Two
cases of avian influenza A (H5N1) a Hong Kong
family that had traveled to China One person
recovered, the other died
17
Avian Influenza Infections in Humans
2003 Avian influenza A (H7N7) in the
Netherlands infections among poultry workers
and their families More than 80 cases of H7N7
and 1 patient died 2003 H9N2 infection in a
child in Hong Kong, recovered
18
Recent Influenza A(H5N1) Cases
- October 2003, Vietnam reported cases of severe
respiratory illness in people from provinces
surrounding Hanoi. On January 26, reported its
first confirmed cases in the south of the
country, with two cases in Ho Chi Minh City . -
January 23, 2004 , the Government of Thailand
began reporting cases of avian influenza
A(H5N1) infections in humans
19
H5N1 Infections Among Poultry in Asia
Outbreaks of avian influenza A (H5N1) have been
confirmed among poultry in Cambodia, China, Hong
Kong, Indonesia, Japan, Korea, Laos, Thailand,
and Vietnam. ( H7 has been confirmed in Pakistan)
20
Concept of Epidemiology
????????????????????????????
Agent
Host
Environmental
21
Concept of Epidemiology
?????????????????????????
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Host
Agent
Environmental
22
Concept of Epidemiology
?????????????????????????
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Susceptible host ?????
Agent
Host
Environmental
23
Concept of Epidemiology
?????????????????????????
Agent
Host
??????????????????
??????????
Environmental
24
Factors in Infectious Disease Emergence

• Ecological Changes
• Human Demographics and Behavior
• International Travel and Commerce
• Technology and Industry
• Microbial Adaptation and Change
• Breakdown in Public Health Infrastructure

25
Factors in Infectious Disease Emergence

• Human Susceptibility to Infection
• Economic Development and Land Use
• Climate and Weather
• War and Famine
• Lack of Political Will
• Poverty and Social Inequality
• Bioterrorism

26
EMERGING INFECTIOUS DISEASES in Thailand
Bioterrorism
11 September 2001
2001-2002 Anthrax Hoax
27
Bioterrorism Poor mans nuclear bomb
Intentional or threatened use of viruses,
bacteria, fungi, or toxins from living organisms
to produce death or disease in humans, animals,
or plants
28
EMERGING INFECTIOUS DISEASES in Thailand

• SARS November 2002-5July 2003
• Avian influenza January-April 2004

29
Lessons learned for Thailand from SARS Avian
influenza

• Faithfulness
• Infrastructure National Plan, Manpower,
  Networking,
• Information system, Resources,
• Technology
• Crisis response worked and Work on old merits
• Multi-sectional cooperation
• Political support
• Dedication working

30
Preventing Emerging Infectious Diseases

• Surveillance and Response
• Prevention and Control
• Health Infrastructure and Training
• Basic Applied Research

31
Preventing Emerging Infectious Diseases

• Surveillance and Response
• Detect, investigate, and monitor
• emerging pathogens, the diseases,
• and the factors influencing their emergence,
• and respond to problems

32
Surveillance in Thailand
- ??. 506 - Sentinel surveillance EID -
Laboratory surveillance Influenza,
Antimicrobial-resistance AFP
surveillance
Outbreak response team
???????????????????????????????? ???????????????,
FETP ??????????????????????????????????
????????????????? 1-12 ???????????????????????????
?????????????????????, CUP ?
33
Preventing Emerging Infectious Diseases

• Prevention and Control
• Ensure prompt implementation of prevention
  strategies and enhance communication of public
  health information about emerging diseases.

34
Preventing Emerging Infectious Diseases

• Infrastructure and Training
• Strengthen public health infrastructures to
  support surveillance, response, and research and
  to implement prevention and control programs.
• Provide the public health work force with the
  knowledge and tools it needs.

35
Preventing Emerging Infectious Diseases

• Basic Applied Research
• Integrate laboratory sciences and epidemiology to
  increase the effectiveness of public health
  practice.

36
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