Medical Microbiology and Immunology 554

1
Medical Microbiology and Immunology 554
Bioterrorism and Emerging Infectious Diseases
2
Time We Will Start on Time at 1205 and
officially end at 1255 (we will try to end a
couple of minutes early) Attendance We
expect you to attend class and participate in
discussion when provided with the opportunity.
3
Grading
Short answer, short essay mid-term examine on
October 13th. This is 120 points Longer answer
and longer essay examine December 8th. This is
120 points 5 page paper due at the final time
(12/21). This is 60 points Three discussion
groups (10 pt questions due at the start) Total
is 330 points
4
Were on the Web
Almost all lectures (not from some guest
speakers) will be posted on our website before
the lecture date, so you can download the
powerpoints and print them before class to take
notes on. From the Medical Microbiology and
Immunology site, click on Undergraduate
Program, on the left side there is an area
called MMI undergraduate courses.
http//www.medmicro.wisc.edu/undergraduate/cour
ses/554/index.html
5
No Required Text Book but
Microbial Threats to Health Emergence,
Detection, and Response (2003) From the Board on
Global Health (BGH), Institute of Medicine
(IOM) http//www.nap.edu/openbook.php?isbn0309088
64X 11/19-The epidemic of antibiotic resistant
infections a call to action Clinical
Infectious Diseases 2008. 46, 155-64 12/10-Negle
cted Infections of Poverty in the United States
of America PLoS Neglected Tropical Diseases June
2008. 2(6) e256 http//www.plosntds.org/article/i
nfo3Adoi2F10.13712Fjournal.pntd.0000256 12/15-
News article analysis before media panel.
6
Educational ObjectivesQuestions to keep asking
yourself
What is the problem? Why do we have this
problem? What can we do about it? Because
EID situations are always changing and
unpredictable, we are only going to give you
disease examples so you can learn to think
through new situations as they arise.
7
Infections in the Pre-antibiotic Era
Infections were the major cause of death and
disabilities in the U.S. until mid-20th
century Smallpox, tuberculosis, diphtheria,
cholera, plague, polio, mumps, measles,
typhoid, scarlet, and rheumatic fever Life
expectancy in the U.S. with birth in 1900 -45
years male -47 years female Elderly population
(65) was 3-4 of the total population
8
Changes Brought by Pasteurs Germ Theory
Antisepsis Antibiotics Immunization Sanitation
Public Health
9
Impact of Germ Theory
Reduced childhood mortality Life expectancy in
the U.S. with birth in 2000 -74 years male -79
years female Elderly population (65) is 13 of
the population (36 million) Life expectancy at
65 and 75 65 75 males 15 yrs 9
yrs females 19 yrs 14 yrs
10
Current Top Causes for Death in the U.S.

• Heart Disease
• Cancer
• Stroke
• Pneumonia
• Howeverworldwide infections account for 30-35
  of all deaths
• for example TB infects 30 of the world
  population

11
Costs of Infectious Diseases in the US
Costs of common infectious diseases can be broken
into -direct costs such as treatment -indirect
costs like lost work due to death or disability
Disease
Estimated Costs Intestinal
infections 23 billion total
Food Borne diseases 5-6 billion
total S.T.Ds. (excluding AIDS) 5
billion in direct costs Influenza
5 billion in direct
costs 12 billion in indirect costs
Antibiotic Resistant bacteria 4
billion in direct costs
12
(No Transcript)
13
What do you think a Definition of Emerging
Infectious Diseases is?
14
Definition of Emerging Infections New,
re-emerging, or drug resistant infections whose
incidence in humans has increased within the past
two decades or whose incidence threatens to
increase in the near future. -Institute of
Medicine, 1992
15
What are the factors that you think lead to an
infectious disease emerging?
16
Factors of Emergence
Board on Global Health (BGH) and the Institute of
Medicine (IOM) Microbial adaptation and
change Human Demographics and Behavior
International Travel and Commerce Economic
Development and Land Use Technology and
Industry Breakdown of public health
measures Human susceptibility to
infection Climate and weather Changing
ecosystems Poverty and social inequality War
and famine Lack of political will Intent to
harm
17
Microbial Adaptation and Change
A number of microbes utilizing different genetic
mechanisms -genome sequences show that lateral
transfer is common -high mutation rates in RNA
viruses-rapid adaptation -quick reproduction so
rare mutations build up rapidly Antimicrobials
for livestock growth enhancement and over
prescription of antimicrobials by Drs.
(convenience) -evolve modifying enzymes and
drug pumps Superbugs Streptococcus and
penicillin, Staphylococcus and
vancomycin Tuberculosis and isoniazid Malaria
and chloroquine.
18
Human Demographics and Behavior
Increases in the human population, even in the
U.S. Urbanization-more people concentrated in
cities-often without adequate
infrastructure Increases in the elderly
populations Increases in children in daycare
working woman with kids under 5 was 30 in
1970, is 75 in 2000. Fast paced Lifestyles-
increase in convenience items and more
stress High-risk behavior- Drug use and
unprotected sex
19
International Travel and Commerce
365 days to circumnavigate the globenow it takes
36 hours -used to quarantine ships, but 36 h
faster than disease incubation 400 million
people per year travel internationally
increased incidence of both Tuberculosis and
Influenza transmission on long
flights Transportation of products is an
increased concern -rapid transport of disease
harboring fresh produce -transport of livestock
facilitates movements of viruses and
arthropods (especially ticks) Increases in
Cruise ship travel
20
Economic Development and Land Use
Consumption of natural resources, deforestation,
and dam building Logging in the rain forest has
exposed people to new viruses Historic example
-emergence of Yellow Fever when humans entered
the Central American jungle to build the Panama
Canal New standing water from dam building,
canalization, and irrigation Historic example
-the Aswan high dam increases rates of
Schistosomiasis in Egypt Reforestation in some
parts of North America has caused the emergence
of Lyme disease in those areas
21
Technology and Industry
Advances in Technology-most changes are positive
but Medical technology -people living longer
but have weaker immune systems -blood
transfusions and organ transplants save lives but
can cause infections (implanting parts causes
biofilm growth) Transportation technology -the
ability to rapidly move people and goods.
Industrial Changes- Mass production of food
now we all get our water and food from the
same sources. Industrial Pollution-increases
incidence of TB
22
Breakdown of Public Health
World-wide breakdown of public health measures
(such as adequate sanitation, immunizations, tb
control) have dramatically increased EID. Late
1970s- IMF and World Bank forced reductions in
public sector investment, especially in Latin
America and Africa. Debate over whether this
had a negative impact on public health. -The
bank has shown that these countries are
economically better off. -The other side
says, the reduction in public health sector
caused immunization levels, nutrition,
and medical supplies to drop. A similar
reduction in public health funding occurred in
the US. -reduction in programs for disease
prevention and surveillance Lack of diagnosis
and treatment in many areas of the world.
-In Kikwit, the Ebola outbreak went with high
mortality for a while before there help
sent.
23
Human Susceptibility to Infection
Impaired Host Immunity -AIDS -Increases in the
older population Genetic Polymorphisms
Malnutrition-host susceptibility is aggravated
24
Climate and Weather
Global warming-climatologists project temps to
increase up to 5.8C by 2100 Elevated rainfall
-creates new breeding habitats for mosquitoes
-decreases salinity which can
increase toxic bact. -increases
vegetation which increases rodents (1993
Hanta virus outbreak) -increases
runoff into drinking reservoirs (1993
Cryptosporidiosis outbreak) Higher ocean temps
increase Vibrio parahaemolyticus
(shellfish) Some soil pathogens carried by dry
dusty winds (Coccidiodes)
25
Changing Ecosystems
Ecological changes can increase the risk of
infection by altering human exposure or
pathogen distribution. Rainforest
destruction -forests reduce while cropping
increases humidity Urban development increases
atmospheric particles and increases air
temperatures Of the 10 EID targeted by WHO, 7
have arthropod vectors
26
Poverty and Social Inequality
Mortality from infectious diseases more closely
than ever correlates with income. -developing
and former communist bloc countries Factors
malnutrition, lack of clean water and sanitation,
poor housing, ignorance of risky behaviors
(including absence of social agencies to
teach), lack of transportation, lack of funds
for out-of-pocket expenses. Population of the
poorest is increasing the fastest
27
War and Famine
War refugees are a full 1 of the global
population War refuges are forced onto new areas
where they are exposed to new microbes from
vectors and people. War and famine are closely
linked. In 2001, tracking 16 countries with
food emergencies, showed that 9 were because
of civil unrest. Famine is also caused by
social, economic, and political forces. Weather
and HIV/AIDS
28
Lack of Political Will
A global political commitment is rather
vague -Who will be the parties in a global
social contract? -How is their will
determined? -How can the liberties of individual
coutnries be balanced against collective
responsibility? Is there collective
responsibility? Must have commitment from 4
groups donors, health care professionals,
country authorities, and patients Developing
world diseases dont matter to politicians here.
29
Intent to Harm
Even before 2001, some recognized the
threat. 1972- the Biological Weapons Convention
(BWC) treaty- prohibited the possession,
stockpiling, and use, BUTit had nothing for
monitoring, inspection, or enforcement. The US
abandoned its biological warfare program is 1969,
BUT The Soviet Union kept its program up after
signing the BWC, we did not find this out until
the mid-1990s Aum Shinrikyo had also
experimented with botulin, anthrax, and sent
teams to Zaire for Ebola.
30
Six Priority Areas of the CDC

• International Outbreak Assistance (emergency
  response, epidemology)
• Global Approach to Disease Surveillance (global
  early warning networks)
• Applied Research on Diseases of Global Importance
  (lots into flu now)
• Application of Proven Public Health Tools (bed
  nets, vaccines, etc)
• Global Initiatives for Disease Control (the big
  three and vaccines)
• Public Health Training and Capacity Building
  (International
• Emerging Infections Programs)

31
The Big Three for ID
Cases (Annual)
Cases (Total)
Deaths (Annual)
Disease
Microbe
300-500 million
300-500 million
Malaria
1 million
Plasmodium
M. tuberculosis
8 million
2 million
2 billion
Tuberculosis
AIDS
HIV
5 million
3.1 million
40 million
32
Factors of Emergence
Board on Global Health (BGH) and the Institute of
Medicine (IOM) Microbial adaptation and
change Human Demographics and Behavior
International Travel and Commerce Economic
Development and Land Use Technology and
Industry Breakdown of public health
measures Human susceptibility to
infection Climate and weather Changing
ecosystems Poverty and social inequality War
and famine Lack of political will Intent to
harm