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ANTC68 WINTER 2013 Lecture # 10 – Ebola, CJD & SARS EMERGING INFECTIOUS DISEASES  Re-emerging diseases include heliobacter pylori, AIDS, Ebola, Lyme Disease, MDR-TB, MRSA, SARS, vCJD, Legionnaires, hantabirus, hepatitis C  1995: CDC created the journal Emerging Infectious Disease to promote recognition of new diseases and dissemination of information to the scientific community SURVEILLANCE  Notifiable diseases are those that must legally be reported to the government  In Canada, PHAC maintains a list of over 50 notifiable diseases  Canada produces a weekly communicable disease report (CCDR) as well as FluWatch  Malaria and HIV in Canada  The World Health Organization used to have a list of specific notifiiable diseases  Starting in 2005, the WHO changed their notification requirements  No longer about specific diseases, may include non-disease emergencies  Now, each member state defines “an event that may constitute a public health emergency of international concern” o Group 1: Smallpox, Polio, Human Influenza from new subtype, SARS o Group 2: any other PHEIC that could become a pandemic  The CDC in the USA publishes the “Morbidity and Mortality Weekly Report”  US started an Epidemic Intelligence Service (EIS) in 1950, fear of malaria from troops  Turned out malaria was already gone in USA  Next surveillance programs: polio, influenza  Focus of EIS is fieldwork – large role in smallpox eradication  These days, NIAID monitors infectious diseases in the US  Foege (2000) argues 4 steps are necessary to monitoring diseases, and that it requires USA leadership o Combine marketplace and disease-control needs (cheaper vaccines/drugs, business compensation) o Thinking about a global plan (human and animal surveillance, rapid diagnostic techniques, modelling) o Global equivalent of EIS o Exert pressure on US political system for leadership in international health EBOLA  First Case in August 1976 in Zaire for Mabalo Lokela  Symptoms: Fever, Uncontrolled Vomiting, Diarrhea, bleeding from nose, gums, and eyes, severe headache  Ebola Outbreak spread to 50 villages, 318 cases, 280 deaths  Ebola is a member of the family of filoviruses – looks like spindly filaments  Filoviruses are very old, although Ebola is quite recent  Slower rate of mutuation compaired to influenza  Four types of human disease causation: Ebola Zaire, Ebola Sudan, Ebola Bundibugyo, Ebola Ivory Coast  5gh type: Ebola reston, has not been know to cause symptoms in humans ANTC68 WINTER 2013  Ebola is a HEMORRHAGIC fever, meaning it causes extensive bleeding from orifices  Other sympotmos: rashes, headache, vomiting, diarrhea  Case fatality rate of Ebola Zaire = over 90%  Spread through personal contact with blood, body fluids, bedding  Treatment: palliative (care for patient, no cure)  Possible respiratory transmission in lab monkeys  Practice of reusing needles contributed to the initial and subsequent outbreaks  Funerals were also instrumental in the early spread of the outbreak  Barrier Nursing: effectively prevents spread by using disposable gowns, masks, gloves, sterilized equipment, removing contaminated bedding  Since 1976, there have been almost 2400 cases of Ebola, with almost 1600 deaths  Epidemics occur in African countries: Zaire, Sudan, Uganada,  Isolated outbreaks in other countries are usually a result of lab accidents (Ebola Virus or Monkeys)  Most recently, epidemics in Uganda (24 cases, 17 deaths) and the DRC (72 cases, 32 deaths) in July 2012  Two vaccines in development EBOLA RESTON  1989, lab monkeys (crab eating macaque( imported to Reston, Virginia from the Phillipines  Researchers were investingating simian hemorrhagic virus  The monkeys were found to have a filovirus similar to Ebola  new strain Ebola Reston  Despite its status as Level 4 biosafety hazard (required hazmat suits, protective gear), workers were infected  Luckily, this string turned out not to cause symptoms in humans, although they developed antibodies  The Reston incident caused quite a media sensation due to the proximiting of Reston, Virginia to major US cities including Washington, DC  Ebola can be found in chimpanzees and gorillas and other similar primates  Human epidemics linked to bushmeat (link to economics, population increase)  Most likely reservoir – bats  Ebola epidemics localized to East and Central Africa SARS  Recall: experts worried abou the next big pandemic, most likely source is AVIAN influenza – like the 1918 influenza but worse  SARA as an influenza-like illness came close to being that big pandemic  Feb 2003 – WHO’s Weekly Epidemiological Record mentioned a mysterious “atypical pneumonia” in Guangdong province, China  Sympotms: Muscle aches, chills, couge, damage to lung  At first killed only 5 people but within a few week, reports started coming from Hong Kong, Singapore, Vietnam, and Toronto  On March 17, 2003, the new illness was labeled SARS: Severe Acute Respiratory Syndrome  First case: Guangdong province, China. November 16 , 2003  Super spreaders: people who were able to infect a disproportionately large number of people ANTC68 WINTER 2013  First super spreader infected three hosptials a nd a nephrology profession who went to a conference in Hong Kong  Several peple at the Hong Kong hotel were infected and travelled back to Vietnam, Singapore, and Toronto  Due to air travel, SARS spread quicker than the incubation period  On March 15 , 2003, the WHO issued an alert about SARS as well as a travel advisory against non-essential travel to Toronto  SARS ended on July 5, 2003 and had 8273 cases worldwide, 775 deaths in 26 countries  SARS is caused ba coronavirus (SARS-CoV)  Clinical symptoms: fever, muscle aches, chills cough)  Respiratory transmission  Case Fatality Rate: 9.4% highest in elderly  20% of cases were in health care workers  WHO set up worldwide collaborative initiative online for researchers, daily teleconferences  SARS provoked an unprecedented am
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