Class Notes (837,001)
Canada (509,985)
Anthropology (1,602)
ANTC68H3 (58)
R Song (25)


6 Pages
Unlock Document

R Song

ANTC68: Deconstructing Epidemics Lecture 7: Re-emergent Infectious Diseases: Tuberculosis The Third Epidemiological Transition  Persistence of Chronic Non-Infectious Diseases, Newly Emergent & Re-Emergent Infectious Disease Infectious diseases notable for: 1) Many new diseases causing mortality being detected 2) Increased incidence and prevalence of previously controlled (re-emergent) infectious diseases 3) Many re-emergent pathogens evolving into drug-resistant strains Re-emergence of Disease The interaction of: 1) Social change 2) Demographic change 3) Environmental change 4) Microbial adaptation (medical malpractice) 5) Drug Development Factors in Disease Re-/Emergence  US Institute of Medicine (see Barrett et al. 1998: 264): 1. Ecological change 2. Human demographics and behaviour 3. International travel and commerce 4. Technology and industry 5. Microbial adaptation and change 6. Breakdown in public health measures  Anthropogenesis of Disease Re-/Emergence Tuberculosis  Chronic disease of Mycobacterium bacteria  In humans, originated w/ population aggregation  Airborne transmission (saliva, mucus)  Only 5-10% of those infected will develop active TB  Most cases of active TB from adult re-activation from earlier (latent) exposure (despite BCG vaccine), at times of stress  Once inhaled: focuses in the lung, body responds by developing a granuloma to wall off the bacillae – called a Tubercle  Chronic cough (blood), fever, chills, weight loss, fatigue, night sweats  With flare-up, bacillae increase and breaks from tubercle to spread throughout body, esp. areas of RBC production (esp. cancellous bone): ribs, epiphyses, vertebral bodies, pelvis, even skull Hard Tissue Evidence --> destroys bone tissue  Vertebrae  Hip  Knee  Pott's Spine  Bone destruction not formation Tuberculosis Old World vs. New World  Very old, in early written records: China 2700 BC, India 2000 BC  Early archaeological evidence: Neolithic grave in Germany (5000 BC), Egypt (3700 BC), Denmark (2500 BC)  Precolonial New World: North America, South America  1000 year old Peruvian mummy: pulmonary lesion typical of TB discovered in lung tissue (1994)  Confirms existence of TB in New World pre-Columbus  Probably brought with Asian migrants over Bering Strait at approx. 20,000 ya and 12-10,000 ya  Mummy torso presenting with extensive pleural adhesions (left) and anterior destruction of two lumbar vertebral bodies (middle) Historical perspectives on TB?  Everyone was susceptible to TB in Europe  N America's approach to TB prevention was through sanitorium TB and Minority / Immigrant Groups  First nations and immigrants in Canada  Migrants with Tb restricted  Migrants without TB ...have higher risk of re-active Tb if they test negative the first time around  First nations ... poverty, A Critical Epistemology of Re-/ Emerging Infectious Disease What is emerging? What is re-emerging? Social Construction of Epidemics Rhetoric of Immediacy (Farmer 1999) Disease Visibility TB Today  Approx. 1.5 million deaths annually (2011), though rate is dropping: by 41% between 1990-2011  98% TB deaths in the developing/underdeveloped world  2 billion people, or 1/3 of the world's total population, are infected (most dormant, not active)  Approx 9 million will develop the active disease annually  Today TB is a pandemic  While the highest rates per capita are in Africa (a quarter of all TB cases), half of all new cases are in 6 Asian countries: Bangladesh, China, India, Indonesia, Pakistan, Philippines In a latent phase of the infection: no symptoms In the early active stages:  Fever  Chills  Sweating  Night sweats  Flu-like symptoms  Gastrointestinal symptoms  Weight loss  No appetite  Weakness  Fatigue In the late active stages:  Persistent cough  Chest pain  Coughing up bloody sputum  Shortness of breath  Breathing difficulty  Recurring bouts of fever  Weight loss  Progressive shortness of breath Drug Resistance  WHO: 50 million people may already be infected with drug-resistant TB strains  Drug resistance develops in 10% of the 8 million new TB infections each year  Person with active TB (or drug-resistant patient who remains infectious) can infect about 10-15 other people over the course of one year (one of whom, on average, will come down with active MDR-TB [WHO])  Russia's epidemic of drug-resistant tuberculosis is one of the worst in the world. Economic decline, the breakdown of social safety nets, alcoholism, poverty and a high incarceration rate have been key factors in the dramatic increase of TB and the subsequent rise of multidrug-resistant strains (Farmer, various)  In the population of Tomsk Oblast, Siberia -- where Partners In Health has been working since 2000 to expand its successful MDR-TB treatment model -- 11.2 percent of new TB infections are drug-resistant (Farmer Drug Resistance  MDR-TB: multi-drug-resistant TB – when there is resistance to two of the most potent first-line TB drugs (isoniazid and rifampicin), with or without resistance to other first-line drugs  In virtually all 109 countries recently surveyed by WHO  425,000 new MDR-TB cases occur every year with the highest rates in the former USSR and China, where up to 14% of all new cases are not responding to the standard drug treatment XDR-TB: extensively drug-resistant TB - resists treatment by two of the first-line drugs (isoniazid, rifampicin) and resistance to any of the fluoroquinolones, and any one of the three injectable second-line drugs (amikacin, capreomycin, kanamycin)  First detected in 2006, but now seen in 45 countries, most notably South Africa, amongst HIV patients TB and Medical Mismanagement Individuals at Risk:  Friends/family of those w/active disease  Poor and medically underserved  Homeless people  Prisoners  Elderly  Those from countries with high incidence rates  Residents of care/nursing homes  Alcoholics and intravenous drug users  Those with pre-existing conditions, esp. HIV, or those undergoing treatments that impair immune function  Health care workers and those in contact with high risk populations, e.g., prison guards Marginalized and Invisible Disease, Risk Groups and Stigma  Risk Groups… highlight vulnerable groups for public health focus, but what are the potential consequences?  Stigma: social disapproval of personal characteristics, behaviours or beliefs that are perceived to contravene dominant cultural norms; often based on misunderstood or false information; denotes negative characterization and results in discrimination Is
More Less

Related notes for ANTC68H3

Log In


Join OneClass

Access over 10 million pages of study
documents for 1.3 million courses.

Sign up

Join to view


By registering, I agree to the Terms and Privacy Policies
Already have an account?
Just a few more details

So we can recommend you notes for your school.

Reset Password

Please enter below the email address you registered with and we will send you a link to reset your password.

Add your courses

Get notes from the top students in your class.