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Lecture 11

HLTB21- Lecture 11- Nov 28 .docx

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Department
Health Studies
Course
HLTB21H3
Professor
R Song
Semester
Fall

Description
HLTB21- Lecture 11- November 28, 2013 MERS: Middle East Respiratory Syndrome (quite new) • Novel coronavirus infecting humans • First reported in Sept. 2012 (Zaki 2012) • Incubation 5-12? days; cough, fever, breathing difficulties (we really don’t know much about MERS) • Zoonotic in origin (bats; camels?) • Unlike SARS, it damages many types of human cell lines (killing cells rapidly) and different organs in body; as well as many different animals
  Could be more virulent than SARS • Patients suffer multiple organ failure, esp. renal failure; pneumonia Novel SARS-like Coronavirus in the Middle East • Mar. 2013: 17 cases, 11 dead (since Sept 2012); 65% case fatality rate • Nov. 2013: 160 cases,
68 deaths: 43% case fatality 
rate • (SARS:~11%overall) • Qatar, Saudi Arabia, United Arab Emirates, Oman, Kuwait, • Jordan, Pakistan; probable - Germany, UK, France, Spain, Italy, Tunisia • WHO: not as easily spread between people as SARS MERS Transmission • Person-to-person transmission observed • Via: healthcare settings & close family contact • Most cases in men (why?), and individuals with co-morbidities -> because it was mostly men doing pilgrimages; they were also older > Imp. factors: pre-existing conditions (esp. diabetes, kidney disease) and a degree of immunosuppression > resulted in a lower case rate than SARS SARS vs. MERS Greater Case Fatality Rate with MERS (40-50% vs. 11%) • Much fewer health-care workers have been infected with MERS • Probably due to changed practices: improved infection control in hospitals, increased surveillance, public awareness campaigns, epidemiological investigations, and greater collaboration with international experts However, some have been critical about the relatively slow rate of knowledge gathering compared to SARS: we still don’t know much about MERS Approaches to Controlling Emerging and Re-Emerging Infections • Primary prevention: modification of, or elimination of, risk factors • Secondary prevention by early clinical recognition, rapid laboratory definition and prompt intervention; effective global surveillance is fundamental 
(see Louria 2000) Primary Prevention 1. Immunization : the developing world seems to be more accepting of immunization than those in the developed world 2. Adequate (and functioning) public health infrastructure : problematic of the developing world, because hard to get proper access 3. Responsible anti-microbial usage : national and international regulation of drug usage 4. “Amelioration of the societal variables that 
provide the milieu in which emerging and 
re-emerging infections arise and flourish” (Louria 2000) Technological Advancements in Infectious Disease Control (see Waldvogel 2004)  Quorem Sensing: with recognition of inter-bacterial communications, research on substances inhibiting cell-to-cell communication; production of antimicrobials that are less prone to the emergence of resistance  Genomics: improved understanding of bacterial genomes; re: bacterial evolution, potential virulence genes  Microbial gene expression profiling: better understanding of microbial or host tissue behaviour during infectious process; to aid in search for new antibiotics  Data handling and simulation systems, re: virtual experimentation, artificial testing of various conditions  Combinatorial chemistry: tool for screening new anti-infective drugs, compounds inhibiting resistance enzymes, or modification of known, useful antibiotics  Nanotechnology and nanobiology: re: drug discovery and delivery (nano- level) We’re using so many anti-bacterial things (i.e. creams) for things that don’t ca
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