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GGRB28 Notes from assigned readings

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Mark Hunter

GGRB28 Changing patterns of infectious disease most of the twentieth century the predominant feeling infectious diseases was optimismthe development and successes of antibiotics and immunizations victory declared increasing emphasis was directed at the noninfectious diseases such as cancer and heart diseaseIn much of the developed world the public had forgotten the impact of infectious diseases This optimism shaken by a series of outbreaks and epidemicsInfectious diseases in the twentieth century At the beginning of the twentieth century infectious diseases were the leading cause of death worldwidetb pneumonia and diarrheal diseasehighchild mortality rates and low life expectancy by 1900 morbidity and mortality from infectious diseases had already considerably improved in much of the developed worldattributed to a series of factors that were decreasing host susceptibility and curtailing disease transmission better nutrition and housing safer food etcthe introduction of antimicrobial agents in the midtwentieth century accelerated this improvement By the end of the twentieth century in most of the developed world mortality from infectious diseases had been replaced by mortality from chronic illnesses infectious disease remained a major cause of morbidity in the developing world thby the end of the 20 century new infectious agents had the potential for rapid international spreadalso re emergence of old infectious diseases such as ebolaResistance to antimicrobial agents was becoming a serious global problemin 1992 the Institute of Medicine IOM issued report defined an emerging infection as a new reemerging or drugresistant infection whose incidence has increased in the last two decades or whose incidence threatens to increase Factors influencing emergenceEmergence is often the consequence of societal and technological change and is frequently unexpected and unpredictable Ironically some factors that have resulted in a decline in one disease can contribute to an increase in another The development of refrigeration provided an advantage to organisms such as ListeriaThe recurring theme throughout all of these factors that influence the emergence of infectious diseases is change 6 factors contributing to re emergence followChanges in demographics and behaviour Demographic changes fall into several broad areas changes in population such as the increasing prevalence of persons with susceptibility to infection societal changes and moments of infected ppl Changes in behaviour include increases in recognized risky behaviours increase in susceptible populationsAgeing of the population increases in underlying diseases and technological advances in health care have all contributed Medical technology is also increasing the survival of persons with otherSexual activity is an important behavioural risk factor that has contributed to emergence also smoking and iv drug use geographical moves One of the strongest influences on the emergence of resistance has been the unnecessary use of antimicrobial agentsChanges in technology and industry changes in food production and distribution allows for the emergence of food borne illnessEnvironmental change and land use Changes in environment and in land use are global activities that include both natural and manmade changespreserving deer populations have led to the spread of Lyme disease Climate change whether natural or manmade is also contributing to the emergence of infectious diseasesInternational travel and commerce travel facilitates the global transmission of diseases spread by infections too can spread more rapidly Diseases that would normally have a limited geographic distribution have become part of the differential diagnosis of the unwell traveller International foodborne disease outbreaks Microbial adaptation and change As society and technology change so do microorganism change can be the result of selective pressure Breakdown of public health measures Some infectious diseases have emerged or reemerged because the public health systems established to prevent or control them have broken down due to complacency from past successes against infectious diseases limited resources and competing priorities in public health social unrest wars and population movementsTB good example of these factors Emerging infections in the twentyfirst centuryDuring one century most of the developed world experienced vast improvements in health However much of the improvement was limited in the developing worldSocietal and technological change accounted for both the control and the emergence of infectious diseases One lesson learned from history is that change leads to the continued emergence of infectious diseasesFoodborne diseaseearly in our history there were diseased animals unsafe food handling unsafe drinking water and malnutrion incidence offoodborne diseases was soon reduced by a series of regulatory and technological changes including food inspection Nutrition was improved by the fortification of food with vitamins and minerals and social programmes to feed the poor It is ironic that for present generations malnutrition from excessive amounts or types of food is increasing susceptibility to infectious diseases by contributing to heart diseasediabetesResistance to antimicrobial agents Microbes that once were easily controlled by antimicrobial drugs are more and more often causing infections that no longer respond to treatment with these drugs A combination of increased selective pressure from the use of antimicrobials increased disease transmission and a decline in the development of new antibiotics has raised the spectre of once treatable infections becoming untreatableLOOK UP VRE related to drug resistance Communities have also experienced problems Drug resistance in the developed world has been increasing in foodborne pathogens One of the most worrying problems for the community has been the emergence of drug
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