EMERGING AND RE-EMERGING DISEASES


          Are diseases which are being identified among human beings for the first time or, having been progressively getting better controlled, have started to show rising incidences or to appear in places where they did not exist before.
          Include: AIDS (1981); SARS (March 2003); Lassa (1950s, 1969); Marbug (1967); Ebola (1976); Legionellosis (Penn., 1976); Lyme (Conn., 1977); Rift Valley; West Nile; Venezuelan equine encephalitis; etc.
          Then, Tuberculosis; Dengue; (Buruli & Yaws); Malaria, Yellow fever, Drug resistant STIs; E coli; Salmonella; Influenza.

HIV/AIDS
          Origin, virus types, modes of transmission, window period, incubation/latency period, curability; “a development crisis in Africa”.
          Problems with prevention: venereal shame, double-dealing, “stigma”; poverty; cost of care, etc.
          Control: behavioural change, mass education, family and community support, international support, etc; the condoms pros and cons.
SERIOUS ACUTE RESPIRATORY SYNDROME
          First cases in March 2003 in China.
          Present with fever, cough, chest pain, dyspnoea, lobar consolidation, etc. Study show it to be due to corona virus.
          Control so far by isolation, surveillance and symptomatic treatment.
          Safety assurance for laboratory procedures involving the specimens.
LASSA FEVER
          Outbreaks started to occur in the 1950s but it was not till the attack on American missionaries and the isolation of the virus in 1969 that the name was given; endemic disease of West Africa.
          Reservoir in rat (Mystomys natalensis).
          Transmission by contamination with rat excreta or direct blood or secretion of sufferer.
          Control by isolation, contact surveillance & post-exposure prophylaxis with ribavirin; barrier nursing; rat control.
MARBUG VIRAL DISEASE
          First cases in 1967 in Marbug, West Germany by contamination with blood, organs and cell cultures of African Green monkeys.
          Several cases have been seen from East and Central Africa.
          Reservoir-host-vector chain yet undetermined.
          Incubation of 3 – 9 days
          Control essentially as for Lassa fever.
EBOLA HAEMORRHAGIC FEVER.
          A haemorrhagic fever of East and Central African countries (Congo, etc) that started in 1976.
          Viral cause of the same family as Marbug.
          Transmission by contact with blood or secretions of infected person; but reservoir-vector-host factors not yet fully determined.
          Control as for Lassa except for unknown reservoir and vectors; and not sensitive to ribavirin.
TUBERCULOSIS
          Re-emerging as a result of real time deterioration of health and human conditions, rich-poor gap, urban migration and growth in urban slums, multi-drug resistance phenomenon.
          Epidemiology otherwise as before.
          Association with silicosis and HIV/AIDS.
          Control programme by the DOTS; social rehabilitation also.
DENGUE FEVER
          Disease of South-East Asia and the Western Pacific which got to pandemics involving the Caribbean in 1977. Got to Nigeria with the trade in used tyres from the far East 70s and 80s.
          Normal epidemiology in the endemic countries; and yet unclear in the others.
          Control essentially in vector (Aedes egypti) control; no vaccine as yet.
OTHER RE-EMERGING DISEASES
          Buruli ulcer by Mycobacterium ulcerans, not a major emerging disease and epidemiological basis most likely related to other mycobacteria. Control by ulcer excision, early dressing, hygiene
          Leprosy by Mycobacterium leprae with epid. Virtually as for TB with more social stigma.
   Control by single dose rifampicin, ofloxacin and minocycline for paucibacillary infection; daily dapsone + monthly rifampicine for 6 months; and daily dapsone + clofazimine and supervised rifampicin + clofazimine monthly for 12 months. BCG, contact tracing + Rx; social rehabilitation
          TB control by directly observed multidrug treatment strategy; INH+rifampicin+pyrazinimide+ethambutol daily for 2months + isoniazid+rifampicin 3ice wkly for another 4 months
HEALTH SERVICES AND CONTROL OF EMERGING AND RE-EMERGING DX
          Essential community health services for effective disease control, including the emerging diseases.
          Slide 2 and look at the other diseases there.
ARTICLE SOURCE
Prof. MC Asuzu,
Dept. of Community Medicine,
UCH, Ibadan.
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