A Global Perspective: Epidemiology Of Major Global Diseases Flashcards
WHO
-agency of UNITED NATIONS, concerned with international public health.
CDC
Mission
- PRTECT AMERICA from health, safety and security threats, both foreign and in the US
- MONITOR DISEASES that start at home or abroad
- conducts research
- provides health information
Measles (Rubeola)
- RESPIRATORY TRACT DISEASE caused by a virus. Rash, high temps, cough, red watery eyes
- many complications: diarrhea, ear infections, pneumonia, encephalitis, seizures, death
- transmits person to person through droplets from nose, mouth, throat
- HIGHLY CONTAGIOUS
- affects MOSLY KIDS
- rash on head and trunk
- no treatment, recover within 2-3 weeks
- COMPLICATIONS WITH MALNOURSHED KIDS AND REDUCED IMMUNITY
Morbidity and mortality of measles
- 20 MILL people affected each year
- worldwide decrease in deaths 2000-2016. Vax, still common in many developing countries
- preventable by vaccine, either alone, or measles-mumps-rubella
- THERE IS NO EVIDENCE THIS VACCINE CAUSES AUTISM
Measles and the eye
- UP TO 60,OOO CASES OF BLINDNESS worldwide per year attributed to measles
- most in developing nations and suffer from a VITAMIN A DEFICIENCY
Measles in the US 1944-2007
1940-1960, several hundred thousands of cases in US
- mid 1960s vax developed and cases dropped dramatically to small number
- in 1980, there was an uptick of measles and a second dose was recommended, after that, cases back down to close to zero
- there was an outbreak in 2014: occurred in California in Disney Land.
- 2017 had another small outbreak. Most were unvaccinated
Ebola hemorrhagic fever
- virus first seen in 1976
- severe bleeding, organ failure, death
- origin-passed from ANIMAL HOSTS-FRUIT BATS or primates. Zoonotic Disease-normally existing in animals, transmitted from vertebrates animals to humans (SARS, HIV). BATS are most common mammal-to-human source of viruses
- now PERSON TO PERSON contact via blood and other BODILY FLUIDS (mucuous membranes)
Spread of Ebola
- pathetically for NOSOCOMIAL (healthcare settings) tranmission
- does not spread as easily as colds, flu, measles
- no evidence spread though the air or water
- cannot spread disease UNTIL SYMPTOMS APPEAR
Ebola virus outbreaks by year
Highest in 1976, 1995-2003, 2007, and very highest in 2014
Ebola 2014-2016 epidemic
- first confirmed case MARCH 2014
- multiple countries in west Africa. 28000 reported cases; 11,000 deaths
UNITED STATES
- two imported cases, including one death
- tow locally acquired cases in healthcare workers
Epidemic was over as of march 2016, BUT NEW OUTBREAK IN APRIL 2018 in Congo
-EXPERIMENTAL VACCINE has been developed and has been distributed to millions
TB
- mycobacterium tuberculosis, attacks LUNGS
- SPREAD THROUGH AIR-respiratory droplets-sneezing, coughing, inhalation
- NOT spread by sharing food, touching surfaces
- can become infected by NOT DEVELOP ACTIVE symptomatic disease
- not contagious until active disease occurs
- 1/4 OF THE WORLDS POPULATION is infected with TB
TB symptoms
- persistent fought )blood included) night sweats, fever, weight loss, chills, fatigue
- greater risk with COMPROMISED IMMUNE SYSTEMS-AIDS, DM, leukemia, kidney disease, and head or neck cancer
- there are drug resistance strain
Reported TB cases US 1982-2016
Uptick in 1990 and now levels off and slow decline
-higher in American Indians and Alaskans and Asian populations
TB prevalence map
High in Africa, Asia
Ocular manifestations of TB
- sSYSTEMIC SYMPTOMS NOT NECESSARY FOR OCULAR SYMPOMS
- can affect almost any part of the eye
- conjunctivitis, keratitis, PHLKYCTENULE, UVEITIS, iris nodules, cataract, choroiditis, retinal vasculitis, neuroretinitis
- granulomatous anterior uveitis with MUTTON FAT KERATIC PERCIPITATES (KPs) (also caused by sarcoidosis, syphilis)
- PHLYCTENULE: hypersensitivity reaction (also caused by staph)
HIV
- targets iMMUNE SYSTEM, weakens defense against infections and cance r
- AIDS is the most advanced HIV. 2-15 years to develop. AIDS DEFINED BY development of opportunistic disease and CLINICAL MANIFESTATIONS: cancer, infections
- leading cause of death in HIV patients worldwide is TB
- tranmission-blood, breast milk. Seem, and vaginal secretions
Leading cause of death in HIV patients
TB
HIV prevalence in the world
South Africa most prevalent South America Mexico Asia Australia
Mortality of HIV
1.1 million worldwide deaths in 2015
Reduction in incidence of HIV
New cases
- 2001-3.4mill
- 2013-2.1mill
Proportion of cases by race over time of HIV
Whites on the decline, but started with the highest prevelance in the 80s
AA on the rise
Hispanic very slight rise
Asian, American Indian/Salamanca, and Hawaiian have virtually no cases
Ocular manifestations of AIDS
- kaposi sarcoma on conjunctiva
- toxoplasmosis
- HSV, HZV
- fungal infections
- syphilis
- TB
- CMV** RETINITIS
- choroiditis
- acute rental necrosis
- uveitis
- COTTON WOOL SPOTS. Infarction of the NFL, swells. In the presence of no other retinal findings
**All are much less common now with treatment
ZIKA
Virus transmitted by mosquito
- this VECTOR also trnamits yellow fever, dengue, and other tropical diseases
- may be transmitted by a mosquito biting an infected person then transferring infecte blood by biting an uninflected person
- increased risk at lower altitudes
Also transmitted DIRECLTY through sexual contact
Discovered in 1947** in Uganda, small outbreaks occurred for decades,
May, 2015 BRAZIL, large increase in cases
Zika symptoms
- relatively MILD EFFECT on adults. 20% have symptoms
- fever, rash, joint pain
- can be confirmed with blood or urine test
- no vaccine or cure: give palliative care
When occurs in pregnancy, can be passed to fetus and cause MICROCEPHALY. More likely EARLY in pregnancy
MICROCEPHALY
- virus destroys brain, skull collapses on part that was destroyed
- permanent physical and intellectual disabilities
Zika in Brazil. Control
- 95% fewer cases in may 2017
- insecticides to 20 million homes
- released genetically modified mosquitos to mate with carriers
US symptomatic ZIKA cases reported
2015: 6 cases, ALL in travelers returning from affected areas
2016: 5102 cases. FLORIDA and TEXAS transmitted locally via mosquito, sexually and unknown persons to person
2017: 140 cases
2018: 20 cases
TOTAL SO FAR 2461 cases in pregnant women as of may 2018
FLORIDA and Zika
Cautionary zones and no go zones for pregnant women
-the have been removed June 2, 2017
Ocular findings of Zika
- conjunctivitis
- RETINA AND CHOROID (primarily noted in congential cases). Pigment mottling, chorioretinal atrophy
NO EVIDENCE OF TRANSMISSION THOUGH TEARS
Zika travel guidelines
Consult the CDC
Some cautionary areas on the map you can see
Control of Zika
- present mosquito bites
- avoid mosquito locations: REMOVE STNADING WATER where they breed; MOIST buckets, bowls, plants, flower pots; Dark humid places, under sinks
- bite MORE LIKELY DURING THE DAY
- insecticide
- GMO mosquitos to mate with Zika virus mosquitos. Offspring die
- control blood supply
- vaccine development
Non infectious global epidemic: DM
- lack of or ineffective use of INSULIN
- beta cells in pancrease produce insulin, enables cells to absorb GLUOCSE to produce energy
Type I diabetes
Autoimmune disease
- body attacks beta cells resulting in ABSENCE OF INSULIN
- typically childhood onset
Type II Dm
Insulin is present but body “resistant” to it
- typically adult onset
- 90% DIABETICS worldwide
- risk factors: sedentary lifestyle, obesity
- but can convert to type I as beta cells become destroyed in effort to compensate by producing more insulin
Glucose cannot get into the cells, increases in blood
HYPERGLYCEMIA
Diabetes incidence and prevalence
- world wide prevelance of 8.5%***
- US=9.4%***
- 84 MILLION** HAVE PREDIABETES (1/3 of american adults). Increased risk of heart disease and stroke
US incidence diabetes
-1.7 million NEW cases per year
Ethnic group with high prevalence of DM
Native Americans
Global projections of diabetes 2010-2030
51% increase worldwide
Mortality < 60 of diabetes world wide
Higher all over the world
Incidence in US of diabetes in last few years
DECREASE in INCIDENCE not prevalence
Exercise, diet, awareness
Ocular signs of DR
Traditional RD
Iris neo
PRP
Diebetes and obesity
Risk factor
Ecological data
BMI and Risk for DM II
As one goes up, the other does too
-relative risk increases with BMI
Risk factors for the diabetes epidemic in Asia
- Asians have lower rates of overweight and obesity than their western counterparts, using conventional definitions
- despite lower BMI, some Asian countries have similar or even higher prevalence of diabetes than western countries. These data confirm that the risk of type II DM starts at a lower BMI for Asians than for Europeans
