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I&I WC1 > Emerging Infectious Diseases > Flashcards

Emerging Infectious Diseases Flashcards

This deck contains all the emerging infectious diseases lectures given on Tuesday the 16th of January

1
Q

What are the major global threats in EID?(3)

A
  • Biodiversity loss
  • Global warming
  • Zoonotic risk
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2
Q

What are the main direct drivers of the increase in rate of global change? (5)

A
  • Changes in land and sea use
  • Direct exploitation of organisms
  • Climate change
  • Pollution
  • Invasion of alien species
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3
Q

What are the underlying causes of these main direct drivers?

A
  • Twofold increase in the human population
  • Fourfold increase in the global economy
  • Tenfold increase in global trade
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4
Q

Name the two key messages from the IPBES 2019

A
  • Transformative changes are needed
  • We have to steer away from the current limited paradigm of economic growth
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5
Q

Why are ‘planetary boundaries’ used?

A

To categorize environmental impact from all human activities at the global scale

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6
Q

Name the four planetary boundaries

A
  • Climate change
  • Biodiversity loss
  • Land use change
  • Disturbance of biochemical flows (N, P)
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7
Q

What are human-animal interface factors?

A

Factors that contribute to the evolving risk for cross-species transmission of pathogens

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8
Q

Name the human-animal interface factors important for cross-species transmission of pathogens (6)

A
  • Domestication
  • Agriculture
  • Urbanization
  • Colonization
  • Trade
  • Industrialization
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9
Q

What is important to remember with respect to the human-animal interface factors?

A

That changes in the scope and range have been accompanied by the evolving risk for cross-species transmission of pathogens

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10
Q

How did people from the human-gatherer society acquire new infectious diseases?

A
  • Eating meat and moving into new territories
  • Locally circulating endemic infections in wild animals
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11
Q

What influenced animal-to-human spread of infectious diseases in the agricultural society?

A
  • People learned to grow plants and to herd animals
  • Living in settlements
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12
Q

Zoonotic transmissions during the agricultural society (5)

A
  • Tuberculosis (cattle)
  • Smallpox (cattle)
  • Measles (dogs)
  • Leprosy (water buffalo)
  • Influenza (horses)
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13
Q

Important underlying causes of the increase of emergence of zoonoses (3)

A
  • Increased human incursion into forests
  • Increased numbers of farmed animals
  • Increased trade/transport of animals
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14
Q

Why are increased numbers of farmed animals and increased trade and transport causing this increase?

A

The numbers game. Increasing numbers of both allow infections to spread more easily

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15
Q

Why do the increased human incursion into forests contributes to the emergence of zoonoses?

A

People become exposed to pathogens in animals with whom they did not previously have much contact

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16
Q

Name the factors involved in the framework for categorizing drivers of emergence (3)

A
  • Changes in human-animal interactions
  • Proximate drivers
  • Ultimate drivers
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17
Q

Name the changes in human-animal interactions (3)

A
  • Interspecies contact
  • Range expansion
  • Population growth/aggregation
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18
Q

Name the proximate drivers (3)

A
  • Habitat change
  • Food/water change
  • Migration/movement
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19
Q

Name the ultimate drivers (3)

A
  • Climate variability
  • Land-use change
  • Animal management change
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20
Q

Which driver was important in the 2002 and 2019 SARS outbreak?

A

Increased trade/transport of animals

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21
Q

Which driver was important in the 1980 AIDS outbreak?

A

Increased human incursion into forests

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22
Q

Which driver was important in the 1997 and 2020 HPAI outbreaks?

A

Increased number of farmed animals

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23
Q

Which driver was important in the 2013 ebola outbreak?

A

Increased human incursion into forests

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24
Q

What is the definition of emerging infectious diseases?

A

Infectious diseases that have recently:
- Increased in incidence or geographic range in original host species
- Moved into new host species
- Been caused by newly evolved pathogens

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25
Q

Where do emerging infectious diseases come from?

A

More than 60% of emerging infectious diseases in the human population comes from animals

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26
Q

What is the definition of the (natural) reservoir host?

A

A species in which the pathogen endemically circulates and is considered to have co-evolved with

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27
Q

What is the definition of the intermediate (amplifying) host?

A

A species infected by a virus that is NOT the reservoir host, that plays an important role for spillover (to humans)

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28
Q

What is the definition of the vector?

A

A carrier of a disease-causing agent from an infected individual to a non-infected individual or its food or environment

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29
Q

What are vectors often used for?

A

Non-vertebrate reservoirs or objects

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30
Q

Which animal classes are important sources of emerging zoonotic viruses?

A

Birds and mammals

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31
Q

What species of mammal/bird is more likely to have a zoonotic virus?

A

It doesn’t matter to which order a mammal/bird belongs

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32
Q

Why do zoonotic viruses occur more in bats and rodents than other wildlife species?

A

There are more bat and rodent species

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33
Q

Why are bats special? (2)

A
  • They do not show illness for diseases that are very lethal to humans
  • Their antiviral response is different than that of humans
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34
Q

Which factors are relevant to take into account for zoonotic viruses (3)

A
  • Number of zoonotic viruses
  • Transmissibility to humans
  • Mortality
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35
Q

Why is it important to know reservoir species?

A
  • Helps to target surveillance
  • Helps to understand epidemiology
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36
Q

Most human cases of HPAIV result from contact with..

A

Chickens

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37
Q

Most human cases of Hendra virus result from contact with..

A

Domestic horses

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38
Q

Most human cases of MERS result from contact with..

A

Dromedary camel

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39
Q

True or false: ‘Farmed animals often the reservoir host, while wildlife often the intermediate host’

A

False. Farmed animals are often the intermediate host, while wildlife is often the reservoir host

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40
Q

What are the risk factors involved in the wildlife trade driving the emergence of zoonoses?

A
  • More intimate contact wildlife/livestock/humans
  • Increased number and density of farmed animals
  • Increased volume and longer distance of transport
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41
Q

Examples of wildlife trade driving the emergence of zoonoses

A
  • Monkeypox
  • SARS
  • COVID-19
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42
Q

What does wildlife trade lack?

A

Pathogen surveillance

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43
Q

What is most regulatory oversight of wildlife trade aimed at?

A

Conservation, rather than prevention of disease incursion

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44
Q

How many bat species are there in The Netherlands?

A

17

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45
Q

What types of food do bats eat?

A
  • Insects
  • Fruit
  • Pollen
  • Nectar
  • Fish
  • Blood
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46
Q

What is the host of EBLV-1 in The Netherlands?

A

Serotine Bat

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47
Q

Host for rabies virus in South America

A

Vampire bat

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48
Q

Host for Marburg virus in Africa

A

Egyptian Rousette

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49
Q

True or false: “Animals are often the origin of EIDs, while human activity is the cause”

A

True

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50
Q

How much milk does the world now produce?

A

800 million tonnes

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51
Q

How much meat did the world produce in 2018?

A

340 million tonnes

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52
Q

Live animal markets have likely played a significant role in the spread of…

A
  • SARS-CoV-2
  • Avian Influenza
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53
Q

Name factors that enhance likelihood of pathogen shedding, transmission, cross-species spillover and illness that are intensified in live animal markets (5)

A
  • Animals often held for long periods of time in overcrowded conditions
  • Poor hygiene practices
  • Mixed diverse species and close contact with traveling people
  • Subsequent travel of purchased animals
  • Complex trading chains
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54
Q

Which kinds of poultry farming are happening in Guangdong?

A
  • Large scale poultry farming
  • Smaller sale backyard farming
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55
Q

How many birds are annually imported into Guangdong?

A

200 million

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56
Q

Characteristics Influenza A virus (4)

A
  • High diversity of host species
  • High mutation rate
  • 8 segments that can reassort
  • Viruses named after HA and NA
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57
Q

Describe the process of the poultry market chain in Guangdong via large scale producers

A
  • Day old chicken
  • Large scale producers
  • Automatic slaughtering facility
  • Supermarkets/Fast food chains
  • Consumers
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58
Q

Describe the process of the poultry market chain in Guangdong via small- and medium scale producers

A
  • Day old chicken
  • Small- and medium scale producers
  • Wholesale poultry market
  • Live bird market
  • Consumers
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59
Q

Two which animal are hepatitis E-like viruses mostly related?

60
Q

How do viruses jump species? (3)

A
  • Direct jump
  • Adaptation
  • Reassortment
61
Q

Why are animal reservoirs important in livestock?

62
Q

Characteristics poxviridae (5)

A
  • Linear dsDNA
  • Genome size: 130-375kb
  • Brick-shaped and enveloped
  • Envelope not needed for infection
  • Replication only in cytoplasm
63
Q

Which layer surrounds the core/nucleopratein complex?

A

Pallisade layer

64
Q

How are the larger structures called that are located near the border of the pallisade layer?

A

Lateral bodies

65
Q

What does IMV stand for with respect to the poxviridae?

A

Intracellular mature viruses

66
Q

What does EEV stand for with respect to the poxviridae?

A

Extracellular enveloped viruses

67
Q

What can be said about IMV and EEV particles?

A

Both particles are infectious, but antigenically distant

68
Q

What division can be made host-wise for the poxviridae classification?

A
  • Insect host
  • Vertebrate host
69
Q

What division can be made pathogen-wise for the poxviridae classification?

A
  • Obligate human pathogens
  • Zoonotic pathogens
70
Q

Which viruses are obligate human pathogens (poxviridae)?

A
  • Molluscum Contagiosum virus
  • Variola virus
71
Q

Which viruses are zoonotic pathogens (poxviridae)?

A
  • Cowpox virus
  • Vaccinia virus
  • Monkeypox virus
72
Q

What did Edward Jenner show in 1796?

A

Linkage between the presence of skin and mucosal lesions on cows and on the hands of they milk-maids, and the low percentage of smallpox between those milkmaids

73
Q

When was M-Pox recognized as disease?

A

After Smallpox eradication

74
Q

When was M-Pox identified?

A

in 1958 in laboratory animals

75
Q

Which clades of M-Pox are circulating?

A

Clade I and II

76
Q

Which clade of M-Pox is more pathogenic?

A

Clade I (11% vs 1-3%)

77
Q

To which clade did the 2022 M-Pox outbreak strain belong to?

A

Clade II2B, most likely one single origin

78
Q

To which disease are the large proportion of confirmed M-Pox deaths related to?

A

Development of encephalitis

79
Q

Animal-to-human: describe the paths of M-pox transmission

A
  • Bite/Scratch from infected animals
  • Hunting: consume infected animals
  • Contact with infected secreations/lesions
80
Q

Human-to-human: describe the paths of M-pox transmission

A
  • Respiratory droplets from close contact
  • Direct contact with lesions
  • Contaminated surfaces
81
Q

What are the sequential phases of M-pox infection?

A
  • Incubation period
  • Prodromal phase
  • Rash phase
  • Desquamation phase
82
Q

How long is the incubation period of M-pox?

A

7-14/21 days

83
Q

How long is the prodromal phase of M-pox?

84
Q

Which symptoms characterize the prodromal phase?

A
  • Headache/Fever
  • Myalgia
  • Chills
  • Sore throat
  • Malaise/Fatigue
  • Lymphadenopathy
85
Q

How long is the rash phase of M-pox?

86
Q

Which symptoms characterize the rash phase?

A

Skin rash that develops into papuples and vesicles and eventually crust and heal

87
Q

What characterizes the desquamation phase?

A

Crusting and peeling off of lesions

88
Q

True of false: “M-Pox lesions have a different development stage”

A

False. All lesions in M-Pox have the same development stage

89
Q

True or false: “Chickenpox lesions have different development stage”

90
Q

Describe the five stages of M-pox lesions

A
  • Macule: rash starts as flat, red spots
  • Papule: spots become hard, raised bumps
  • Vesicle: bumps get larger and look like blisters with clear fluid
  • Pustule: blisters fill with puss
  • Scabs: spots crust over and become scabs that eventually fall off
91
Q

Diagnostics: how do you determine if someone has smallpox or m-pox?

A

Swabbing of lesions to perform PCR

92
Q

Human-to-human transmission: Describe the proposed pathogenesis of m-pox

A
  • Viral entry and replication in Oropharyngeal or Respiratory mucosa
  • Viral load circulates to LN draining mucosa
  • Primary Viremia
  • Lymphoid organs and distant LN: viral replication occurs
  • Secondary viremia
  • Tertiary organs/skin: clinical manifestation
93
Q

Animal-to-human transmission: Describe the proposed pathogenesis of m-pox

A
  • Viral load circulates to LN draining mucosa
  • Primary Viremia
  • Lymphoid organs and distant LN: viral replication occurs
  • Secondary viremia
  • Tertiary organs/skin: clinical manifestation
94
Q

What delayed the detection of the M-pox outbreak in 2022?

A

Differential diagnosis of syphilis, chickenpox and other STDs

95
Q

What were the symptoms of the 2022 M-pox outbreak?

A
  • Lesions often in anogenital and oral areas
  • Solitary genital skin lesions
  • Lesions involving palms and soles; rarely more than 10 lesions
96
Q

What is so special about the 2022 M-Pox outbreak?

A

Uncommon symptoms in the beginning hard to diagnose

97
Q

M-pox risk factors in Africa (4)

A
  • Living in forested areas near squirrels
  • Disease burden in children and females
  • Human-to-human transmission through close contact
  • Nosocomial infection females
98
Q

M-Pox prevention/treatments (4)

A
  • Supportive care during infection
  • Vaccinia Immunoglobulin (immunocompromised patients)
  • Vaccines
  • Antivirals
99
Q

Describe smallpox vaccines

A
  • 0 generation: Variolation
  • 1st generation: Dryvax
  • 2nd generation: ACAM 2000
  • 3rd generation: MVA
100
Q

Are smallpox vaccines cross-reactive to M-pox?

A

Yes, smallpox vaccination lowers probability of contracting M-Pox by 85%

101
Q

Which antivirals are used to combat M-Pox?

A
  • Tecovirimat
  • Cidofovir
  • Brincidofovir
102
Q

How can you develop an antiviral to an eradicated disease?

A

FDA animal rule

103
Q

What kind of genome do enteroviruses have?

A

Small (pico) positive strand RNA

104
Q

To which family do enteroviruses belong?

A

Picornaviridae

105
Q

When was poliovirus first identified?

106
Q

When did polio outbreaks occur in Europe and the US?

A

In the beginning of the 20th century

107
Q

What happened in 1949 with respect to polioviruses?

A

Ability to propagate poliovirus in cultured cells led to:
- Identification of 3 serotypes
- Generation of vaccines

108
Q

Poliovirus: clinical manifestations of human infections (5)

A
  • Asymptomatic
  • Non-paralytic polio
  • Non-paralytic CNS disease (meningitis)
  • Paralytic poliomyelitis (acute flaccid paralysis)
  • Bulbar paralytic polio myelitis (brain stem)
109
Q

Poliovirus: outcomes after paralytic disease

A
  • 10% complete recovery
  • 80% permanent paralysis
  • 10% fatal
110
Q

What is post-polio syndrome and when does it occur?

A

Muscle atrophy and weakness, pain, new disabilities, fatigue, sleep problems. Occurring 15-60 year post- paralytic or non-paralytic disease.

111
Q

Which two vaccins are available for polio?

A
  • Salk inactivated poliovaccine
  • Sabin live-attenuated vaccine
112
Q

What are the advantages and disadvantages of the Salk-inactivated poliovirus vaccine?

A

Advantages:
- Almost 100% seroconversion
- No severe side effects

Disadvantages:
- Expensive
- Needles required
- Low intestinal immunity - only reduced virus shedding

113
Q

What are the advantages and disadvantages of the Sabin live-attenuated vaccine?

A

Advantages:
- Cheap
- Intestinal immunity
- Passive immunization of unvaccinated persons
- Does not require a cold-chain
- Oral drops - easy to administer

Disadvantages:
- Acquisition of virulence mutation
- Vaccin-associated paralytic poliomyelitis (VDPV)
- Circulation of VDVP

114
Q

What is the goal of the Global Polio Eradication Initiative?

A

To complete the eradication and containment of all wildtype and vaccine-related polioviruses, such that no child ever again suffers paralytic poliomyelitis

115
Q

True or false: “Eradication of poliovirus = eradication of acute flaccid paralysis?”

A

Nope –> neurotropic enteroviruses

116
Q

Name four neurotropic enteroviruses

A
  • Coxsackievirus
  • Echovirus
  • Enterovirus 71
  • Enterovirus D68
117
Q

Which symptoms are associated with enterovirus D68?

A

Predominantly:
- Severe respiratory illness

CNS diseases:
- Acute flaccid myelitis
- Cranial nerve dysfunction
- Encephalomyelitis

118
Q

Where can you detect enterovirus D68 in the body?

A

Respiratory samples, occasionally in CSF

119
Q

Which (sub)clade is responsible for the 2014 D68 outbreak?

A

Subclade B1 most prevalent

120
Q

Is neurotropic potential a clade specific effect?

121
Q

What is the difference in pathogenesis between EV-D68 and other enteroviruses?

A

Replication in the respiratory tract:
- behaves more like a rhinovirus
- acid sensitive
- replication optimal at 33C

122
Q

What is a similarity between poliovirus and EV-D68 target-wise?

A

Both viruses target motor neurons in the spinal cord

123
Q

What is difference between poliovirus and EV-D68?

A

Primary replication site differs (intestinal- vs respiratory tract)

124
Q

What are the three steps of the pathogenesis of EV-D68?

A
  • Respiratory infection
  • Systemic dissemination
  • CNS invasion
125
Q

What are the characteristics of the respiratory phase of EV-D68 infection?

A
  • Infection of ciliated respiratory epithelial cells
  • Cell death and inflammation
  • Severe disease often associated with asthma
126
Q

What is a complication during the respiratory phase of EV-D68 infection?

A

Virus spreads to lower respiratory tract leading to pneumonia and severe asthma exacerbations

127
Q

In which sites of the body can you confirm EV-D86 infection?

A

Lymphoid tissues and gastro-intestinal tract

128
Q

Which cells are susceptible for EV-D68 in lymphoid tissues?

A

Lymphoid cells such as B cells

129
Q

Which cells are susceptible for EV-D68 infection in the gastro-intestinal tract?

A

Intestinal epithelial cells

130
Q

What are complications of systemic dissemination of EV-D68?

A
  • Acute cardiac failure
  • Skin rash
131
Q

What are CNS complications observed in patients infected with EV-D68?

A
  • Acute flaccid myelitis
  • Cranial nerve dysfunction
  • Encephalitis
  • Aseptic meningitis
  • Meningo-encephalitis
132
Q

What are the routes of CNS invasion by EV-D68?

A
  • Cranial nerves
  • Viremia –> muscle cells –> motor neurons –> spinal cord
133
Q

What is needed to control outbreaks?

A
  • Identification and characterization of the pathogen
  • Development of diagnostics to detect the virus in patients
  • identify and isolate the individuals infected and place contacts in quarantine
  • Lockdowns to protect the vulnerable when vaccines are not available
  • Vaccination
134
Q

Did MERS-CoV zoonotic transmission come from bats?

A

MERS-CoV is phylogenetically related to bat CoVs and replicates in a range of bat cell lines

135
Q

What are risk factors for MERS illness?

A
  • Dromedary farms
  • Milking dromedaries while on farm
136
Q

Why were vaccines not needed to control the 2003 SARS outbreak?

A
  • Virus excretion in SARS patients peaked after lower respiratory tract symptoms occurred: isolation and quarantine of patients effective
  • Few asymptomatic cases
137
Q

What made SARS-CoV-2 hard to contain?

A
  • Viral shedding peaks before symptoms occur
  • Many infected individuals are asymptomatic
138
Q

What are the steps in the diagnostic response to emerging infections?

A
  • Problem definition
  • Collection of background information
  • Defining the criteria
  • Choose the methods
  • Validate
  • Interpretation
139
Q

What do you have to look out for during problem definition?

A

For which application is the assay needed
- Diagnosis of infection
- Determining the cause of illness
- Surveillance tool
- Research question
- Linking cases to a common source

140
Q

What do you have to look out for during the collection of background information?

A

What is known about the pathogen/infection
- Pathogen, taxonomy, basic properties
- Clinical picture, age range, duration of complaints
- Kinetics of infection (shedding, immune response, relation to clinical symptoms)
- Incidence

141
Q

What do you have to look out for during defining the criteria?

A

What are the assay requirements
- Turn-around time
- Costs
- Simplicity
- Need for high throughput?
- Safety requirements?

142
Q

What do you have to look out for during validation?

A
  • Assay sensitivity
  • Assay specificity
  • Detection limit
  • Range/broadness
  • Positive- and negative predictive values
143
Q

What sensitivity and specificity are often used?

144
Q

What do you have to look out for during the interpretation of results?

A
  • Cut-off
  • Qualitative or quantitative result
  • Minimum number of specimens tested to assign outbreak to a pathogen
145
Q

For correct interpretation of a test result, you need…

A
  • Accurate specification of the assay
  • Data on validation
  • Basic information on patients
  • Optimal sampling

I&I WC1 (25 decks)

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