Epidemics, Pandemics and the Protection of the Public (17)

Question 1

Types of transmission

Answer 1

Direct, Indirect or Airborne

Question 2

Direct

Answer 2

Direct - STIs, Scabies

Feacal-Oral - Viral GE

Question 3

Indirect

Answer 3

Vector-borne - Malaria, Dengue

Vehicle-borne - Viral GE, Hep B

Question 4

Airborne

Answer 4

Respiratory - TB, Legionella

Question 5

Epidemic

Answer 5

Serious outbreak in a single community, population or region

Question 6

Pandemic

Answer 6

Epidemic spreading around the world affecting hundreds of thousands of people, across many countries

Question 7

Nasty diseases

Answer 7

Acute encephalitis, Leptospirosis, Ophthalmia neonatorum, Relapsing fever, Scarlet fever, Viral hepatitis

Question 8

Vaccine preventable diseases

Answer 8

Acute poliomyelitis, Diphtheria, Measles, Meningitis and Meningococcal septicaemia, Mumps, Rubella, Tetanus, Whooping cough

Question 9

Infectious diseases that can be controlled

Answer 9

Food poisoning, TB, Viral hepatitis

Question 10

If you suspect a notifiable disease..

Answer 10

notify Public Health England asap

Question 11

Influenza B

Answer 11

Sporadic outbreaks, children, prone to mutation, human virus

Question 12

Influenza C

Answer 12

Mild symptoms, stable human virus

Question 13

Influenza A

Answer 13

• Can infect pigs, cats, horses, birds and sea mammals
• Very prone to mutation (no proof reading mechanism)
• Antigenic drift - flexibility causes seasonal epidemics
• Segmented into 8 genes
• Genes swapping occurs during co-infection with human and avian flu virus > antigenic shift

Question 14

Haemagglutinin

Answer 14

Virus binding and entry to cells, 15 subtypes, immunity confers protection but only to specific subtype

Question 15

Neuraminidase

Answer 15

Release of newly formed viruses from infected cells, 9 subtypes, immunity to subtype reduces amount of virus released from cells resulting in less severe disease

Question 16

All 15N and 9N subtypes have been detected in

Answer 16

birds

Question 17

Seasonal Influenza

Answer 17

Every year ‘flu jab’

Question 18

Avian Influenza

Answer 18

Disease of birds H5N1, H7

mild disease in birds - ruffled feathers and depression

Question 19

Swine Flu

Answer 19

Disease of pigs

Question 20

Pandemic Influenza

Answer 20

Change/mutation in a flu virus to produce a new virus that can be transmitted easily between humans

Question 21

Pandemic flu will cause

Answer 21

• High morbidity
• Excess mortality
• Social disruption
• Economic disruption

Question 22

20th century pandemics influenza

Answer 22

1918 Spanish flu
1957 Asian flu
1968 Hong Kong flu

Question 23

What to expect from Pandemic Flu?

Answer 23

• Incubation 1-4 days
• Infectious from onset of symptoms - 5 days after
• 10% infectious before symptom onset
• Take 4-6 months before vaccine available

Question 24

Most seasonal influenza get..

Answer 24

Secondary bacterial pneumonia

Question 25

H5N1 causes

Answer 25

A primary viral pneumonia

Question 26

Controlling Avian Flu

Answer 26

- Cull affected birds - Biosecurity and quarantine - Disinfecting farms - Control poultry movement - Vaccine workers - Antivirals for poultry workers - Personal Protective Equipment (PPE) - Reduce change of co-infection

Question 27

H1N1 is

Answer 27

Swine Flu

Question 28

Swine Flu

Answer 28

- Human to human transmission - Sensitive to Oseltamivir and Zanamivir - Seasonal influenza vaccine not effective - People over 40 have some immunity - 474 deaths in UK

Question 29

Staff issues

Answer 29

- Anxiety (unwilling to work) - Adequate protection - Access to antivirals - Risk to family - Child care - Segregation of staff - Redeployment of staff - Recycling of staff - Organisations sharing staff

Question 30

Vaccines

Answer 30

- 6-10 months to develop - Limited availability - who first? - Two doses required for at risk groups

Question 31

Consequences of Measles

Answer 31

Measles encephalitis, thrombocytopenia, subacute sclerosing pan-encephalitis, death

Question 32

1 child with measles will infect ... others

Answer 32

15

Question 33

MMR vaccine

Answer 33

12-13months and 3.5 years, single dose offers 95% protection, two doses >99%

Question 34

Wakefield Controversy (1998)

Answer 34

8/12 parents linked onset of behavioural problems with MMR, but parents were less clear about timing of abode symptoms (MMR linked to Autism)

Question 35

Issues with Wakefield Controversy

Answer 35

Bowel and behavioural pathologies may have occurred by chance, selection bias or lack of biological basis