Epidemiology 3a Flashcards
What is Tajikistan?
Tajikistan is one of five Central Asian countries that were formerly part of the Soviet Union. It is one of the poorest of these countries, with less than 7% of its land available for cultivation.
What happened to Tajikistan in 1991?
Tajikistan became an independent nation in 1991 as the result of the dissolution of the former Soviet Union
Why did tajikistan become an independant nation in 1991?
As a result of the dissolution of the soviet union.
What was the problem for tajikistan of the dissolution of the soviet union?
The shift in its status from being a member of a totalitarian republic to an independent nation brought with it certain challenges.
What were the challenges for tajikistan as a result of becoming an independent nation?
- Basic public services (e.g., health care, water supply, and sewer systems), previously guaranteed for even the poorest nations in the Soviet Union, were no longer supported through the Soviet cost-sharing system.
- Financial hardships and inadequate tariffs in Tajikistan severely limited provision of services and maintenance of equipment.
- Faulty design and installation of equipment while Tajikistan was still part of the Soviet Union added to these problems.
What caused even worse problems for tajikistan after becoming an independent nation?
To make matters worse, shortly after becoming an independent nation, Tajikistan experienced a civil war that continued until a cease-fire occurred in 1996
What happened during the civil war in tajikistan?
During the civil war, an estimated 50,000 lives were lost and 1.2 million persons were internally displaced. In addition, a substantial number of trained technical and professional workers left the country.
What happened by 1997 in tajikistan?
By 1997, the country’s economy and much of its infrastructure had collapsed. Consequently, the health of the people of Tajikistan suffered. Diseases rarely seen before the dissolution of the Soviet Union reappeared in increasing numbers.
What reappeared in tajikistan?
Diseases rarely seen before the dissolution of the Soviet Union reappeared in increasing numbers.
What caused the reappearance of diseases?
Lack of hygiene, access to (clean) water, nutrition problems, disease, population density.
What health problems are common in countries with displaced populations,
economic hardships, and deteriorating infrastructure?
malnutrition, waterborne diseases, and outbreaks of vaccine-preventable diseases like measles and cholera. Additionally, mental health issues such as anxiety and depression are also prevalent.
What did the primary health care offer in tajikistan?
The polyclinics provided ambulatory care and certain acute care services
What did the polyclinics in tajikistan lack?
Lacked surgical and post- operative care facilities. Limited hospital beds at nationally run hospitals were available for patients needing in- patient services
How were notifiable disease reported?
Cases of notifiable disease were reported each week from the polyclinics and hospitals to the Sanitary Epidemiologic Service (SES).
What is the Sanitary Epidemiologic Service (SES)?
the public health unit that monitored infectious diseases.
What was reported in feb 1997 in Dushanbe, the capital of tajikistan?
an increase in typhoid fever cases was reported in Dushanbe, the capital of Tajikistan (population approximately 600,000).
Details about the spread of typoid fever in dushanbe?
Typhoid fever was endemic in this area, more than 2,000 cases had been reported during January 29−February 11 (i.e., a 2-week period), compared with approximately 75 cases each week during the previous month. During the same 2-week period in 1996, only 23 cases had been reported.
Where were typoid fever patients hospitalized?
All typhoid fever patients were hospitalized at one of six full-service hospitals in the city, as required by a central government edict.
What did SES staff do in response to the increase in transmission of typhoid fever?
SES staff studied the situation to determine the likelihood of an outbreak.
Besides an outbreak, what are other possible explanations for the increase in cases of typhoid fever reported to the SES? How would you go about ruling out these other explanations?
Better tests, better labs, better diagnostic tools, better patient psychology.
Ruled out by conducting an investigation into the outbreak. Finding the cause of the outbreak.
What did SES investigators do as a first step in investigating the increase of typhoid fever?
SES investigators confirmed the diagnosis of typhoid fever in a sample of patients admitted to one of the Dushanbe hospitals. They also examined laboratory testing procedures and reagents at all six hospitals. No evidence of laboratory error or contamination of cultures was identified.
What did the SES investigators find in their investigations into the increase of typhoid fever?
SES investigators were unable to identify recent events that might have led to an increase in the completeness of
case reporting.
SES investigators noted that the civil war had resulted in the displacement of substantial numbers of Tajikistan citizens and an increase in the Dushanbe population. However, movement of the displaced persons was spread over a lengthy period and seemed an unlikely explanation for the sudden increase in typhoid fever cases during Jan−Feb 1997.
What did SES investigators conclude?
SES staff concluded that the increase in typhoid fever cases was real and likely represented an outbreak. Because previous typhoid fever outbreaks had been associated with foods and beverages sold by street vendors, the city government prohibited such sales. However, considerable debate remained about the source of the outbreak and appropriate control measures.
What was the first step of SES investigators?
to review known information about the disease and risk factors on the basis of its epidemiology and previous outbreaks.
What is typhoid fever?
Typhoid fever is an acute, life-threatening febrile illness caused by the bacterium Salmonella enterica serotype Typhi. Paratyphoid fever is a similar illness caused by S. Paratyphi A, B, or C.
What bacterium causes typhoid fever?
Salmonella enterica serotype Typhi
What are the modes of transmission for typhoid fever?
Humans are the only source. No animal or environmental reservoirs have been identified.
Typhoid and paratyphoid fever are most often acquired through consumption of water or food that have been contaminated by faeces of an acutely infected or convalescent individual or a chronic asymptomatic carrier.
Transmission through sexual contact, especially among men who have sex with men, has rarely been documented.
Describe the occurrence of typhoid fever.
An estimated 22 million cases of typhoid fever and 200,000 related deaths occur worldwide each year; an additional 6 million cases of paratyphoid fever are estimated to occur annually.
Approximately 400 cases of typhoid fever and 150 cases of paratyphoid fever are reported to CDC each year among persons
with onset of illness in the United States, most of whom are recent travellers.
What areas are at risk of typhoid fever?
Risk is greatest for travellers to South Asia (6 to 30 times higher than all other destinations). Other areas of risk include East and Southeast Asia, Africa, the Caribbean, and Central and South America.
What are travellers to south asia at highest risk for?
Travelers to South Asia are at highest risk for infections that are nalidixic acid-resistant or multidrug-resistant (i.e., resistant to ampicillin, chloramphenicol, and trimethoprim– sulfamethoxazole).
Travelers who are visiting…
…friends or relatives are at increased risk of typhoid fever.
What does the risk of acquiring typhoid fever increase with?
increases with the duration of stay.
although, travellers have acquired typhoid fever even during visits of less than 1 week to countries where the disease is endemic.
What is the incubation period of typhoid and paratyphoid infections?
The incubation period of typhoid and paratyphoid infections is 6–30 days
Describe the onset of typhoid fever symptoms.
The onset of illness is insidious, with gradually increasing fatigue and a fever that increases daily from low-grade to as high as 102° F–104° F (38.5° C–40° C) by the third to fourth day of illness. Headache, malaise, and anorexia are nearly universal. Hepatosplenomegaly can often be detected. A transient, macular rash of rose-coloured spots can occasionally be seen on the trunk.
Describe the fever symptom of typhoid fever.
Fever is commonly lowest in the morning, reaching a peak in late afternoon or evening
How long does typhoid fever last for untreated?
Untreated, the disease can last for a month.
How long does it take for serious complications of typhoid fever to begin?
The serious complications of typhoid fever generally occur only after 2–3 weeks of illness
What are some of the serious complications of typohid fever?
mainly intestinal haemorrhage or perforation, which can be life threatening.
What does infection with typhoid or paratyphoid fever result in?
Infection with typhoid or paratyphoid fever results in a very low-grade septicaemia
How often is blood culture found positive?
Blood culture is usually positive in only half the cases.
