Hyttysvälitteisiä tauteja Flashcards
1
Q
Dengue is a …
A
…viral infection transmitted to humans through the bite of infected female mosquitoes
2
Q
About half of the world’s population is now at risk of …
A
…dengue with an estimated 100–400 million each year.
3
Q
Dengue (break-bone fever) is found in…
A
… tropical and sub-tropical climates worldwide,
mostly in urban and semi-urban areas.
4
Q
Prevention and control of dengue depend
A
on vector control.
5
Q
There is no specific treatment for
A
dengue/severe dengue
6
Q
Symptoms of dengue (although most will not have symptoms)
A
high fever, headache (pain behind eyes),
body aches, nausea, and rash.
Most will get better in 1–2 week
7
Q
You can lower your risk of dengue by
A
avoiding mosquito bites especially during the day.
8
Q
Individuals who are infected for the second time are at greater risk of
A
severe dengue.
9
Q
Severe dengue symptoms often come after the fever has gone away:
A
severe abdominal pain
persistent vomiting
rapid breathing
bleeding gums or nose
fatigue
restlessness
blood in vomit or stool
being very thirsty
pale and cold skin
10
Q
Pain/fewer control in dengue:
A
Acetaminophen (paracetamol).
NSAIDs are avoided as they can increase the risk of bleeding.
11
Q
2023 ongoing transmission, combined with an unexpected spike in dengue cases, resulted
A
over 6.5 million cases and more than 7300 dengue-related deaths
12
Q
spread of the dengue epidemic (1.):
A
-the changing distribution of the vectors (chiefly Aedes aegypti and Aedes albopictus mosquitoes),
especially in previously dengue naïve countries
13
Q
Dengue; the consequences of El Niño phenomena in 2023…
A
… and climate change leading to increasing temperatures and high rainfall and humidity;
14
Q
Dengue spread (2.-4.):
A
- fragile health systems in the midst of the COVID-19 pandemic;
- and political and financial instabilities in countries facing complex humanitarian crises
- and high population movements
15
Q
Dengue is spreading to new areas in …
A
…Europe, the Eastern Mediterranean and South America
16
Q
A high number of Dengue cases were reported 2023…
A
… in Asia: Bangladesh, Malaysia, Thailand, and Viet Nam
17
Q
After feeding on a infected person, the dengue virus
A
…replicates in the mosquito midgut before disseminating to its salivary glands.
18
Q
The time it takes from ingesting the dengue virus to actual transmission to a new host is termed the extrinsic incubation period (EIP). The EIP takes about …
A
…8–12 days when temperature is between 25–28°C.
19
Q
Rare cases of dengue transmission via …
A
blood products, organ donation and transfusions have been recorded
20
Q
Is there a possibility of maternal transmission with dengue fever?
A
yes
21
Q
vertical transmission rates with dengue fever
A
appear low
22
Q
When a pregnant mother does have a dengue infection…
A
… babies may suffer from pre-term birth, low birthweight, and fetal distress.
23
Q
Urbanization (especially unplanned), is associated with dengue transmission through
A
population density, human mobility,
access to reliable water source, water storage practice
24
Q
Community risks to dengue/DENV also depend on a
A
population’s knowledge,
attitude and practice towards dengue,
behaviours such as water storage, plant keeping, and
self-protection against mosquito bites.
25
engaging to Routine vector surveillance and control activities
greatly enhances a community’s resilience
26
Lower the risk of getting dengue by protecting yourself from mosquito bites by using:
-clothes that cover as much of your body as possible;
-mosquito nets sprayed with insect repellent;
-window screens;
-mosquito repellents (containing DEET, Picaridin or IR3535);
and
coils and vaporizers.
27
Mosquito breeding can be prevented by:
-preventing mosquitoes from accessing egg-laying habitats;
disposing of solid waste properly and removing artificial man-made habitats that can hold water;
covering, emptying and cleaning domestic water storage containers on a weekly basis;
applying appropriate insecticides to outdoor water storage containers.
28
one vaccine (QDenga) has been approved and licensed in some countries.
However, it is recommended only for
the age group of 6 -16 years in high transmission settings.
29
Denguerokotetta voidaan harkita
+4-vuotiaille matkailijoille, jotka ovat aiemmin
sairastaneet Denguen ja
jotka ovat lähdössä vähintään 4 viikoksi esiintymisalueille
30
Yellow fever is an infectious disease transmitted by
Aedes and Haemagogus mosquitoes that bite mostly during the day.
31
Yellow fever is prevented by a vaccine, which is...
... safe and affordable.
A single dose is sufficient to grant life-long protection.
32
A modelling study based on African data sources estimated the burden of yellow fever during 2023
was 84 000–170 000 severe cases and 29 000–60 000 deaths
33
Yellow fever is caused by an
arbovirus (a virus transmitted by vectors such mosquitoes, ticks or other arthropods)
34
Yellow fever transmitting mosquitoes breed
around houses (domestic), in forests or jungles (sylvatic),
or in both habitats (semi-domestic).
35
Yellow fever is a high-impact high-threat disease, with risk of...
...international spread, which represents a potential threat to global health security.
36
The incubation period for yellow fever is
3 to 6 days. Many people do not experience symptoms.
37
Common symptoms in yellow fever include
fever, muscle pain, headache, loss of appetite, nausea or vomiting.
In most cases, symptoms disappear after 3 to 4 days.
38
A small percentage of yellow fever patients enter a second, more toxic phase within
24 hours of recovering from initial symptoms.
High fever returns,
liver and the kidneys are affected -> jaundice,
dark urine, and
abdominal pain with vomiting. Bleeding can occur from the mouth, nose, eyes, or stomach.
39
Half of the yellow fever patients who enter the toxic phase ....
die within 7–10 days.
40
Patients with yellow fever should ...
rest, stay hydrated and seek medical advice.
41
Detecting yellow fever
(PCR) works sometimes in early stages of the disease.
In later stages, testing to identify antibodies is needed (ELISA and PRNT).
42
The yellow fever vaccine provides effective immunity within 10 days for...
80–100% of people vaccinated, and within 30 days for more than 99%
43
People who are usually excluded from yellow fever vaccination:
-infants < 9 months;
-pregnant women (except during a yellow fever outbreak when the risk of infection is high);
-people with severe allergies to egg protein;
-people with severe immunodeficiency (symptomatic HIV/AIDS, others)
- who have a thymus disorder.
44
For yellow fever, vector surveillance targeting
Aedes aegypti and other Aedes species will help inform where there is a risk of an urban outbreak
45
A confirmed case of yellow fever in an unvaccinated population is
considered an outbreak.
46
The Eliminate Yellow Fever Epidemics (EYE) Strategy was developed in response to two urban yellow fever outbreaks
– in Luanda (Angola)
and Kinshasa (Democratic Republic of the Congo)
47
ITN =
insecticide-treated net;
48
IRS =
indoor residual spraying
49
LLINs =
long-lasting insecticidal nets
50
PBO =
piperonyl butoxide
51
Zika virus is transmitted primarily by
Aedes mosquitoes, which bite mostly during the day.
52
Most people with Zika virus infection do not develop symptoms;
symptoms start 3-14 days after infection:
including rash, fever,
conjunctivitis,
muscle and joint pain, malaise and headache, pain behing eyes (like in Dengue,) that last for 2–7 days.
53
rash associated with zika virus is either morbilliform (papules) or scarlatiniform (micropapules).
It starts on the face on the first day of illness and spreads to trunk and limbs. The rash may affect palms and soles, which may be swollen.
It begins to fade within 2–3 days and is gone completely within a week.
54
Zika virus infection during pregnancy can cause 5-15% of infants
to be born with microcephaly and other congenital malformations (limb contractures, high muscle tone, eye abnormalities and hearing loss) as well as
preterm birth and miscarriage.
55
Zika virus infection is associated with
Guillain-Barré syndrome, neuropathy and myelitis in adults and children
56
Although cases of Zika virus disease declined from 2017 onwards globally, transmission persists at low levels in.
several countries in the Americas and other endemic regions
57
first local mosquito-transmitted Zika virus cases were reported in Europe in 2019 and...
... Zika virus outbreak activity was detected in India in 2021
58
Zika virus is also transmitted
from mother to fetus during pregnancy, as well as through sexual contact, sperm,
transfusion of blood and blood products,
and possibly through organ transplantation
59
WHO recommends the use of whole blood, serum,
or plasma routine diagnostic testing for
arboviruses, and urine for ZIKV NAAT testing.
60
Molecular assays are the preferred detection
method for Zika virus but
the period of RNA detectability
following infection is limited
61
Interpretation of serologic test results remains
challenging because of ...
...cross-reactivity and
prolonged detection of virus-specific antibodies;
their utility depends on the patient’s current and
prior flavivirus exposures.
62
People with Zika virus-like symptoms such as rash, fever or joint pain should get
plenty of rest, drink fluids, and treat symptoms with antipyretics and/or analgesics.
(NSAIDs should be avoided until dengue virus infections are ruled out because of bleeding risk).
63
Prevention of Zika virus
No vaccine is yet available for the prevention or treatment of Zika virus infection.
64
Protection against mosquito bites during the day and early evening is
a key measure to prevent Zika virus infection,
especially among pregnant women, women of reproductive age and young children.
65
Sexual transmission of Zika virus, pregnant women should...
...practice safer sex (including condoms) or abstain from sexual activity for at least the entire duration of pregnancy
66
Japanese encephalitis virus (JEV) is a flavivirus related to dengue, yellow fever and West Nile viruses, and is spread by
mosquitoes (especially Culex tritaeniorhynchus).
67
JEV is the main cause of viral encephalitis in many countries of Asia with an estimated
100 000 clinical cases every year
68
the case-fatality rate among those with Japanese encephalitis can be .
as high as 30%
69
of those with Japanese encephalitis,
permanent neurologic, cognitive and behavioural sequelae...
...occur in 30–50%
70
The majority of JEV cases occur in
children below 15 years of age.
71
endemic JEV transmission, exposing
...more than 3 billion people to risks of infection
72
Is there a cure for JEV?
There is no cure for the disease.
73
Most JEV infections are
mild (fever and headache) or without apparent symptoms,
but approximately 1 in 250 infections results in severe clinical illness
74
The incubation period for JEV is
4–14 days.
75
In children, JEV shows as
gastrointestinal pain and vomiting may be the dominant initial symptoms.
76
Severe disease of JEV is characterized by
rapid onset of high fever, headache,
neck stiffness,
disorientation, coma,
seizures, spastic paralysis
and ultimately death (of these 30%).
77
permanent cognitive, behavioural or neurological sequelae in JEV such as
seizures,
hearing or vision loss,
speech, language,
memory,
and communication problems
or weakness of the limbs in 30-50%
78
The JEV exists in a transmission cycle between
mosquitoes, pigs and/or water birds (enzootic cycle).
79
The JEV is predominantly found in
rural and periurban settings,
close proximity to domestic pigs (warm weather causes epidemic peaks)
and storks
80
Transmission of JEV in the tropics and subtropics..
intensifies during the rainy season and
pre-harvest period in rice-cultivating regions.
81
Initial diagnosis of JE can be made by
clinical examination followed by a lumbar puncture.
-JEV-specific IgM antibody in a single sample of cerebrospinal fluid (CSF) or
serum, using an IgM-capture ELISA.
82
Testing of CSF sample in a suspected JE patient is preferred to...
... reduce false-positivity rates from previous infection or vaccination.
83
Encephalitis is a
medical emergency and requires urgent medical attention
84
low- and middle-income countries individuals and families with members disabled by encephalitis should be encouraged to seek
services and guidance from local and national Organizations of Disabled People (ODPs) and other disability focused organizations
85
There are three main types of JE vaccines currently in use:
1. inactivated Vero cell-derived vaccines,
2. a live attenuated vaccine,
3. and a live recombinant (chimeric) vaccine.
86
Personal preventive measures against JE include
the use of mosquito repellents,
long-sleeved clothes,
coils and vaporizers.
87
the spread of JEV in new areas has been correlated with
agricultural development
and intensive rice cultivation supported by irrigation (keinokastelu) programmes.
88
Chikungunya is a disease transmitted to humans by mosquitoes in
Africa, Asia, and the Americas; sporadic outbreaks have been reported in other regions
89
Chikungunya causes
fever and severe joint pain, which is often debilitating and varies in duration;
other symptoms include joint swelling, muscle pain, headache, nausea, fatigue and rash.
90
Rash of Chikungunya
An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days.
It can be patchy or diffuse on the face, trunk and limbs.
It is typically asymptomatic but may be pruritic
91
Rash of Chikungunya
92
Severe symptoms and deaths from chikungunya are
rare and usually related to other coexisting health problems.
93
Chikungunya is spread by Aedes albopictus (or Aedes aegypti) mosquitos, a viral disease caused by
the chikungunya virus (CHIKV), an RNA virus in the alphavirus genus of the family Togaviridae.
94
Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus bite
primarily during daylight hours.
95
Aedes (Stegomyia) aegypti and Aedes (Stegomyia) albopictus lay eggs in...
...containers with standing water.
Both species feed outdoors, and Ae. aegypti also feeds indoors.
96
In symptomatic patients, CHIKV disease onset is typically
4–8 days (range 2–12 days) after the bite of an infected mosquito.
97
CHIKV disease onset is characterized by an
abrupt onset of fever, frequently accompanied by severe joint pain.
The joint pain is often debilitating and usually lasts for a few days but may be prolonged, lasting for weeks, months or even years (tulotason lasku, työnteko hankalaa).
98
Other common signs and symptoms of CHIKV include
joint swelling, muscle pain,
headache, nausea,
fatigue and
rash.
99
complications that have been reported with CHIKV infections
occasional cases of eye, heart, and neurological complications
100
Pienet lapset ja perussairauksia omaavat vanhukset ovat vaarassa
saada CHIKV:stä vakavan tautimuodon ja kuolleisuuden riski on korkeampi
101
Diagnostics
Chikungunya virus may be detected directly in
first week of illness using RT–PCR or ELISA
102
Diagnostics
Chikungunya virus; Other tests can detect a person’s immune response typically used
after the first week of infection to test for antibodies to the virus
and can still be detected for about 2 months.
103
CHIKV; non-steroidal anti-inflammatory drugs (NSAIDs) can increase the
risk of bleeding.
104
Is there a vaccine against CHIKV?
No
105
The main method to reduce transmission of CHIKV is
through control of the mosquito vectors
106
Repellents should contain
DEET, IR3535 or icaridin.
107
malaria
108
malariatapausta, ja kuolemaa
263 miljoonaa tapausta
* 600 000 kuolemaa
109
the resurgence of malaria
in Iran
in 2022, after 4 years of zero
indigenous cases,
110
Endeemiset alueet tulevat leviämään
vuoristoalueille korkeammalle
merenpinnasta
* Anopheles-hyttynen tulee leviämään
pohjoisempaan
111
Diagnostiikka Malarille
Mikroskopointi
Antigeeni
-pikatesti
Nukleiinihappo
-pikatesti
112
Malarian hoito
Artemisiini yhidstelmähoidot (ACT)
* Suomessa: artemeetteri-lumefantriini (Riamet)
113
Artemisiiniresistenssi ?
* PfKelch13-mutaatio Rwanadassa ja Ugandassa
* Myanmar ja länsi-Thaimaa 65% näytteissä mutaatio joka
altistaa osittaiselle artemisiiniresistenssille
114
Vakavan malarian tunnistaminen
* Aivomalaria
* Vaikea anemia
* Hengitysvajaus
* Munuaisten vajaatoiminta
* Metabolinen asidoosi,
hypoglykemia
115
Estolääkitys lapsille malariaan
* Seasonal Malaria Chemoprevention (SMC)
* Alueilla, jossa malaria kausittainen
* Alle 5-vuotiaille lapsille
* Amodiaquine + sulfadoxine-pyrimethamine
(AQ+SP), hoitokuuri 1kk välein
116
Malaria raskauden aikana
* Raskaana olevat naiset ovat erityisen
alttiita P. falciparum malarialle
* Piilevä istukan infektio heikentää sen
verenkiertoa ja hidastaa sikiön kasvua
-> Altistaa ennenaikaisille synnytyksille
117
Malarian estolääkitys:
Verrattuna vuoteen 2000,
falciparuminfektiot olivat vähentyneet 50%,
anemia vähentynyt 33%,
syntymäpainon
mediaani noussut 130 g
118
WHO:n suositus raskauden aikana
* Hyttysverkon käyttö
* SP sulfadoxine-pyrimethamine-estolääkitys jokaisen neuvolakäynnin
yhteydessä toisesta trimesteristä alkaen, myös
alueilla jossa SP-resistenssiä esiintyy
* Tehokas diagnostiikka ja hoito (ensilinjan
artemisiini-yhdistelmähoitoa voidaan käyttää)
119
Malariarokotteet
* RTS,S ja R21
* Vähentää lasten sairaalahoitoa vaativaa
malariaa 22%
* All-cause-mortality väheni 13%
120
Malariarokotteet: Rokottamalla 200 lasta estetään
1 kuolema
121
Malariarokote: Ensimmäinen parasiitti-rokote, jota
WHO suosittelee osaksi yleistä
rokotusohjelmaa (kohtalaisen tai
korkean transmission alueet)
122
Mikä on arbovirus?
ARthropod-BOrne virus
* Arboviruksiksi kutsutaan RNA- viruksia
jotka leviävät verta imevien
niveljalkaisten (hyönteisten) välityksellä
123
Dengue * Taudin sairastuvuus
on vuosittain
kymmeniä miljoonia ja
mortaliteetti
20 -25000 ihmistä, valtaosa lapsia.
124
Denguen ilmaantuvuus on
kahdeksankertaistunut viimeisen
20v. aikana
125
paikallisia dengue tartuntoja
on todettu myös ei-endeemisillä
alueilla kuten
Ranskassa, Italiassa,
Saksassa ja Espanjassa
126
Denguekuumetta aiheuttaa Flaviviruksen
4 eri serotyyppiä:
DEN-1, DEN-2, DEN-3 ja DEN-4.
127
* Yhden dengueviruksen serotyypin sairastaminen antaa pysyvän
immuniteetin
vain kyseiselle serotyypille, joten sama
henkilö voi sairastaa denguekuumeen elämänsä aikana
useamman kerran.
128
dengue taudinkulku
129
Vakava dengue, labrat
Matalat Trom
Hkr lasku
Hb lasku
Matala albumiini
Maksa-arvojen nousu
Pleuranesteily
130
Dengue - Diagnostiikka
* RT-PCR
* NS1 ELISA antigeenitesti, positiivinen 3-5vrk
taudin alusta
* Vasta-aine määritys kun oireiden alusta 7vrk
131
* HUS:ssa suositus denguen diagnostiikkaan
denguevirus-pakettitutkimus (S-DenAgAb),
antaa diagnoosin > 95 %:lle
denguepotilaista.
132
133
134
Chikungunya =
"that which bends up."
135
Chikungunya, Taudin sairastaneelle syntyy
elinikäinen
immuniteetti
136
Zikavirus; Sikiövaurion riski on raskauden
...1.kolmanneksen aikana 5-8 % ja
myöhemmässä raskaudessa hyvin vähäinen
137
Zikavirus Diagnostiikka:
* PCR ( akuuttivaihe)
* IgM anti-Zika-vasta -aineet
* Zika MAC-ELISA (2-12 vko)
138
JE: Vain x
kaupunkialueelle matkustavasta
turistista sairastuu
1 miljoonasta
139
Chikungunyaan on nyt elävä rokote =
IXCHIQ vähintään 18-vuotiailla henkilöillä.
-pidemmälle matkalle endeemiseen maahan
-ja jolle CHIKV infektio olisi hankala (esim yli 65v. tai jokin perussairaus)
-ei voi antaa immunosupressoiduille
140
Maailmassa >460 Anopheles-lajia, joista
30-40 voi
levittää malariaa
141
Vektorikontrollin ongelmia
Nykyiset keinot (ITN, IRS, LLIN) Afrikassa eivät ole riittäviä (vähentävät
malarian ilmaantuvuutta, insidenssiä, mutta eivät yleisyyttä, prevalenssia)
Hyttyset kehittäneet vastustuskykyä pyretroideille ja permetriinille
Malariahyttyset oppivat väistämään kemiallisia torjuntakeinoja
Torjuntakeinoja vesissä ei suositella maanviljelyalueilla
Ulkoilmassa pistävät hyttyset (esim. vartijat)
