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Communicable Diseases > Week 9-13 > Flashcards

Week 9-13 Flashcards

1
Q

What are the two most prolific foodborne pathogens in Australia?

A

Campylobacter and Salmonella

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2
Q

What are the three broad steps in foodborne illness outbreaks?

A

Identification, investigation, action

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3
Q

What are the three types of data used to link illnesses to contaminated foods in order to solve outbreaks?

A

Epidemiological, environmental (traceback), laboratory

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4
Q

What are some examples of epidemiological information used in foodborne outbreaks?

A

Data from case interviews
Discovery of clusters w/ same exposures
Past outbreaks of same pathogen

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5
Q

How are environmental data gathered in foodborne outbreaks?

A

Look for common point of contamination in distribution chain (from farm to fork)
E.g. inspections of farms, factories, restaurants

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6
Q

How are laboratory data gathered during a foodborne outbreak?

A

Collect samples from sick people/compare to food, investigated environments (such as retail and production environment)

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7
Q

What is OzFoodNet and by whom is it coordinated nationally?

A

National network of foodborne disease epidemiologists and surveillance officers in each state/territory health department
Coordinated nationally by OzFoodNet Central Team within the Aus Government Department of Health

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8
Q

Who coordinates a foodborne outbreak that crosses multiple jurisdictions?
(Two agencies, one for epidemiological investigation and one for environmental investigation)

A

Epi: OzFoodNet Central
Environmental: food safety agencies under the binational Food Safety Network

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9
Q

Approximately how many cases of Campylobacter are there in the community vs those that seek medical attention?

A

10 in community for every one seeking medical attention

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10
Q

What were some wide-scale outcomes that occurred as a result of the N QLD Campylobacter outbreak of 2010?

A
  • Closer working relationship w/ Safe Food Production QLD
  • Safe Food Production QLD became more prescriptive w/ industry
  • Development of FSANZ Compendium of Microbiological Criteria for food 2018
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11
Q

What foodborne pathogen causes haemolytic uraemic syndrome?

A

Shigatoxin-producing E. coli

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12
Q

What are the objectives of the Food Act 2006?

A
  • Ensure food safe/suitable for human consumption
  • Prevent misleading conduct related to sale of food
  • Apply Food Standards Code
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13
Q

What is the international body responsible for setting food standards?
Who established it?

A

Codex Alimentarius Commission (Codex)

Established by UN Food and Agriculture organisation and WHO

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14
Q

What is the body responsible for setting food standards in Australia specifically?

A

Food Standards Australia New Zealand (FSANZ)

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15
Q

What was the source of the Salmonella outbreak in Sydney in 2007? (location and what was contaminated?)

A

Sydney bakery

Salmonella found on many foods/surfaces in bakery - unable to pinpoint specific source (widespread contamination)

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16
Q

What is HACCP?

A

Hazard Analysis of Critical Control Points

Management system addressing food safety through analysis and control of hazards

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17
Q

What is the PHLN?

A

Public Health Laboratory Network - group of labs w/ expertise in public health micro in Aus & NZ
- Subcommittee of AHPPC

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18
Q

Define hazard

A

Anything that may pose a danger to human health, property, and/or the environment.
“Potential energy”

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19
Q

Define risk

A

possibility that harm might occur when exposed to a hazard

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20
Q

Define risk control

A

Taking action to eliminate health and safety risks

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21
Q

What are the four steps involved in managing WHS risks?

A
  • ID hazards
  • Assess risks
  • Control risks
  • Review control measures
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22
Q

What is the process of incident notification (as per WHS Act 2011)?

A

PCBU notifies WHSQ (Work Health Safety QLD, or equivalent in other state)

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23
Q

What are some ways of reducing antimicrobial resistance as per the O’Neill review

A
  • Public education campaign
  • Infection prevention
  • Reduce use in agriculture
  • Improve global surveillance
  • Promote/develop vaccines
  • Improve recognition/pay of infection professionals
  • Establish global innovation fund for non-commercial research
  • Better incentives for new drug development
  • Build global coalition for action
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24
Q

What is GLASS (re: UN), and what is its aim?

A

Global Antimicrobial resistance Surveillance System
Support global surveillance and research to strengthen evidence-base on AMR
- Looks at antimicrobial use and resistance

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25
Q

What is AURA?
What does it do?
Who is it hosted by?

A
  • Antimicrobial Use and Resistance in Australia
  • Coordinated surveillance on antimicrobial use and resistance (coordinates multiple different programs)
  • Hosted by the Australian Commission on Safety and Quality in Healthcare (ACSQHC)
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26
Q

What are the “four pillars” of reducing antimicrobial resistance?

A
  • Infection prevention and control
  • AMS
  • Better diagnostics
  • New drug development
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27
Q

What are three broad categories of barriers to health promotion and disease prevention?

A
  • Demographic barriers
  • Cultural barriers
  • Healthcare system barriers
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28
Q

How is Ebola transmitted?

A
  • Blood/body fluids of person/body infected w/ EVD
  • Semen from man recovered from EVD
  • Infected fruit bats/non-human primates
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29
Q

What is the latent period of EVD?

A

2-21 days (average 8-10 days)

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30
Q

What are some factors that caused challenges in EVD control in Sierra Leone in 2014?

A
  • Mortuary rituals involving touching and washing the dead
  • Burying dead in own community
  • Belief that could have been caused by another disease
  • Fear of stigma
  • Lack of trust in healthcare providers/healthcare system
  • Fear of police/armed forces who came in to support
  • Fear of healthcare providers (that they were spreading EVD, and appearance of PPE)
  • Fatalism
  • Poor quality healthcare
  • Poor access to healthcare
  • Choice for traditional healing
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31
Q

1) What is the cornerstone of primary healthcare?

2) The perceived benefits of what increase the likelihood of this cornerstone? (four factors)

A

1) Community participation
2) - Creation of an enabling environment for public health interventions
- Health behaviour modification
- Improved efficiency, utilisation, and sustainability of health services
- Harnessing of community capacity and resources (to supplement limited allocations for healthcare)

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32
Q

What are some determinants of community participation at the following levels?

1) Individual
2) Household
3) Community
4) Govt/civil society

A

1) Knowledge/perceptions of disease, vulnerability vs/ resilience factors, social stigma, acceptability of intervention, incentives/disincentives
2) Gender roles/power relationships, cultural norms, access to interventions, geography/logistics
3) Community heterogeneity vs/ social cohesion, social environment, disease epidemiology/complexity of intervention, congruence to local priorities
4) Type of political system (e.g. democratic, dictatorship), political advocacy/support for participation, decentralisation of power/resources to local level, health authority commitment to Primary Health Care, intersectoral coordination, human resources

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33
Q

What are the 7 principles of ethics in public health action (particularly outbreaks and emergency situations)?

A
  • Justice
  • Beneficence
  • Non-maleficence
  • Autonomy
  • Accountability
  • Fidelity
  • Veracity
34
Q

What is distributive justice?

A

Equitable distribution of scarce resources amongst socioeconomic groups and population sectors

35
Q

What are the four areas of ethical concern in mitigating pandemic disease?

A
  • Equitable access to healthcare in a pandemic
  • Ethics of public health actions taken in response to pandemic
  • Obligations of healthcare workers during a pandemic and the obligations of society to them in return
  • Obligations amongst countries and intergovernmental organisations
36
Q

Briefly describe each of the 7 ethical principles related to pandemic response:

1) Utility
2) Efficiency
3) Fairness
4) Liberty
5) Transparency
6) Participation
7) Review and revisability
8) Effectiveness

A

1) Acting to produce the greatest good
2) Minimising resources needed to produce a particular result
3) Treating cases alike
4) That one should not trade freedom for security
5) Info about processes/basis for decisions should be made available to the affected population
6) Stakeholders should be involved through appropriate institutions and means, in processes formulating the objectives and adopting policies
7) Stakeholders should have a way to appeal policies that have been adopted; processes should be in place to allow policies/plans to be reviewed and revised in light of experience
8) There must be ways to translate the other principles into practice (otherwise principles will be irrelevant)

37
Q

What are the four principles that must be contemplated when considering an autonomy-limiting public health strategy?

A
  • Clear + measurable harm to others if unchecked (and must be spread person-to-person)
  • Proportionality principle should be used (least restrictive measures to achieve goals)
  • Reciprocity (assist in discharged effected of obligations, provide food, shelter, psychological support)
  • Transparency (communicate justification clearly, allow process for appeal)
38
Q

What three questions need to be addressed when considering large-scale quarantine?

A
  • Do public health and medical analyses warrant imposition of large-scale quarantine?
  • Are implementations and maintenance feasible?
  • Do potential benefits outweigh risks?
39
Q

What is the difference between biosecurity and biosafety?

A

Biosecurity - keeping things out (e.g. border quarantine)

Biosafety - keeping things contained (e.g. lab setting)

40
Q

1) What does the Australian government do to protect biosecurity?
2) What legislation is in place to support this?

A

1) - Management of unwell travellers
- Vector monitoring and control
- Yellow fever vaccination
- Regulation re: bringing human remains into Aus
2) Biosecurity Act (2015) (+IHR & JEE internationally)

41
Q

What is the National Biosecurity Committee (NBC)?

A
  • Formally established intergovernmental agreements (signed by all states/territories in 2012 except Tasmania)
  • Manages biosecurity threats
  • Provides advice to Agricultural Senior Officials Committee on national biosecurity
42
Q

What is the IRA?

A

Import Risk Assessment
- Preborder biosecurity (on-ground surveillance, climate monitoring e.g. wind for flying vector spread, vessel/aircraft reconnaissance)

43
Q

What are state/territory jurisdictions responsible for re: biosecurity?

A
  • Regional surveillance, response, compliance monitoring
  • Lab capabilities
  • Chemical & residue detection & testing
44
Q

What is the act used in QLD to provide comprehensive biosecurity measures, replacing the many separate pieces of legislation previously used to manage biosecurity?

A

The Biosecurity Act (2014)

45
Q

What are the three foundation principles of biosecurity?

A

1) Shared responsibility
- All parties responsible; those who take risk should manage risk
2) General biosecurity obligation (GBO)
- Everyone must take reasonable steps to prevent/minimise biosecurity risks
3) Risk-based decision-making

46
Q

What’s the postulated transmission pathway of vCJD into humans?

A

Scrapie in sheep&raquo_space; cattle fed meat meal containing CNS material&raquo_space; cattle +ve for BSE&raquo_space; humans consume CNS material from BSE cows&raquo_space; human +ve for vCJD

47
Q

Why is BSE difficult to find in cows?

A
  • Long incubation period
  • May be asymptomatic
  • No reliable antemortem Dx test (Dx by IHC on brain tissue)
48
Q

How did Australia attempt to prevent BSE?

A
  • 1966 ban on imported meat + bone meal
  • 1996 - banned feeding ruminants to ruminants
  • 1999 - restricted animal materials rules applied
  • All material from vertebrate animal other than tallow, gelatin, milk products, or oils now banned
49
Q

What is a zoonosis?

A

Any disease or infection naturally transmissible from vertebrate animals to humans

50
Q

What % of emerging disease are zoonotic?

A

75%

51
Q

What is driving emergence of zoonotic diseases?

A
  • Changes in demographics/behaviour
  • Change in environment/land use
  • Breakdown of public health measures
  • Microbial adaptation/change
  • International travel/commerce
  • Changes in tech/industry
    »>These lead to:
  • Increase host susceptibility
  • Increase disease transmission
  • New diseases
52
Q

What is leptospirosis? What’s the entry point in humans?

A

Motile, aerobic, gram -ve spirochaete; enters through skin/mucosa, multiplies in blood/tissue

53
Q

What adverse outcomes can leptospirosis cause in:

1) Kidneys
2) Liver
3) Skeletal muscle
4) Lungs
5) Brain

A

1) Interstitial nephritis, tubular necrosis&raquo_space; renal failure
2) Centrilobular necrosis, jaundice, hepatocellular dysfunction
3) Oedema, focal necrosis
4) Haemorrhagic pneumonitis
5) Meningoencephalitis

54
Q

What are the four broad clinical categories of leptospirosis?

A

1) Mild, flu-like illness
2) Weil’s syndrome (jaundice, renal failure, haemorrhage, myocarditis)
3) Meningitis/meningoencephalitis
4) Pulmonary haemorrhage/resp failure

55
Q

What are risk factors for contracting lepto?

A
  • Occupation/recreation
  • Often after floods
  • Exposure to animal urine/H2O contam w/ animal urine
  • Skin contact w/ infected aborted foetal/placental materials
  • Ingestion/contact w/ contaminated soil, water, food
56
Q

Which Brucella spp causes most burden in Aus (i.e. occurs in Aus & has high pathogenicity in humans)?
What animal does this occur in and how is it spread to humans?

A

B suis
Pigs
Contact w. infected tissues, blood, urine, uterine discharges, aborted foetuses (uncommonly inhalation)

57
Q

How is hendravirus transmitted to humans?

A

Flying foxes&raquo_space; horses (contam feed or water)&raquo_space; humans

58
Q

What are the symptoms/mortality rate of hendravirus?

A

Flu-like illness +/- resp complication, encephalitis/meningitis, death in 50%

59
Q

How to prevent hendravirus?

A
  • Vaccinate horses
  • Reduce flying fox/horse contact (e.g. no water bins under trees)
  • Isolate sick horse
  • Avoid contact w/ sick horses
60
Q

What is ringworm?

A

Highly contagious opportunistic dermatophyte

61
Q

How do you treat scabies?

A

Topical permethrin or oral ivermectin

62
Q

How is toxicariasis transmitted to humans?

A

Ingestions w/ embryonated eggs - often through contamination of food, soil, and fomites (from dogs)

63
Q

What are the three clinical syndromes of toxicariasis?

A

Visceral larval migrans
Ocular larval migrans
Covert toxocariasis

64
Q

How is tularaemia transmitted to humans?

A
  • Vector-borne
  • Skin contact w/ infected animals/carcasses
  • Bites/scratches from infected animals
  • Drinking contaminated water, eating undercooked contaminated meat
  • Inhalation contaminated dust
65
Q

What are the clinical Sx of tularaemia?

A 
High fever, chills, fatigue, myalgia, headache, nausea
Skin ulcer @ site of bite
Swelling of eye
Lymphadenopathy
Cough, chest pain
66
Q

What three ways can anthrax be transmitted to humans?

What is the result of each?

A 
Inhalation
- Death within 5 days
Skin contact (spores enter cuts)
- Skin infections, sepsis
Ingestion
- Ulcers, gangrene of spleen, death within 3 days
67
Q

What are the three most common forms of plague?

A

Bubonic
Pneumonic
Septicaemic

68
Q

Based on modelling, what type of environment is most conducive to emerging infectious diseases?

A

Forested tropical regions experiencing land-use changes, where wildlife biodiversity is high

69
Q

What is biosecurity?

A

Procedures or measures designed to protect population against harmful biological or biochemical substances

70
Q

What is the difference between the case fatality rate and the infection fatality rate?

A

CFR - deaths/diagnosed cases; IFR - deaths/total infected

71
Q

What were some advantages and disadvantages of (some) LMICs in COVID-19?

A

Advantages: transmission likely delayed 2’ low travel numbers, high proportion of children
Disadvantages: weaker health systems, overcrowding, increased comorbidities, policies developed in high income countries might not translate, informal economies, lockdowns can be more harmful when work is essential for survival (+some face concurrent outbreaks, e.g. dengue in Ecuador & Brazil)

72
Q

What are some reasons why Brazil has had a particularly high COVID-19 transmission/mortality rate?

A

Inadequate policy response
High population density
Close living quarters
Transmission to Indigenous population through illegal miners/loggers in rainforest

73
Q

What is the Global Health Security Agenda?

A

Partnership of nations + international organisation + non-government stakeholders (e.g. WHO) w/ goal of a world that is safe and secure from infectious disease threats

74
Q

What framework is key for building capacity to respond to threats to health security in the Indo-Pacific region?

A

Third Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies

75
Q

What is the Sydney Statement?

What does it state?

A

Set of principles for addressing global health threats established at 1st International Global Health Security Conference in Sydney in 2019
It states that this should be done through a set of principles:
- Inclusive, data-driven, equitable
- Disease prevention, detection, and response needed by all countries
- Governments must cooperate w/ IHR + other regularly agreements
- Requires action/engagement by all, incl philanthropic, private, public sectors
- One Health approach
- Countries w/ higher capacity to respond to adverse public health events have a moral + ethical duty to work w/ those w/ lower capacity

76
Q

What is the AHPPC?

A

Australian Health Protection Principle Committee

  • Chaired by Chief Health Officer
  • Comprised of all state and territory CHOs
  • Ongoing role to advise the AHMAC (Australian Health Minister’s Advisory Council) on health protection/national security
77
Q

What is AIIMS?

What are its functions?

A

Australian Interservice Incident Management Service
Functions:
- National incidence management service
- Operations, planning, logistics, communications, space, staff, systems, flow

78
Q

What are the four resilience potentials?

Potential to:

A

Respond
Monitor
Learn
Anticipate

79
Q

What is the ISDR framework?

A

Integrated Disease Surveillance and Response

- Makes surveillance/lab data more useable, helps improve detection/response to health issues in African countries

80
Q

What was the initial R0, serial interval, and incubation period of COVID-19?

A

2.5 (2-3)
4.4-7.5 days
5-6 days

81
Q

What is the GPHIN?

A

Global Public Health Intelligence Network
- Internet-based early warning tool; continuously searches global media sources to ID info re: disease outbreaks + other events of international public health concern

Communicable Diseases (4 decks)

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