Lesson 3

 Emerging diseases are those that have recently appeared

in a population or have existed but are rapidly increasing
in incidence or geographic range.
 Re-emerging diseases are those once were health
problems globally or in a particular region, and then
declined, but are again becoming a health problems for a
significant portion of a population.
  Emergence or re-emergence of a disease is the result of a
complex set of interactions between population and their
environment. Operationally, diseases emergence can be viewed
as a two-step process. Disease may be first introduced into a new
population and then establishes itself and disseminates within that
population. This framework is easily applied to infections diseases.
Many emerging infections diseases originate from pathogens
already present in the environment, brought out of obscurity or
given selective advantage by changing environmental conditons.
 Are those that are transmitted
from animals to humans,
limiting their infectiousness
until the disease agent adapts to
a human host.
 Such as heart disease, diabetes,
and cancer are often not
considered within the
merging/re-emerging disease
framework despite the dramatic
increase in prevalence and
scope over the past several
decades
 Drivers Example Disease
-Schistosomiasis (dams)
Deforestation/Reforestation, flood
-Hantavirus ( climate )
Ecological change drought: climate change;
-Mountain Spotted fever (
agricultural development
Reforestation)
Drug resistance (overuse of
-Influenza virus
Evolutionary forces and microbial antibiotics) and anti-viral; selective
-Hepatitis B
adaptation pressure in the environment
-Staphyloccocus
microbial evolution

Population growth, urbanization and -Dengue

Human behavior and demographic
rural to urban migration; aging -HIV
change
population structure -Obesity

Inadequate sanitation and potable

water sources; reduction,
-Trypanosomiasis
Political conflict and Public Health elimination of disease surveillance
-Vibro cholera
infrastructure collapse and prevention programs
-Yellow fever
curtailment of vector control
measures
Air Travel; globalization of food -Influenza virus
Mobility and globalization
supply -SARS
 The virus outbreaks occurred in 1979 and the discovery
of the virus was reported in 1977. Indigenous cases
have been confirmed in four countries in Africa.
Through June 1997, 1054 cases have been reported to
WHO ( World Health Organization), 754 of which proved
fatal.
 The virus which causes AIDS was first isolated in 1983.
By the Beginning of June 1998, the number of AIDS
cases reported to WHO ( World Health Organization )
by national authorities since beginning of the epidemic
was close to 19 million.
 Identified in 1089, this virus is now known to be the
most common cause of post-transfusion hepatitis
worldwide, with approximately 90% of cause in japan,
United States, and Western Europe. Up to 3% of the
world population are estimated to be infected among
which 170 million are chronic carries at risk of
developing liver cirrhosis or liver cancer.
 This influenza virus is well known pathogen in birds but
was isolated from human cases for the first time in
1997. The Emergence of human Influenza A (H5N1)
initially followed a possible scenario of the expected
next influenza pandemic, but in the event, the virus
appeared to have been contained in 1997
 The detection of the bacterium in 1997 explained the
outbreak of severe pneumonia on a convention centre
in USA in 1976 and it has since been associated with
outbreaks linked to poorly maintained air conditioning
system.
  Detected in 1982, this bacterium is typically
transmitted through contaminated food and has caused
outbreaks of haemolytic uraemic syndrome in North
America, Europe, and Japan.
 Detected in the USA in 1982 and identified as the cause
of lyme disease, this bacterium is now known to be
endemic in North America and Europe and is
transmitted to humans by tricks
 First detected in 1992 in India, this bacterium has been
reported in 7 countries in Asia. The emergence of a
new serotype permits the organism to continue to
spread and cause disease even in populations
protected by antibodies generated in response to
previous exposure to other serotype of the same
organism.
 Are due to the appearance of and an increase in the
number of infections from disease which is known but
which had formerly caused so few infections that it had
no longer been considered a public health problem.
 It has been re-introduced into countries and continents
where it had previously disappeared, where it can
spread because water and sanitation system have
deteriorated and food safety measures are not
adequate.
 It has spread in many part of South-East Asia since the
1950s and re-emerged in America in 1990s following
the deterioration and active mosquito control and
spread of the vector into urbans areas
 It has re-emerged in the Russian Federation and some
other republics of the former Soviet Union in 1994 and
culminated in 1995 with areas where 50,000 cases have
been reported. The re-emergence was linked to a
dramatic decline in the immigration programs
following the disruption of health services that have
been established, reversing the upward trend.
  This occurs worldwide but devasting, large-scale
epidemics have mainly been in the drug Sub-Saharan
regions of Africa, designated the “African meningitis
belt.”
 This an example of a disease for which an effective
vaccine exists but because it is not widely used in
many areas at risk, epidemics still continue to occur.