Harms of Smoking and Health Benefits of Quitting

Key Points
 Tobacco smoke is harmful to smokers and nonsmokers.
 Cigarette smoking causes many types of cancer, including cancers of the lung, esophagus, larynx (voice box), mouth, throat, kidney,
bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia.
 Quitting smoking reduces the health risks caused by exposure to tobacco smoke.
1. Does tobacco smoke contain harmful chemicals?
Yes. Tobacco smoke contains chemicals that are harmful to both smokers and nonsmokers. Breathing even a little tobacco
smoke can be harmful (1–3).
Of the more than 7,000 chemicals in tobacco smoke, at least 250 are known to be harmful, including hydrogen cyanide, carbon
monoxide, and ammonia (1, 4).
Among the 250 known harmful chemicals in tobacco smoke, at least 69 can cause cancer. These cancer-causing chemicals
include the following (1, 4):
o Arsenic
o Benzene
o Beryllium (a toxic metal)
o 1,3–Butadiene (a hazardous gas)
o Cadmium (a toxic metal)
o Chromium (a metallic element)
o Ethylene oxide
o Nickel (a metallic element)
o Polonium-210 (a radioactive chemical element)
o Vinyl chloride
Other toxic chemicals in tobacco smoke are suspected to cause cancer, including the following (3):
o Formaldehyde
o Benzo[α]pyrene
o Toluene
2. What are some of the health problems caused by smoking?
Smoking harms nearly every organ of the body and diminishes a person’s overall health. Millions of Americans have health
problems caused by smoking.
Smoking is a leading cause of cancer and death from cancer. It causes cancers of the lung, esophagus, larynx, mouth, throat,
kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia (1, 2).
Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive
pulmonary disease (COPD) (chronic bronchitis andemphysema), asthma, hip fractures, and cataracts. Smokers are at higher
risk of developingpneumonia and other airway infections (1, 2).
A pregnant smoker is at higher risk of having her baby born too early and with an abnormally low birth weight. A woman who
smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS) (1, 2). Men
who smoke are at greater risk oferectile dysfunction (5).
Cigarette smoking and exposure to tobacco smoke cause more than 440,000 premature deaths each year in the United States
(1). Of these premature deaths, about 40 percent are from cancer, 35 percent are from heart disease and stroke, and 25
percent are from lung disease (6). Smoking is the leading cause of premature, preventable death in this country.
Regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting.
3. What are the risks of tobacco smoke to nonsmokers?
Secondhand smoke (also called environmental tobacco smoke, involuntary smoking, and passive smoking) is the combination
of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a
smoker) (3, 4, 7, 8). The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon
General, and the International Agency for Research on Cancer have classified secondhand smoke as a known human
carcinogen (cancer-causing agent) (4, 8, 9). Inhaling secondhand smoke causes lung cancer in nonsmoking adults (1, 3).
Approximately 3,000 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure
to secondhand smoke (7). The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of
developing lung cancer by 20 to 30 percent (3).
 Secondhand smoke causes disease and premature death in nonsmoking adults and children (1, 3). Exposure to secondhand
smoke may increase the risk of heart disease by an estimated 25 to 30 percent (3). In the United States, exposure to
secondhand smoke is thought to cause about 46,000 deaths from heart disease each year (3). Pregnant women exposed to
secondhand smoke are at risk of having a baby with low birth weight (1). Children exposed to secondhand smoke are at an
increased risk of SIDS, ear infections, colds, pneumonia, bronchitis, and more severe asthma. Being exposed to secondhand
smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless (1, 3).
For more information, refer to the National Cancer Institute (NCI) fact sheet Secondhand Smoke and Cancer, which is available
athttp://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS on the Internet.
4. Is smoking addictive?
Yes. Nicotine is a drug that is naturally present in the tobacco plant and is primarily responsible for a person’s addiction to
tobacco products, including cigarettes. During smoking, nicotine enters the lungs and is absorbed quickly into the bloodstream
and travels to the brain in a matter of seconds. Nicotine causes addiction to cigarettes and other tobacco products that is
similar to the addiction produced by using drugs such as heroin and cocaine (10).
5. How much nicotine is in cigarettes and cigars?
Cigarettes, cigars, and other tobacco products vary widely in their content of nicotine, cancer-causing substances, and other
toxicants. In a cigarette (which contains less than 1 gram of tobacco), the nicotine content can vary between 13.7 and
23.2 milligrams per gram of dry tobacco (11). In a cigar (which can contain as many as 20 grams of tobacco), the nicotine
content can vary between 5.9 and 335.2 milligrams per gram of tobacco (12).
The way a person smokes a tobacco product is more important than the nicotine content of the product in determining how
much nicotine gets into the body. Nicotine is absorbed in the lungs and through the lining of the mouth. Increased levels of
nicotine are absorbed by inhaling the smoke into the lungs and taking frequent and deep puffs.
For more information about cigars, you may want to read the NCI fact sheet Cigar Smoking and Cancer, which can be found
at http://www.cancer.gov/cancertopics/factsheet/Tobacco/cigars on the Internet.
6. Are other tobacco products, such as smokeless tobacco or pipe tobacco, harmful and addictive?
Yes. All forms of tobacco are harmful and addictive. There is no safe tobacco product.
In addition to regular cigarettes and cigars, other forms of tobacco include smokeless tobacco (also called chewing tobacco,
snuff, and snus), pipes, hookahs (waterpipes), bidis, and kreteks. Although most research has focused on the harms of
cigarette smoking, all forms of tobacco are harmful.
All tobacco products contain nicotine and cancer-causing substances. Both smokeless tobacco and smoking tobacco are known
to cause cancer in humans (3, 8). These products may also cause heart attacks, mouth problems, and other diseases.
o Cigars: Information about cigars and cancer is available in the NCI fact sheet Cigar Smoking and
Cancer at http://www.cancer.gov/cancertopics/factsheet/Tobacco/cigars on the Internet.
o Smokeless tobacco: Information about smokeless tobacco and cancer can be found in the NCI fact sheet Smokeless Tobacco
and Cancer athttp://www.cancer.gov/cancertopics/factsheet/Tobacco/smokeless on the Internet.
o Pipes: Pipe smoking causes lung cancer and increases the risk of cancers of the mouth, throat, larynx, and esophagus (8, 13).
o Hookahs or waterpipes (other names include argileh, ghelyoon, hubble bubble, shisha, boory, goza, and narghile): A hookah
is a device used to smoke tobacco. The smoke passes through a partially filled water bowl before being inhaled by the
smoker. Some people think hookah smoking is less harmful and addictive than smoking regular cigarettes (14), but all forms
of tobacco smoking are harmful and addictive. Tobacco smoke, including the smoke produced by a hookah, contains harmful
chemicals such as carbon monoxide and cancer-causing substances (15).
o Bidis: A bidi is a flavored cigarette made by rolling tobacco in a dried leaf from the tendu tree, which is native to India. Bidi
use is associated with heart attacks and cancers of the mouth, throat, larynx, esophagus, and lung (8, 16).
o Kreteks: A kretek is a cigarette made with a mixture of tobacco and cloves. Smoking kreteks is associated with lung cancer
and other lung diseases (16).
7. Is there a tobacco product that is less hazardous than cigarettes?
All tobacco products are harmful and cause cancer, and the use of these products is strongly discouraged. There is no safe
level of tobacco use. People who use any type of tobacco product should be urged to quit. For help with quitting, refer to the
NCI fact sheet Where To Get Help When You Decide To Quit
Smoking athttp://www.cancer.gov/cancertopics/factsheet/tobacco/help-quitting on the Internet.
8. What are the immediate benefits of quitting smoking?
The immediate health benefits of quitting smoking are substantial:
o Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal.
 o Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s
ability to carry oxygen.)
o Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as
often.
o Within several months of quitting, people can expect substantial improvements in lung function (17).
o In addition, people who quit smoking will have an improved sense of smell, and food will taste better.
9. What are the long-term benefits of quitting smoking?
Quitting smoking reduces the risk of cancer and other diseases, such as heart disease and COPD, caused by smoking.
People who quit smoking, regardless of their age, are less likely than those who continue to smoke to die from smoking-
related illness:
o Quitting at age 30: Studies have shown that smokers who quit at about age 30 reduce their chance of dying prematurely from
smoking-related diseases by more than 90 percent (18, 19).
o Quitting at age 50: People who quit at about age 50 reduce their risk of dying prematurely by 50 percent compared with
those who continue to smoke (19).
o Quitting at age 60: Even people who quit at about age 60 or older live longer than those who continue to smoke (19).
10. Does quitting smoking lower the risk of cancer?
Yes. Quitting smoking reduces the risk of developing and dying from cancer. However, it takes a number of years after quitting
for the risk of cancer to start to decline. This benefit increases the longer a person remains smoke free (2).
The risk of premature death and the chance of developing cancer from smoking cigarettes depend on many factors, including
the number of years a person smokes, the number of cigarettes he or she smokes per day, the age at which he or she began
smoking, and whether or not he or she was already ill at the time of quitting. For people who have already developed cancer,
quitting smoking reduces the risk of developing a second cancer (20–22).
11. Should someone already diagnosed with cancer bother to quit smoking?
Yes. There are many reasons that people diagnosed with cancer should quit smoking. For those having surgery, chemotherapy,
or other treatments, quitting smoking helps improve the body’s ability to heal and respond to therapy (2, 20). It also lowers
the risk of pneumonia and respiratory failure (2, 20). Moreover, quitting smoking may lower the risk of the cancer returning or
a second cancer developing (20–22).
12. How can I get help to quit smoking?
NCI and other agencies and organizations can help smokers quit:
o Go online to Smokefree.gov (http://www.smokefree.gov), a Web site created by NCI’s Tobacco Control Research Branch,
and use the Step-by-Step Quit Guide.
o Call the NCI Smoking Quitline at 1–877–44U–QUIT (1–877–448–7848) for individualized counseling, printed information, and
referrals to other sources.
o Refer to the NCI fact sheet Where To Get Help When You Decide To Quit Smoking, which is available
at http://www.cancer.gov/cancertopics/factsheet/tobacco/help-quitting on the Internet.
Selected References
1. U.S. Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for
Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2010.
2. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General.
Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center
for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004.
3. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A
Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control
and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2006.
4. National Toxicology Program. Report on Carcinogens. Eleventh Edition. U.S. Department of Health and Human Services,
Public Health Service, National Toxicology Program, 2005.
5. Austoni E, Mirone V, Parazzini F, et al. Smoking as a risk factor for erectile dysfunction: Data from the Andrology Prevention
Weeks 2001–2002. A study of the Italian Society of Andrology (S.I.A.). European Urology 2005; 48(5):810–818. [PubMed
Abstract]
6. Centers for Disease Control and Prevention. Annual smoking-attributable mortality, years of potential life lost, and
productivity losses—United States, 1997–2001. Morbidity and Mortality Weekly Report 2005; 54(25):625–628. [PubMed
Abstract]
7. National Cancer Institute. Cancer Progress Report 2003. U.S. Department of Health and Human Services, Public Health
Service, National Institutes of Health, 2004.
8. International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking. Lyon, France: 2002. IARC
Monographs on the Evaluation of Carcinogenic Risks to Humans, Vol. 83.
9. U.S. Environmental Protection Agency. Respiratory Health Effects of Passive Smoking (Also Known as Exposure to
Secondhand Smoke or Environmental Tobacco Smoke―ETS). U.S. Environmental Protection Agency, Office of Research and
Development, Office of Health and Environmental Assessment, 1992.
10. Hatsukami DK, Stead LF, Gupta PC. Tobacco addiction. Lancet 2008; 371(9629):2027–2038.
[PubMed Abstract]
11. Djordjevic MV, Doran KA. Nicotine content and delivery across tobacco products. Handbook of Experimental
Pharmacology 2009; 192:61–82.
[PubMed Abstract]
12. Henningfield JE, Fant RV, Radzius A, Frost S. Nicotine concentration, smoke pH and whole tobacco aqueous pH of some
cigar brands and types popular in the United States. Nicotine Tobacco Research 1999; 1(2):163–168.
[PubMed Abstract]
13. Henley SJ, Thun MJ, Chao A, Calle EE. Association between exclusive pipe smoking and mortality from cancer and other
diseases. Journal of the National Cancer Institute 2004; 96(11):853–861. [PubMed Abstract]
14. Smith-Simone S, Maziak W, Ward KD, Eissenberg T. Waterpipe tobacco smoking: Knowledge, attitudes, beliefs, and
behavior in two U.S. samples. Nicotine Tobacco Research 2008; 10(2):393–398. [PubMed Abstract]
15. Cobb C, Ward KD, Maziak W, Shihadeh AL, Eissenberg T. Waterpipe tobacco smoking: An emerging health crisis in the
United States. American Journal of Health Behavior 2010; 34(3):275–285. [PubMed Abstract]
16. Prignot JJ, Sasco AJ, Poulet E, Gupta PC, Aditama TY. Alternative forms of tobacco use.International Journal of Tuberculosis
and Lung Disease 2008; 12(7):718–727. [PubMed Abstract]
17. U.S. Department of Health and Human Services. The Health Benefits of Smoking Cessation.Rockville, MD: U.S. Department
of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Chronic Disease Prevention
and Health Promotion, Office on Smoking and Health, 1990.
18. Peto R, Darby S, Deo H, et al. Smoking, smoking cessation, and lung cancer in the U.K. since 1950: Combination of national
statistics with two case-control studies. British Medical Journal2000; 321(7257):323–329. [PubMed Abstract]
19. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British
doctors. British Medical Journal 2004; 328(7455):1519–1527. [PubMed Abstract]
20. McBride CM, Ostroff JS. Teachable moments for promoting smoking cessation: The context of cancer care and
survivorship. Cancer Control 2003; 10(4):325–333. [PubMed Abstract]
21. Travis LB, Rabkin CS, Brown LM, et al. Cancer survivorship―genetic susceptibility and second primary cancers: Research
strategies and recommendations. Journal of the National Cancer Institute 2006; 98(1):15–25. [PubMed Abstract]
22. Parsons A, Daley A, Begh R, Aveyard P. Influence of smoking cessation after diagnosis of early stage lung cancer on
prognosis: Systematic review of observational studies with meta-analysis.British Medical Journal 2010; 340:b5569. [PubMed
Abstract]
Smokers' metabolisms may suggest which quitting aid
is best for them
Last updated: 12 January 2015 at 12am PST

76Like85

there are a range of products aimed at helping smokers quit, but how can doctors predict with any accuracy which
strategy will be the most helpful for an individual? A new study suggests that patients' metabolisms may provide clues to
how successful different cessation aids may be.

The authors say that, based on the study results, slow metabolizers would benefit more from using the patch than from
taking pills to help give up smoking.

Although smoking rates have fallen considerably in the US since the 1960s, when smoking was at its peak, there
are currently 42 million Americans who smoke - including teenagers and young adults.

About 6 million people die every year from smoking-related diseases worldwide. Globally, $200 billion is spent
annually on tobacco-related health care costs. What is more, nearly 70% of smokers who attempt to quit fail within
their first week. As such, there is a great demand for scientists to provide suggestions for improved cessation
treatments.
Some studies have previously investigated the relationship between metabolism and smoking cessation treatments.
However, the metabolisms of participants were not tested before the participants were randomly assigned to
treatments in these studies. Also, none of the previous studies investigated varenicline - a newer cessation
medication.

The new study is a multi-center collaboration by researchers from the Perelman School of Medicine at the University
of Pennsylvania in Philadelphia, the Centre for Addiction and Health at the University of Toronto, Canada, the State
University of New York at Buffalo, NY, and The University of Texas MD Anderson Cancer Center in Houston.

The findings of the study - purported to be the first of its kind - are published in The Lancet Respiratory Medicine.

Across the four medical centers, researchers recruited a total of 1,246 treatment-seeking smokers. Testing the
metabolisms of the participants, the researchers sorted the participants into two groups - 662 people were "slow
metabolizers" and 584 people were considered to be "normal metabolizers."

Metabolism measured using nicotine-derived metabolites

To distinguish between "slow" or "normal," the researchers took blood samples from the participants and examined
the ratio of two metabolites that are derived from nicotine during smoking. This ratio is reflective of the activity of the
major nicotine and cotinine-metabolizing enzyme in the liver - CYP2A6 - which helps smokers to metabolize
nicotine.

The participants were then randomized to 11 weeks of treatment with either the nicotine patch plus a placebo pill,
varenicline plus placebo patch, or a placebo patch and pill. All of the participants also received behavioral
counseling.

The smoking behaviors of the participants were assessed at the end of the 11-week treatment period and followed
up again at 6 and 12 months.

The team found that, among the normal metabolizers, nearly 40% of varenicline users had not relapsed,
compared with 22% of patch users. Among the slow metabolizers, the effectiveness of these two treatments
was about the same.

However, the slow metabolizers reported more overall side effects from taking varenicline. The authors say this
suggests that slow metabolizers would benefit more from using the patch than from taking pills to help give up
smoking.

The authors report that quitting success had decreased by the time of the 6- and 12-month follow-ups - which was
expected, given the previous success rates reported in other smoking cessation studies - but that the ratios for
normal and slow metabolizers using the patch and varenicline remained.

"This is a much-needed, genetically-informed biomarker that could be translated into clinical practice," says lead
author Caryn Lerman, PhD, professor of psychiatry and director of Penn Medicine's Center for Interdisciplinary
Research on Nicotine Addiction.

Lerman adds:

"Matching a treatment choice based on the rate at which smokers metabolize nicotine could be a viable strategy to
help guide choices for smokers and ultimately improve quit rates.
These findings not only support the use of the nicotine metabolite ratio as a biomarker to guide treatment choices,
but also underscore the notion that tobacco dependence is a heterogeneous condition and that smoking cessation
treatments are not equally effective for all smokers."
Study identifies levels at which five foods may trigger
allergic reactions
For people with food allergies, vague warnings on food products - such as "may contain nuts" - can be confusing; is the
product safe to consume or not? In a new study, researchers claim to have identified the levels at which five common
food allergens - peanut, hazelnut, celery, fish and shrimp - cause a reaction in only 10% of people who are allergic to
them.

Around 90% of food allergies are caused by eight foods: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat
and soybeans. Peanuts are the most common trigger of food-allergic reactions in the US.

The research team - led by Prof. Clare Mills of the Institute of Inflammation and Repair at the University of
Manchester in the UK - says they hope the findings will lead to improved allergy warnings on food products.

Approximately 15 million people in the US have food allergies, with children accounting for around 6 million of
these cases. Around 90% of food allergies are caused by eight foods: milk, eggs, fish, crustacean shellfish, tree
nuts, peanuts, wheat and soybeans. Peanuts are the most common trigger of food-allergic reactions in the US.
The Food Allergen Labeling and Consumer Protection Act of 2004 states that the eight primary food allergens must
be clearly labeled in simple terms on food products, either through an allergen statement or in the ingredient list.

For food products that accidentally contain traces of allergens - due to being made in a factory that handles the
allergens, for example - precautionary warnings may be applied to labels. But this precautionary labeling is neither
consistent nor regulated.

Prof. Mills notes that food allergy sufferers have varying levels of tolerance to allergens, and inconsistent
precautionary labeling may lead to confusion and risk taking among consumers.

"What we wanted was to find a level of allergen which would only produce a reaction in the most sensitive 10% of
people," Prof. Mills explains. "This sort of data can then be used to apply a consistent level of warning to food
products."

1.6-10.1 mg of hazelnut, peanut or celery protein needed to trigger allergic

reaction
For their study, published in the Journal of Allergy and Clinical Immunology, the researchers analyzed data from 436
people who were allergic to peanuts, hazelnuts, celery, fish or shrimp.

All subjects were drawn from the EuroPrevall project - a scheme that aims to assess the underlying risk factors
associated with food allergies and their epidemiology across the European population.

Each participant was required to take part in a food challenge, which involved consuming small doses of the food
they were allergic to while researchers monitored their reactions.

In the 10% of participants who were most sensitive to food allergens, the team found that between 1.6-10.1
mg of hazelnut, peanut and celery protein needed to be consumed to trigger an allergic reaction, while 27.3
mg of fish and 2.5 g of shrimp protein were required to produce a response.

The team says they hope these findings will better inform food allergy sufferers of the allergen doses that may
trigger a reaction, as well as contribute to improved food product labeling. Prof. Mills adds:

"What we'd like to see are warnings which tell people with allergies to avoid certain products completely or just apply
to those who are most sensitive."

In August 2014, Medical News Today reported on a study by researchers from the Johns Hopkins Children's Center
in Baltimore, MD, which suggested children who live in inner-city areas may be more likely to develop food
allergies.
Protein sustains both 'a sound mind and a strong
heart'
“Mens sana in corpore sano" is a Latin aphorism written by the Roman poet Juvenal, usually translated as "a sound mind
in a sound body." Juvenal made an early connection between the relationship of a sound mind and a sound body.
However, a new study from John Hopkins explains the link between the two could be biochemical, and not merely
coincidental.

There is a possible biochemical link between depression and heart disease, two disorders that often occur in tandem, but
with a relationship that remains poorly understood.

The study, published in Proceedings of the National Academy of Sciences, reveals that a protein, already known to
act as a natural antidepressant, enhance learning and memory, powes nerve cell growth and nourish blood
vessels, is also a key player in maintaining heart muscle vitality.

The research team conducted experiments in mice and lab-grown heart cells, findings of which showed the multi-
tasking protein - a nerve-growth factor called BDNF (brain-derived neurotrophic factor) - helps sustain the ability of
heart muscle cells to contract and relax properly.

The results of the research, indicate that BDNF can precipitate heart muscle dysfunction and has a role in a
cascade of molecular signaling events in heart cells, the disruption of which leads to heart muscle failure.
Heart failure affects nearly 6 million Americans and more than 23 million people worldwide. If the study is confirmed
in humans, the finding could pave the way for new treatments for certain forms of heart failure.
Single multi-tasking protein affects 'many organs and functions'
BDNF is known for having antidepressant effects and boosting nerve cell health. Results suggest a possible
biochemical link between depression and heart disease, two disorders that often occur in tandem, but with a
relationship that remains poorly understood.
Lead investigator, Dr. Ning Feng, a cardiology fellow at the Johns Hopkins University School of Medicine in
Baltimore, MD, says:
"Our results are not only a vivid reminder of the astounding complexity of the heart's chemistry and physiology, but
also a striking example of the ability of a single protein to act on multiple fronts and affect many organs and
functions."

Also clarified by the findings is the biological means behind recent and unexplained observations, which heart failure
patients, whose cardiac function worsens during physical exertion, have low levels of BDNF in the blood.

"Our observation that BDNF directly controls the ability of heart muscle cells to 'beat' properly offers one possible
explanation behind the declining cardiac function seen in people with heart failure, especially during exercise,"
comments senior author Dr. Nazareno Paolocci, assistant professor of medicine at Johns Hopkins.

Initial experiments, by the scientists, consisted of isolating cardiac cells from rodents with either normal or failing
hearts in a lab dish and exposing the cells to BDNF.

Cardiac cells from rodents with normal hearts responded by contracting and relaxing vigorously in the
presence of BDNF. Cardiac cells obtained from failing hearts, even when awash in BDNF, responded weakly
or not at all.

The team set out to determine why the cells responded in such a way by homing in on BDNF's receptor, a molecule
called TrkB, located on the surface of cells and responsible for receiving BDNF's chemical signals and transmitting
them inside the cell.

TrkB receptors from mice with normal hearts were compared with those from the failing hearts, results
showed that the failing heart cells displayed a slightly different version of the TrkB receptor. The main
difference being that it produces less of a catalyst protein responsible for triggering critical signaling inside
the cardiac cell.

The inefficient version of the TrkB receptor was less responsive to BDNF, rendering the cardiac cell less sensitive to
the protein. While this TrkB variant is fairly common and does not necessarily predict disease, it may render the
heart cells of those who carry the altered version less capable of using BDNF.

Mice engineered to carry the ineffective TrkB receptors in their cardiac cells developed impaired cardiac function -
the hearts contracted poorly, pumped blood less efficiently and took additional time to relax after every beat. Feng
says:

"Taken together, these findings show that any abnormality in the way BDNF communicates with its receptor appears
to unlock a cascade of chemical glitches that eventually leads to poor cardiac function."

Signaling disruptions explain chemotherapy-induced heart failure

These disruptions in efficient BDNF-TrkB signaling can also explain the force behind chemotherapy-induced heart
failure, a serious side effect of certain cancer treatments. Such treatments contain chemicals that block multiple
growth-factor receptors, including TrkB, to bring tumor growth to a halt.
While this approach is essential to keep cancer progression at bay, interfering with the ability of cardiac cells to
respond to BDNF can inadvertently lead to heart failure.

The investigators identify that low BDNF levels alone may not be sufficient to cause immediate heart
disease. However, chronic BDNF deficiency or insensitivity, compounded by additional physiologic or
pathologic stressors, is a main culprit in fueling the disease.
"In the absence of chronic stressors, such as hypertension or an elevated workload of the heart muscle, BDNF
deficiency may not cause full-blown disease, but it could be the proverbial straw that leads to a 'broken heart,'"
Paolocci concludes.
Medical News Today recently reported that researchers investigating patterns in Beethoven's music believe the
great composer may have suffered from irregular heartbeat, or arrhythmia, because they can hear what they
describe as musical arrhythmias in some of his compositions.
Written by Hannah Nichols
 Effects of Smoking on Your Health

The effects of smoking are serious. It can harm nearly every organ of the body. It

causes nearly one of every five deaths in the United States each year.

 Is smoking a risk factor for autoimmune diseases?

 How does smoking affect my bones?

 How does smoking affect my heart and blood vessels?

 How does smoking affect my lungs and breathing?

 Can smoking affect my vision?

 Do cigarettes cause cancer?

 Do light cigarettes cause cancer?

 Do menthol cigarettes cause cancer?

 Can smoking cigars and pipes cause cancer?

Infographic text-only version.

Is smoking a risk factor for autoimmune diseases?

The immune system is the body’s way of protecting itself from infection and disease. Smoking compromises the immune

system, making smokers more likely to have respiratory infections.

 Smoking also causes several autoimmune diseases, including Crohn’s disease and rheumatoid arthritis. It may also play a role

in periodic flare-ups of signs and symptoms of autoimmune diseases. Smoking doubles your risk of developing rheumatoid

arthritis.

Smoking has recently been linked to type 2 diabetes, also known as adult-onset diabetes. Smokers are 30% to 40% more likely

to develop type 2 diabetes than nonsmokers. Additionally, the more cigarettes an individual smokes, the higher the risk for

diabetes.
Back to top

How does smoking affect my bones?

Recent studies show a direct relationship between tobacco use and decreased bone density. Smoking is one of many factors—

including weight, alcohol consumption, and activity level—that increase your risk for osteoporosis, a condition in which bones

weaken and become more likely to fracture.

Significant bone loss has been found in older women and men who smoke. Quitting smoking appears to reduce the risk for low

bone mass and fractures. However, it may take several years to lower a former smoker’s risk.

In addition, smoking from an early age puts women at even higher risk for osteoporosis. Smoking lowers the level of the

hormone estrogen in your body, which can cause you to go through menopause earlier, boosting your risk for osteoporosis.
Back to top

How does smoking affect my heart and blood vessels?

The chemicals in tobacco smoke harm your blood cells and damage the function of your heart. This damage increases your risk

for:

 Atherosclerosis, a disease in which a waxy substance called plaque builds up in your arteries

 Aneurysms, which are bulging blood vessels that can burst and cause death

 Cardiovascular disease (CVD), which includes:

o Coronary heart disease (CHD), narrow or blocked arteries around the heart

o Heart attack and damage to your arteries

o Heart-related chest pain

o High blood pressure

 Coronary Heart disease, where platelets—components in the blood—stick together along with proteins for form clots which can

then get stuck in the plaque in the walls of arteries and cause heart attacks

 Peripheral arterial disease (PAD), a condition in which plaque builds up in the arteries that carry blood to the head, organs, and

limbs

 Stroke, which is sudden death of brain cells caused by blood clots or bleeding
 Breathing tobacco smoke can even change your blood chemistry and damage your blood vessels. As you inhale smoke, cells

that line your body’s blood vessels react to its chemicals. Your heart rate and blood pressure go up and your blood vessels

thicken and narrow.

Back to top

How does smoking affect my lungs and breathing?

Every cigarette you smoke damages your breathing and scars your lungs. Smoking causes:

 Chronic obstructive pulmonary disease (COPD), a disease that gets worse over time and causes wheezing, shortness of breath,

chest tightness, and other symptoms

 Emphysema, a condition in which the walls between the air sacs in your lungs lose their ability to stretch and shrink back. Your

lung tissue is destroyed, making it difficult or impossible to breathe.

 Chronic bronchitis, which causes swelling of the lining of your bronchial tubes. When this happens, less air flows to and from

your lungs.

 Pneumonia

 Asthma

 Tuberculosis

People with asthma can suffer severe attacks when around cigarette smoke.

Back to top

Can smoking affect my vision?

Smoking is as bad for your eyes as it is for the rest of your body. Research has linked smoking to an increased risk of

developing age-related macular degeneration, cataract, and optic nerve damage, all of which can lead to blindness.
Back to top

Do cigarettes cause cancer?

Tobacco smoke contains more than 7,000 chemicals. About 70 of them are known to cause cancer. Smoking cigarettes is the

number-one risk factor for lung cancer. But, smoking can affect your entire body, and is known to cause cancer in the:

 Lungs

 Trachea

 Bronchus

 Esophagus

 Oral Cavity

 Lip

 Nasopharynx
 Nasal Cavity

 Larynx

 Stomach

 Bladder

 Pancreas

 Kidney

 Liver

 Uterine Cervix

 Colon

 Rectum

In addition, smoking is known to cause leukemia.

Learn more about cigarettes.

Back to top

Do light cigarettes cause cancer?

There is no such thing as a safe cigarette. People who smoke any kind of cigarette are at an increased risk for smoking-related

diseases. Although it is no longer legal to sell light cigarettes, people who smoked light cigarettes in the past are likely to have

inhaled the same amount of toxic chemicals as those who smoked regular cigarettes. They remain at high risk of developing

smoking-related cancers and other diseases. Learn more about light cigarettes.
Back to top

Do menthol cigarettes cause cancer?

All cigarettes are harmful, including menthol cigarettes. Many smokers think menthol cigarettes are less harmful, but there is no

evidence that menthol cigarettes are safer than other cigarettes. Like other cigarettes, menthol cigarettes harm nearly every

organ in the body and cause many diseases, including cancer, cardiovascular diseases, and respiratory diseases. Menthol

cigarettes, like other cigarettes, also negatively impact male and female fertility and are harmful to pregnant women and their

unborn babies.

Some research shows that menthol cigarettes may be more addictive than non-menthol cigarettes. More research is needed to

understand how addiction differs between menthol and non-menthol cigarette use. Learn more about menthol cigarettes.
Back to top

Can smoking cigars and pipes cause cancer?

Cigar and pipe smoke, like cigarette smoke, contains toxic and cancer-causing chemicals that are harmful to both smokers and

non-smokers. Cigar and pipe smoking causes:

 Bladder cancer

 Esophageal cancer

 Laryngeal (voice box) cancer

 Lip cancer

 Lung cancer

 Mouth cancer

 Throat cancer

 Tongue cancer

If you smoke cigars daily, you are at increased risk for developing heart disease and lung diseases such as emphysema.
Tobacco use diminishes health throughout an individual’s lifetime, and these effects accumulate throughout adulthood, resulting
in preventable illness and, all too often, premature death. Nicotine is most efficiently delivered through smoking, resulting in
death to nearly half of lifetime users. Over the years, other nicotine products have entered the market in a cloud of controversy
and debate. Tobacco companies have introduced products marketed in a manner that implies they are “safer,” but RESEARCH
INDICATES THAT THERE IS NO COMPLETELY SAFE FORM OF TOBACCO. Smoking cigarettes, including cigarettes with low tar as
measured by a machine, has been scientifically proven to harm nearly every organ in the body and to increase morbidity and
mortality. Smokeless tobacco products increase the risk of oral cancers, and smokers of cigars, pipes, water pipes, kreteks, and
bidis also experience serious adverse health consequences.
Smoking is particularly harmful to pregnant women and their fetuses. Smoking during pregnancy is dangerous to the mother
and can cause growth retardation, low birth weight, and possibly death of the fetus.
The harm caused by today’s tobacco use will extend for decades into the future, which is made more tragic by the fact that the
negative effects of tobacco are entirely preventable. Quitting tobacco use greatly reduces illness by immediately providing
short-term benefits and lowering the risk of all diseases caused
by smoking.
THE INDUSTRY SAYS:

We recognize that cigarettes are an addictive product. That doesn’t mean you can’t stop smoking. But nicotine is not the issue. It’s the
other compounds that are created—they’re called volatile compounds—that are created in smoke. They’re the ones who create the
harm, and they’re the ones we’re working on in terms of our reduced risk products.

Louis Camilleri, CEO, Philip Morris International, 2011

RESEARCH SAYS:

To date, no tobacco products have been scientifically proven to reduce the risk of tobacco-related disease, improve safety, or cause
less harm than other tobacco products.

Food and Drug Administration, US, 2011

- See more at: http://www.tobaccoatlas.org/harm/harm_from_smoking/text/#sthash.Tf9kmqif.dpuf
Why Is Smoking Bad For You?
Smoking is responsible for several diseases, such as cancer, long-term (chronic) respiratory diseases, and heart
disease, as well as premature death. Over 440,000 people in the USA and 100,000 in the UK die because of
smoking each year. According the US CDC (Centers for Disease Control and Prevention), $92 billion are lost each
year from lost productivity resulting from smoking-related deaths.

Of the more than 2.4 million deaths in the USA annually, over 440,000 are caused by smoking.

Smoking is the largest cause of preventable death in the world. Recent studies have found that smokers can
undermine the health of non-smokers in some environments.

In an article published online in Medical News Today on 30 May 2013, we presented data demonstrating that, on
average, smokers die ten years sooner than non-smokers.

Smoking causes cancer

90% of lung cancer patients developed their disease because of smoking. Lung cancer is one of the most common
causes of cancer deaths in the world. Smokers also have a significantly higher risk of developing:

 Bladder cancer

 Kidney cancer
 Cancers of the pharynx and larynx (throat cancer)

 Mouth cancer
 Esophagus cancer

 Cancer of the pancreas

 Stomach cancer
 Some types of leukemia
 Cancer of the nose and sinuses

 Cervical cancer
 Bowel cancer
 Ovarian cancer
 In some cases, also breast cancer
According to Cancer Research UK, one person dies every 15 minutes in Great Britain from lung cancer.

Smoking also raises the risk of cancer recurrences (the cancer coming back).

Why does smoking raise cancer risk?

Scientists say there are over 4,000 compounds in cigarette smoke. A sizeable number of them are toxic - they are
bad for us and damage our cells. Some of them cause cancer - they are carcinogenic.

Tobacco smoke consists mainly of:

 Nicotine - this is not carcinogenic. However, it is highly addictive. Smokers find it very hard to quit because they
are hooked on the nicotine. Nicotine is an extremely fast-acting drug. It reaches the brain within 15 seconds of
 being inhaled. If cigarettes and other tobacco products had no nicotine, the number of people who smoke every
day would drop drastically. Without nicotine, the tobacco industry would collapse.

Nicotine is used as a highly controlled insecticide. Exposure to sufficient amounts can lead to vomiting,
seizures, depression of the CNS (central nervous system), and growth retardation. It can also undermine a
fetus' proper development.
 Carbon Monoxide - this is a poisonous gas. It has no smell or taste. The body finds it hard to differentiate
carbon monoxide from oxygen and absorbs it into the bloodstream. Faulty boilers emit dangerous carbon
monoxide, as do car exhausts.

If there is enough carbon monoxide around you and you inhale it, you can go into a coma and die. Carbon
monoxide decreases muscle and heart function, it causes fatigue, weakness, and dizziness. It is especially toxic
for babies still in the womb, infants and individuals with heart or lung disease.
 Tar - consists of several cancer-causing chemicals. When a smoker inhales cigarette smoke, 70% of the tar
remains in the lungs. Try the handkerchief test. Fill the mouth with smoke, don't inhale, and blow the smoke
through the handkerchief. There will be a sticky, brown stain on the cloth. Do this again, but this time inhale and
the blow the smoke through the cloth, there will only be a very faint light brown stain.
Top 10 Most Contagious Diseases in the
Philippines
BY PPCINC · APRIL 16, 2014
1

Vote

Far more than any other man – be it on a rampage or in a fanatical group bent on delivering chaos –
could ever do, the most dangerous killers known to man are those that escape his mortal eyes. Yes,
it’s not the macro that presents the bulk of the causa mortis, it’s the micro: bacterias, viruses, germs
and the like. Get the drift?

Especially so, in a Third World country like the Philippines. Where some people are living under
bridges for lack of an option. And countless children not even in their teens catch the front pages of
major dailies for being prostituted on cam by their very own blood parents. Dire straits has
definitely acquired a new meaning in this internet age. Yet, all these filth and poverty has only
served as a launching pad for infectious diseases to flourish. Right in our very backyards. And
though on one hand Philippine society is hurtling itself towards modernization in the 21st century,
its hands are far from clean, people are still dying from diseases known centuries ago.

Ladies and gentlemen of the hour, the Top 10 most dreaded infectious diseases in the country
today.
#10. Hepatitis A
Be careful when eating just about anywhere. Food that you are taking could be contaminated with
fecal matter especially if you are in an area where sanitation is low. Cases of outbreaks have been
reported due to eating in carenderias. As this attacks the liver (i.e., hepar = Greek for liver), victims
will exhibit fever, jaundice and diarrhea. A fraction of these victims, 15% to be exact, could suffer
for 6-9 months.
Although the disease is curable and a vaccine is available, this form of Hepatitis is most common.
Since the virus dies in high temperature, eating raw food (e.g., shellfish) can introduce you to the
disease. Good thing is once you’re stricken, you become immune.

Hepa A morbidity is at a low at 0.3 to 1.8 percent

source: contaminated food or water

nature: viral

#9. Hepatitis E

Just like Hepa A, this one is fecal-oral, meaning you get via eating or drinking contaminated
sources. This is the more dangerous kind with more reported deaths than its distant cousin. Hepa E
is a leading cause of infant deaths with 20% of infants from expecting mothers stricken with the
disease to experience fatal complications.
Over-all, the hepatitis group of diseases, which constitutes Hepa A, B, C, D and E, is a global
problem bigger than HIV/AIDs with over a million dying from the disease every year in the Asia
Pacific region. In the Philippines, it is estimated one of every 6 could be infected with the deadly
virus or a whopping 16.7 percent.

source: contaminated food or water, semen

nature: viral
#8. Typhoid

This bacterial disease is spread through contact with water or food contaminated with sewage or
fecal matter. Again, poor sanitation is a leading cause of the disease. Typhoid is deadly especially
for children with mortality rates reaching as high as 20% and cases of deaths have been reported
nationwide. Symptoms include sustained high fever.
source: contaminated food or water
nature: bacterial

#7. Japanese Encephalitis

Mosquito-borne (Culex tritaeniorhynchus), this viral disease is a menace in the rural areas. The sad
part is the mortality rate is high, up to 30%, with infected people experiencing acute encephalitis
which can progress to coma and eventual death.

source: Mosquito-borne
nature: viral

#6. Leptospirosis

Another disease that is aggravated by dirty living conditions.The disease is bacterial but can easily
be spread as it can be spread with infected animal urine (e.g., rats, dogs, cats) coming in contact
with breaks in the skin, mouth, nose or even the vagina. It is no coincidence that the disease has
been reported in areas of the Philippines experiencing massive flooding. Sadly, the disease has
claimed dozens of lives. A classic example is the 2013 outbreak in Olongapo City which affected
over 600 people.
source: water-borne
nature: bacterial
#5. Rabies

The disease identified mainly through dog bites has been dubbed a public menace in the Philippines
and government has been actively pursuing deterrence of the spread of the virus. In advanced
stages, infected persons will start to exhibit strange behaviors almost dog-like (e.g., biting, lunging
at anyone, fear of water). If untreated, rabies can cause cardio-respiratory arrest and eventual death
in 3-5 days.
Good thing is it’s 100 percent preventable and a vaccine is available. However, rabies still claims
200-300 lives annually.

source: dog bites

nature: viral

#4. Dengue
Dengue is another major menace in the Philippines with the government actively pursuing its
eradication. Mosquito-borne (Aedes aegypti) the disease has struck in the heart of major cities.

In early 2013 alone, almost 200 Filipinos died of the disease with urban centers affected the most.

source: mosquito-borne (Aedes aegypti)

nature: viral
#3. TB

This bacterial disease that attacks the lungs, tuberculosis claims the lives of 2 million people
worldwide per year. In South-East Asia which includes the Philippines, there are around 3 million
cases of TB occurrence per year in a data provided by WHO (World Health Organization).
One of the top 3 in the DOH list, Philippines has one of the highest incidence of TB and it is the
sixth leading cause of death in the country. Since the disease is air-borne and can be spread via a
sneeze or cough, the disease can spread fast. From 2003 to 2011 alone over 4.6 million TB cases
were reported in the archipelago. The good news is these numbers are slowly going down.

source: air-borne (Aedes aegypti)

nature: bacterial

#2. Malaria

Part of the top 3 priority infectious disease, the disease can be transmitted via the bite of the
Anopheles female mosquito. Also it can infect an individual via syringe or blood transfusion, or
transplacenta (mother to child) and has claimed thousands of lives.
Though DOH has declared war on malaria and is posting a target of having a Malaria-free
Philippines by 2020, there were about 10,000 cases reported in 2011, a drop from roughly 20,000
cases in 2003.

source: mosquito-borne (Aedes aegypti)

nature: viral

#1. HIV/AIDs

The disease may not have claimed as many lives as those in this A-lister but its nature is of the
deadliest kind. Since the disease can be spread via blood transfusion (i.e., needle) and coitus
(sexual act), its rise has been imminent especially in highly-urban areas (Manila, Cebu). Many of
the active carriers of the disease have led promiscuous lifestyles. The abomination has also been
linked to availability of global work, the gay rights movement and the growth of the call center
industry.
In 2013, DOH listed a total of roughly 10,000 active carriers of the disease nationwide with 92%
infected via sexual contact with over 80% affected engaging in male-to-male (MSM) sexual
activity. Of the total carriers, 20% are OFW’s.

source: needle, sexual contact

nature: viral

Major infectious diseases: degree of risk: high

food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2013)

Definition: This entry lists major infectious diseases likely to be encountered in countries
where the risk of such diseases is assessed to be very high as compared to the United
States. These infectious diseases represent risks to US government personnel traveling to
the specified country for a period of less than three years. Thedegree of risk is assessed
by considering the foreign nature of these infectious diseases, their severity, and the
probability of being affected by the diseases present. The diseases listed do not
necessarily represent the total disease burden experienced by the local population.
The risk to an individual traveler varies considerably by the specific location, visit duration,
type of activities, type of accommodations, time of year, and other factors. Consultation
with a travel medicine physician is needed to evaluate individual risk and recommend
appropriate preventive measures such as vaccines.
Diseases are organized into the following six exposure categories shown in italics and
listed in typical descending order of risk. Note: The sequence of exposure categories
listed in individual country entries may vary according to local conditions.
food or waterborne diseases acquired through eating or drinking on the local economy:
Hepatitis A - viral disease that interferes with the functioning of the liver; spread through
consumption of food or water contaminated with fecal matter, principally in areas of poor
sanitation; victims exhibit fever, jaundice, and diarrhea; 15% of victims will experience
prolonged symptoms over 6-9 months; vaccine available.
Hepatitis E - water-borne viral disease that interferes with the functioning of the liver;
most commonly spread through fecal contamination of drinking water; victims exhibit
jaundice, fatigue, abdominal pain, and dark colored urine.
Typhoid fever - bacterial disease spread through contact with food or water contaminated
by fecal matter or sewage; victims exhibit sustained high fevers; left untreated, mortality
rates can reach 20%.
vectorborne diseases acquired through the bite of an infected arthropod:
Malaria - caused by single-cell parasitic protozoa Plasmodium; transmitted to humans via
the bite of the female Anopheles mosquito; parasites multiply in the liver attacking red
blood cells resulting in cycles of fever, chills, and sweats accompanied by anemia; death
due to damage to vital organs and interruption of blood supply to the brain; endemic in
100, mostly tropical, countries with 90% of cases and the majority of 1.5-2.5 million
estimated annual deaths occurring in sub-Saharan Africa.
Dengue fever - mosquito-borne (Aedes aegypti) viral disease associated with urban
environments; manifests as sudden onset of fever and severe headache; occasionally
produces shock and hemorrhage leading to death in 5% of cases.
Yellow fever - mosquito-borne viral disease; severity ranges from influenza-like
symptoms to severe hepatitis and hemorrhagic fever; occurs only in tropical South
America and sub-Saharan Africa, where most cases are reported; fatality rate is less than
20%.
Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus) viral disease
associated with rural areas in Asia; acute encephalitis can progress to paralysis, coma,
and death; fatality rates 30%.
African Trypanosomiasis - caused by the parasitic protozoa Trypanosoma; transmitted
to humans via the bite of bloodsucking Tsetse flies; infection leads to malaise and
irregular fevers and, in advanced cases when the parasites invade the central nervous
system, coma and death; endemic in 36 countries of sub-Saharan Africa; cattle and wild
animals act as reservoir hosts for the parasites.
Cutaneous Leishmaniasis - caused by the parasitic protozoa leishmania; transmitted to
humans via the bite of sandflies; results in skin lesions that may become chronic; endemic
in 88 countries; 90% of cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil, and
Peru; wild and domesticated animals as well as humans can act as reservoirs of infection.
Plague - bacterial disease transmitted by fleas normally associated with rats; person-to-
person airborne transmission also possible; recent plague epidemics occurred in areas of
Asia, Africa, and South America associated with rural areas or small towns and villages;
manifests as fever, headache, and painfully swollen lymph nodes; disease progresses
rapidly and without antibiotic treatment leads to pneumonic form with a death rate in
excess of 50%.
Crimean-Congo hemorrhagic fever - tick-borne viral disease; infection may also result
from exposure to infected animal blood or tissue; geographic distribution includes Africa,
Asia, the Middle East, and Eastern Europe; sudden onset of fever, headache, and muscle
aches followed by hemorrhaging in the bowels, urine, nose, and gums; mortality rate is
approximately 30%.
Rift Valley fever - viral disease affecting domesticated animals and humans; transmission
is by mosquito and other biting insects; infection may also occur through handling of
infected meat or contact with blood; geographic distribution includes eastern and southern
Africa where cattle and sheep are raised; symptoms are generally mild with fever and
some liver abnormalities, but the disease may progress to hemorrhagic fever,
encephalitis, or ocular disease; fatality rates are low at about 1% of cases.
Chikungunya - mosquito-borne (Aedes aegypti) viral disease associated with urban
environments, similar to Dengue Fever; characterized by sudden onset of fever, rash, and
severe joint pain usually lasting 3-7 days, some cases result in persistent arthritis.
water contact diseases acquired through swimming or wading in freshwater lakes,
streams, and rivers:
Leptospirosis - bacterial disease that affects animals and humans; infection occurs
through contact with water, food, or soil contaminated by animal urine; symptoms include
high fever, severe headache, vomiting, jaundice, and diarrhea; untreated, the disease can
result in kidney damage, liver failure, meningitis, or respiratory distress; fatality rates are
low but left untreated recovery can take months.
Schistosomiasis - caused by parasitic trematode flatworm Schistosoma; fresh water
snails act as intermediate host and release larval form of parasite that penetrates the skin
of people exposed to contaminated water; worms mature and reproduce in the blood
vessels, liver, kidneys, and intestines releasing eggs, which become trapped in tissues
triggering an immune response; may manifest as either urinary or intestinal disease
resulting in decreased work or learning capacity; mortality, while generally low, may occur
in advanced cases usually due to bladder cancer; endemic in 74 developing countries with
80% of infected people living in sub-Saharan Africa; humans act as the reservoir for this
parasite.
aerosolized dust or soil contact disease acquired through inhalation of aerosols
contaminated with rodent urine:
Lassa fever - viral disease carried by rats of the genus Mastomys; endemic in portions of
West Africa; infection occurs through direct contact with or consumption of food
contaminated by rodent urine or fecal matter containing virus particles; fatality rate can
reach 50% in epidemic outbreaks.
respiratory disease acquired through close contact with an infectious person:
Meningococcal meningitis - bacterial disease causing an inflammation of the lining of
the brain and spinal cord; one of the most important bacterial pathogens is Neisseria
meningitidis because of its potential to cause epidemics; symptoms include stiff neck, high
fever, headaches, and vomiting; bacteria are transmitted from person to person by
respiratory droplets and facilitated by close and prolonged contact resulting from crowded
living conditions, often with a seasonal distribution; death occurs in 5-15% of cases,
typically within 24-48 hours of onset of symptoms; highest burden of meningococcal
disease occurs in the hyperendemic region of sub-Saharan Africa known as the
"Meningitis Belt" which stretches from Senegal east to Ethiopia.
animal contact disease acquired through direct contact with local animals:
Rabies - viral disease of mammals usually transmitted through the bite of an infected
animal, most commonly dogs; virus affects the central nervous system causing brain
alteration and death; symptoms initially are non-specific fever and headache progressing
to neurological symptoms; death occurs within days of the onset of symptoms.

Source: CIA World Factbook - Unless otherwise noted, information in this page is
accurate as of August 23, 2014
Major infectious diseases: degree of risk: high
food or waterborne diseases: bacterial diarrhea, hepatitis A, and typhoid fever
vectorborne diseases: dengue fever and malaria
water contact disease: leptospirosis (2013)

Definition: This entry lists major infectious diseases likely to be encountered in countries
where the risk of such diseases is assessed to be very high as compared to the United
States. These infectious diseases represent risks to US government personnel traveling to
the specified country for a period of less than three years. Thedegree of risk is assessed
by considering the foreign nature of these infectious diseases, their severity, and the
probability of being affected by the diseases present. The diseases listed do not
necessarily represent the total disease burden experienced by the local population.
The risk to an individual traveler varies considerably by the specific location, visit duration,
type of activities, type of accommodations, time of year, and other factors. Consultation
with a travel medicine physician is needed to evaluate individual risk and recommend
appropriate preventive measures such as vaccines.
Diseases are organized into the following six exposure categories shown in italics and
listed in typical descending order of risk. Note: The sequence of exposure categories
listed in individual country entries may vary according to local conditions.
food or waterborne diseases acquired through eating or drinking on the local economy:
Hepatitis A - viral disease that interferes with the functioning of the liver; spread through
consumption of food or water contaminated with fecal matter, principally in areas of poor
sanitation; victims exhibit fever, jaundice, and diarrhea; 15% of victims will experience
prolonged symptoms over 6-9 months; vaccine available.
Hepatitis E - water-borne viral disease that interferes with the functioning of the liver;
most commonly spread through fecal contamination of drinking water; victims exhibit
jaundice, fatigue, abdominal pain, and dark colored urine.
Typhoid fever - bacterial disease spread through contact with food or water contaminated
by fecal matter or sewage; victims exhibit sustained high fevers; left untreated, mortality
rates can reach 20%.
vectorborne diseases acquired through the bite of an infected arthropod:
Malaria - caused by single-cell parasitic protozoa Plasmodium; transmitted to humans via
the bite of the female Anopheles mosquito; parasites multiply in the liver attacking red
blood cells resulting in cycles of fever, chills, and sweats accompanied by anemia; death
due to damage to vital organs and interruption of blood supply to the brain; endemic in
100, mostly tropical, countries with 90% of cases and the majority of 1.5-2.5 million
estimated annual deaths occurring in sub-Saharan Africa.
Dengue fever - mosquito-borne (Aedes aegypti) viral disease associated with urban
environments; manifests as sudden onset of fever and severe headache; occasionally
produces shock and hemorrhage leading to death in 5% of cases.
Yellow fever - mosquito-borne viral disease; severity ranges from influenza-like
symptoms to severe hepatitis and hemorrhagic fever; occurs only in tropical South
America and sub-Saharan Africa, where most cases are reported; fatality rate is less than
20%.
Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus) viral disease
associated with rural areas in Asia; acute encephalitis can progress to paralysis, coma,
and death; fatality rates 30%.
African Trypanosomiasis - caused by the parasitic protozoa Trypanosoma; transmitted
to humans via the bite of bloodsucking Tsetse flies; infection leads to malaise and
irregular fevers and, in advanced cases when the parasites invade the central nervous
system, coma and death; endemic in 36 countries of sub-Saharan Africa; cattle and wild
animals act as reservoir hosts for the parasites.
Cutaneous Leishmaniasis - caused by the parasitic protozoa leishmania; transmitted to
humans via the bite of sandflies; results in skin lesions that may become chronic; endemic
in 88 countries; 90% of cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil, and
Peru; wild and domesticated animals as well as humans can act as reservoirs of infection.
Plague - bacterial disease transmitted by fleas normally associated with rats; person-to-
person airborne transmission also possible; recent plague epidemics occurred in areas of
Asia, Africa, and South America associated with rural areas or small towns and villages;
manifests as fever, headache, and painfully swollen lymph nodes; disease progresses
rapidly and without antibiotic treatment leads to pneumonic form with a death rate in
excess of 50%.
Crimean-Congo hemorrhagic fever - tick-borne viral disease; infection may also result
from exposure to infected animal blood or tissue; geographic distribution includes Africa,
Asia, the Middle East, and Eastern Europe; sudden onset of fever, headache, and muscle
aches followed by hemorrhaging in the bowels, urine, nose, and gums; mortality rate is
approximately 30%.
Rift Valley fever - viral disease affecting domesticated animals and humans; transmission
is by mosquito and other biting insects; infection may also occur through handling of
infected meat or contact with blood; geographic distribution includes eastern and southern
Africa where cattle and sheep are raised; symptoms are generally mild with fever and
some liver abnormalities, but the disease may progress to hemorrhagic fever,
encephalitis, or ocular disease; fatality rates are low at about 1% of cases.
Chikungunya - mosquito-borne (Aedes aegypti) viral disease associated with urban
environments, similar to Dengue Fever; characterized by sudden onset of fever, rash, and
severe joint pain usually lasting 3-7 days, some cases result in persistent arthritis.
water contact diseases acquired through swimming or wading in freshwater lakes,
streams, and rivers:
Leptospirosis - bacterial disease that affects animals and humans; infection occurs
through contact with water, food, or soil contaminated by animal urine; symptoms include
high fever, severe headache, vomiting, jaundice, and diarrhea; untreated, the disease can
result in kidney damage, liver failure, meningitis, or respiratory distress; fatality rates are
low but left untreated recovery can take months.
Schistosomiasis - caused by parasitic trematode flatworm Schistosoma; fresh water
snails act as intermediate host and release larval form of parasite that penetrates the skin
of people exposed to contaminated water; worms mature and reproduce in the blood
vessels, liver, kidneys, and intestines releasing eggs, which become trapped in tissues
triggering an immune response; may manifest as either urinary or intestinal disease
resulting in decreased work or learning capacity; mortality, while generally low, may occur
in advanced cases usually due to bladder cancer; endemic in 74 developing countries with
80% of infected people living in sub-Saharan Africa; humans act as the reservoir for this
parasite.
aerosolized dust or soil contact disease acquired through inhalation of aerosols
contaminated with rodent urine:
Lassa fever - viral disease carried by rats of the genus Mastomys; endemic in portions of
West Africa; infection occurs through direct contact with or consumption of food
contaminated by rodent urine or fecal matter containing virus particles; fatality rate can
reach 50% in epidemic outbreaks.
respiratory disease acquired through close contact with an infectious person:
Meningococcal meningitis - bacterial disease causing an inflammation of the lining of
the brain and spinal cord; one of the most important bacterial pathogens is Neisseria
meningitidis because of its potential to cause epidemics; symptoms include stiff neck, high
fever, headaches, and vomiting; bacteria are transmitted from person to person by
respiratory droplets and facilitated by close and prolonged contact resulting from crowded
living conditions, often with a seasonal distribution; death occurs in 5-15% of cases,
typically within 24-48 hours of onset of symptoms; highest burden of meningococcal
disease occurs in the hyperendemic region of sub-Saharan Africa known as the
"Meningitis Belt" which stretches from Senegal east to Ethiopia.
animal contact disease acquired through direct contact with local animals:
Rabies - viral disease of mammals usually transmitted through the bite of an infected
animal, most commonly dogs; virus affects the central nervous system causing brain
alteration and death; symptoms initially are non-specific fever and headache progressing
to neurological symptoms; death occurs within days of the onset of symptoms.

Source: CIA World Factbook - Unless otherwise noted, information in this page is
accurate as of August 23, 2014