Emerging and Re-emerging - Have not occurred in humans before (this type of
Infectious Diseases emergence is difficult to establish and is
Seminar 2
Infectious Diseases
 Are caused by pathogenic microorganisms, such as
bacteria, viruses, parasites, or fungi
 The diseases can be spread, directly or indirectly,
from one person to another
 Zoonotic diseases
- Infectious disease of animals that can cause
disease when transmitted to humans
History: Infectious Diseases on the rise!
 Fifty years ago, many people believed the age-old
battle of humans against infectious disease was
virtually over, with humankind the winners
 The events of the past two decades have shown the
foolhardiness of that position
 At least a dozen “new” diseases have been identified
such as AIDS, Legionnaire’s disease, and hantavirus
pulmonary syndrome), and traditional diseases that
appeared to be “on their way out” (such as malaria
and tuberculosis) are resurging
 Many diseases thought to be adequately controlled
appear to be making a “comeback”
 In developed countries, public health measures such
as sanitation, sewage treatment, vaccination
programs, and access to good medical care have
virtually eliminated “traditional” diseases such as
Diphtheria, whooping cough, and tuberculosis
 Many of these disease are becoming a public health
problem once again, as immunization programs and
other public standards are enforced less vigorously
and, as antibiotic pathogens evolve
 Strains of pneumonia-caused by Staphylococcus
aureus are resistant to all of the currently available
drug treatments
 Among the diseases re-emerging as a consequence
of microbial resistance are tuberculosis, and malaria,
leading causes of death from infectious disease
worldwide
Emerging Infectious Disease
 An infectious disease that has newly appeared in a
population or that has been known for some time
but is rapidly increasing in incidence or geographic
range
 Newly identified and previously unknown infectious
agents that cause health problems either locally or
internationally
 Are diseases that:
probably rare)
- Have occurred previously but affected only small
numbers of people in isolated places (AIDS and
Ebola hemorrhagic fever are examples)
- Have occurred throughout human history but
have only recently been recognized as distinct
diseases due to an infectious agent (Lyme
disease and gastric ulcers are examples)
Re-emerging Infectious Disease
 Diseases that once were major health problems
globally or in a particular country, and then declined
dramatically, but are again becoming public health
problems for a significant proportion of the
population
 Are infectious diseases that have been known for
some time, had fallen to such low levels that they
were no longer considered public health problems
and are now showing upward trends in incidence or
prevalence worldwide
Factors contributing to the Emergence
 Infectious Agent
- Evolution of pathogenic infectious agents
(microbial adaptation and change)
- Development of resistance to drugs
- Resistance of vectors to pesticides
 Host
- Human demographic change (inhabiting new
areas)
- Human behavior (sexual and drug use)
- Human susceptibility to infection
(immunosuppression)
- Poverty and social inequality
 Environment
- Climate and changing ecosystems
- Economic development and land use
(urbanization, deforestation)
- Technology and industry (food processing and
handling)
- International travel and commerce
- Breakdown of public health measure (war,
unrest, overcrowding)
- Deterioration in surveillance systems (lack of
political will)
 Transmission of infectious agent from animals to
humans
- >2/3 emerging infections originate from animals
– wild and domestic
 - Emerging influenza infections in humans  Use of anti-infective drugs in animals and
associated with geese, chickens, and pigs plants
- Animal displacement in search of food after - Consequences:
deforestation or climate change (Lassa fever)  Prolonged hospital admissions
- Humans themselves penetrate/modify  Higher death rates from infections
unpopulated regions – come closer to animal  Requires more expensive, more toxic drugs
reservoirs or vectors (Yellow fever, malaria)  Higher health care costs
 Climate and environmental changes
- Deforestation forces animals into closer human Examples of Re-emerging Diseases
contact – increased possibility for agents to Disease Infectious Agent Contributing Factors
Cryptosporidiosis Cryptosporidium Inadequate control in
breach species barrier between animals and parvum (protozoa) water supply;
humans international travel;
- El Nino – triggers natural disasters and related increased use of child-
outbreaks of infectious diseases (malaria, care facilities
Diphtheria Corynebacterium Interruption of
cholera)
diphtheria immunization
- Global warming – spread of malaria, dengue, (bacterium) program due to
leishmaniasis, filariasis political changes
 Poverty, neglect and weakening of health Malaria Plasmodium species Drug resistance;
(protozoon) favorable conditions
infrastructure
for mosquito vector
- Poor populations – major reservoir and source of Meningitis, Group A Uncertain
continued transmission Necrotizing Streptococcus
- Poverty and malnutrition – severe infectious fasciitis (flesh- (bacterium)
eating disease),
disease cycle
Toxic shock
- Lack of funding syndrome, and
- Poor prioritization of health funds – misplaced in other diseases
curative rather than preventive infrastructure Pertussis Bordetella pertussis Refusal to vaccinate
(Whooping (bacterium) based on fears that
- Failure to develop adequate health delivery cough) the vaccine is unsafe;
systems other possible factors:
 Uncontrolled urbanization and population decreased vaccine
displacement efficacy or waning
immunity among
- Growth of densely populated cities – vaccinated adults
substandard housing, unsafe water, poor Rabies Rhabdovirus group Breakdown in public
sanitation, overcrowding, indoor air pollution (virus) health measures;
(>10% preventable ill health) changes in land use;
travel
- Problem of refugees and displaced persons Rubeola Morbilivirus genus Failure to vaccinate;
- Diarrheal and intestinal parasitic diseases, ARI (Measles) (virus) failure to receive
Lyme disease (B. burgdorferi) – changes in second dose of
ecology, increasing deer populations, suburban vaccine
migration of population Schistosomiasis Schistosoma Dam construction;
species (helminth) ecological changes
 Human behavior favoring snail host
- Unsafe sexual practices (HIV, gonorrhea, Tuberculosis Mycobacterium Antibiotic-resistant
syphilis) tuberculosis pathogens;
(bacterium) immunocompromised
- Changes in agricultural and food production populations
patterns – food-borne infectious agents (E. coli) (malnourished, HIV-
- Increased international travel (influenza) infected, poverty-
- Outdoor activity stricken)
Yellow fever Flavivirus group Insecticide resistance;
 Antimicrobial drug resistance (virus) urbanization; civil
- Causes: strife
 Wrong prescribing practices
 Non-adherence by patients
 Counterfeit drugs
Examples of Emerging Infectious Diseases - Has something to do with birds (chicken)
Disease Infectious Agent Year Contributing - Humans get infected when they are exposed or
Recognized Factors
Lassa fever Arenaviridae 1969 Urbanization and get in contact with infected bird or surface
family (virus) other conditions contact with bird droppings or saliva
that favor the
rodent host;
 Nipah Virus
nosocomial
transmission
Ebola Filoviridae family 1977 Unknown natural
hemorrhagic (virus) reservoir;
fever nosocomial
transmission
Legionnaire Legionella 1977 Cooling and
disease pneumophila plumbing
(bacterium) systems
Hemolytic Eschirichia coli 1982 Mass food
uremic 0157:H7 production
syndrome (bacterium) systems
Lyme Borrelia 1982 Conditions
borreliosis burgdorferi favoring the tick
(bacterium) vector and deer, - These are commonly transmitted from bats
such as  Ebola Virus
reforestation
near homes
AIDS Human 1983 Migration to
immunodeficiency cities, global
virus travel,
transfusions,
organ
transplants,
intravenous drug
use, multiple
sexual partners
Gastric ulcers Helicobacter 1983 Newly recognized
pylori (bacterium) as due to
infectious agent
Cholera Vibrio cholera 1992 Evolution of new
0139 (bacterium) strain of bacteria
combining - The source is from South Africa
increased
virulence and - Has something to do with bats
long-term - Non-human primates can also be infected
survival in the
environment  Marburg Virus
Hantavirus Bunyaviridae 1993 Environmental
pulmonary family (virus) changes favoring
syndrome contact with
rodent hosts
Pandemic Orthomyxoviridae New viral Pig-duck
influenza family (virus) strains agriculture
emerge (possibly)
periodically

Emerging Zoonoses: Human-Animal Interface

Examples:
 Avian Influenza Virus - This is first discovered in Marburg, Germany
- Humans get infected through exposure to bats
 Lyme Disease
 - Borrelia burgdorferi is the cause of the disease
- Has something to do with deer ticks (Ixodes
scapularis)
 Lassa Fever
- The cause of this disease is the Mostomys
rodent
- Humans get infected through close contact with
the rodent
 Hantavirus Pulmonary Syndrome
- The cause of this disease is due to Peromyscus
maniculatus rodent
Emerging Infectious Diseases of the 21st Century
 SARS-CoV
- Causes SARS (Severe Acute Respiratory
Syndrome), a viral respiratory disease of
zoonotic origin
- Outbreak occurred in Southern China between
November 2002 to July 2003 that led to 8,439
cases and 812 deaths in multiple countries with
majority of cases found in Hong Kong
- Phylogenetic analysis of these viruses indicated a
high probability that it originated in bats and
spread to humans either directly or indirectly
through animals held in Chinese markets
- Although no new cases have been reported since
2004, SARS should not be considered eliminated
because the causative virus has no animal
reservoir from which it conceivably could
reemerge
- Lessons learned from SARS-CoV
 An infectious disease in one country is a
threat to all
 Important role of air travel in international
spread
 Tremendous negative economic impact on
trade, travel and tourism, estimated loss of
30 – 150 billion dollars
 High level commitment is crucial for rapid
containment
 WHO can play a critical role in catalyzing
international cooperation and support
 Global partnerships and rapid sharing of data
or information enhances preparedness and
response
 MERS-CoV
- A novel human coronavirus that was isolated
from a patient with acute pneumonia in 2012 in
Saudi Arabia
- Almost all cases have been linked to Saudi
Arabia; cases have been reported in 23 countries
- Fatality is considerably higher than SARS-CoV
- May be originating from bats due to its high
sequence homology to the bat virus; it is
speculated that the virus spreads form bats to
human via the dromedary camel
- Although human-to-human transmission seems
to be inefficient, it has been shown to spread
between people who are in close contact
- Transmission is not yet under control as new
cases are still being reported
 SARS-CoV-2
- A novel coronavirus designated as SARS-CoV-2
emerged in the city of Wuhan, Hubei province,
China, and caused an outbreak of unusual viral
pneumonia
- Severe acute respiratory syndrome coronavirus
2 is a highly transmissible and pathogenic
 coronavirus that emerged in the late 2019 and
has caused a pandemic of acute respiratory
disease, named ‘coronavirus disease 2019’
(COVID19), which threatens human health and
public safety
- Causes COVID-19, the third highly pathogenic
human coronavirus disease to date
- Although less deadly than SARS and MERS, the
rapid spreading of this highly contagious disease
has posed the severest threat to global health in
this century
- The SARS-CoV-2 outbreak has lasted for more
than 2 years now, and it is likely that this
emerging virus will establish a niche in humans
and coexist with us for a long time
- Despite a flood of SARS-CoV-2 research
published every week, current knowledge of this
novel coronavirus is just the tip of the iceberg
- The animal origin and cross-species infection
route of SARS-CoV-2 are yet to be uncovered
- The molecular mechanisms of SARS-CoV-2
infection pathogenesis and virus-host
interactions remain largely unclear
- Intensive studies on these virological profiles of
SARS-CoV-2 will provide the basis for the
development of preventive and therapeutic
strategies against COVID-19
- Continued genomic monitoring of SARS-CoV-2 in
new cases is needed worldwide, as it is
important to promptly identify any mutation
that may result in phenotypic changes of the
virus
Variants of Interest (VOI) Currently Circulating VOCs
 A SARS-CoV-2 variant:
- With genetic changes that are predicted or
known to affect virus characteristics such as
transmissibility, disease severity, immune
escape, diagnostic or therapeutic escape; and
- Identified to cause significant community
transmission or multiple COVID-19 clusters, in
multiple countries with increasing relative
prevalence alongside increasing number of cases
over time, or other apparent epidemiological
impacts to suggest an emerging risk to global
public health
Variants under Monitoring (VUM)
- Currently, there is no circulating variant of  A SARS-CoV-2 variant with genetic changes that are
interest suspected to affect virus characteristics with some
- Previously circulating variants of interests: indication that it may pose a future risk, but evidence
 Epsilon of phenotypic or epidemiological impact is currently
 Zeta unclear, requiring enhanced monitoring and repeat
 Eta assessment pending new evidence
 Theta
 Iota
 Kappa
 Lambda
 Mu

Variants of Concern (VOC)

 A SARS-CoV-2 variant that meets the definition of a As of March 18, 2022
VOI and, through a comparative assessment, has
 Globally
been demonstrated to be associated with one or
- 466,313,781 total number of cases
more of the following changes at a degree of global
- 6,067,720 deaths
public health significance:
- Increase in transmissibility or detrimental - Vaccine doses administered: 10,761,003,578
change in COVID-19 epidemiology; or  Philippines
- Increase in virulence or change in clinical disease - 3,673,201 total number of cases
presentation; or - 45,491 active cases
- Decrease in effectiveness of public health and - 57,999 deaths
social measures or available diagnostics, - 3,569,711 recoveries
vaccines, therapeutics - Vaccination coverage: 63,074,268
 62.8% of the total eligible population – as of
Previously Circulating VOCs Feb 27, 2022
Fatality Rate Data

Key Tasks in Dealing with Emerging Diseases

 Surveillance at national, regional, global level
- Epidemiological
- Laboratory (for identification of infectious agent)
- Ecological (habitat of the causative agent and
intermediate host)
- Anthropological (related to the vectors)
 Investigation and early control measures
 Implement prevention measures
- Behavioral
- Political
- Environmental
 Monitoring, evaluation