Emerging Infectious Diseases

MEDF1021

September 2014

Infections of concern
The following list of microorganisms changes
with time and place
• Ebola
• Dengue
• Influenza
• SARS
• HIV
• TB

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 Ebola virus
causing

Ebola haemorrhagic fever

SOURCE: CDC/ Dr. Frederick A. Murphy - from

the Centers for Disease Control and Prevention's
Public Health Image Library (PHIL), with
identification number #1833.

2014 West Africa outbreak

www.spatioepi.com 4
 As of 6 September 2014, 4269 (probable,
confirmed and suspected) cases and 2288
deaths have been reported in the current
outbreak of Ebola virus disease by the
Ministries of Health of Guinea, Liberia
and Sierra Leone. The increase in cases
continues to accelerate in countries with
widespread and intense transmission:
Guinea, Liberia and Sierra Leone.

http://www.who.int/csr/disease/ebola/situation-reports/en/

Dengue virus
causing

Dengue haemorrhagic fever

http://www.fiocruz.br/ioc/cgi/cgilua.exe/sys/star
t.htm?infoid=663&sid=32

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 Aedes aegypti

virus Aedes albopictus

mosquito

human 7

The uninvited virus

www.spatioepi.com 8
 In Hong Kong, dengue is largely an
imported condition

but

Aedes albopictus (the mosquito

carrying dengue virus) has gone
global because of human activities,
so dengue has also gone global

Influenza
Bird flu (H1N1)
Avian flu
Seasonal flu
Epidemic flu
Pandemic flu
Spanish flu
Swine flu
H5N1

etc etc etc

An influenza virus particle, or “virion” in a 1981
image released by the U.S. Centers for Disease
Control (CDC), April 24, 2009. REUTERS/Cynthia
Goldsmith/Centers for Disease Control/Handout

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 Two seasonal peaks each year in Hong Kong

http://www.chp.gov.hk/files/pdf/FLU_EXPRESS_Wk%2032_2007.pdf

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H1N1 – used to be called swine flu

J. Cohen Science 324, 700 -702 (2009)

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Published by AAAS
The spatial distribution of reported H1N1 cases in 4 geographic
regions in Hong Kong (n=24,415).

Wong NS, Lee SS. The spatiotemporal diffusion of Pandemic Influenza (H1N1)
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2009 in Hong Kong. Procedia Environmental Sciences 2011; 3: 26‐31.

Influenza avian influenza

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Nations with confirmed cases of
H5N1 Avian Influenza (May 19, 2006)

http://www.pandemicflu.gov/ 15

H7N9
China

Lee SS, Wong NS,

Leung CC. Exposure to
avian influenza H7N9
in farms and wet
market. Lancet 2013;
381: 1815.

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Emergence of avian influenza
- Changes of farming practice
- Opportunity for influenza virus in human and birds
(and swine) to mix, leading to the generation of
new virus which we are unable to protect
ourselves from.

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According to the World Health Organization

(WHO), a total of 8,098 people worldwide
became sick with SARS during the 2003 outbreak.
Of these, 774 died.

http://www.cdc.gov/about/history/sars/index.htm

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 Coronavirus

http://www.virology.net/big_virology/BVRNAcorona.html

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New SARS?

MERS-CoV

NCoV

hCoV-EMC

SARS-CoV

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 Tracking the origin of the new coronavirus

www.spatioepi.com 21

HIV
Human immunodeficiency virus
HIV-1
HIV-2

Electron micrograph of HIV. CDC/Dr. Edwin P. Ewing,

Jr. epe1@cdc.gov
http://pathmicro.med.sc.edu/lecture/hiv9.htm

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Annual new HIV infections in adults
by population group
a decline from early prevention successes, an
increase from current failures

UNAIDS. Redefining AIDS in Asia – report of the Commission on

AIDS in Asia. New Delhi: OUP, 2008

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Understanding infections
requires an understanding of
- Microorganisms
- Exposure of human population to these microorganisms
- Routes of transmission
- Dynamics of spread
- Prevention strategy

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 Microorganisms are small organisms

Micororganism causes diseases – they are pathogenic

Pathogenic致病 “pathos” + “genic” (Greek)

pathos = disease
genic = producing

A microorganism is also a ‘pathogen’病原體if it causes disease

The likelihood of one organism causing disease is its “pathogenicity”致病性

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microorganism

exposure infection disease

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 Sources of infections
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microorganism

vector

human

More than 2 organisms (human, virus) are involved!

A vector is an organism that serves as an

intermediary in the transmission of a
host‐to‐host disease. For instance, many
infections are transmitted by mosquitoes,
fleas, ticks, etc. to people.
Paul Bugl. University of Hartford Course: AUCT 140, Epidemics and
AIDS. http://uhaweb.hartford.edu/BUGL/auct-syl.htm
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Classifying infections
by routes of transmission

• Respiratory tract
• Gastrointestinal tract (oro-faecal, faeco-oral)
• Urinary tract
• Direct contact (skin)
• Sexual transmission
• Blood (transfusion, injection, trauma)
• vector borne infections

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routes

exposure infection disease

host
immunity herd
immunity

Dissemination in
society

• sporadic infection • epidemics

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Epidemic theory
three variables:

agent, host, and environment

microorganism human ??????

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Epidemics
An epidemic is an occurrence of cases of a disease in excess of
usual expectations for a particular population.

A pandemic is a worldwide epidemic that kills or incapacitates

huge numbers in many countries

A single case of a rare and dangerous contagious disease that

has never occurred before or has long been absent from a
community represents a potential epidemic, as does a small
cluster of cases of a disease such as typhoid in an urban
community with good sanitation.

Conditions that are constantly present in a community are called

endemic

Encyclopedia of Public Health

The Gale Group, Inc
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So what is an emerging infection?

or emerging infectious disease?

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 Definition
US Department of Defense
Global Emerging Infections Surveillance and Response System
(DoD-GEIS)

There is no simple definition of an emerging infectious

disease. In general, it can be a completely new disease
or an old disease occurring in new places or new peoples;
with new presentations; or is newly resistant to available
treatments.

http://www.geis.fhp.osd.mil/default.asp
Accessed on 9 April 2007

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Conditions underlying the emergence of infections

Environment: De/Reforestation, Floods, Water

Human Behaviour: Sex, Drug Use, Travel, Diet, Play
Food Supply: Globalization and Processing
Public Health Infrastructure: Lack of Surveillance, Training,
Laboratory Support
Microbial Adaptation: Evolution, Drug Resistance
Social Change: Crowding, Poverty, Migration
Health Care: Immunosuppression, Medical Devices, Antibiotic Misuse

http://www.geis.fhp.osd.mil/GEIS/aboutGEIS/FAQs/FAQ3.asp
Accessed on 9 April 2007
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Infection / Infectious Diseases
is a cross-disciplinary subject

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