Professional Documents
Culture Documents
Control of Viral Diseases: Derek Wong "Wong's Virology" Http://virology
Control of Viral Diseases: Derek Wong "Wong's Virology" Http://virology
Derek Wong
Wongs Virology http://virologyonline.com
Terms
Surveillance of Infectious
Diseases
Yellow fever
Poliomyelitis
Measles
Mumps
Rubella
Rabies (Human and Animal)
Viral Hepatitis
Dengue fever
Chicken Pox
H5N1 influenza
SARS
Animal Reservoir
among
Contact tracing
Health education
Man-Arthropod-Man Cycle
Animal-Arthropod-Man Cycle
Examples of Arthropod
Vectors
Aedes Aegyti
Culex Mosquito
Assorted Ticks
Phlebotmine Sandfly
Vaccination
Types of Vaccination
Strategies
Characteristics of vaccines
The characteristics of the vaccine used is a major determinant on
the outcome of the vaccination strategy. Factors to consider
include
Response rate
Type of protection
Duration of protection
Local immunity
Side effects
Route of administration
Stability
Cost
Developing a vaccination
policy
The following questions should be asked when a vaccination policy
against a particular virus is being developed.
1.
2.
3.
4.
5.
6.
For most viral infections, R0 is the average number of secondary cases produced by a
primary case in a wholly susceptible population. Clearly, an infection cannot maintain
itself or spread if R0 is less than 1.
The larger the value of R0, the harder it is to eradicate the infection from the community
in question.
A rough estimate of the level of immunization coverage required can be estimated in the
following manner: eradication will be achieved if the proportion immunized exceeds a
critical value pinc = 1-1/R0.
Thus the larger the R0, the higher the coverage is required to eliminate the infection.
Thus the global eradication of measles, with its R0 of 10 to 20 or more, is almost sure to
be more difficult to eradicate than smallpox, with its estimated R0 of 2 to 4.
Critical Coverage
Av Age of
infection
Epidemic
Period
Ro
Critical
Coverage
Measles
4-5
15-17
92-95
Pertussis
4-5
3-4
15-17
92-95
Mumps
6-7
10-12
90-92
Rubella
9-10
3-5
7-8
85-87
Diptheria
11-14
4-6
5-6
80-85
Polio
12-15
3-5
5-6
80-85
Eradication of Smallpox - 1
Smallpox was transmitted by respiratory route from lesions in the respiratory tract of
patients in the early stage of the disease
During the 12 day incubation period, the virus was distributed initially to the internal
organs and then to the skin.
Variola major caused severe infections with 20-50% mortality, variola minor with <1%
mortality
Smallpox was eradicated from most countries in Europe and the US by 1940s. By the
1960s, smallpox remained a serious problem in the Indian subcontinent, Indonesia and
much of Africa.
The WHO listed smallpox as the top on the list for eradication in 1967.
Eradication of Smallpox - 2
The initial strategy was separated into 3 phases;
Attack phase - This applied to areas where the incidence of smallpox exceeded 5
cases per 100,000 and where vaccination coverage was less than 80%. Attention
was given to mass vaccination and improvement in case surveillance and
reporting. This phase lasted from 1967-1973. A large amount of financial
resoureces were provided for setting up surveillance centres and reference centres.
Priority was given to Brazil, sub-saharan African, S.Asia and Africa.
Consolidation Phase - In areas where the incidence was less than 5 cases per
100,000 and vaccination coverage exceeded 80%, the objective was the
elimination of smallpox. Vaccination uptake was to be maintained and surveillance
improved. Facilities should be made available for isolation.
Maintenance Phase - once smallpox had been eliminated, it was essential it was
not reintroduced. This phase was entered in 1978. In 1980, the world was declared
to be free of smallpox.
Eradication of Smallpox - 3
It soon became clear that smallpox could not be eradicated with mass vaccination alone.
In some countries, it was not possible to achieve a smallpox vaccination uptake rate of
80%.
Therefore more attention was paid to case tracing and isolation procedures. Experience
in West Africa and Indonesia had shown that smallpox can be eliminated without mass
vaccination, provided that a high rate of case detection was achieved.
The Indian subcontinent was a special problem because of its large size and population.
It provided a reservoir for variola major infection. Extra attention was paid to search out
unnotified cases that proved to be highly effective. The last cases of variola major
occurred in the Indian subcontinent in 1975.
The last case of variola minor occurred in Somalia in 1977. The last cases of smallpox
occurred in a Birmingham laboratory in 1979.
It was estimated that the smallpox eradication campaign costed US $312 million. If
smallpox had not been eradicated, routine efforts to control smallpox would have costed
US $1000 million.
7. Low communicability
8. No carrier state
Key Events
Early Feb 2003 Guandong province reported 305 cases and 5 deaths
caused by atypical pneumonia of unknown cause.
21st Feb Prof Liu Jian Lung came to Hong Kong to attend a
relatives wedding. He stayed at Rm 911 of the Metropole Hotel. Six
people were infected and they carried the infection to the rest of Hong
Kong, Vietnam and Canada.
22nd March CDC isolated a virus that caused a CPE in Vero E6 cells
from a patient from Thailand and showed coronavirus-like particles on
electron microscopy. Serum from SARS patients were sent by the
GVU to the CDC for confirmation. GVU visualized coronavirus
particles in faeces of a mouse that had been inoculated (this was
proved later not to be SARS-CoV)
23rd March CDC identified the new agent as a coronavirus and gave
sequences of initial primers to collaborating laboratories.
Virological Aspects
Positive Rate
110
100
NPA
90
Faeces
80
70
60
50
40
30
20
10
0
<=0
1- 3
4- 6
7- 9
10- 12
13- 15
16- 18
19- 21
22- 24
4. 35
2. 03
4. 03
18. 27
41. 67
74. 34
93. 41
95. 68
93. 75
69
413
686
883
1003
1155
1337
1476
1572
NPA
34. 6
45. 2
58. 4
59. 7
41. 9
39. 1
12. 5
20
10
Faeces
12. 5
28. 3
46. 9
70. 3
68. 2
54. 2
38. 5
48. 3
11. 6
Posi t i ve Rat e
Tot al Number of Sera
Day Di ff erence
Epidemiological Aspects
Amoy Garden this was a unique event. The index patient was a 33-yr
old man with chronic renal disease treated at PWH. He visited Amoy
Garden frequently and had diarrhoea over a 3-day period. Dry U-traps in
bathroom floors allowed contaminated sewage droplets to enter
households.
The virus resurfaced in Feb 2003 to cause 2 infections (one fatal) in a Hong
Kong family who had recently traveled to China. It began to cause outbreaks
in the rest of Asia that year that were unnoticed.
It is now thought that highly pathogenic H5N1 is now firmly endemic Asia
and has also spread to Russia and Southern Europe.
2004
2005
2006
2007
2008
Total
Country
cases
death
s
cases
death
s
cases
death
s
cases
death
s
cases
death
s
cases
death
s
cases
death
s
Azerbaijan
Cambodia
China
13
30
20
Djibouti
Egypt
18
10
25
47
20
Indonesia
20
13
55
45
42
37
15
12
132
107
Iraq
Laos
Myanmar
Nigeria
Pakistan
Thailand
17
12
25
17
Turkey
12
12
Total
46
32
98
43
115
79
88
59
27
21
378
238
Risks of a pandemic
The present H5N1 strains do not have the ability to transmit efficiently
between humans. To date, there had been no certain cases of human to
human transmission.
It is thought an avian influenza may acquire this capability through
either 1. Reassortment with human influenza viruses (1957 and 1968),
or 2. gradual mutations ?1918.
Reassortments in 1957 (H1N1-H2N2), and 1968 (H2N2-H3N2) are
thought to have occurred through an intermediary host such as the pig.
Direct infection of humans by H5N1 opens the possibility that
reassortment can occur without an intermediary host.
Therefore many experts believe that a pandemic was stopped in 1997
by the culling of chickens.
The bottom line is that nobody knows when and if a pandemic will
arise out of the current H5N1 outbreaks.
Control Measures - 1
Measures should be taken to reduce the contact between poultry and migratory
birds through increased biosecurity
Steps such as a central slaughtering facility would reduce the risk of contact
with humans.
Control Measures - 2
Pandemic Planning
Despite an advance warning that has lasted almost two years, the world is illprepared to defend itself during a pandemic. WHO has urged all countries to
develop preparedness plans, but only around 40 have done so.