Emerging and Reemerging Infections

Juan Ismael G. Sumagaysay, MD, FPCP

History
Smallpox
 The history of smallpox extends into pre-history; the disease likely emerged in human
populations about 10,000 BC
 The earliest credible evidence of smallpox is found in the Egyptian mummies of people
who died some 3000 years ago
 During the 18th century the disease killed an estimated 400 000 Europeans each year
 During the 20th century, it is estimated that smallpox was responsible for 300-500 million
deaths. In the early 1950s and estimated 50 million cases of smallpox occurred in the
world each year
 To this day, smallpox is the ONLY human infectious disease to have been completely
eradicated.

Plague
 Caused by Yersinia pestis
 Flu-like symptoms develop. This includes fever, headaches, and vomiting
 Swollen and painful lymph nodes occur in the area closest to where the bacteria entered
the skin.
 Plague is believed to be the cause of the Black Death that swept through Asia, Europe,
and Africa in the 14th Century and killed an estimated 50 million people.
 This was about 25-60% of the European population

Cholera
 The word cholera is from Greek; χολέρα cholera from χολή kholē "bile".
 Cholera likely has its origin in the Indian subcontinent; it has been prevalent in the
Ganges delta since ancient times.
 Since it became widespread in the 19th Century, Cholera has killed tens of millions of
people
 Between 1900 and 1920, perhaps eight (8) million people died of cholera in India

 Signal flag “Lima” called the “Yellow Jack” which when flown in harbor means ship is
under quarantine.
Tuberculosis
Malaria

Great Influenza Pandemic

 An Influenza Pandemic is an epidemic of an Influenza virus that spreads on a worldwide

scale and infects a large proportion of the human population.
 1918 Spanish flu being responsible for the deaths of approximately 50-100 million
people.

H1N1
 Influenza A (H1N1) in humans
 Influenza A (H1N1) is caused by a novel flu virus that resulted from the reassortment of 4
viruses from pigs, humans, and birds.
 On 11 June 2009, a new strain of H1N1 influenza was declared to be a global pandemic
(Stage 6) by the WHO after evidence of spreading in the southern hemisphere – over
6,250 deaths.
 There is no vaccine vet to protect humans from this virus. But there are existing and
recommended medicines that are effective in treating these Influenza A (H1N1) viruses.
 Influenza A (H1N1) is fatal to humans.

Signs and symptoms in humans similar to the symptoms of regular flu such as:
 Fever
 Headache
 Fatigue
 Muscle or joint pains
 Lack of appetite
 Runny nose
 Sore throat
 Cough
 Vomiting or nausea
 Diarrhea

Mode of Transmission
 Exposure to droplets from the cough and sneeze of an infected person
 Influenza A (H1N1) is not transmitted by eating thoroughly-cooked pork

Prevention
 Cover your nose and mouth when coughing and sneezing
 Always wash hands with soap and water
 Use alcohol-based hand sanitizers
 Avoid close contact with sick people
 Increase your body’s resistance
 Have at least 8 hours of sleep
 Be physically active
  Manage your stress
 Drink plenty of fluids
 Eat nutritious food

*treat all patients as a potential source of infection

SARS 2003
 Is a newly identified clinical illness linked to outbreak of respiratory illness which
appeared in Guandong, China

SARS
Causative agent:
 SARS CoV, a new virus from the Coronavirus family
Mode of transmission:
 Person-to-person through respiratory droplets and direct contact of body fluids of
person with SARS
 Other possible modes:
o Fomites or orofecal spread (uncommon)
o

Incubation period:
 2-7 days after exposure to a SARS case, with a maximum of 10-13 days
Prodromal period:
 Duration is variable, usually 2-7 days
 Sudden onset of fever (>38oC)
 Other signs and symptoms similar to other respiratory viral infections
 Cough, chills, headache, body malaise possibly low risk of transmission during this
time
Other Laboratory findings:
 Low white cell count
 Abnormal liver function
 Renal function remains normal
*Important is history of exposure, travel and occupation

Treatment
 Supportive
 Empiric broad spectrum antibiotic for CAP and Atypical pneumonia

SARS suspect:
1. Fever (> 38oC) and one or more of the following symptoms:
 Cough
 Shortness of breath
 Dyspnea
2. A person with unexplained acute respiratory illness resulting in death and one of the
following exposures during the 10 days prior to onset of symptoms:
 Close contact
  History of travel to an area with recent local transmission of SARS
 Residing in an area with recent local transmission of SARS

Probable SARS:
 Suspect with CXR infiltrates consistent with pneumonia, or
 Autopsy findings consistent with Pathology of ARDS without an unidentifiable cause

Case Fatality:
 7-13% below 6 years old;
 50% in aged 60

Prognostic Factor
 Age (the older you are, the worse the prognosis)

Middle East Respiratory Syndrome Corona Virus (MERS CoV)

 MERS – is a viral respiratory illness first reported in Saudi Arabia in 2012
 Caused by Corona virus called MERS-CoV
 Sever acute respiratory illness

Transmission
 The risk of sustained person-to-person transmission appears to be very low (WHO)
 The cells MERS-CoV infects in the lungs only accounts for 20% of respiratory
epithelial cells – large number of virions are likely needed to be inhaled to cause
infection
 No strong evidence that camels are the source
 Possible source: Egyptian bats
 CAN contaminate a person in close contact

Incubation
 14 days

Symptoms:
 Fever
 Cough
 Shortness of breath
 Renal failure
 Diarrhea

 If you develop a fever & symptoms of lower respiratory illness, such as cough or
shortness of breath after a known exposure within 14 days to a seriously sick patient
with compatible signs and symptoms, or within 14 days after traveling from countries
in the Arabian Peninsula and neighboring countries, consult with a healthcare
provider and inform him of possible exposure or travel.

Prevention and Cure

  Proper hand washing
 Wearing of medical masks
 Sneezing into a sleeve, flexed elbow, or tissue (dispose properly after use)
 N95 is effective for protection while nursing a MERS CoV patient
 There are no specific treatments for illness caused by MERS-CoV. Do preventive
measures.
 If you develop symptoms, in 2 weeks’ time get a PCR.

Diagnosis
 PCR

Guide for Healthcare Facilities

1. Screen
2. Triage
3. Isolate – admit to a single room
4. Report

 Healthcare workers taking care of the patient should wear appropriate PPE
 Hand hygiene
 Limit visitors and patient contact
 Facilitate transfer

Chikungunya
 (/tʃɪkʊŋˈɡʊnjə/, /ˌtʃɪkənˈɡʌnjə/ CHI-kan-GUUN-ya; Makonde for “that which bends
up”) is an infection caused by the chikungunya virus.
 The mortality rate is a little less than 1 in 1000, with the elderly or those with
underlying chronic medical problems most likely having severe complications
 The virus is passed to humans by two (2) species of mosquito of the genus Aedes:
A. albopictus and A. aegypti. Animal reservoirs of the virus include monkeys, birds,
cattle, and rodents

Characteristic symptoms:
 Sudden onset high fever
 Joint pain; and
 Rash
Other:
 Headache
 Fatigue
 Digestive complaints
 Conjunctivitis
Ebola Outbreak: A Growing Threat?
Juan Ismael G. Sumagaysay, MD, FPCP

Ebola Virus
 The first EVD outbreaks occurred in remote villages in Central Africa, near tropical
rainforests, but the most recent outbreak in West Africa has involved major urban, as
well as rural areas.

Transmission
 It is thought that fruit bats of the Pteropodidae family are natural Ebola Virus hosts

Viral Transmission

 Ebola then spreads through human-to-human transmission via direct contact

(through broken skin or mucous membranes) with the blood, secretions, organs, or
other bodily fluids of infected people.
 Burial ceremonies in which mourners have direct contact with the body of the
deceased person can also play a role in the transmission of Ebola.
 People remain infectious as long as their blood and bodily fluids, including semen
and breastmilk, contain the virus.
 Ebola isn’t as contagious as more common viruses like colds, influenza, or
measles.
 People remain infectious as long as their blood and body fluids contain the virus
 Men who have recovered can still transmit the virus through semen up to 7 weeks after
recovery
 A person who has Ebola but has no symptoms can’t spread the disease.

Incubation Period
 2-21 days

Signs and Symptoms

 Gets worse, causes bleeding
 First symptom appears around Day 7-9

Diagnosis
 Difficult to diagnose by signs and symptoms
 ELISA
 PCR
  Cell culture

Treatment and Vaccines

 Supportive care
o Rehydration with oral or intravenous fluids; and
o Treatment of specific symptoms improves survival

Prevention:
 Reducing the wildlife-to-human transmission, outbreak containment