2013 Disease Detectives

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1 2013 Disease Detectives Since the catastrophic earthquake that hit Haiti in January of 2010, there have been an alarming number of cases of Cholera, spread by the Vibrio cholera bacterium, reported within the country. Immediately after the earthquake, a large and diverse United Nations peacekeeping force from all over the world was sent to the island country to aid the Haitian people in recovering from the disaster. UN workers lived in primitive camps alongside a major river and water source. Comparison of the Haitian cholera strain with one circulating in Nepal around the same time shows the two differed in only 1 out of 4 million genetic elements. Since the disaster, there has been a large outbreak of Cholera, which has affected about 640,000 people and, of those, killed around 8,000. Cholera is a major cause of epidemic diarrhea throughout the developing world. There has been an ongoing global pandemic in Asia, Africa and Latin America for the last four decades. However, Cholera incidence in the United States is extremely low. A group of scientists were appointed by the United Nations to investigate the origin, the reason the disease spread and possible solutions to the problem in Haiti. Extended Answer Questions 1. Explain the societal and global health implications of this dilemma. Why might this be an important issue to investigate? 2. Briefly describe how you would go about finding the origin of the bacterium that causes Cholera. 3. Develop two hypotheses for the cause of the introduction of this bacterium to the Haitian people. 4. Give three reasons why this bacterium was able to spread so quickly through the Haitian population and explain why each of these reasons would allow the bacteria to spread.

2 5a. Identify and explain two different ways to slow the spread of Cholera in Haiti. 5b. Identify a factor that could make the solution discussed in 5a challenging to execute. 6. Is this an example of an epidemic or a pandemic? 7. What is the difference between an epidemic and a pandemic? 8. Why do diseases spread quicker in third world countries than in more advanced countries?

3 Multiple Choice 1. Which of these is not present in a virus? b a. Capsid b. Nucleus c. Sheath d. Tail Fiber 2. Which three things must be included in a hypothesis for the cause of a disease? c a. A time, a place, and a person b. A time, a temperature, and a region c. An agent, a host, and an environment d. Other local occurrences, a person, and a time. 3. The resistance of a large percentage of a population to an attack by a disease is called c a. Immune Evolution b. Group resistance c. Herd Immunity 4. The total population growth for a given period could be expressed as c a. Natality x Mortality b. Natality Mortality c. Mortality Natality d. Natality Mortality 5. Which of the following is an example of a pandemic? b a. Cholera outbreak in Haiti b. The Black Plague c. Indonesian Dengue Fever d. Asian SARS 6. Antibodies bind to proteins called b a. DNA b. Albumin c. RNA d. Antigens 7. Which range of temperatures is most optimal for bacterial growth?a a F b. < 0 or >120 c F d F

4 8. Which of the following is a symptom of Cholera is the most likely to result in death? 2 a. Fever b. Dehydration c. Liver Failure d. Kidney Failure 9. Which of the following is NOT true about norovirus infection? a a. It is easily treated with antibiotics b. It is a foodborne illness c. It causes gastrointestinal illness d. All of the Above 10. Malaria is caused by a. a a. Protozoan b. Fungi c. Virus d. Bacteria 11. An insect which transmits a disease is known as a/n. c a. Intermediate Host b. Parasite c. Vector d. Prey 12. A chronic case of a disease denotes. d a. A severe attack of the disease b. A mild attack of the disease. c. The disease occurs over a very short period of time. d. The disease occurs over a very long period of time. 13. Congenital diseases are those which. B a. Are deficiency diseases b. Are present from the time of birth c. Are spread from man to man d. Occur at some point during the lifetime 14. The AIDS virus has. D a. Single Strand DNA b. Double Strand DNA c. Double Strand DNA d. Single Strand DNA

5 15. What are antigens? c a. Proteins found in the blood that cause foreign blood cells to clump. b. Proteins embedded in B cell membranes. c. Foreign molecules that trigger the generation of antibodies. d. Proteins that consist of two light and two heavy polypeptide chains. 16. Which of the following cell types are responsible for initiating a secondary immune response? a a. Memory Cells b. Macrophages c. B Cells d. T Cells 17. Which of the following is a characteristic of the early stages of local inflammation? c a. Anaphylactic Shock b. Fever c. Release of histamine d. Attack by cytotoxic T cells 18. An infectious disease is one that is caused by. A a. Pathogens b. Heredity c. Hemophilia d. Pollutants in the environment 19. In response to endotoxins released by certain bacteria, leukocytes may release. B a. Antibodies b. Endogenous Pyrogens c. Antigens d. Interferon 20. Antibodies belong to a group of proteins called. d a. Albumins b. Alpha Globulins c. Interferons d. None of the above

6 2013 Disease Detectives Since the catastrophic earthquake that hit Haiti in January of 2010, there have been an alarming number of cases of Cholera, spread by the Vibrio cholera bacterium, reported within the country. Immediately after the earthquake, a large and diverse United Nations peacekeeping force from all over the world was sent to the island country to aid the Haitian people in recovering from the disaster. UN workers lived in primitive camps alongside a major river and water source. Comparison of the Haitian cholera strain with one circulating in Nepal around the same time shows the two differed in only 1 out of 4 million genetic elements. Since the disaster, there has been a large outbreak of Cholera, which has affected about 640,000 people and, of those, killed around 8,000. Cholera is a major cause of epidemic diarrhea throughout the developing world. There has been an ongoing global pandemic in Asia, Africa and Latin America for the last four decades. However, Cholera incidence in the United States is extremely low. A group of scientists were appointed by the United Nations to investigate the origin, the reason the disease spread and possible solutions to the problem in Haiti. Questions 1. Explain the societal and global health implications of this dilemma. Why might this be an important issue to investigate? Clearly, the disease was brought to Haiti from another part of the world. The residents of Haiti are not equipped to handle this outbreak, which is why it is having such a devastating impact. This is an issue as when natural disasters occur, countries need to be prepared for having help travel from other parts of the world where other diseases are prevalent. Natural disasters can make water sanitation and food contamination more likely, which is a major concern. Should countries be more cautious about whom they allow to help? This is an important issue to investigate because of the global implications and because so many people in Haiti are currently suffering. Some of the reasons for investigating are to find out what type of contamination caused the illness, to prevent the cholera from spreading further, and to recommend ways of preventing the recurrence of this problem in another place or time. Also, they must determine how to treat the people who are currently affected. 2. Briefly describe how you would go about finding the origin of the bacterium that causes Cholera. Step 1: Would need to Confirm the diagnosis you should first make certain that these people actually have Cholera. Data Needs and Sources: You need to get diagnostic data from local doctors and hospital emergency room staff. Could perform laboratory testing on samples from various locations to identify areas of the country, which were affected the worst. Step 2: Confirm that an outbreak really occurred you should show that the number of people with Cholera in this group was higher than would normally be expected. Data Needs and Sources: Need to know how many people and from where volunteered to help in Haiti. Also, what is the total population in Haiti and which areas were affected the most.

7 Step 3: Define and identify cases of illness you will first need to develop a case definition using data on the symptoms, the time and place the illness occurred, and common characteristics of the people who were ill. Case Definition: Cholera is one of the ancient classical diseases and particularly prone to cause major outbreaks following major natural disasters, such as earthquakes and hurricanes, where the normal separation between sewage and drinking water is destroyed. This was the case following the 2010 earthquake in Haiti. Rumors spread that Nepalese soldiers serving as United Nations peacekeepers brought the disease to Haiti. This possible connection has never been confirmed; however genetic testing shows extreme similarities in strains from Haiti and Nepal. Data Needs and Sources: To identify cases, sequencing the genomes of bacteria can give detailed information on whether isolates from different sites share a common origin. You would also need to contact area physicians, clinics, and hospital emergency rooms. Is there a vaccine for Cholera? What does it cost? 3. Develop two hypotheses for the cause of the introduction of this bacterium to the Haitian people. The biological comparison between the strain of cholera in Nepal and that found in Haiti, may explain the source of the outbreak. UN peacekeepers from Nepal, who were living in these primitive camps that were likely unsanitary may have led to contamination of food or a water source via the nearby river. A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water and/or food. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill. Global travel and trade provide many opportunities for infectious diseases such as cholera to spread from one country to another. When water and sewage treatment is inadequate, as in post-earthquake Haiti, cholera can spread rapidly. It is also possible that the disease spread by an infected person from another country. 4. Give three reasons why this bacterium was able to spread so quickly through the Haitian population and explain why each of these reasons would allow the bacteria to spread. Once the bacterium enters a water source, it can easily spread. Due to lack of hygiene or sanitation methods, the bacterium likely spread to more people and infection was not prevented. In times of natural disaster, sewage methods may not be operating properly and clean water may not be readily available. This also leads to a higher risk of infection and also more fatalities because the infected cannot get rehydrated. For a cholera outbreak to occur, two conditions have to be met: (1) there must be significant breaches in the water, sanitation, and hygiene infrastructure used by groups of people, permitting large-scale exposure to food or water contaminated with Vibrio cholerae organisms; and (2) cholera must be present in the population. It is unclear how cholera was introduced to Haiti.

8 5a. Identify and explain two different ways to slow the spread of Cholera in Haiti. Drink only bottled, boiled, or chemically treated water and bottled or canned carbonated beverages. When using bottled drinks, make sure that the seal has not been broken. Wash your hands often with soap and clean water. Clean your hands especially before you eat or prepare food and after using the bathroom. Do not eat raw and undercooked meats and seafood or unpeeled fruits and vegetables. Dispose of feces in a sanitary manner to prevent contamination of water and food sources 5b. Identify a factor that could make the solution discussed in 5a challenging to execute. Drinking only bottled or boiled water could be difficult during a natural disaster when the access to supplies is limited. People may not have an area to boil water or be able to receive bottled water in a timely manner. Lack of knowledge about proper hygiene may contribute, so there wasn t enough hand washing or bathing going on especially before eating.

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