Adjunct Faculty, Division of Epidemiology UC Berkeley School of Public Health. San Francisco Department of Public Health.

Transcription

1 Infectious Disease Threats in the 21st Century: Prevention, Control, and Emergency Response Tomás J. Aragón, MD, DrPH Health Officer, City & County of San Francisco Director, Population Health Division San Francisco Department of Public Health Adjunct Faculty, Division of Epidemiology UC Berkeley School of Public Health May 17, 2013 Overview 1 Communicable disease challenges 2 Prevention and control concepts 3 Prevention and control responses

2 Recent and ongoing challenges Meningococcal disease in MSM H7N9 Avian Influenza A in China Typhoid case at SF Restaurant Novel coronavirus (ncov) in Middle East Human Immunodeficiency Virus (HIV) Meningococcal disease

3 Human Avian Influenza A (H7N9) Typhoid Mary (Mary Mallon)

4 Prevention and control concepts Prevention and control responses Prevention and control concepts Toma s J. Arago n, MD, DrPH, Health Officer Infectious Disease Threats in the 21st Century Prevention and control responses Infectious Disease Threats in the 21st Century Human Immunodeficiency Virus (HIV) Communicable disease challenges Toma s J. Arago n, MD, DrPH, Health Officer Human SARS Coronavirus, SARS outbreak, 2003 Communicable disease challenges

5 Chain model of infectious diseases Source: Epidemiologic Methods for the Study of Infectious Diseases, Oxford Natural history of infection and infectiousness When the latent period is longer than the incubation period, an infected person becomes infectious after symptom onset.

6 Convergence model for human-microbe interaction Institute of Medicine. Microbial threats to health: Emergence, Detection, and Response. National Academy Press, 2003 Transmission dynamics

7 Transmission containment Control strategies 1 Reduce contact rate (c) 2 Reduce fraction of population that is infectious (P ) 3 Reduce biological infectiousness (affects p) 4 Reduce biological susceptibility (affects p) 5 Interrupt transmission (physical, chemical) (affects p) 6 Reduce fraction of population that is susceptible (x) Control measures... are interventions designed to address control strategies. Always consider mutliple perspectives: host, agent, infectious sources, and environment (physical, social, economic, political, etc.) Example: Response to human pandemic influenza 1 Surveillance and epidemiology 2 Laboratory diagnostics 3 Transmission containment Community mitigation measures Isolation (of cases) Quarantine (of exposed) Social distancing Sheltering (of non-exposed) Vaccine distribution and use Antiviral drug distribution and use 4 Infection control and clinical guidelines 5 Environmental and occupational health 6 Medical & mental health care, and surge capacity 7 Public health communications (media, public, clinicians, facilities)

8 Summary of talk Communicable diseae challenges Meningococcal disease in MSM H7N9 Avian Influenza A in China Typhoid case at SF Restaurant Novel coronavirus (ncov) in Middle East Human Immunodeficiency Virus (HIV) Concepts for prevention and control Transmission mechanisms Transmission dynamics Transmission containment