International Sanitary Regulation - Common Communicable Diseases

International Sanitary Regulation - Common Communicable Diseases

Disease: Condition that interferes w/ the operation of the body & mind Communicable Disease: Caused by a pathogen that can be spread from one living thing to another.

Non-Communicable Disease: Caused by something other than a pathogen Go HGConsu sdmedica Explicit S1on 0fmedl exact SearchMe Example- Heart Disease These diseases are not contagious!

Pathogen: -Disease-causing organism or germ -5 types: A) Viruses B) Bacteria C) Rickettsia D) Fungi E) Protozoa -All communicable diseases are caused by one of these 5!

Pathogen: -Not all pathogens are bad--- some are good! -5 types:

A) Viruses -The simplest pathogens -1-millionth of a inch long----can only be seen w/ an electron microscope! -A thousand times smaller than bacteria! -Are programmed to infect only certain body cells

A) Viruses -Walk a fine line between living & non-living things -Because viruses do not carry out their own biochemical reactions, antibiotics do not affect them. -Immunizations work by preinfecting the body so it knows how to produce the right antibodies as soon as the virus starts reproducing.

-Viral diseasesmeasles, chickenpox, cold, influenza, herpes This is the common cold virus

How viruses invade our body:

How viruses invade our body: How do you think fever protects us against this?

How do you think fever protects us against this? because the ideal temperature for this to happen in is 98.6. Anything higher slows down the replication...

A) Viruses -Bacteria can live on their own if they have the proper environment -Viruses need to be inside another living cell such as a human or animal -The goal of viruses is to find a perfect host, reproduce, & spread -Can mutate to adjust to new environments

Primary Herpes Infection w/ mouth ulcers Herpes Simples cold sore

Human Immunodeficiency Virus(HIV)

Ebola, Marburg Viral hemorrhagic fever is a collective name given to a group of viruses, including Ebola and Marburg. These fevers range in seriousness from the mild to the usually fatal. Ebola and Marburg are particularly deadly and mysterious. Ebola was named after the Ebola River in Zaire. It was in this region that the first epidemics occurred in the 1970s. Ebola is thus a classic "emerging disease" - one which has only recently entered the human ecology. Emerging diseases are becoming increasingly common as human populations swell, the environment is degraded and the climate warms. Today's tip: you really don't want to get Ebola. It's a nightmare become real. The first symptoms are a low-grade headache. This quickly progresses to a debilitating fever and muscle pain. Then things get truly bad as the major organs, the digestive tract, the skin, the eyes, the gums, all begin to break down and bleed. The body begins to dissolve. Blood pours out of body orifices while the victim writhes in pain. Death usually comes from systemic shock and blood loss. Researchers were shocked when they first autopsied people who died from these fevers.

E b o l a

B) Bacteria -Single-celled microorganism Strep throat bacteria -There are more than 1000 types, but only about 100 cause disease -Some are helpful (Ex.- Bacteria in your intestines aid digestion) -Bacteria diseases- Strep Throat, Tuberculosis, Lyme Disease

B) Bacteria -Are so small that a BILLION could fit on a teaspoon -There are more than 1000 types, but only about 100 cause disease -One bacterium is smaller than a grain of salt--- must use a microscope to see these -All different shapes- comma, stick, etc. E-Coli Bacteria

Strep Throat

C) Rickettsia -Pathogens that Grow inside living Cells & resemble bacteria -Much smaller than bacteria -Ex.- Rocky Mtn. Spotted Fever, Typhus

Rocky Mountain Spotted Fever

Typhus patient (Disease in areas where people & rodents live in close proximity (Fleas bite the rats & then contact humans )

D) Fungi- Plant-like organisms such as yeast & molds -Can cause diseases of the skin, lungs, or mucous membranes -Fungal diseases- Athlete s foot, jock itch, ringworm Fungus that causes athlete s foot

-Love damp warm places such as under rocks, between your toes, etc. -Most are relatively harmless & can be treated

F.Y.I.- Athlete s foot is just on the foot

E) Protozoa- Tiny single-celled organisms that produce toxins that produce disease -Can cause diseases of the skin, lungs, or mucous membranes -Fungal diseases- Malaria, dysentery, African Sleeping Sickness An example of a protozoa

-Live in rivers, ponds, water, etc. -Actually eat bacteria & other organisms wastes that is good -Some are parasites---that is bad such as when they cause malaria or intestinal problems. Another example of a protozoa

MALARIA HOT ZONES

These PROTOZOA can cause problems if they contaminate contact lenses since they cause erosion of the eye lens.

3 Terms to Know When Talking About Diseases 1- Symptom- A change in the way your body functions or behaves from the usual. Ex.- One of the symptoms of mono is being extremely tired

3- Antibiotic- A substance that slows the growth of pathogens

2- Diagnosis- Finding out what is wrong by having an exam,studying symptoms, & having tests

HOW PATHOGENS ARE SPREAD 1- Direct Contact: Kissing, intercourse, transfusion, touching sores, body fluids 2- Contact w/ pathogens in air 3- Indirect Contact 4- Animals & Insects 5- Contaminated food & water -All communicable diseases are caused by one of these 5!

4 WAYS PATHOGENS ARE SPREAD!!!

CONTAGIOUS PERIOD -All communicable diseases have a Contagious Period (Time that a disease can be spread) -Often occurs before person shows symptoms

CONTAGIOUS PERIOD OF SOME DISEASES -CHICKEN POX- 1-5 days before symptoms appear to when spots crust over -MUMPS- 3-4 days before symptoms appear to 9 days after -MEASLES- 3-4 days before rash starts to 4 days after -COMMON COLD- At least 24 hrs. after symptoms appear

Why is it important to understand the contagious period of common communicable diseases?

Related Terms When a communicable disease spreads rapidly in a community it is an.

Related Terms When a communicable disease spreads rapidly in a community it is an epidemic.

1918 influenza epidemic

Related Terms When this spreads across a country or continent or many people around the world get the disease you have a.

Related Terms When this spreads across a country or continent or many people around the world get the disease you have a pandemic.

Related Terms refers to a disease that has spread rapidly & widely with no cure.

Related Terms Plague refers to a disease that has spread rapidly & widely with no cure.

Do you share any of the following items with friends?: *Water Bottle *Combs *Makeup *Pop Can or Bottle

So how does the body protect itself from diseases and germs?

8 Ways the Body Protects Itself Against Disease -Each day our bodies are exposed to countless pathogens -The human body can trap, repel, or destroy most of them before they do damage

8 Ways the Body Protects Itself Against Disease 1- SKIN-Unbroken skin prevents pathogens from entering -The outer layer of skin, the dead cells, is removed when you bathe. -Taking a shower/bath rids the body of the pathogens on the outer layer

8 Ways the Body Protects Itself Against Disease 2- TEARS, SALIVA, & PERSPIRATION- -All contain chemicals that kill pathogens -Saliva kills organisms that enter the mouth -Tears wash them away

8 Ways the Body Protects Itself Against Disease 3- MUCOUS MEMBRANES- tissues that line the body openings & secrete mucous -Mucous from nose & throat traps pathogens

8 Ways the Body Protects Itself Against Disease 4- STOMACH ACIDS- - When a person puts a finger or hand in their mouth, pathogens may enter -Saliva acids takes care of some of these -Most are swallowed & killed by stomach

5- FEVER- -When pathogens multiply in your body, the reaction is a fever. -An increase of even 1 or 2 degrees changes the environment in the body slowing down the pathogens -Many pathogens cannot live at a higher body temperature

8 Ways the Body Protects Itself Against Disease 6- IMMUNE SYSTEM RESPONSE- Immune System- Cells & organs that fight disease in our bodies -

Lymphnodes are like fighting arenas because battles occur there. They are found throughout the body: neck, armpits, and groin. B and T platoons wait for invaders there and go to war. A swollen gland is a sign that a battle is raging in the lymphnode. Go back to the top

-T-Cells- White blood cells that regulate the immune system

T-Cells

Phagocytes- White blood cells that kill pathogens by ingesting them B Cells- Cells that produce antibodies Antibodies- Proteins that cover the surface of pathogens making it hard for them to attack body cells

This is a phagocyte engulfing a bacteria cell

8 Ways the Body Protects Itself Against Disease -Immunity- Resistance to a disease 7- ACTIVE IMMUNITY- Resistance to a disease due to production of antibodies. There are 2 ways to get this!

2 WAYS TO GET ACTIVE IMMUNITY 1- By getting a disease (Ex.- Chickenpox) After beating the disease, your body forever stores some T-CELLS as memory cells

2 WAYS TO GET ACTIVE IMMUNITY 1- Getting vaccinated (Ex.- Polio) You are given dead or weakened cells of the disease which allows your body to fight the disease to develop antibodies against it. This explains why you sometimes get sick after getting a shot

The effects of polio infection can be debilitating. These children live in a home in Freetown, Sierra Leone. Hospital wards like this one, filled with people in iron lungs, were common sites in 1940s and 50s North America when polio was rife.

Child in an iron lung c. 1930. Photo courtesy of the March of Dimes This 70 year-old man had polio earlier in life. You can see how one leg has atrophied.

-Vaccine- Giving dead or weakened pathogens

-The body then makes antibodies for the specific pathogen Ex.: Measles Mumps, Polio, Typhoid Ex.: Smallpox was eliminated in 1980

8 Ways the Body Protects Itself Against Disease 8- PASSIVE IMMUNITY- Immunity that results from putting antibodies into the bloodstream. -Could be from another person s blood -Babies get immunity from their mothers that last 4-6 months -Short-term immunity (weeks or months) -Used when faced with immediate risk

KEEPING YOUR IMMUNE SYSTEM HEALTHY 1- Avoid alcohol, tobacco, & other drugs- They lower your # of T-Cells & phagocytes 2- Practice stress management skills- Stress lowers your # of T-Cells & phagocytes

3- Get plenty of rest- Sleep helps you to have more energy. 4- Vitamin C- Keeps your immune system strong 5- Get appropriate vaccines- Triggers the immune system to produce antibodies

Ways to Reduce the Risk of Communicable Disease 1- Do not share personal items such as combs, toothbrushes, eating utensils, towels, make-up, etc. 2- Wash hands w/ soap after using restroom, before eating, etc. 3- Cover mouth & nose when sneezing or coughing Others are found on P. 352-353.

International Travel 80 900 U S R esident travel in millions 70 60 50 40 30 20 10 800 700 600 500 400 300 200 100 Worldwide arrivals in millions US nonresident Inbound (ITA) US Resident Air Outbound (ITA) All US Resident Outbound (ITA) Worldwide arrivals (WTO) 0 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 0

Travellers Health Risks Of 100,000 travellers to a developing country for 1 month: 50,000 will develop some health problem 8,000 will see a physician 5,000 will be confined to bed 1,100 will be incapacitated in their work 300 will be admitted to hospital 50 will be air evacuated 1 will die Steffen R et al. J Infect Dis 1987; 156:84-91

The Patient: Medical Issues Age-specific issues Underlying illness, immunosuppression Systems review Medical history Medication use Vaccination history Allergies Contraindications to vaccines and medications

The Patient: Other Issues Reproductive Pregnant Breastfeeding Preconception Risk-taking behaviors

Travel Itinerary Full itinerary Dates, duration, stopovers Seasonal considerations Styles of travel Rural vs. urban Budget vs. luxury Accommodation Hotel vs. camping Activities Business vs. tourism Adventure, safari Missionary/Humanitarian/NGO

Travel Health Resources CDC Travelers Health Website www.cdc.gov/travel World Health Organization www.who.int/int State Department travel.state.gov International Society of Travel Medicine www.istm.org Health Information for International Travel CDC Yellow Book International Travel and Health WHO Green Book

Travelers Health Website www.cdc.gov/travel

Region-specific pages Regional Destinations Goal to move to country-specific format

Travel Notices & Announcements

Deaths Related to International Travel Cardiovascular Medical Injury Homicide/Suicide Infectious Disease Other N = 2463 Hargarten S et al, Ann Emerg Med, 1991. 20:622-626

Infectious Disease Risks to the Traveller Malaria Diarrhea Leishmaniasis Rabies Dengue Meningococcal Meningitis Schistosomiasis Tuberculosis Leptospirosis Polio Yellow Fever Measles JEV, SARS, Influenza A/H1N1 ETC.

Injury Deaths and International Travel N = 601 Motor Vechicle Drowning Air Crash Homicide/Suicide Poisoning Other Hargarten S et al, Ann Emerg Med, 1991. 20:622-626

Other Risks to the Traveller Accidental injury Environmental hazards Crime and assault Psychiatric problems Animal bites, stings and envenomations Dermatologic disorders Altitude. ETC.

Immunizations to Consider for Adult Travellers Routine Diphtheria* Tetanus* Pertussis* Measles + Mumps+ Rubella + Varicella Pneumococcus Influenza Travel related Hepatitis A Hepatitis B Typhoid Rabies Meningococcal disease Polio Japanese encephalitis Yellow Fever * Td or Tdap + MMR

Malaria Travel Medications: Prophylaxis & Treatment chloroquine, atovaquone/proguanil (Malarone), doxycycline, mefloquine (Lariam), primaquine Diarrhea quinolone, azithromycin Altitude acetazolamide Motion sickness scopolamine, dimenhydrinate (Dramamine)

Patient Counseling Sufficient time for patient education Tailored to suit traveller Fitness for travel Understanding impact on existing conditions Advisability of destinations

Travel Preparation Travel health insurance Medical care Hospitalization Evacuation Obtaining medical care abroad Awareness of travel notices Hand washing and hygiene

Environmental Precautions Air Travel Jet Lag Sun Protection Extreme Heat and Cold dehydration, heat stroke hypothermia, frostbite Altitude Water recreation Drowning, boating & diving accidents Risk of schistosomiasis or leptospirosis Biological and chemical contamination

Food and Water Precautions Bottled water Selection of foods well-cooked and hot Avoidance of salads, raw vegetables unpasteurized dairy products street vendors ice

Vector Precautions Covering exposed skin Insect repellent containing DEET 25 50% Treatment of outer clothing with permethrin Use of permethrin-impregnated bed net Use of insect screens over open windows Air conditioned rooms Use of aerosol insecticide indoors Use of pyrethroid coils outdoors Inspection for ticks

Bloodborne and STD Precautions Prevalence of STDs Hepatitis B Hepatitis C HIV Unprotected sexual activity Commercial sex workers Tattooing and body piercing Auto accidents Blood products Dental and surgical procedures

Animal Precautions Animal avoidance Rabies Specific animal threats Medical evaluation of bites/scratches Post exposure immunization and immunoglobulin Envenomations Snakes, scorpions, spiders Maritime animals

Vehicles Injury and Crime Risk of road and pedestrian accidents Night travel Seat belts and car seats Use of drugs and alcohol Understanding local crime risks Scam awareness Situational awareness Location avoidance

Travel Emergency Kit Copy of medical records and extra pair of glasses Prescription medications Over-the counter medicines and supplies Analgesics Decongestant, cold medicine, cough suppressant Antibiotic/antifungal/hydrocortisone creams Pepto-Bismol tablets, antacid Band-Aids, gauze bandages, tape, Ace wraps Insect repellant, sunscreen, lip balm Tweezers, scissors, thermometer

Post-Travel Care Post-travel checkup Long term travellers Adventure travellers Expatriates in developing world Post-travel care Fever, chills, sweats Persistent diarrhea Weight loss

Questions?

Other Resources

Journals American Journal of Tropical Medicine and Hygiene Bulletin of the World Health Organization Emerging Infectious Diseases Journal Eurosurveillance Weekly Journal of Travel Medicine Morbidity and Mortality Weekly Report Tropical Medicine and International Health Vaccine

Books Textbook of Travel Medicine and Health, 2 nd Ed. DuPont, H.L. and Steffen R. (editors) The Travel and Tropical Medicine Manual, 3 rd Ed. Jong, E.C., McMullen, R. Travel Medicine Keystone, J.S., Kozarsky, P.E., et al

Websites Eurosurveillance www.eurosurveillance.org Travax EnCompass www.travax.com GIDEON www.gideononline.com International SOS www.internationalsos.com Medical Advisory Service for Travelers Abroad (MASTA) http://www.masta.org/ Armed Forces Medical Intelligence Center www.afmic.detrick.army.mil/ Central Intelligence Agency www.cia.gov/cia/publications/factbook/