Mad Cows Brits with holes in their

Mad Cows & Brits with holes in their brains (& other infectious diseases) Lecture 3 Dulai - FIB - 2008

Comeback Diseases § Infectious diseases such as Cholera Rheumatic fever Plague Vibrio comma though still quite rare, are on the rise and are threats to be reckoned with. § For example, cholera, Vibrio comma , is turning up in the shellfish population, mainly on the U. S. Gulf Coast. § It's usually transmitted to humans when they eat undercooked shellfish.

Revisiting! § Likewise, outbreaks of such maladies of yesteryear as Measles Mumps Diphtheria Tuberculosis Syphilis § are on the rise.

Why? § Lax use of drugs by patients § Because parents, doctors and public health authorities have failed to mount the effort needed to make sure everyone susceptible to preventable diseases, regardless of economic status, is vaccinated. § Even people who have been properly immunized are being stricken. § Population Growth and overcrowding

What next? § It is common knowledge amongst scientists that IT IS NOT IF, BUT WHEN, the next major pandemic will be coming. § Millions, if not hundreds of millions, may die! § What will it be? Influenza Ebola TB MSRA Prions

Lets quickly consider these examples…

Influenza § § § Agent: Virus which attacks our cells. What can the stupid flu do to me? I am healthy and strong I live in a country with a lot of wealth I have nothing to fear… …or so you think!

Influenza - learn from history § Flu pandemics tend to occur on a regular basis 1918 1957 1968 ? 2008 -9 § The disease bears little resemblance to the ‘flu’ - except at the molecular level § The virus gets its start when one of the many strains which constantly circulates in wild and domestic birds evolves into a form that infects humans

Hybrid strain § The bird strain then exchanges genes with the native human flu strain to produce a novel germ - that is highly contagious! § Some of these strains are mild § Others, which mutate faster than the immune system can defend against, cause severe and/or fatal illness § It is predicted that the next pandemic has the potential to claim more lives in a single year than AIDS has in the last 25 years!…

Warnings § Epidemiologists have warned that the next pandemic could sicken 1/3 people on the planet § Killing 10, 000 to 100, 000 people § It would spare no nation, no race, no income group § There will be no way to avoid it!

My government will have a vaccine for me. So I will be just fine. …will you?

Asian Bird Flu is doing the rounds § Hard to predict when it will come § Conditions are ripe at this time § There is a fierce strain of avian flu killing people in Asia, and infecting birds in a rapid westward lunge towards Europe § Influenza A (H 5 N 1) does not pass readily from person to person - not yet!!!! § The virus is evolving and the birds are beginning their migrations… § What can we do?

Defense § 1. 2. 3. 4. Our best bets Surveillance Vaccines Containment Medications

Remember the Alamo Katrina § The government had a great plan for a hurricane hitting the Texas coast § It failed to implement properly § It has a great plan for the ‘bird flu’ too § Can they stick to their plans if the same workers are downed by the flu?

Case in point… Jakarta, Indonesia They HAD a plan too…

FLU Strain H 5 N 1 § Late June - In a wealthy suburb of Jakarta, a 8 -year old daughter of government auditor falls ill. § She gets antibiotics, but gets worse § June 28 th - She is hospitalized § July 4 th - Her father and sister fall ill too § July 9 th - Sister dies § July 12 th - Father dies

H 5 N 1 continued § July 13 th - doctors alert US Navy medical base § July 14 th - the girl dies § July 14 th - techs isolate and ID H 5 N 1 form blood samples § July 22 nd - Government acknowledges that there is a problem. § Hospitals prepare for an outbreak. § - Over 30 days elapsed - containment window would have closed. § Luckily - This time it was a false alarm.

Use Vaccines to Control Flu § Vaccines have worked to almost eradicate smallpox and polio § BUT, this tactic will not work with influenza (unless we have a major advance in vaccine technology) § Why? It takes about 6 months to make vials of vaccine One will need two injects of vaccine 4 weeks apart - primer and booster Add it up and it would take about 8 months to get immunity from the start of the pandemic

Vaccines - Who will get them? § There is capacity to make about 300 million doses per year § More capacity on the way but still have other problems too § Make flu vaccine or pandemic vaccine - cannot make both at the same facility § Delays and shortages will abound § Who will get them first? Government works Police Health works Teachers Elderly & infants Ill people Will YOU?

EBOLA The new “jungle fever”

Ebola § Ebola is both the common term used to describe a group of viruses § …and the common name for the disease which they cause, Ebola fever § Thought to be transmitted by the fruit bat § Ebola hemorrhagic fever Vomiting, diarrhea, general body pain, internal and external bleeding, and fever. Mortality rates are generally high, ranging from 50% - 90%, with the cause of death usually due to shock or organ failure - one of the most virulent viral diseases known to humankind

Ebola - Infectious § Among humans, the virus is transmitted by direct contact with infected body fluids - sex § or to a lesser extent, skin or mucus membrane contact § The incubation period can be anywhere from 2 to 21 days, but is generally between 5 and 10 days § Monkeys - seems to be airborne, not humans- yet! § Transmission of the Ebola virus has also occurred by handling ill or dead infected chimpanzees. (Did we not blame them for giving us HIV/AIDS too!)

Tuberculosis TB for tubercle bacillus

Chest X-ray of Patient

TB - ‘The comeback kid’ § Today about 5000 people die of this once thought conquered disease! § It is caused by a bacteria § Primarily attacks the lungs, although it can also attack a number of other locations nerves, blood, lymph, genitals, skin, etc. § Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks.

TB - ‘The comeback kid’ § Over 20% of the cases are now drug resistant in many countries § With a further 4% requiring 2 nd line treatments § Will it be the next ‘BIG ONE’?

MRSA Methicillin-resistant Staphylococcus aureus

MRSA § MRSA is characterized by antibiotic resistance to all penicillins including methicillin and other narrow-spectrum penicillin antibiotics. § MRSA was discovered for the first time in 1961 in the UK, but it is now widespread in the hospital setting. § MRSA is commonly termed a superbug. § MRSA infection can be fatal.

Natural flora § Staphylococcus bacteria are normally found on the skin or in the nose of about one-third of the population § If you have staph on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected with MRSA § Healthy people can be colonized with MRSA and have no ill effects, however, they can pass the germ to others.

MRSA… § Enters through Nose Cuts IV sites Urinary tract Infections § About 5 times the risk of dying over those that do not get it. § Costs more to treat too, as you have to spend about 3 X longer in the hospital.

Common place § Cases are now being reported outside the hospital setting - in communities § This has huge implications for us. Will we reach a point where we will have no further antibiotics left to treat this infection the bacteria is evolving very fast!

Finally… HELLO I’M BACK! WATCH ME…

Prions “ATTACK OF THE KILLER PROTEINS” In pure At a slaughter house near you…

MAD COW DISEASE § BSE - Bovine Spongiform Encephalitis Spongy Brain Disease § Makes cows mad § Known as Creutzfeldt-Jakob disease (CJD) in man

proteinaceous infectious particle

Watch and learn Whilst watching the video answer the following questions please: 1. How old was the first patient? 2. What did the natives of Papua New Guinea eat that caused them to get ‘kuru”? 3. How did it get into cows? 4. What is the cause of BSE? 5. What happens to the patients brain?

Group Questions

Group Questions 1. 2. 3. 4. 5. 6. If you were a health worker, how would you change your habits after today's lecture? Do you believe that killer diseases are inevitable? As we become more and more parasitic on other species, what could be some of the outcomes? Discuss and then outline at least three possibilities. Some say that the best way to control the human population is to allow these diseases to run their course. What do you think? Downer Cattle & the meat factory in the news in California. Now do you understand why downer cattle are not allowed into the human foodchain.