Infectious Disease Animations Tuberculosis Malaria HIV Avian Flu Cholera

Communicable Diseases and Human Security Kelechi Ohiri MD MPH MS Health, Nutrition, Population Human Development Network World Bank Review the choice of the title

Tuberculosis 2 billion people infected with microbes that cause TB. Not everyone develops active disease A person is infected every second globally 22 countries account for 80% of TB cases. >50% cases in Asia, 28% in Africa (which also has the highest per capita prevalence) In 2005, there were 8.8 million new TB cases; 1.6 million deaths from TB (about 4400 a day) Highly stigmatizing disease Two billion people – one third of the world’s total population–are infected with the microbes that cause TB. Of these, 10% will become sick with active TB in their lifetime. Risks are higher in those with HIV infection. A total of 1.6 million people died from TB in 2005, equal to about 4400 deaths a day. TB is a disease of poverty, affecting mostly young adults in their most productive years. The vast majority of TB deaths are in the developing world, with more than half occurring in Asia TB/HIV- About 200 000 people with HIV die from TB every year, most of them in Africa. TB is a worldwide pandemic. Although the highest rates per capita are in Africa (28% of all TB cases), half of all new cases are in six Asian countries (Bangladesh, China, India, Indonesia, Pakistan and the Philippines). Multidrug-resistant TB (MDR-TB) is a form of TB that does not respond to the standard treatments using first-line drugs. MDR-TB is present in virtually all countries recently surveyed by WHO and its partners. About 450 000 new MDR-TB cases are estimated to occur every year. The highest occurrence rates of MDR-TB are in China and the countries of the former Soviet Union. Extensively drug-resistant TB (XDR-TB) occurs when resistance to second-line drugs develops. It is extremely difficult to treat and cases have been confirmed in South Africa and worldwide. WHO’s Stop TB Strategy aims to reach all patients and achieve the target under the Millennium Development Goals (MDG): to reduce by 2015 the prevalence of and deaths due to TB by 50% relative to 1990 and reverse the trend in incidence. The Global Plan to Stop TB 2006-2015, launched January 2006, aims to achieve the MDG target with an investment of US$ 56 billion. This represents a three-fold increase in investment from 2005. The estimated funding gap is US$ 31 billion.

Tuberculosis and HIV A third of those living with HIV are co-infected with TB About 200,000 people with HIV die annually from TB. Most common opportunistic infection in Africa 70% of TB patients are co-infected with HIV in some countries in Africa Impact of HIV on TB TB is harder to diagnose in HIV-positive people. TB progresses faster in HIV-infected people. TB in HIV-positive people is almost certain to be fatal if undiagnosed or left untreated. Most cases of XDR-TB were in HIV infected individuals.

Global Prevalence of TB cases (WHO)

Tuberculosis

Tuberculosis Control Challenges for tuberculosis control MDR-TB - In most countries. About 450000 new cases annually. XDR-TB cases confirmed in South Africa. Weak health systems TB and HIV The Global Plan to Stop TB 2006-2015. an investment of US$ 56 billion, a three-fold increase from 2005. The estimated funding gap is US$ 31 billion. Six step strategy: Expanding DOTS treatment; Health Systems Strengthening; Engaging all care providers; Empowering patients and communities; Addressing MDR TB, Supporting research

Malaria Every year, 500 million people become severely ill with malaria causes 30% of Low birth weight in newborns Globally. >1 million people die of malaria every year. One child dies from it every 30 seconds 40% of the world’s population is at risk of malaria. Most cases and deaths occur in SSA. Malaria is the 9th leading cause of death in LICs and MICs 11% of childhood deaths worldwide attributable to malaria SSA children account for 82% of malaria deaths worldwide More than one million people die of malaria every year, mostly infants, young children and pregnant women and most of them in Africa Approximately, 40% of the world’s population, mostly those living in the world’s poorest countries, are at risk of malaria. Every year, more than 500 million people become severely ill with malaria. Most cases and deaths are in sub-Saharan Africa.

Annual Reported Malaria Cases by Country (WHO 2003)

Global malaria prevalence

Malaria Control Malaria control Challenges in malaria control Early diagnosis and prompt treatment to cure patients and reduce parasite reservoir Vector control: Indoor residual spraying Long lasting Insecticide treated bed nets Intermittent preventive treatment of pregnant women Challenges in malaria control Widespread resistance to conventional anti-malaria drugs Malaria and HIV Health Systems Constraints Access to services Coverage of prevention interventions With full LLITN coverage, child mortality from all causes is reduced by 18%

HIV/AIDS In 2005, 38.6 million people worldwide were living with HIV, of which 24.7 million (two-thirds) lived in SSA 4.1 million people worldwide became newly infected 2.8 million people lost their lives to AIDS New infections occur predominantly among the 15-24 age group. Previously unknown about 25 years ago. Has affected over 60 million people so far. One of the most devastating conditions of the 21st century An estimated 38.6 million [33.4 million–46.0 million] people worldwide were living with HIV in 2005. An estimated 4.1 million [3.4 million–6.2 million] became newly infected with HIV and an estimated 2.8 million [2.4 million–3.3 million] lost their lives to AIDS.

HIV Co-infections Impact of TB on HIV HIV and Malaria TB considerably shortens the survival of people with HIV/AIDS. TB kills up to half of all AIDS patients worldwide. TB bacteria accelerate the progress of AIDS infection in the patient HIV and Malaria Diseases of poverty HIV infected adults are at risk of developing severe malaria Acute malaria episodes temporarily increase HIV viral load Adults with low CD4 count more susceptible to treatment failure Growing body of evidence on the interactions between both conditions Both are diseases of poverty

Global HIV Burden

HIV/AIDS Interventions depend on Elements of an effective intervention Epidemiology – mode of transmission, age group Stage of epidemic –concentrated vs. generalized Elements of an effective intervention Strong political support and enabling environment. Linking prevention to care and access to care and treatment Integrate it into poverty reduction and address gender inequality Effective monitoring and evaluation Strengthening the health system and approaches Challenges in prevention and scaling up treatment globally include Constraints to access to care and treatment Stigma and discrimination Inadequate prevention measures. Co-infections (TB, Malaria)

Avian Influenza Seasonal influenza causes severe illness in 3-5 million people and 250000 – 500000 deaths yearly 1st H5N1 avian influenza case in Hong Kong in 1997. By October 2007 – 331 human cases, 202 deaths.

Avian Influenza Control depends on the phase of the epidemic Pre-Pandemic Phase Reduce opportunity for human infection Strengthen early warning system Emergence of Pandemic virus Contain and/or delay the spread at source Pandemic Declared Reduce mortality, morbidity and social disruption Conduct research to guide response measures Antiviral medications – Oseltamivir, Amantadine Vaccine – still experimental under development. Can only be produced in significant quantity after an outbreak Limited evidence suggests that some antiviral drugs, notably oseltamivir (commercially known as Tamiflu), can reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset.

Confirmed human cases of HPAI

Migratory pathway for birds and Avian influenza

Neglected diseases Cause over 500,000 deaths and 57 million DALYs annually. Include the following Helminthic infections Hookworm (Ascaris, trichuris), lymphatic filariasis, onchocerciasis, schistosomiasis, dracunculiasis Protozoan infections Chagas disease Bacterial infections Cholera

Cholera Latin American Current News and Events on the 16th February 2011

Antibiotics Methods of Functioning: Antibiotic Resistance Bacteria Structure Antibiotic Resistance Competitive Inhibition