1. Emerging Infectious Diseases:
The ongoing Pandemics
د. وائل أحمد هياجنة
Wail A. Hayajneh, MD, FAAP
Associate Professor of Pediatric Infectious Diseases
JUST, KAUH, & KHCC
26/06/2018
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2. Defining Respiratory emerging and re-emerging diseases
Objectives
Defining Respiratory emerging and re-emerging diseases
Why are we worried?
Basics of new diseases 2

3. Global Causes of Children Deaths: 2013

4. New Millennium Outbreaks
SARS
2012
MERS - CoV
2005
H5N1
2009
PandemicH1N1

5. Summary of outcomes Disease Cases Deaths SARS 8273 775 H5N1 850 449
?????? (millions)
284500
MERS - CoV
1733
628

6. Economic Costs of Major Infectious Diseases Outbreaks

7. Definition: Emerging Infectious Diseases
Newly identified & previously unknown infectious agents that cause public health problems either locally or internationally

8. Definition: Re-emerging Infectious Diseases
Infectious agents that have been known for some time, had fallen to such low levels that they were no longer considered public health problems & are now showing upward trends in incidence or prevalence worldwide

9. Definition New Pathogen A known pathogen invading a new host
A known pathogen causing worse disease
New antimicrobial resistance patterns

10. Where is the Origin? (Known Infections)
Carnivores
Primates
Ruminants
Birds
Rodents
Infectious Agents
Humans
61 % of 1415 Infections
Ann. Rev. Ecol. Evol. Syst. 41 (2010) 231–250.

11. Where is the Origin? (Emerging Infections)
Carnivores
Primates
Ruminants
Birds
Rodents
Infectious Agents
Humans
71 % of emerging infections
Ann. Rev. Ecol. Evol. Syst. 41 (2010) 231–250.

12. Multi-host Species Systems
Birds
Pigs
New Pathogen
Human
Host 3

13. Density-dependent transmission Frequency-dependent transmission
Do host communities influence the dynamics of pathogens?
Density-dependent transmission
Directly-transmitted infections
Frequency-dependent transmission
Sexually transmitted diseases
Vector-borne diseases

14. Recognized in the past 2 decades
Emerging Diseases: NIAID List: Group I
Recognized in the past 2 decades
Acanthamebiasis Australian bat lyssavirus Babesia, atypical Bartonella henselae Ehrlichiosis Encephalitozoon cuniculi Encephalitozoon hellem Enterocytozoon bieneusi Helicobacter pylori Hendra or equine morbilli virus Hepatitis C Hepatitis E Human herpesvirus 8 Human herpesvirus 6 Lyme borreliosis Parvovirus B19

15. Re-emerging Pathogens
Re-emerging Diseases: NIAID List: Group II
Re-emerging Pathogens
Enterovirus 71 Clostridium difficile Mumps virus Streptococcus, Group A Staphylococcus aureus

16. Emerging Diseases: NIAID List: Group III
Agents with Bioterrorism Potential (Cat A)
Bacillus anthracis (anthrax)
Clostridium botulinum toxin (botulism)
Yersinia pestis (plague)
Variola major (smallpox) and other related pox viruses
Francisella tularensis (tularemia)
Viral hemorrhagic fevers
Arenaviruses
LCM, Junin virus, Machupo virus, Guanarito virus
Lassa Fever
Bunyaviruses
Hantaviruses
Rift Valley Fever
Flaviruses
Dengue
Filoviruses
Ebola
Marburg

17. Emerging Diseases: NIAID List: Group III
Agents with Bioterrorism Potential (Cat B)
Burkholderia pseudomallei
Coxiella burnetii (Q fever)
Brucella species (brucellosis)
Burkholderia mallei (glanders)
Chlamydia psittaci (Psittacosis)
Ricin toxin (from Ricinus communis)
Epsilon toxin of Clostridium perfringens
Staphylococcus enterotoxin B
Typhus fever (Rickettsia prowazekii)

18. Emerging Diseases: NIAID List: Group III
Agents with Bioterrorism Potential (Cat B) Food- and Waterborne Pathogens
Diarrheagenic E.coli
Pathogenic Vibrios
Shigella species
Salmonella
Listeria monocytogenes
Campylobacter jejuni
Yersinia enterocolitica
Hepatitis A
Cryptosporidium parvum
Cyclospora cayatanensis
Giardia lamblia
Entamoeba histolytica
Toxoplasma
Microsporidia

19. Agents with Bioterrorism Potential (Cat C)
Emerging Diseases: NIAID List: Group III
Agents with Bioterrorism Potential (Cat C)
Tickborne hemorrhagic fever viruses (CCHF)
Tickborne encephalitis viruses
Yellow fever
Tuberculosis, including drug-resistant TB
Influenza
Other Rickettsias
Rabies
Prions
Chikungunya virus
SARS
Antimicrobial resistance

20. الانفلــــونزا الموسمية: حقائـــق وأوهــــام
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21. INFLUENZA VIRUS
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22. INFLUENZA: Types Influenza A Influenza B Influenza C HA √ √ √ NA √ √ X
DRIFT √ √ X
SHIFT √ X X
Human √ √ √
Animals √ X X
Epidemics √ √ X
Pandemics √ X X
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23. INFLUENZA VIRUSES H1----H16 N1----N9 H5N1 H5N2 H5N3 H5N4 H5N5 H5N6
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24. HUMAN VIRUSES H1 H2 H3 N1 N2 H1N1 H2N1 H3N1 H1N2 H2N2 H3N2 26/06/2018
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25. EPIDEMICS HISTORY Year Strain Deaths 1889 H2N2 1900 H3N2 1918 H1N1
Comments
1889
H2N2
1900
H3N2
1918
H1N1
40 millions
Spanish Flu
1957
H2N2
70,000
Asian Flu
1968
H3N3
34,000
Hong Kong Flu
1977
H2N2
1997
H5N1
Hong Kong Epidemic
2003
H7N7
2004
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H5N1
KAUH-2015

26. الانفلونزا الاسبانية 1918
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KAUH-2015

27. كيف تكون الفيروس
فيروس 3
فيروس 2
فيروس 1
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28. Minor changes during genomic Replication Major changes (Reassortment)
GENETICS DYNAMICS
SHIFT
Minor changes during genomic Replication
DRIFT
Major changes (Reassortment)
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29. PANDEMIC PHASES Virus only in animals
The virus has caused infection in human
PHASE 3
Few Human-to-Human transmission
PHASE 4
Community-level outbreaks
PHASE 5
Spread in 2 countries of the same WHO region
PHASE 6
PANDEMIC: 2 WHO Regions
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30. PANDEMIC PHASES
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31. Global Circulation of Influenza Viruses
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32. Global Circulation of Influenza Viruses
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KAUH-2015

33. Global Circulation of Influenza Viruses: Northern Hemisphere
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KAUH-2015

34. Global Circulation of Influenza Viruses: Southern Hemisphere
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KAUH-2015

35. Global Circulation of Influenza Viruses: EMRO
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KAUH-2015

36. Global Circulation of Influenza Viruses: Jordan
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KAUH-2015

37. Global Circulation of Influenza Viruses: Jordan
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KAUH-2015

38. الفحوصات اللازمة PCR Full blood count (CBC) Serum electrolytes
Hepatic function (AST,ALT)
Renal function (urea,creatinine)
Glucose
Urine analysis
Chest x ray
CPK, LDH
Blood Culture
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39. Mild Case with risk factors
Evaluation of suspected case In Isolation Room at ER
Mild Case without risk factors
Mild Case with risk factors
Severe Case
Discharge home
No PCR
No Oseltamivir
Infection Control
Education at Home
Return to ER if
worsens
Discharge home
No PCR
Give Oseltamivir
Infection Control
Education at Home
Return to ER if
worsens
Admission
PCR
Oseltamivir
Infection Control
precautions
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KAUH-2015

40. ANTIVIRALS
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41. ANTIVIRAL USE 75 mg twice per day for 5 days No Prophylaxis < 15 kg
Agent
Weight or Age
Treatment
Prophylaxis
Oseltamivir
Adults
75 mg twice per day for 5 days
No Prophylaxis
Children ≥ 12 months
< 15 kg
30 mg twice per day for 5 days
15-23 kg
45 mg twice per day for 5 days
24-40 kg
60 mg twice per day for 5 days
>40 kg
Children < 12 months
< 3 months
12 mg twice per day for 5 days
3-5 months
20 mg twice per day for 5 days
6-11 months
25 mg twice per day for 5 days
Zanamivir
10 mg (two inhalations) twice per day
Children ≥ 7 years
Children 5-6 years
Not recommended
Children < 5 years
26/06/2018
KAUH-2015

42. IIV-(Inactivated Influenza Vaccine)
Flu Vaccines
IIV-(Inactivated Influenza Vaccine)
- IIV3(egg-based and cell culture-based trivalent inactivated influenza vaccine (IIV3), and
- IIV4(egg-based quadrivalent inactivated influenza vaccine (IIV4).
RIV4
LAIV4
26/06/2018
KAUH-2015

43. REDUCING RISK FOR COMUNITY
Frequent handwashing
Covering coughs
Reduction of unnecessary social contacts
Avoidance crowded settings whenever possible .
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44. MERS - CoV
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