1. 1 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Introduction of Communicable Diseases Department of Infectious Diseases, First Affiliated Hospital, School of Medicine RUAN Bing

2. 2 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Introduce myself M.D. & Ph.D RUAN Bing M.D. & Ph.D RUAN Bing 阮 冰 阮 冰 Professor; Doctoral advisor; Vice-Director of Infectious Diseases Department Office: 87236585; Mobile ： 13858182230 Email: ruanbing@zjwst.gov.cn ruanbing@zjwst.gov.cn

3. 3 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 传染病学科简介 1996 年 2001 年 2006 年 2007 年 卫生部病毒性传染病重点实验室卫生部病毒性传染病重点实验室 1956 年 国家重点学科内科学（传染病）国家重点学科内科学（传染病） 浙江省传染病重点实验室浙江省传染病重点实验室 传染病诊治国家重点实验室传染病诊治国家重点实验室 传染病科和传染病研究所创建传染病科和传染病研究所创建 学科整体水平进一步提升！学科整体水平进一步提升！ 卫生部传染病重点实验室卫生部传染病重点实验室 2002 年 55 年前艰难创业，近年蓬勃发展

4. 4 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases 1956 1956 19972006

5. 5 Conception Communicable diseases: caused by various pathogens, transmitted to others, spread in the population Infectious diseases: caused by infection

6. 6 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Why we learn? In histry, many pestilences were rampant. plague, cholera, smallpox, influenza, malaria, schistosomiasis, kala-azar

7. 7 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Why we learn? Achievements YearScientistachievement 1683Leeuwen hoekfound bacteria 1796Edward Jennersmallpox vaccine 1876Robert Kochbacteria of anthrax, cholera, tuberculosis 1880Louis Pastearvaccines against anthrax, rabies 1892Dmitri Ivanowskfilterable virus 1898Beijerinckpick up the virus 1921 Leon Calmette, Camile Guerin B.C.G.Vaccine 1928Alexander Flemingpenicillin 1942Selmen Waksmanstreptomycin 1961Abrahamcephalosporin Controlled and eradicated: smallpox, poliomyelitis, plague, cholera, measles

8. 8 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Why we learn? Many diseases are still popular. — viral hepatitis, HFRS, infectious diarrhea — zoonoses (foot and mouth disease, plague, anthrax, rabies, tuberculosis)

9. 9 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Why we learn? Some “old” diseases are re-emerging — Tuberculosis — Schistosomiasis — Cholera — Syphilis — Measles

10. 10 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Why we learn? Some “new” diseases are emerging — Pathogens found in some non-infectious diseases Helicobacter pyloyi — Pathogens found in some infectious diseases hepatitis C/E, lyme disease, legionellosis — New appeared disease AIDS, SARS, human avian influenza, resistant mutants

11. 11 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Why we learn? bioterrorism — Pathogens may be used as biological weapon (anthrax, plague, smallpox, Ebola)

12. 12 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Characteristics Diagnosis Treatment Prevention Communicable diseases Infection & immunity Epidemic process

13. 13 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Infection and immunity 13 Section 1

14. 14 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Conception of infection Infection ： interaction between pathogen and host Infectious disease ： biochemical, physiologic, metabolic and immunologic manifestation of the interaction How infection occur? — pathogenic organisms — human reactions "opportunistic infection" environmental factors

15. 15 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Infection spectrum (1) Pathogen is eliminated or eradicated (2) Covert infection (3) Overt infection (4) Carrier state (5) Latent infection

16. 16 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases (1) Pathogen is eliminated or eradicated Non-specific immunity barrier Specific immunity — active immunity — passive immunity

17. 17 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Only make the host producing specific immune response Not having histomorphological damage — no symptoms and signs — no any biochemical changes — only discovered by immunological examinations Pathogens can be eradicated or carried (2) Covert infection

18. 18 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Make the host producing specific immune response Having pathological changes Immunity can be consolidated or temporary (3) Overt infection

19. 19 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases No clinical manifestation but microorganism excreted Various forms: — virus or bacteria carrier — convalescent, healthy or incubatory carrier — acute or chronic carrier (4) Carrier state

20. 20 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Locates the pathogen but can not wipes it out Can latently for a long time Can occurs overt infection What is the different point between latent infection and carrier state ? (5) latent infection

21. 21 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The role of pathogen in the infectious process (1) Invasiveness (2) Virulence (3) Amount of the pathogen (4) Variability

22. 22 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Invade directly — Leptospira, Filariform larva of Ancylostoma Adhere, colonize and produce enterotoxin — Vibrio cholera Promote spread — Vi antigen of Salmonella typhi (1) Invasiveness

23. 23 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Toxins — Exotoxin (Vibrio cholera ， Corynebacterium diphtheriae, Clostridium tetani) — Endotoxin (S. typhi, Sh. dysentery) Enzymes (Entamoeba histolytica) (2) Virulence

24. 24 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Positive relation with pathogenicity Least number differ greatly (3) Quantity of pathogens

25. 25 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Factors: — environmental, drug and hereditary Various forms: — pathogenicity variation — antigenic variation — drug-resistant variation (4) Variability

26. 26 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The role of individual immunity in the infectious process (1) Non-specific immunity (natural immunity) — anatomic barriers, phagocytosis, humoral effects (2) Specific immunity (acquired, adaptive, or postinfection immunity) — cell-mediated immunity, humoral immunity

27. 27 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Epidemic process & influenced factors 27 Section 2

28. 28 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Essential conditions of epidemic process (1) Sources of infection (2) Routes of transmission (3) Susceptibility of the population

29. 29 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Patients — measles Persons of covert infection — poliomyelitis, epidemic cerebrospinal meningitis Pathogen carriers — typhoid fever, bacillary dysentery Infected animals — rabies, plague, leptospirosis, scrub typhus (1) Sources of infection

30. 30 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Air transmission Water and food transmission Contagious transmission Arthropod-bone transmission (blood-sucking arthropods: mosquito, lice, flea, sandfly, mite, tick) Blood, blood products and body fluid Mother to infant (vertical transmission) (2) Routes of transmission

31. 31 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The ratio of susceptible persons decide the crowd susceptibility The crowd susceptibility is relation to periodicity of an epidemic The periodicity of an epidemic may be prevented by artificial active immunization (3) Susceptibility of the population

32. 32 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Influenced factors of epidemic process Natural factors — geography; climate; ecology — focus of infection — zoonosis (plague, leptospirosis, human avian influenza) Social factors — social background; economical condition; cultural level; anti-epidemic measures

33. 33 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Characteristics of communicable diseases 33 Section 3

34. 34 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Basic characteristics (1) Pathogens (2) Infectivity (3) Epidemiologic feature (4) Postinfection immunity

35. 35 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Specific Be found with natural science advancements (1) Pathogens

36. 36 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases As main distinction “Infective period” (2) Infectivity

37. 37 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Endemic (sporadic occurrence, epidemic, pandemic & epidemic outbreak) Seasonal (distribution in time) Regional (distribution in space) Exotic (3) Epidemiologic feature

38. 38 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Specific, active, protective Can transfer to newborns through placenta Lasting time varies with the diseases “Concomitant immunity” (helminthiasis) (4) Postinfection immunity

39. 39 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The phase in the development of clinical course (1) Incubation period (2) Prodromal period (3) Period of apparent manifestation (4) Convalescent period

40. 40 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Normal distribution (quarantine evidence) Related with: — invading quantity of pathogens — time of the toxin (bacterial food poisoning) — wound location (rabies) (1) Incubation period

41. 41 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Non-specific — headache, fever, fatigue, anorexia, and myalgia Coexist in many infectious diseases Usually persist one to three days even miss (sudden onset) (2) Prodromal period

42. 42 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Special symptoms and signs presented enough — rashes, jaundice, heptomegaly, splenomegaly, meningeal irritation signs Especially in some acute diseases — measles & varicella Abortive type — poliomyelitis, epidemic encephalitis (3) Period of apparent manifestation

43. 43 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Immunity increases to a certain level — appetite and physical strength recovered — residual pathologic & biochemical change — infectivity may persist (convalescent carrier) Relapse & recrudescence — the symptoms repeatedly and fever rise again (4) Convalescent period

44. 44 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Common symptoms and signs Fever Rash (eruption) Toxemic symptoms Mononuclear phagocyte system (MPS)

45. 45 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Three phases — effervescence, fastigium, defervescence Fever types — sustained — remittent — intermittent — irregular Fever

46. 46 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Exanthem and enanthem Appearing, distribution, order, shape Four groups: (a) mocule & papule (b) petechia & ecchymosis; (c) vesicle & pustule; (d) urticaria Rash (eruption)

47. 47 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases A lot of non-specific symptoms — fever, fatigue, general malaise, anorexia, headache, myalgia, arthralgia, skeletal pain In severe patients: — disturbance of consciousness, delirium, meningeal irritation, toxic encephalopathy, respiratory and circulatory failure (septic shock) Toxemic symptoms

48. 48 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Liver Spleen Lymph nodes enlarged Reactions of MPS

49. 49 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Diagnosis of communicable diseases 49 Section 4

50. 50 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Clinical data Detailed history — way of an onset — symptoms, accompanied ones Careful physical examination — specific signs (rose spot, eschar, Kopliks spots)

51. 51 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Epidemiological data Age, occupation, season and district Inoculation history and past history Occurrence in the local or the same unit Family history

52. 52 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Laboratory data General laboratory detection Detection of pathogens Immunoassay

53. 53 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases MethodSignificance (e.g.) leucocytes countpyogenic infections urine routine testleptospirosis stool routine testhelminthiasis biochemical detectionviral hepatitis General laboratory detection

54. 54 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases MethodPathogens (e.g.) Direct detection microscope or macroscopy malarial parasites Isolation with artificial culture medium bacteria, spirochete, fungi Molecular biological assay hybridization assay, polymerase chain reaction (PCR) specific viral nucleic acid (such as HBV DNA) Detection of pathogens

55. 55 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases LaboratorySignificances Serologic test enzyme linked immunosorbent assays (ELISA) immunofluorescence technique radio-immunoassay (RIA) specific antibody Othersskin test detection of immunoglobulin classification of lymphocytes subsets humoral immunity cellular immunity Immunoassay

56. 56 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Treatment of communicable diseases 56 Section 5

57. 57 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases General and supporting General therapy — Isolation, nursing care and psychologic care Supporting therapy — Nutrition, balance of water and electrolytes, Enhancement of immunity by blood and biologic products transfusion

58. 58 State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesAnti-pathogenic Antibiotics Chemical drugs Immune serum preparations

59. 59 State Key Laboratory for Diagnosis and Treatment of Infectious DiseasesSymptomatic Ease patient ’ s suffering Reduce his energy consuming Protect the main organs from injury Maintain his functions

60. 60 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Prevention of communicable diseases 60 Section 6

61. 61 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Managementof the sources of infection Management of the sources of infection Diagnosis & treatment Isolation of patient & carrier Report disease to CDC In time

62. 62 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases GroupDiseases Group Aplague, cholera Group Binfectious atypical pneumonia (SARS), AIDS, viral hepatitis, poliomyelitis, avian influenza, measles, epidemic hemorrhagic fever, rabies, epidemic encephalitis B, dengue fever, anthrax, bacillary and amebic dysentery, pulmonary tuberculosis, typhoid fever and paratyphoid fever, epidemic cerebrospinal meningitis, pertussis (whooping cough), diphtheria, tetanus in neonate, scarlet fever, brucellosis, gonorrhea, syphilis, leptospirosis, schistosomiasis, malaria Group Cinfluenza, mumps, rubella, acute hemorrhagic conjunctivitis, leprosy, epidemic typhus and endemic typhus, kala-azar, hydatid disease, filariasis, other infectious diarrhea The lawful communicable diseases in China

63. 63 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Interruption of the route of transmission Achievement in: — diseases transmitted by food, water and insets — parasitic diseases Methods: — disinfection, insecticide, hygiene measures

64. 64 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Protection of susceptible population Special immunological method — active: vaccine, bacterial vaccine, toxoid — passive: antitoxin, γ- globulin, immunoglobulin Non-special immunological method — improvement of nutrition — physical training

65. 65 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The procedure of a childhood program for immunization AgeVaccine Neonate BCG HBV 1 months after birth HBV 2 months after birth OPV 3 months after birth OPV DTP 4 months after birth OPV DTP 5 months after birth DTP 6 months after birth HBV 8 months after birth MV Enhanced: 1.5-2 years DTP 4 years OPV 7 years BCG MV DT

66. 66 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Questions Reviews

67. 67  Pathogen is eliminated or eradicated by host immunity  Covert infection  Overt infection  Carrier state  Latent infection Conception of infection spectrum ?

68. 68 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases  Invasiveness  Virulence  Amount of the pathogen  Variability The role of pathogen in the communicable diseases ?

69. 69 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases  Sources of infection  Routes of transmission  Susceptibility of the population Essential conditions of epidemic process with communicable diseases ?

70. 70 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Conception of zoonosis ? Some natural ecologic environment is suitable to the transmission of infectious diseases among wild animals. This area is called “focus of infection”. The human race may be infected when they get into these areas. This disease is called “zoonosis”, such as plague, leptospirosis, human avian influenza, and so on.

71. 71 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases  Pathogen  Infectivity  Epidemiologic feature  Postinfection immunity Basic characteristics of communicable diseases ?

72. 72 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases  Incubation period  Prodromal period  Period of apparent manifestation  Convalescent period The clinical phase in the development of acute communicable diseases ?

73. 73 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases  Management of the sources of infection  Interruption of the route of transmission  Protection of susceptible population Prevention of communicable diseases ?

74. 74 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases The system of communicable diseases notification?  It is an important method for discovering communicable diseases in early, and must be followed.  According to the law of prevention and treatment of communicable diseases of the People’s Republic of China and its detailed rules and regulation, the lawful infectious diseases were divided into three groups.  Group A (plague, cholera) must be reported in 2 hours in town and 6 hours in rural area, while Group B in 6 and 12 hours, and Group C in 24 hours as well.

75. 75 State Key Laboratory for Diagnosis and Treatment of Infectious Diseases Thanks! 谢谢！