1. Pathogens and Pandemics Introduction

2. Pathogen Trivia What was the name of the viral epidemic that happened in 1918? What virus was deliberately put on blankets by the English before giving the blankets to the Native Americans in 1754? What did the Tartars catapult across the walls of Kaffa in an ancient seige? What virus saved a Polish village from a Nazi attack during WWII? http://ed.ted.com/lessons/how-pandemics-spread

3. In June, 2009 – the following news report was given: http://www.youtube.com/watch?v=-871tHE4jzg The next few slides are adapted from an online PowerPoint created by Christine Herrmann, PhD. The questions are in order of the slides. Turn in at end of hour.

4. www.BioEdOnline.org Infectious Diseases - Definitions Disease – a pathological condition of body parts or tissues characterized by an identifiable group of signs and symptoms. Infectious disease – disease caused by an infectious agent such as a bacterium, virus, protozoan, or fungus that can be passed on to others. Infection – occurs when an infectious agent enters the body and begins to reproduce; may or may not lead to disease. Pathogen – an infectious agent that causes disease. Host – an organism infected by another organism. Virulence – the relative ability of an agent to cause rapid and severe disease in a host.( BioEd Online

5. www.BioEdOnline.org Infectious Diseases as a Cause of Death Infectious diseases are responsible for a quarter to a third of all deaths worldwide. Infectious diseases account for more than half of all deaths in children under the age of 5. Of the top ten causes of death compiled by the World Health Organization, five are due to infectious diseases. The top single agent killers are HIV/AIDS, malaria and tuberculosis. The other top killers are lower respiratory infections and diarrheal diseases, which are caused by a variety of agents. BioEd Online

6. www.BioEdOnline.org Infectious Diseases Throughout History Infectious agents have probably always caused disease in humans. Smallpox has been described in ancient Egyptian and Chinese writings and may have been responsible for more deaths than all other infectious diseases combined. There is evidence that malaria and poliomyelitis have existed since ancient times. In the 14 th Century, the bubonic plague, or Black Death, killed about 20 million people in Europe alone. In the 20 th Century, the 1918 influenza may have killed up to 50 million people worldwide Close to 20 million people have died of AIDS to date. Courtesy of CDC Recreated 1918 Influenza virions. The 1918 Spanish flu killed more than 500,000 people in the United States and up to 50 million worldwide. BioEd Online

7. www.BioEdOnline.org Koch’s Postulates Koch developed four criteria to demon- strate that a specific disease is caused by a particular agent. 1. The specific agent must be associated with every case of the disease. 2. The agent must be isolated from a diseased host and grown in culture. 3. When the culture-grown agent is introduced into a healthy susceptible host, the agent must cause the same disease. 4. The same agent must again be isolated from the infected experimental host. BioEd Online

8. www.BioEdOnline.org Infectious Disease Agents Most infectious agents that cause disease are microscopic in size and thus, are called microbes or microorganisms. Different groups of agents that cause disease are: Bacteria Viruses Protozoa (Protists) Fungi Helminths (Animals) Courtesy of CDC BioEd Online

9. www.BioEdOnline.org Transmission of Infectious Diseases Agents that cause infectious diseases can be transmitted in many ways. Through the air Through contaminated food or water Through body fluids By direct contact with contaminated objects By animal vectors such as insects, birds, bats, etc. Courtesy of VOA Chinese students wearing masks during a SARS outbreak Courtesy of CDC Aedes aegypti mosquito Known to transmit Dengue fever BioEd Online

10. www.BioEdOnline.org Phases of Infectious Disease Incubation period – time between infection and the appearance of signs and symptoms. Prodromal phase – mild, nonspecific symptoms that signal onset of some diseases. Clinical phase – a person experiences typical signs and symptoms of disease. Decline phase - subsidence of symptoms. Recovery phase – symptoms have disappeared, tissues heal, and the body regains strength. BioEd Online

11. www.BioEdOnline.org Classification of Infectious Disease By duration Acute – develops and runs its course quickly. Chronic – develops more slowly and is usually less severe, but may persist for a long, indefinite period of time. Latent – characterized by periods of no symptoms between outbreaks of illness. By location Local – confined to a specific area of the body. Systemic – a generalized illness that infects most of the body with pathogens distributed widely in tissues. By timing Primary – initial infection in a previously healthy person. Secondary – infection that occurs in a person weakened by a primary infection. BioEd Online

12. www.BioEdOnline.org How Infectious Agents Cause Disease Production of poisons, such as toxins and enzymes, that destroy cells and tissues. Direct invasion and destruction of host cells. Triggering responses from the host’s immune system leading to disease signs and symptoms. Courtesy of CDC Human Immunodeficiency Virus. HIV-1 virions can be seen on surface of lymphocytes. BioEd Online

13. www.BioEdOnline.org Example of an Infectious Disease - Flu Acute contagious disease caused by the influenza virus. Respiratory tract infection, but symptoms felt throughout entire body. Epidemics occur seasonally with low fatality; more deadly pandemics occur several times each century. Highly changeable virus that can infect multiple species, including humans, pigs, and birds. Concern exists that current avian flu or H1N1 will lead to a new pandemic. BioEd Online

14. www.BioEdOnline.org Example of an Infectious Disease - AIDS AIDS (Acquired Immune Deficiency Syndrome) is the disease caused by the virus called HIV (human immunodeficiency virus). HIV attacks cells of the immune system and destroys their ability to fight infection by other agents. HIV is spread through the direct exchange of body fluids. There is a long period of time from HIV infection to the onset of AIDS. Anti-HIV drugs prolong the length and quality of life, but there is no vaccine or cure for AIDS. Courtesy of CDC This highly magnified transmission electron micrographic (TEM) image revealed the presence of mature forms of the human virus immunodeficiency (HIV) in a tissue sample under investigation. BioEd Online

15. www.BioEdOnline.org Emerging Infectious Diseases Emerging diseases are those that have recently appeared within a population, or whose incidence or geographic range is increasing rapidly. Diseases can emerge or re-emerge due to: appearance of a previously unknown agent. evolution of a new infectious agent. spread of an infectious agent to a new host. spread of an infectious agent to new locations. acquisition of resistance to anti-microbial drugs. deliberate introduction into a population. BioEd Online

16. www.BioEdOnline.org Reducing the Spread of Infectious Diseases Vaccines Antimicrobial drugs Good personal hygiene and sanitation Protection against mosquitoes Quarantine BioEd Online

17. Read the Handwashing Fact Sheet The following slides are from a research study done on handwashing in America. View the research study and then answer the questions.

18. www.harrisinteractive.com ©2007, Harris Interactive Inc. All rights reserved. A Survey of Handwashing Behavior (Trended) Prepared for September 2007

19. 19 Research Objectives The American Society for Microbiology and the Soap and Detergent Association are interested in continuing to monitor handwashing habits of people in public restrooms. The objective of the research is to compare the actual observed number of U.S. adults who wash their hands after using a public restroom against the percentage who self-report that they wash their hands in several situations: After petting a dog or cat Before handling or eating food After coughing or sneezing After using a public restroom After handling money After changing a diaper After using the bathroom in their home The purpose of this research is to increase public awareness of the importance of handwashing.

20. 20 Methodology – Telephone Survey The data from the telephone survey are based on a nationally representative sample, stratified by census region and weighted by gender, education and ethnicity composure to represent the U.S. population. This method assures a valid national probability sample. Harris Interactive has conducted the self-reported handwashing habits among adult Americans in 2003, 2005, and 2007. 1,001 telephone interviews were conducted between August 17-20, 2007. 1,013 telephone interviews were conducted between August 19-22, 2005. 1,000 telephone interviews were conducted between August 22-26, 2003. Findings from similar telephone studies in 2000 and 1996 are also referenced in this report.

21. 21 2007 Methodology – Public Attractions Observations  Harris Interactive observed the behavior of 6,076 adults who appear to be age 18 and older in public restrooms located at major public attractions in the U.S. and recorded whether or not they washed their hands after using the facilities. The research was conducted in four cities and at six different locations:  Atlanta – Turner Field  Chicago – Museum of Science and Industry and Shedd Aquarium  New York City – Penn Station and Grand Central Station  San Francisco – Ferry Terminal Farmers Market  Observers discreetly watched and recorded whether or not adults using public restrooms washed their hands. Observers were instructed to groom themselves (comb their hair, put on make-up, etc.) while observing and to rotate bathrooms every hour or so to avoid counting repeat users more than once. Observers were also instructed to wash their hands no more than 10% of the time.  The 2007 observational research results can be directly compared to the 2005 findings (6,336 observations) they took place at the same locations using the same methodology. The 2003 observational research findings are not directly comparable to 2005 and 2007 because they took place at different locations.  The 2003 observational research represent the observed behavior of 7,541 individuals in public restrooms located in major metropolitan airports in the U.S. and Canada, specifically: New York City, Chicago, San Francisco, Dallas, Miami and Toronto.

22. 22 2007 Methodology – Public Attractions Observations City and Location Male Washers Male Non-Washers Female Washers Female Non-Washers TOTAL Atlanta: Turner Field (Atlanta Braves baseball games) 464351723381,576 Chicago: Museum of Science and Industry 2518839258789 Chicago: Shedd Aquarium3327924357711 New York City: Grand Central Station36013045045985 New York City: Penn Station1629820946515 San Francisco: Ferry Terminal Farmers Market 4692816301201,500 TOTAL2,0381,0272,6473646,076

23. 23 Executive Summary Similar to 2005, nine in ten (92%) adults say they always wash their hands after using public restrooms; however just over three in four (77%) were observed doing so (down from 83% in 2005 and unchanged from 78% observed in 2003). The highest percentage of handwashing among men was observed in Chicago’s Shedd Aquarium (81%). For women, the highest percentage of handwashing was observed in Atlanta’s Turner Field (95%). The decline in handwashing observations is largely due to males. The percentage of males observed washing their hands fell from 75% in 2005 to 66% in 2007. Overall, percentage of females observed washing their hands is down slightly from 90% in 2005 to 88% in 2007. The largest decline in observations was seen among San Francisco males, down 15 percentage points from 85% in 2005 to 63% in 2007. The largest decline in observations among females were observed at the Shedd Aquarium in Chicago (-12 pts) and Penn Station (-10 pts). The largest gap between male and female handwashing patterns was observed at the Braves baseball game where 95% of women were observed washing their hands compared to 57% of males. Among observational findings from public attractions in four major cities, the lowest percentage of hand washers were in Atlanta (Braves baseball game) and New York City (Penn & Grand Central Stations). The highest percentage of non-washers were observed at Penn Station (28%) and the Braves baseball game (25%). While 92% of adult Americans self-report always washing their hands after using a public restroom and 86% self-report always washing their hands after using the bathroom in their home, only one-quarter (25%) self-report always washing their hands after handling money and one-third (34%) after coughing or sneezing.

24. 24 2007 Detailed Findings

25. 25 2007 Public Attractions Observations – 2007 Observational Findings Among Complete Sample – 2007 Based on the observation of 6,076 individuals in public restrooms located at major public attractions 2005 Based on the observation of 6,336 individuals in public restrooms located at major public attractions % Washers Non-Washers 2005 83 17 74 26 88 12 78 22 88 12 2005 87 13 89 11 79 21 77 23

26. 26 2007 Based on the observation of 3,065 males 2005 Based on the observation of 3,206 males – 2007 Observational Findings Among Males – % 2007 Public Attractions Observations Washers Non-Washers 2005 75 25 63 37 83 17 65 35 85 15 2005 81 19 85 15 67 33 64 36

27. 27 2007 Based on the observation of 3,011 females 2005 Based on the observation of 3,130 females – 2007 Observational Findings Among Females – % 2007 Public Attractions Observations % Washers Non-Washers 2005 90 10 84 16 93 7 90 10 91 9 2005 93 7 7 89 11 92 8

28. 28 After petting a dog or cat Before handling or eating food After coughing or sneezing After using the bathroom in your home After changing a diaper After handling money After using a public restroom Handwashing Habits: National Telephone Survey Results How Frequently Do Americans Say They Are Washing Their Hands? Always wash my hands (Usually wash my hands) – Self Reported Handwashing Practices: Total Sample (2003 to 2007) – Q: I am going to read you a list of activities and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after… 2003 44% (17%) 2005 42% (16%) 2003 80% (14%) 2003 31% (27%) 2003 87% (8%) 2005 77% (14%) 2005 32% (23%) 2005 83% (10%) 2003 75% (2%) 2005 73% (4%) 2003 95% (3%) 2005 91% (6%) 2003 22% (16%) 2005 21% (18%) 2007 34% (27%) 2007 78% (13%) 2007 42% (14%) 2007 86% (9%) 2007 73% (5%) 2007 25% (19%) 2007 92% (5%)

29. 29 – Self Reported Handwashing Practices: Men vs. Women (2005 & 2007) – Petting a Dog or Cat Handling/ Eating Food Coughing/ Sneezing Using a Public Restroom Handling Money Changing Diapers Using Bathroom at Home % 20052007 20052007 20052007 20052007 20052007 20052007 20052007 Women Always/ Usually 6564 9395 6668 9798 4752 8784 9699 Always 50488284 39 9496 2730 8280 8889 Men Always/ Usually 504987 4453 9697 3036 6871 9092 Always 343571 2428 8889 1419 6465 7882 Q: I am going to read you a list of activities and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after… While men remain less likely than women to wash their hands regardless of activity, they appear more likely than last year to wash after coughing or sneezing. Similarly, both men and women are more likely to wash after handling money.

30. 30 Petting a Dog or Cat Handling/ Eating Food Coughing/ Sneezing Using a Public Restroom Handling Money Changing Diapers Using Bathroom at Home % 20052007 20052007 20052007 20052007 20052007 20052007 20052007 Age <35 Always/ Usually 6153 8587 5664 98100 3742 7681 9192 Always 4739 7271 3528 9492 2021 7273 82 Age 35-54 Always/ Usually 5860 9394 5861 9897 3743 8581 9397 Always 3944 7780 3237 9394 2124 8076 8388 Age 55+ Always/ Usually 57 9293 5359 9596 4048 7371 9497 Always 4344 8083 3037 8892 2029 6869 8489 Q: I am going to read you a list of activities and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after… Generally, various age groups suggest similar washing patterns with the exception of lower percentages of adults 55+ washing after diaper changes and adults younger than 35 less likely to wash before handling/eating food. – Self Reported Handwashing Practices: By Age (2005 & 2007) –

31. 31 Petting a Dog or Cat Handling/ Eating Food Coughing/ Sneezing Using a Public Restroom Handling Money Changing Diapers Using Bathroom at Home % 20052007 20052007 20052007 20052007 20052007 20052007 20052007 Education: High School or Less Always 4546807832378889213169728385 Some College/ College/Post Grad Always 4238 76 32 9495 2119 7773 8487 Income Level: Annual Income <$40K Always 4750828336389394242874718387 Annual Income $40K+ Always 3735727527299291181976758485 Q: I am going to read you a list of activities and I’d like you to tell me how often you make it a practice of washing your hands. How often do you wash your hands after… Those with higher education are more diligent about washing their hands after using a public restroom. Similar to 2005 those with lower incomes are more likely to wash after petting a dog/cat, before handling/eating food, after coughing/sneezing, and after handling money. – Self Reported Handwashing Practices: By Education and Income Level (2005 & 2007) –

32. 32 2007 Telephone Survey Demographics Gender 48%Male 52%Female Household Income 18%Less than $20,000 13%$20,000 to $30,000 9%$30,000 to $40,000 8%$40,000 to $50,000 34%$50,000 or more Age 28%Younger than 35 38%35-54 31%55 or older Education 13%Some high school 32%High school grad 28%Some College 17%College grad 9%Post grad – Among U.S. Adults –

33. Answer questions about research What type of research study did they conduct? Why do you think that? What does the study conclude about handwashing in America today? Michigan Studyhttp://www.youtube.com/watch?v=P T45b7NLYCQhttp://www.youtube.com/watch?v=P T45b7NLYCQ

34. To emphasize the point… to the Beatles tune, “I Wanna Hold Your Hand” http://www.youtube.com/watch?v=AtlcS77 LaB0http://www.youtube.com/watch?v=AtlcS77 LaB0

35. International Clean Hands Week September 20-26, 2009 Juniors – You have high school. See individual group instructions for reminding the high school to have clean hands. Bookmarks – Rosa, Mike, Melissa Flyers – Shane, Kayla, Cody Brochures – Jake, Tuff

36. International Clean Hands Week September 20-26, 2009 Seniors – You have elementary school. See individual group instructions for reminding the elementary school to have clean hands. Flyers – Erika, Cotton, Bryar Bookmarks – Andrew, Austin, Cody, Tiffany Brochures – Kerry, Devin, Ethan, Ian, Adam

37. Hall of Shame Select an infectious disease from the provided list. Find out the answers to the provided questions about your infectious disease. This will be due Thursday.