1. 1 Current national emerging infectious disease threads- Bangladesh perspective

2. 2 Introduction An infectious disease - is a clinically evident illness resulting from the presence of pathogenic microbial agents, including pathogenic viruses, pathogenic bacteria, fungi, protozoa, multi cellular parasites, and aberrant proteins known as prions. - are also called communicable diseases or transmissible diseases due to their potential of transmission from one person or species to another by a replicating agent. Infectious Diseases responsible for 15 million (26%) of 57 million annual deaths in a global population of 6·2 billion The prevention and control of communicable diseases represent a significant challenge to those providing health-care services in Bangladesh. Sound knowledge on the disease epidemiology is a must for the health service providers in various levels.

3. 3 Factors involved in infectious disease emergence International trade and commerce Human demographics and behavior Human susceptibility to infection Poverty and social inequality War and famine Breakdown of public-health measures Technology and industry Changing ecosystems Climate and weather Intent to harm Lack of political will Microbial adaptation and change Economic development and land use Morens MD Lancet ID 2008

4. 4 Common ID in Bangladesh The Bangladesh population is namely affected by –diarrheal diseases, –cholera, –hepatitis A & E, –Malaria, –Mycobacterial Disease like Tuberculosis and Leprosy, –Dengue, –Japanese encephalitis, –Nipah virus infection, etc.

5. 5 Factors associated with transmission In Bangladesh the following factors are associated with transmission of Infectious diseases: –Crowding, –poor access to safe water, –inadequate hygiene and toilet facilities, –unsafe food preparation and handling practices

6. 6 Malaria Malaria risk exists throughout the year in Bangladesh. Thirteen out of 64 administrative districts are high malaria endemic areas. 98% of all malaria cases reported are from these districts, which are mainly located in the border areas of India and Myanmar.

7. 7

8. 8 Tuberculosis Tuberculosis still remains as a major public health problem, which ranks Bangladesh fifth among the high-TB burden countries in the world. The present revised National Tuberculosis Program (NTP) was launched and field implementation of DOTS (Directly Observed Treatment short course) was started in 1993.

9. 9 Leishmaniasis or Kala Azar Leishmaniasis or Kala Azar is endemic in Bangladesh and has an incidence of 175 per 100,000 per annum. It is caused by a protozoa which is transmitted from the bite of infected sand fly and may present in cutaneous or visceral forms (particularly common in Bangladesh).

10. 10 Filariasis Filariasis is a mosquito borne parasitic disease causing swelling of limbs, urogenital organs, breast, etc. with long arm disability. In Bangladesh, it is endemic in 23 districts, mostly the bordering ones. About 20 million people are already infected, most of whom are incapacitated.

11. 11 Endemic Status of Filarisis in BD

12. 12 Leprosy Leprosy has been a major health problem in Bangladesh for a long time. Bangladesh was considered a high endemic country and was listed among ten countries with high case load(1992). Leprosy situation has changed globally after 1981 when the Multi Drugs Treatment (MDT) were introduced.

13. 13 Newly detected cases of Leprosy (January – December 2008)

14. 14 Hepatitis Hepatitis A virus infection is common in Bangladesh with a prevalence of about 2% to 7%. Prevalence of hepatitis C virus infection is less than 1%. Sporadic outbreak is often seen caused by hepatitis E virus infection; but presence of hepatitis D infection is not exactly known.

15. 15 Polio Polio free status prevailed from 2001 until now (June 2009) except a small window period in 2006 when 18 cases of child polio were seen in boarder areas of Bangladesh. It is assumed that these cases were imported from India.

16. 16 Dengue Dengue fever/Dengue haemorrhagic fever (DF/ DHF) is a viral disease transmitted by the Aedes aegypty mosquito. It is on the increase in South East Asia. Bangladesh reported 100,000 cases in 2005. However case fatality rate (CFR) remained <1% up to 2006.

17. 17 Source: Dengue Program, DGHS, Mohakhali, Dhaka

18. 18 –The Diarrheal disease is endemic in all countries of the South East Asia Region that includes Bangladesh. –The diseases causes the bulk of the under five mortality in Bangladesh. –The main cause of death from acute diarrhea is dehydration resulting from loss of fluids and electrolytes. –The diarrhoeal diseases are of two types eatery diarrhea and bloody diarrhea (dysentery). –Several microorganisms cause the disease, but major organisms responsible for the disease are V. cholera and Shigella. Diarrhea

19. 19 Diarrhoeal Report by Division and by Year (2001-2008)

20. 20 Nipah Encephalitis Nipah is a zoonotic viral disease first identified in Nipah village of Malaysia in 1998-1999. In Bangladesh, Nipah emerged as a new killer disease from 2001. It may be manifested as a mild form of viral fever to severe form causing encephalitis or severe respiratory distress syndrome. Nipah experience in Bangladesh shows that the disease is a highly fatal one. So far 7 outbreaks have been recorded in Bangladesh.

21. 21 Suspected Nipah outbreak in Bangladesh

22. 22 HIV/AIDS Since 1989 a total cumulative of 1495 cases of HIV/AIDS have been confirmed and reported as end of November 2008.Of which 476 have developed AIDS out of whom 165 have since died. December 2007 to November 2008 a total of 288 new HIV infection recorded and reported, of which 111 new AIDS cases identified of whom 42 died. The estimated total number of people living with HIV/AIDS is around 7,500 as of December 2006.

23. 23 Yearly Cases of HIV-AIDS (2003 to 2008)

24. 24 Avian Influenza (Bird flu) Avian Influenza or "Bird flu" is a contagious disease of animals caused by viruses that normally infect only birds and less commonly pigs. Avian influenza viruses are highly species-specific, but on rare occasions cross the species barrier to infect humans. So far one Avian Influenza case has been identified in Bangladesh on 22 May 2008, but the person is still surviving. Total case reported to WHO till 11 February 2009 is 407. Total numbers of deaths are 254. Case Fatality is calculated as 63%. Since the detection of the first case in our country, Bangladesh is kept in Pandemic Alert Period.

25. 25 Source: Bangladesh Bureau of Statistics (population) and WHO Global Tuberculosis Report (2009) (other indicators)