A Global Perspective: Epidemiology Of Major Global Diseases

Question 1

WHO

Answer 1

-agency of UNITED NATIONS, concerned with international public health.

Question 2

CDC

Answer 2

Mission

• PRTECT AMERICA from health, safety and security threats, both foreign and in the US
• MONITOR DISEASES that start at home or abroad
• conducts research
• provides health information

Question 3

Measles (Rubeola)

Answer 3

• RESPIRATORY TRACT DISEASE caused by a virus. Rash, high temps, cough, red watery eyes
• many complications: diarrhea, ear infections, pneumonia, encephalitis, seizures, death
• transmits person to person through droplets from nose, mouth, throat
• HIGHLY CONTAGIOUS
• affects MOSLY KIDS
• rash on head and trunk
• no treatment, recover within 2-3 weeks
• COMPLICATIONS WITH MALNOURSHED KIDS AND REDUCED IMMUNITY

Question 4

Morbidity and mortality of measles

Answer 4

• 20 MILL people affected each year
• worldwide decrease in deaths 2000-2016. Vax, still common in many developing countries
• preventable by vaccine, either alone, or measles-mumps-rubella
• THERE IS NO EVIDENCE THIS VACCINE CAUSES AUTISM

Question 5

Measles and the eye

Answer 5

• UP TO 60,OOO CASES OF BLINDNESS worldwide per year attributed to measles
• most in developing nations and suffer from a VITAMIN A DEFICIENCY

Question 6

Measles in the US 1944-2007

Answer 6

1940-1960, several hundred thousands of cases in US

• mid 1960s vax developed and cases dropped dramatically to small number
• in 1980, there was an uptick of measles and a second dose was recommended, after that, cases back down to close to zero
• there was an outbreak in 2014: occurred in California in Disney Land.
• 2017 had another small outbreak. Most were unvaccinated

Question 7

Ebola hemorrhagic fever

Answer 7

• virus first seen in 1976
• severe bleeding, organ failure, death
• origin-passed from ANIMAL HOSTS-FRUIT BATS or primates. Zoonotic Disease-normally existing in animals, transmitted from vertebrates animals to humans (SARS, HIV). BATS are most common mammal-to-human source of viruses
• now PERSON TO PERSON contact via blood and other BODILY FLUIDS (mucuous membranes)

Question 8

Spread of Ebola

Answer 8

• pathetically for NOSOCOMIAL (healthcare settings) tranmission
• does not spread as easily as colds, flu, measles
• no evidence spread though the air or water
• cannot spread disease UNTIL SYMPTOMS APPEAR

Question 9

Ebola virus outbreaks by year

Answer 9

Highest in 1976, 1995-2003, 2007, and very highest in 2014

Question 10

Ebola 2014-2016 epidemic

Answer 10

• first confirmed case MARCH 2014
• multiple countries in west Africa. 28000 reported cases; 11,000 deaths

UNITED STATES

• two imported cases, including one death
• tow locally acquired cases in healthcare workers

Epidemic was over as of march 2016, BUT NEW OUTBREAK IN APRIL 2018 in Congo
-EXPERIMENTAL VACCINE has been developed and has been distributed to millions

Question 11

TB

Answer 11

• mycobacterium tuberculosis, attacks LUNGS
• SPREAD THROUGH AIR-respiratory droplets-sneezing, coughing, inhalation
• NOT spread by sharing food, touching surfaces
• can become infected by NOT DEVELOP ACTIVE symptomatic disease
• not contagious until active disease occurs
• 1/4 OF THE WORLDS POPULATION is infected with TB

Question 12

TB symptoms

Answer 12

• persistent fought )blood included) night sweats, fever, weight loss, chills, fatigue
• greater risk with COMPROMISED IMMUNE SYSTEMS-AIDS, DM, leukemia, kidney disease, and head or neck cancer
• there are drug resistance strain

Question 13

Reported TB cases US 1982-2016

Answer 13

Uptick in 1990 and now levels off and slow decline

-higher in American Indians and Alaskans and Asian populations

Question 14

TB prevalence map

Answer 14

High in Africa, Asia

Question 15

Ocular manifestations of TB

Answer 15

• sSYSTEMIC SYMPTOMS NOT NECESSARY FOR OCULAR SYMPOMS
• can affect almost any part of the eye
• conjunctivitis, keratitis, PHLKYCTENULE, UVEITIS, iris nodules, cataract, choroiditis, retinal vasculitis, neuroretinitis
• granulomatous anterior uveitis with MUTTON FAT KERATIC PERCIPITATES (KPs) (also caused by sarcoidosis, syphilis)
• PHLYCTENULE: hypersensitivity reaction (also caused by staph)

Question 16

HIV

Answer 16

• targets iMMUNE SYSTEM, weakens defense against infections and cance r
• AIDS is the most advanced HIV. 2-15 years to develop. AIDS DEFINED BY development of opportunistic disease and CLINICAL MANIFESTATIONS: cancer, infections
• leading cause of death in HIV patients worldwide is TB
• tranmission-blood, breast milk. Seem, and vaginal secretions

Question 17

Leading cause of death in HIV patients

Answer 17

TB

Question 18

HIV prevalence in the world

Answer 18

South Africa most prevalent 
South America 
Mexico 
Asia 
Australia

Question 19

Mortality of HIV

Answer 19

1.1 million worldwide deaths in 2015

Question 20

Reduction in incidence of HIV

Answer 20

New cases

• 2001-3.4mill
• 2013-2.1mill

Question 21

Proportion of cases by race over time of HIV

Answer 21

Whites on the decline, but started with the highest prevelance in the 80s
AA on the rise
Hispanic very slight rise

Asian, American Indian/Salamanca, and Hawaiian have virtually no cases

Question 22

Ocular manifestations of AIDS

Answer 22

• kaposi sarcoma on conjunctiva
• toxoplasmosis
• HSV, HZV
• fungal infections
• syphilis
• TB
• CMV** RETINITIS
• choroiditis
• acute rental necrosis
• uveitis
• COTTON WOOL SPOTS. Infarction of the NFL, swells. In the presence of no other retinal findings

**All are much less common now with treatment

Question 23

ZIKA

Answer 23

Virus transmitted by mosquito

• this VECTOR also trnamits yellow fever, dengue, and other tropical diseases
• may be transmitted by a mosquito biting an infected person then transferring infecte blood by biting an uninflected person
• increased risk at lower altitudes

Also transmitted DIRECLTY through sexual contact

Discovered in 1947** in Uganda, small outbreaks occurred for decades,

May, 2015 BRAZIL, large increase in cases

Question 24

Zika symptoms

Answer 24

• relatively MILD EFFECT on adults. 20% have symptoms
• fever, rash, joint pain
• can be confirmed with blood or urine test
• no vaccine or cure: give palliative care

When occurs in pregnancy, can be passed to fetus and cause MICROCEPHALY. More likely EARLY in pregnancy

Question 25

MICROCEPHALY

Answer 25

- virus destroys brain, skull collapses on part that was destroyed - permanent physical and intellectual disabilities

Question 26

Zika in Brazil. Control

Answer 26

- 95% fewer cases in may 2017 - insecticides to 20 million homes - released genetically modified mosquitos to mate with carriers

Question 27

US symptomatic ZIKA cases reported

Answer 27

2015: 6 cases, ALL in travelers returning from affected areas 2016: 5102 cases. FLORIDA and TEXAS transmitted locally via mosquito, sexually and unknown persons to person 2017: 140 cases 2018: 20 cases TOTAL SO FAR 2461 cases in pregnant women as of may 2018

Question 28

FLORIDA and Zika

Answer 28

Cautionary zones and no go zones for pregnant women | -the have been removed June 2, 2017

Question 29

Ocular findings of Zika

Answer 29

- conjunctivitis - RETINA AND CHOROID (primarily noted in congential cases). Pigment mottling, chorioretinal atrophy NO EVIDENCE OF TRANSMISSION THOUGH TEARS

Question 30

Zika travel guidelines

Answer 30

Consult the CDC | Some cautionary areas on the map you can see

Question 31

Control of Zika

Answer 31

- present mosquito bites - avoid mosquito locations: REMOVE STNADING WATER where they breed; MOIST buckets, bowls, plants, flower pots; Dark humid places, under sinks - bite MORE LIKELY DURING THE DAY - insecticide - GMO mosquitos to mate with Zika virus mosquitos. Offspring die - control blood supply - vaccine development

Question 32

Non infectious global epidemic: DM

Answer 32

- lack of or ineffective use of INSULIN | - beta cells in pancrease produce insulin, enables cells to absorb GLUOCSE to produce energy

Question 33

Type I diabetes

Answer 33

Autoimmune disease - body attacks beta cells resulting in ABSENCE OF INSULIN - typically childhood onset

Question 34

Type II Dm

Answer 34

Insulin is present but body “resistant” to it - typically adult onset - 90% DIABETICS worldwide - risk factors: sedentary lifestyle, obesity - but can convert to type I as beta cells become destroyed in effort to compensate by producing more insulin

Question 35

Glucose cannot get into the cells, increases in blood

Answer 35

HYPERGLYCEMIA

Question 36

Diabetes incidence and prevalence

Answer 36

- world wide prevelance of 8.5%*** - US=9.4%*** - 84 MILLION** HAVE PREDIABETES (1/3 of american adults). Increased risk of heart disease and stroke US incidence diabetes -1.7 million NEW cases per year

Question 37

Ethnic group with high prevalence of DM

Answer 37

Native Americans

Question 38

Global projections of diabetes 2010-2030

Answer 38

51% increase worldwide

Question 39

Mortality < 60 of diabetes world wide

Answer 39

Higher all over the world

Question 40

Incidence in US of diabetes in last few years

Answer 40

DECREASE in INCIDENCE not prevalence Exercise, diet, awareness

Question 41

Ocular signs of DR

Answer 41

Traditional RD Iris neo PRP

Question 42

Diebetes and obesity

Answer 42

Risk factor | Ecological data

Question 43

BMI and Risk for DM II

Answer 43

As one goes up, the other does too | -relative risk increases with BMI

Question 44

Risk factors for the diabetes epidemic in Asia

Answer 44

- Asians have lower rates of overweight and obesity than their western counterparts, using conventional definitions - despite lower BMI, some Asian countries have similar or even higher prevalence of diabetes than western countries. These data confirm that the risk of type II DM starts at a lower BMI for Asians than for Europeans