1 current national emerging infectious disease threads- bangladesh perspective
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Current national emerging infectious disease
threads- Bangladesh perspective
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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.
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Factors involved in infectiousdisease 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
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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.
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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
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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.
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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.
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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).
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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.
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Endemic Status of Filarisis in BD
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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.
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Newly detected cases of Leprosy (January – December 2008)
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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.
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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.
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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.
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Source: Dengue Program, DGHS, Mohakhali, Dhaka
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– 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
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Diarrhoeal Report by Division and by Year (2001-2008)
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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.
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Suspected Nipah outbreak in Bangladesh
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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.
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Yearly Cases of HIV-AIDS (2003 to 2008)
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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.
25Source: Bangladesh Bureau of Statistics (population) and WHO Global Tuberculosis Report (2009) (other indicators)