Lecture 5

Zoonotic diseases
Emerging and Re-emerging Diseases
Healthcare Associated Infections

Dr/ Shimaa Mahmoud
Lecturer of environmental and occupational
medicine
 
 Infections naturally transmitted between animal and
man.
 Role of animal in infection:
 1- Animal Reservoir:
 - Animal primary infected by disease and this
disease is pathogenic to man.
 - Exit of infection through (milk, meat, secretion).
 Examples: Viral: Rabbis, Yellow fever
 Bacterial: Anthrax, Brucella
 
 2- Intermediate host: Tenea saginata (cattle), Tenea
solium (pigs), hymenolepis nana (rats).

 Definitive host: Man may be infected by the larval

stage: Hydatidosis (Echinococcus disease)
 Types of Zoonosis:

 Inhalation Zoonosis: - Psittacosis, Q fever, anthrax,
brucellosis, TB.
 Ingestion Zoonosis: -
 Meat (salmonillosis, tuberculosis, brucella, intestinal
anthrax,
 
 Trichinosis, Hetrophys hetrophys.
 Eggs (salmonella)
 Water (Weill's disease)
 Arthropod- borne Zoonosis
 Contact Zoonosis: Rabbis, cutaneous anthrax
 Emerging Diseases

 Definition:
 Emerging infectious diseases are commonly defined
as:
 − Outbreaks of previously unknown diseases
 − Known diseases that are rapidly increasing in
incidence or geographic range in the last 2 decades
 − Persistence of infectious diseases that cannot be
controlled.
 
 Reemerging diseases are diseases that reappear after
they have been on a significant decline.
 Reemerging diseases include malaria, tuberculosis,
cholera, pertussis, influenza, pneumococcal disease,
and gonorrhea.
 Factors contributing to disease
emergence/re-emergence:

 1. Changes or evolution of existing organisms.
 2. New diseases which may spread to new
geographic areas or new human populations.
 3. Previously unrecognized infections may appear in
persons living or working in areas undergoing
ecological changes, such as deforestation or
reforestation, that increase their exposure to insects,
animals, or environmental sources that may harbour
new or unusual infectious agents.
 
 4. Development of antimicrobial resistance in
existing agents (e.g., gonorrhea, malaria,
pneumococcal disease).
 5. Breakdowns in public health measures for
previously controlled infections (e. g., cholera,
tuberculosis [TB], pertussis and diphtheria).

 The Threat of Emerging
Infections

 − Infectious diseases increasingly threaten public
health and contribute significantly to the escalating
costs of health care all over the world.
 − As society, technology, and the environment change,
pathogens evolve or spread, and the spectrum of
infectious diseases expands.
 − Emerging infections, such as acquired
immunodeficiency syndrome (AIDS) and TB, vividly
illustrate that no nation can be complacent regarding
human ability to the microorganisms with which we
share our environment.
 
 − The incidence of many diseases widely presumed
to under control such as cholera, dengue. Yellow
fever (YF), and TB has increased in many areas or
spread to new regions or populations throughout the
world.
 − Emerging infections are particularly serious with
lowered immunity.
 − Emerging infections transmitted by contaminated
foods and public water supplies place entire
communities at risk.
 
 − In modern times, travel and commerce have fostered
the worldwide spread of emerging infections e.g. HIV
and influenza" clearly, emerging infections can affect
people everywhere, regardless of lifestyle, cultural or
ethinic background, or socioeconomic status.
 According to WHO, the most important emerging
infectious diseases are: Crimean-congo hemorrhagic
fever, Ebola virus disease, Lassa fever, Napah (zoonotic
disease), rift valley fever, Chikungunya and zika virus.
 Recent infectious disease
outbreaks in Egypt.

Influenza A (H5N1) 2006-2017

Influenza A (H1N1) 2009

MERS-CoV 2014

Dengue fever 2015

SARS-CoV-2 2020
 Coronavirus

 The Coronaviridae family includes a broad spectrum
of animal and human viruses, with typical
morphology.
 Before 2003, the virus family was known as the cause
of only mild respiratory illness in humans.
 However, the emergence of severe acute respiratory
virus (SARS-CoV) and Middle east respiratory
syndrome coronavirus (MERS-CoV) shows the
zoonotic potential of causing severe disease
outbreaks in humans
 SARS-CoV MERS- SARS-
CoV CoV-2
(Covid-19)
Distribution Pandemic epidemic Pandemic

2002 2012 2020

Origin South Saudi Wuhan,
China Arabia China
Natural bat bat Bat
reservoir
 How to control emerging
infectious diseases?

 a. Control of Emerging and Re-emerging Diseases
 b. Controlling the reservoir
 c. Interrupting the transmission
 d. Protecting the susceptible host
 e. Early warning systems.
 
 f. Strengthening of the disease surveillance system
 g. Preparedness for emerging infectious disease
which requires: professional expertise, laboratory
support and research capability.
 h. Encouraging research initiations for treatment
regimens and diagnostics
 i. Encouraging research for new methods of control
measures
 Healthcare Associated
Infections (HAIs)

 Definition:Healthcare Associated
Infections (HAIs) /Nosocomial
infections are those acquired
during occurrence in hospital:
 - New infections other than the
existing disease
 - Acquired after 2 days of the stay
in the hospital
 Reservoir of infection: Nosocomial
infections may affect patients,
medical care staff and people
visiting the patient.
 
 Commonest nosocomial infections are urinary tract
infections, pneumonia, wound infections and sepsis.

 Mode of transmission: Third person, direct airborne,

hospital articles, food borne Arthropod borne
 Forms of infection:

1. Surgical wards:
- Streptococcus hemolytic: cellulitis lymphangitis, septicemia
- Staphylococcus aureus: wound sepsis;
- Osteomyelitis
- Tetanus
2. Maternity and obstetric ward:
- Staphylococcus aureus
– Streptococcal
- Clostridium tetani
- E coli
- Puerperal sepsis
 
3. Premature center, Nursery: Pneumonia, broncho-
pneumonia, epidemic diarrhea, skin infection.

4. Outpatient clinic: All forms of cross infection.

5. Infectious disease hospital: (cross infection)

- Staphylococcus aureus:
- Wide spread (nose, skin resistant outside body
penicillin resistant (75%)
Main preventive measures
for nosocomial infections:

1. Sanitary hospital environment (sanitation of
environment surrounding the hospitals).
2. Hospital staff infected must be kept away from work
till cure; hygiene; aprons
3. Isolation of infectious patients
 
4. Best method to prevent Nosocomial infection is hand
washing “Hand-washing with disinfectants” (not soap
and water) as MOST COMMON ROUTE OF
INFECTION is hands.
5. Control of droplet infection: Face mask; bed spacing;
Lighting; Ventilation
6. Dust control: Wet dusting and vaccum cleaning

 
7. Disinfection and sterilization: Patient articles and
body fluids; instruments
8. Chemoprophylaxis.
9. Prevention of cross infection (Hospital design,
isolated wards, isolated cubicles, precautions for
personnel).
10. Administrative measures: Hospital committee on
infection control
11. Surveillance by infection control team.
