Transcript Module: Public Health Disaster Planning for Districts Organization: East Africa HEALTH Alliance, 2009-2012 Author(s): Dr.

Module: Public Health Disaster Planning for Districts
Organization: East Africa HEALTH Alliance, 2009-2012
Author(s): Dr. Immaculate Nabukenya (MoH Uganda), Dr. Justine Lumaya (Yei
Hospital), Ms. Christine Kanyandekwe (RALDA), Dr. Abdu Mohammed (MoH Ethiopia),
Dr. Nlemba Mabela (MoH DRC), Dr. Julius Keyyu (Tanzania Wildlife Research
Institute), Dr. Christina A.O. Othieno (Moi University), Dr. Terence Odoch (Makerere
University), Dr. Robinson Mdegela (Sokoine University), Joel Buhinja (RALDA), Isaac
Ntahobakulira (Rwanda)
Resource Title: Session 1.2b: Epi-zoonotic Diseases of Importance in the Region
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Epi-zoonotic Diseases of
Importance in the Region
river seal, flickr
Anna Briggs, , flickr
ArranET, , flickr
Compiled by the Eastern Africa Disaster Management Training Core Team
Narrated by Dr. Roy William Mayega
10/10/2009
Public Health Disaster Planning for Districts
3
We are going to discuss the following
Epi-zoonotic Diseases:
•
•
•
•
•
•
•
1. Rift Valley Fever
2. Influenza A Viruses
3. Anthrax
4. Rabies
5. Ebola
6. Plague
7. Trypanosomiasis
10/10/2009
CDC, Wikimedia Commons
Public Health Disaster Planning for Districts
4
1. Rift Valley Fever
• An acute disease of domestic ruminants
caused by a mosquito-borne virus
characterized by liver disease, bleeding
disorders and frequent abortions in animals
• Infection can cause severe disease in both
animals and humans with many deaths
Anna Briggs, flickr
• Large outbreaks in animals occur especially
after heavy rains
• The disease is typically distributed along but
not limited to the Great Rift Valley
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5
ArranET, flickr
Transmission of RVF
• Spread among animals is through the bite of an infected
mosquito (esp. Aedes); other biting flies can act as
mechanical transmitters
• Susceptible Animals: Sheep, cattle, goats, camels
• Majority of human infections result from direct or indirect
contact with blood and organs of infected animals
• People at highest risk: Butchers, Veterinarians, Animal
handlers, herders, farmers
• Humans can also be infected directly by infected mosquitoes,
skin cuts and inhalation
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Clinical Presentation of RVF
• Animals:
– Incubation period varies from 1 to 6 days
– Fever, low activity, salivation, diarrhoea, vomiting, nasal discharge,
loss of appetite, low milk yield; Mortality of 10-70% especially
calves
– Outbreaks manifest as a wave of unexplained abortions in
livestock
• Humans:
– Influenza-like syndrome: Fever, headache, muscular pain,
weakness, nausea, upper abdominal discomfort, fear of light;
– Recovery occurs within 4-7 days
– Complications: Eye complications, bleeding disorders, yellow eyes,
meningitis-like illness
and death
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Controlling RVF
• Animals
– Mass vaccination in affected and neighboring areas
– Restricting livestock movement may slow spread
– Control of mosquito populations
– Burn and bury dead and affected animals, abortion products
– Surveillance in animals provides early warning for epidemic in
humans
• Humans
– Control of mosquitoes
– Personal protective measures for high risk groups
– Reducing consumption of raw blood, milk or animal tissue
– In epizootic regions, all animal products should be thoroughly
cooked before eating
– Proper handling of specimens
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2. Influenza
• A highly contagious acute respiratory illness which
affects humans and animals
• Influenza viruses are grouped into 3 types:
• Type A affects many animals (Pigs, Birds, Horses) and are
of veterinary and public health importance
• Type B mainly affects humans; it causes seasonal
influenza that is often mild
• Type C affects pigs and man
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Influenza
• Most Influenza A viruses are
classified as low pathogenic strains
• Occasionally, low pathogenic
Influenza A viruses mutate and
become highly pathogenic, causing
potentially devastating pandemics
• Examples:
– Highly Pathogenic Avian Influenza (HPAI)
(H5N1)
– Influenza A (H1N1) also called “Swine
Flu”
NIH, Wikimedia Commons
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Pandemic Influenzas
• Worldwide, a pandemic has been
occurring every 30 years:
– The Spanish flu (H1N1) caused 20-40
Million deaths in 1918
– The Asian Flu (H2N2) caused 1 Million
deaths in 1957
– The Hongkong flu (H3N2) caused 1
Million deaths in 1968
Stephen & Claire Farnsworth, flickr
– The latest Flu (H1N1) occurred in 2009
and has caused over 3500 deaths
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Public Health Disaster Planning for Districts
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Pandemic Influenzas
• Influenza A viruses cause pandemics
as a result of the following:
– Change in the nature of the virus to a
new strain
– Change in the nature of the virus so that it
can infect humans e.g. a bird or pig virus
changes so that it can infect humans
Source Unknown
– Change in the nature of the virus so that it
can be easily transmitted from person-toperson
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Phases of Pandemic Influenza
Source Unknown
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Avian Influenza
• These are Influenza A viruses found chiefly in birds
• Occasionally, new strains are formed which cause
mass epidemics in birds
river seal, flickr
• Risk is low to most people because the viruses do not
easily infect humans
• However, since 1997, nearly 400 human cases have
been reported in 23 countries
• The virus may change to a form that can cause a
deadly pandemic
10/10/2009
Public Health Disaster Planning for Districts
Bread for the World,
flickr
14
Symptoms of zoonotic flu
• Symptoms of zoonotic flu in animals
– Sudden massive deaths in animals (e.g. Birds), reduced
egg production, bluish comb, swollen head, diarrhoea,
lack of appetite
• Symptoms of zoonotic flu in humans
– Similar to seasonal flu: chills, fever, sore throat, muscle
pains, severe headache, coughing, weakness , general
discomfort
– However, unlike the seasonal flu, the ‘new flues’ may
cause severe disease and massive deaths
– High risk groups: Poultry and animal handlers, travelers to
affected countries/zones, family and community contacts
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Control of Influenza in Animals
– Before the outbreak
•
•
•
•
•
Protection in handling animals
Do not mix different species
Sensitize communities on how to recognize
Train Rapid Response Teams
Surveillance
Jessica Reeder, flickr
– During the outbreak
•
•
•
•
Farmers with affected flocks should report
Immediate Notification and quarantine
Rapid Response Teams should be activated
Destruction and safe disposal of all affected
flocks/animals
• Owners have to work with field teams
• Disinfecting animal houses, farm
10/10/2009
Public Health Disaster Planning for Districts
USFWS Mountain Prairie, flickr
16
Control of Influenza in Humans
• Before the Outbreak
– Targeted Community sensitization on measures for control
• During the Outbreak
– Individual and Community
•
•
•
•
•
•
•
•
Stay home if mildly or moderately sick
Avoid close contact with people who are sick
Nurse sick persons in separate area with personal protection
Wash hands often and avoid touching eyes, nose and mouth
Cover mouth or nose with a tissue when coughing or sneezing
Keep up with health information in your own community
Do not touch or eat affected animals
Severely ill persons should be referred
– System
•
•
•
•
•
10/10/2009
Set up treatment centres for severely ill
Call for immediate logistical support from the Ministry of Health
Give Antiviral drugs if available
Vaccinate high risk groups if vaccine is available
Measures to ensurePublic
security
and Planning
continuity
of other services
Health Disaster
for Districts
17
3. Anthrax
• An acute disease caused by Bacillus anthracis ; most forms of the disease
are deadly
• It most commonly occurs in cattle, sheep, goats, camels, wild-animals, and
other herbivores
• Anthrax is most common in agricultural regions
• When it affects humans, it is usually due to an occupational exposure to
infected animals or their products
• It is more common in developing countries or countries with poor
veterinary public health programs
• It is also associated with the transition from drought to rains; occasionally
during heavy rains
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Transmission of Anthrax
• Animals are infected by ingestion of the spores
when grazing or drinking or inhalation of spores
from dust
• Humans are infected by:
•
•
•
•
Eating infected meat, water or food (Commonest form)
Breathing in contaminated dust
Through broken skin
Humans can be infected from dead animals
• Anthrax does not usually spread from human-tohuman, except when the dead are not handled
carefully
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Clinical Signs of Anthrax
• Clinical signs in Animals
– Incubation period of 1 to 20 days
– May be sudden without showing signs or a short period of fever
– Blood discharge from the body openings in dead animals; the blood
does not clot and the animal does not stiffen at death
– Pigs in particular only show swellings in the neck
• Clinical signs in Humans
– The skin form causes itching of the skin, a pimple and wound
– The lung form causes difficulty in breathing; may kill within a few
hours
– The intestinal form causes fever, malaise, abdominal pain, diarrhoea,
severe illness, chills, collapse and death
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Control of Anthrax
• Animals
– Treat the sick animals using high doses of penicillin
– Avoid opening ‘suspect’ dead animals
– Isolate the sick and quarantine the suspected
– Disinfect the farm with standard disinfectants
– Vaccinate the animals in endemic areas
– Avoid contact with suspicious animal products
– Safe disposal (Burn or bury in deep hole with Lime; the dormant
forms of the organisms stay for over 100 years!!!)
• Humans
– Notify immediately and admit them to a health facility
– Community education
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4. Rabies
• Rabies is a fatal zoonotic disease of all warm blooded
animals caused by a virus and characterized abnormal
behaviour as a result of its effects on the nervous system
• It occurs world wide, but especially where veterinary
services are poor
• Related to poor handling of domestic animals (inability to
feed them, none confinement and not vaccinating them)
• Over 95% of human deaths occur in the tropics
10/10/2009
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Transmission of Rabies
• Virus is present in the saliva of clinically ill
mammals and is transmitted through:
– Bite from an infected animal
– Contact with saliva through broken skin
– Through intact mucous membranes
• 30 to 60% of cases are children under 15 years
• Rabies is also present in wild animals (carnivores
and bats) and is therefore difficult to control
10/10/2009
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Clinical Signs of Rabies
• Animals
– Incubation period of this disease is about 10 days to 2 months and
sometimes even longer
– The animal changes behaviour by becoming dangerously
aggressive, salivating excessively, attacking other animals, people
and objects, and may become paralyzed; it fears waterhydrophobia; abnormal appetite-may eat wood, stones, etc
• Humans:
–
–
–
–
Exhibit the same symptoms
Once symptoms of the disease develop, rabies is fatal
Bark like dogs
Almost always fatal
• NB: There is a mild form that is difficult to detect early
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Control of Rabies
• Animal
–
–
–
–
Notify the authorities of any suspicious case
Awareness creation
Control dog populations; all un-confined animals may be killed
Confine and observe suspect animal for 14 days;
– If it does not die, then it had no virus; DO NOT KILL THE ANIMAL IMMEDIATELY
– If it dies, take its head for laboratory confirmation
– Once signs and symptoms of rabies start, there is no treatment
– Mass vaccination of all domestic carnivores and keep vaccination records
– Maintain documentation of animal disposition and location
• Human
– Notify the authorities
– If bitten/scratched by an animal, clean the wound and seek medical advice
– Immunisation as soon as possible after suspect contact with an animal can
prevent rabies in 100% of cases
– Once signs and symptoms of rabies start, there is no cure
10/10/2009
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5. Ebola
• A highly virulent viral hemorrhagic fever that is often fatal in man and
other primates
• Outbreaks occurred in DRC (1976, 1977, 1995, 2007, 2008), Sudan
(1976, 1979), Kenya (1980), Cote d’Ivoire (1994, 1995), Gabon (1996),
Uganda (2000, 2007)
• Source: Its natural reservoir still unclear; Monkeys and Chimpanzees are
the common source; bats are the suspected as reservoir
• Other similar zoonotic viral hemorrhagic fevers include Marburg, Yellow
Fever, Lassa fever, West-Nile Fever)
• Transmission
– Direct contact with the blood, body fluids and tissues of infected persons
– Handling, eating sick or dead infected wild animals (chimpanzees, gorillas,
monkeys, forest antelope,
fruit bats)
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Clinical signs of Ebola
• Clinical Signs
– Animal
• Infected animals are partially resistant
and do not show the clinical signs
– Man
• Sudden onset of fever, intense weakness,
muscle pain, headache and sore throat
• Followed by vomiting, diarrhoea, rash,
kidney and liver failure
• In some cases, both internal and external
bleeding (from external openings)
• Some get rash and bleeding under the
skin
10/10/2009
Public Health Disaster Planning for Districts
Dr. Lyle Conrad, Wikimedia Commons
27
Prevention and Control of Ebola in
Animals
• Animals
–
–
–
–
Most infected animals do not show signs
Others are completely resistant
Control in wild animals difficult
Avoid contact with or eating wild primates
• Human
– Educate on special precautions with suspects
– No specific treatment or vaccine ; severe cases require
intensive supportive care
– Isolate from other patients and use strict barrier nursing
– Trace and follow up people who may have been exposed
– Disinfect all items used around the patient
– Strict infection control practices by health workers
– Behaviour and cultural change in handling of patients
– Other VHFs: Insect and arthropod control
10/10/2009
Public Health Disaster Planning for Districts
CDC
28
6. Plague
• An acute disease of animals and humans caused by a bacteria
transmitted from small animals to humans by the bite of
infected fleas
• Occurs world wide but with focal distribution depending on
presence of rats and infected fleas in defined geographical
areas
• In 2003, nine countries reported 2118 cases and 182 deaths
• 98.7% cases and 98.9% of deaths were reported from Africa
• Transmitted between animals and humans by the bite of
infected fleas, direct contact, inhalation and rarely, ingestion
of infective materials
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Clinical signs in man
• Plague can be a very severe disease with a case-fatality ratio
of 30%-60% if untreated
• Incubation period of 3-7 days
• Infected persons usually start with “flu-like” symptoms
• They then experience sudden fever, chills, head and bodyaches and weakness, vomiting and nausea
• Clinical plague manifests itself in three forms depending on
the route of infection
• Bubonic: Swellings of lymph nodes in groin, neck,
• Generalized Blood infection: Spread is in the blood, with severe
illness and fever
• Pneumonia: A severe lung infection
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Prevention and control of Plague
• Cases
–
–
–
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Early diagnosis
Treatment
Notification
Isolation in the case of pneumonic plague
• Community level
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–
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Flea control
Rat Control
Hygiene
Surveillance
Awareness creation
Preventive antibiotic therapy
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7. Trypanosomiasis (Sleeping Sickness)
• A disease that affects the central nervous
system of animals
• It occurs in the tsetse belt on either side of the
equator
• 36 countries of sub-Saharan Africa affected
• Endemic in many foci in East Africa
• There are low levels of surveillance and control
programmes
ILRI, flickr
• Recently, major outbreaks occurred in Angola,
the DRC, Sudan, Central African Republic, Chad,
Congo, Côte d’Ivoire, Guinea, Malawi, Uganda
and Tanzania
• Transmission is from the bite of an infected tsetse fly
10/10/2009
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Clinical Signs of Sleeping Sickness
– Animals
• Loss of appetite, weight loss, fever, anemia, rough hair coat,
reduced milk production, some die
– Humans
• Incubation period
• Two stages
• Stage 1 (Early; in blood and lymph nodes): Painless skin swelling at
site (Chancre), fever, swollen lymph nodes, face may be swollen,
itchy rash
10/10/2009
• Stage 2 (Late); Persistent headaches, change on behaviour, loss of
appetite, weight loss, day-time sleepiness and failure to sleep at
night; Confirmation by a Lumbar Puncture is mandatory to indicate
Public Health Disaster Planning for Districts
33
stage of disease
Prevention and Control of Sleeping Sickness
• Animals
• Diagnose and treat animals
• Give prophylaxis to animals in high risk areas
• Tsetse control (Insecticides, bush clearing, trypano-tolerant
animals, tsetse targets)
• Surveillance
• Dipping or spraying with acaricides
• Humans
• Find, diagnose and treat cases
• Surveillance and Mass screening (Checking signs and lab tests)
• Diagnose as early as possible and before the neurological stage
in order to avoid complicated, difficult and risky treatment
• Health education and awareness
• Participate in existing tsetse control programmes
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Other Important Zoonoses
• Other important zoonoses are not likely to
cause epidemics include:
– Brucellosis,
– Bovine Tuberculosis and
– Cysticercosis
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Additional Source Information
for more information see: http://open.umich.edu/wiki/CitationPolicy
Slide 3, Image 1: river seal, "chickens", flickr, http://www.flickr.com/photos/riverseal/22446062/, CC: BY-NC 2.0,
http://creativecommons.org/licenses/by-nc/2.0/
Slide 3, Image 2: ArranET, "Pygora goat", flickr, http://www.flickr.com/photos/arran_edmonstone_photography/4995279544/, CC: BY 2.0,
http://creativecommons.org/licenses/by/2.0/
Slide 3, Image 3: Anna Briggs, "Cow on Kegworth canal bridge", flickr, http://www.flickr.com/photos/anna-b/3160390295/, CC: BY-NC 2.0,
http://creativecommons.org/licenses/by-nc/2.0/
Slide 4, Image 1: CDC, "Ebola outbreak in Gulu Municipal Hospital", Wikimedia Commons,
http://commons.wikimedia.org/wiki/File:Ebola_outbreak_in_Gulu_Municipal_Hospital.jpg, PD-Gov, Public Domain - Government.
Slide 5, Image 1: Anna Briggs, "Cow on Kegworth canal bridge", flickr, http://www.flickr.com/photos/anna-b/3160390295/, CC: BY-NC 2.0,
http://creativecommons.org/licenses/by-nc/2.0/
Slide 5, Image 2: ArranET, "Pygora goat", flickr, http://www.flickr.com/photos/arran_edmonstone_photography/4995279544/, CC: BY 2.0,
http://creativecommons.org/licenses/by/2.0/
Slide 10, Image 1: NIH, "Anigenic Shift", Wikimedia Commons, http://commons.wikimedia.org/wiki/File:AntigenicShift_HiRes.jpg, PD-GOV, Public
Domain, Government
Slide 11, Image 1: Stephen and Claire Farnsworth, "Piglets", flickr, http://www.flickr.com/photos/the_farnsworths/4720941033/, CC: BY-NC-SA 2.0,
http://creativecommons.org/licenses/by-nc-sa/2.0/.
Slide 14, Image 1: river seal, "chickens", flickr, http://www.flickr.com/photos/riverseal/22446062/, CC: BY-NC 2.0,
http://creativecommons.org/licenses/by-nc/2.0/.
Slide 14, Image 2: Bread for the World, "Uganda Chickens", flickr, http://www.flickr.com/photos/breadfortheworld/4995437199/, CC: BY-NC 2.0,
http://creativecommons.org/licenses/by-nc/2.0/
Slide 16, Image 1: Jessica Reeder, "P1030638", flickr, http://www.flickr.com/photos/jessicareeder/3598192525/, CC: BY-SA 2.0,
http://creativecommons.org/licenses/by-sa/2.0/
Slide 16, Image 2: USFWS Mountain Prairie, "Avian Influenza Sampling", flickr, http://www.flickr.com/photos/usfwsmtnprairie/5790548806/, CC: BY
2.0, http://creativecommons.org/licenses/by/2.0/
10/10/2009
Public Health Disaster Planning for Districts
Additional Source Information
for more information see: http://open.umich.edu/wiki/CitationPolicy
Slide 27, Image 1: Dr. Lyle Conrad, "7042 lores-Ebola-Zaire-CDC Photo.jpg", Wikimedia Commons,
http://commons.wikimedia.org/wiki/File:7042_lores-Ebola-Zaire-CDC_Photo.jpg, PD-Gov, Public Domain - Government
Slide 28, Image 1: CDC, "Outbreak Investigation", http://blogs.cdc.gov/publichealthmatters/2011/09/outbreak-investigation-a-cheat-sheet/, Public
Domain – Government
Slide 32, Image 1: ILRI, "A sleeping sickness patient in Soroti, Uganda", flickr, http://www.flickr.com/photos/ilri/5464379313/, CC: BY-NC-SA 2.0,
http://creativecommons.org/licenses/by-nc-sa/2.0/
10/10/2009
Public Health Disaster Planning for Districts