1 Current national emerging infectious disease threads- Bangladesh perspective.

1

Current national emerging infectious disease

threads- Bangladesh perspective

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

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

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

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

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

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

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

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

Endemic Status of Filarisis in BD

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

Newly detected cases of Leprosy (January – December 2008)

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

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

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

Source: Dengue Program, DGHS, Mohakhali, Dhaka

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

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

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

Suspected Nipah outbreak in Bangladesh

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

Yearly Cases of HIV-AIDS (2003 to 2008)

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.

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