An introduction to key challenges and concepts important to understanding the current status and determinants of global health.
What are the Plebeians and Stealth Bombs of Infectious Disease? Part 2
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來自 Duke University 的課程
全球健康的挑战
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從本節課中
Understanding the Key Global Health Challenges
This module focuses on examining the causes and distribution of infectious disease, noncommunicable disease, injury/violence/disaster, and MCH (maternal and child health).
與講師見面
Dr. David BoydHymowitz Family Professor of the Practice of Global Health
Duke Global Health Institute
These neglected tropical diseases range from a variety of worms,
roundworms, whipworms, and hookworms.
Known as geohelminths.
To diseases such as lymphatic filariasis.
A parasite that is spread via mosquitoes.
Which then the mosquito bites the human being and
transmits it the parasites next and multiply in the lymphatic system.
Causing a lot of disfigurement and swelling.
Some of you actually may have seen this, depending on where you live.
Two conditions such as Schistosomiasis.
It's a condition in which a fluke which lives in the water infects snails.
It goes through part of its maturation process in snails.
Human beings get in the water.
The flukes leave the snails, go into penetrate the human via the skin,
then move on into the intestines and the urinary tract.
Long term can cause a variety of blood vessel and
organ damage cancer of the bladder.
We actually even know that because it can cause genital legions it
can increase the risk of HIV as well.
Schistosomiasis is quite common in many parts of the world.
I don't need to go through all of these because you can study them yourself.
But I do think that you should be aware of these neglected tropical diseases.
So that you don't neglect them in your study of global health.
There are many keys to success, to prevent neglected tropical diseases.
Improving sanitation, hygiene, education.
Finding ways to control both the both the vector and the agent.
We also can use MDA, or Mass Drug Administration strategies.
In fact, there is what we call a rapid impact package of medicines.
That can actually treat, prevent,
treat the top seven neglected tropical diseases in school and communities.
It's very common, even in places where I work, that kids are frequently dewormed.
Also for other conditions that are other neglected tropical
diseases such as trachoma, which was in the last slide.
A type of chlamydia that's transmitted via flies or fingers.
Frequently into the eyes, causing inflammation and
irritation can eventually cause blindness.
Strategies such as SAFE have been devised.
Using surgery when necessary to correct
any structural problems that the trachoma has called.
Using antibiotics to treat the infection and practicing face washing and
in modifying the environment to reduce the risk of infection.
These are all important ways to prevent these NTDs.
So please study those slides to learn a little more.
Finally, the stealth bombs.
I've talked about infectious disease.
We talked about the fact that how things like
tuberculosis can become multi drug resistant, can become drug resistance.
Well, in fact not only can there be a rise in drug resistance.
But we can find that old infectious diseases that seem to
have become latent can reemerge, and that new diseases can emerge.
So here we have reemerging infectious diseases, and
the rise of drug, resistance.
I call these, the bombs.
Because they can have an impact and a rapid one.
If one just thinks about Cholera in Haiti after
the earthquake the H1N1 in the world.
Or the 2014 Ebola outbreak in West Africa.
It's very easy for one to understand how how
quickly these issues can become the bombs.
Many reasons for this.
Microbes adapt, they change.
Right? Humans are susceptible to
many infectious diseases.
Ecosystems change, populations change, there are economic and
political changes, there's poverty and inequality in the world.
Antibiotics need to be used, or drugs that need to be used inappropriately, or
not given sufficiently.
Allowing mutation to take place.
Wars in of the crises can create situations
in which diseases can be transmitted.
We do not have enough drug development, access, or
distribution for many infectious diseases.
And with modern travel.
And international commerce, increasingly diseases know no borders.
So, these re-emerging infectious diseases in particular can be new or old friends.
As I said, that can resurface and perhaps even be more virulent.
Take the case of Denghi fever for example.
An infectious disease that is transmitted by mosquitoes.
Effects so between 50 and 100 million people annually.
Until 1981, it had not been in Latin America in quite awhile,
and now it's throughout Latin America.
And now recently is in the southern United States.
Even with something like the flu, we know that every year the,
flu, flu viruses mutate.
Sometimes they just go through minor changes which are called drifts,
sometimes major changes called shifts.
But whether shift or drift the flu,
because it changes can have differing impacts various years.
New ones all the time.
We're still worried about H5N1 avian flu, newer strains that are just emerging,
H7N9 actually worried me a little bit more.
You know, and new ones are coming out all the time.
Think about MERS, Middle Eastern Respiratory virus.
That's likely the origins, camels likely to be hosts.
We don't know for certain.
But I am pleased to say that I took that photograph,
photograph of me with camel was taken.
A couple of years before we knew about MERs before it emerged.
That camel liked me by the way and normally camels hate me.
I don't know.
I don't know why.
Anyway we, we had a bond.
We can just say that.
You know, but these new pathogens are identified annually.
Right?
In fact, most new infectious diseases that emerge are originate in animals.
We call them zoonosis.
That's why it's so important when we're thinking about global health.
We don't just think about the health of humans, but
we think about environmental health and animal health as well.
Hence a new initiative called One Health.
Where people who specialize in human, animal and
environmental medicine all work together.
Now, the drug resistance of the stealth bombs.
Wow.
Like.
Anything else with genes, viruses have genetic changes.
As do bacteria and parasites.
They can become resistant to current medications.
Now these changes can result from natural mutations.
Or as I said earlier, from an inappropriate or
improper use of medications.
Or from both.
Many problems arise because of this.
This is why there are many, many strains of multiple drug resistant
tuberculosis that require more extended extended.
And actually more costly treatment with more side effects.
Recently cases extremely drug-resistant tuberculosis had been found and
at least one case of totally drug-resistant tuberculosis.
We know now that many malaria drugs no longer work, in particular regions.
Artemisinin, which is our new drug of choice.
Or that that we use quite a lot is now showing some signs of resistance.
And non-adherence to HIV regimens, or to ARVs.
Whether it's through conscious means, or just not having the resources or
the access to take them.
Has created new HIV resistant viral strains that we're calling superbugs.
In terms of the growth of anti-viral, of anti-viral anti-bacterial drug resistance.
The Center for Disease Control in the United States is cause,
is called the situation alarming.
How do we diffuse these bombs?
Well there's many ways.
Political financial support addressing the underlying social determinants,
thinking about the impacts of interventions and political actions.
Developing and distributing affordable vaccines.
I've prepared a list here that I want you to study.
But, a lot of it is based on knowledge, support, people working together,
countries working together, organizations working together.
Because disease, infectious diseases know no boundaries.
And the impact and consequences are signficant.
I'll give you three examples before we close.
After 2010 earthquake in Haiti, cholera arrived, we talked about cholera,
cholera before, arrived with the UN.
At least one Nepalese peace-keeper had the had the virus.
Through faulty sewage it got into the water supply at a UN camp,
and spread into the river.
Which is the drinking source, and the source of water.
There have now been over 600 thousand cases of cholera in Haiti, and
8,000 deaths.
Cholera had not been known in Haiti since the 19th century.
Polio, we know that we're still having difficulty eliminating polio in Pakistan.
Well, there's some reasons for that.
Political conflict, rumors, over the side effects.
The polio vaccine is would it cause infertility?
And that that's been targeted by Muslims and Christians, ethnic and
religious strife has happened in Pakistan.
The use of healthcare providers to provide military intelligence have caused
a decrease in trust and disrupted our attempt to eradicate polio globally.
And this issue goes back much, much longer than, than the than, than recent history.
For example, we actually know that one of the ways that HIV spread or
the spread was accelerated in Sub-Saharan Africa.
Was the reuse of syringes in the early days of
trying to provide vast max, vaccinations for other diseases.
The unholy trinity.
The and the stealth bombs.
All playing a major role in the infectious disease burden in global health.
