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Emerging infectious disease

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Emerging Infectious Dieases August 31st, 2016 P. Damronglerd MD
Outlines Definition Zika virus Ebola virus MERS
Definition WHO An emerging disease is one that has appeared in a population for the first time, Or that may have existed previously but is rapidly increasing in incidence or geographic range = Re-emerging disease
Example of Emerging Diseases
ZIKA VIRUS
Epidemiology Family Flaviviridae Genus Flavivirus Mosquito-transmitted virus Aedes genus, mainly Aedes aegypti in tropical regions Usually bite during the day, peaking during early morning and late afternoon/evening Same mosquito that transmits dengue, chikungunya and yellow fever Sexual transmission of Zika virus is also possible Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
TImeline http://www.who.int/emergencies/zika-virus/zika_timeline1000.jpg
Clinical Features 80% = asymptomatic Mild symptom and self- limiting Low grade fever & short term Some cases reported High fever up to 40oC Lymphadenopathy Severe abdominal pain Thrombocytopenia Enantema Hematoma Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
Common Signs and Symptoms Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
Neurological & Congenital Syndrome Guillan-Barr辿 syndrome Meningoencephalitis Acute myelitis Encephalopathy Microcephaly
Situation As of 3 August 2016, 68 countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2007 65 of these countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2015 http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
Distribution of Zika Virus, 2013-2016 http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
Countries and Territories Reporting Mosquito-borne Zika Virus Transmission http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
Microcephaly and/or CNS Malformation Cases Potentially Associated Report http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
Guillain-Barr辿 Syndrome (GBS) Potentially Associated Report http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
Laboratory Diagnosis Can be detected in blood (plasma, serum), CSF, urine, saliva, breast milk, semen, vaginal secretion, amniotic fluid, tissues Viral genome: conventional or real-time RT- PCR Serology (anti-ZIKV IgM or IgG): ELISA, immunofluorescence, plaque-reduction test (PRNT) Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
Treatment Usually mild and requires no specific treatment Should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines If symptoms worsen medical care and advice Currently no vaccine available http://www.who.int/mediacentre/factsheets/zika/en/
犖犢犖迦犖犖萎犢犖迦犢犖迦犖犖伍犖犖迦犖犢犖迦見犖犖園犖犖園犖犖朽謙犖迦犖ム鍵犢犖犢犖迦見犖犢犖迦犖朽犖犖犖迦牽犢犖犢犖犖犖園 犖犖朽謙犖迦犖犖ム鹸犖÷犖巌 犖犖犖園犖犖 31 犖 犢犖÷厳犖犖犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犢犖犖犖犖迦牽犢犖犖巌犖犖迦 1. 犖犖項犢犖犖巌犖犖迦犖犖犖巌犖犖о牽犖犖伍検犖犢犖迦犖犖巌犖犢 犖犖犖犖園犖犖迦牽犖犖園犖犖犖犖犢 犖犢犖犖犖犖迦牽犢犖犖巌犖犖迦 3 犢犖犖劇賢犖 犢犖ム鍵犢犖犖犖萎見犖о犖迦犖犖朽賢犖∇弦犢犢犖犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犖犖犖犖萎犖園犢犖犖巌犖犖迦 犖犖ム険犖犖犖犖犖÷顕犢犖ム犖о賢犖∇犖迦犖犢犖犖 3 犢犖犖劇賢犖 2. 犖犖犖巌犖犖園犖犖犖犖犢犖犖о牽犖犖犖犖迦牽犢犖犖巌犖犖迦犢犖犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 http://beid.ddc.moph.go.th/beid_2014/th/diseases/2078
犖犢犖迦犖犖萎犢犖迦犢犖迦犖犖伍犖犖迦犖犢犖迦見犖犖園犖犖園犖犖朽謙犖迦犖ム鍵犢犖犢犖迦見犖犢犖迦犖朽犖犖犖迦牽犢犖犢犖犖犖園 犖犖朽謙犖迦犖犖ム鹸犖÷犖巌 犖犖犖園犖犖 31 犖 犢犖÷厳犖犖犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犖萎見犖о犖迦犖犖朽賢犖∇弦犢犢犖犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 1. 犖犢 犖犖犖犖園犖犖犢犖犖犢犖÷犢犖犢犖犖項犖∇幻犖犖犖園 犢犖犖∇犖迦牽犢犖犢犖犖迦牽犢犖犖÷元犖犖朽/犖犢犖/犖犖迦犖迦検犢犖犖劇賢犖犢犖迦犖ム鍵 犖犢犖迦犖犖迦権 犖犖о検犢犖犖劇賢犖犢犖迦犖犖犖巌犖犢犖迦犖犖迦権犖÷鹸犖犖犖巌犢犖ム鍵犖犖о検犢犖犢犢犖犖劇賢犖犢犖迦犖朽検犖朽肩犖朽賢犢犖犖 犖犖迦絹犖園権 犖犖∇弦犢犢犖犖犢犖犖犖犖犖園犖犖迦犖迦絹 犖犖朽犖巌犖犖犖萎犖 犖犖巌犖犖犢犖迦犢犖迦 犖犖迦犢犖÷犖÷元 犖犖о牽犖犖犖犢犖犖÷幻犢犖 犢犖犖ム厳犖犖犖犖迦牽犖犢犖迦犖園犖∇幻犖 2. 犖犖ム元犖犢犖ム元犖∇犖犖迦牽犢犖犖巌犖犖迦犢犖犢犖迦犖犢犖犖犖劇犖犖朽犖朽検犖朽犖о顕犖÷犖犖犖園 犖÷元犖犢犖迦犖劇犢犖犖 犢犖犖劇賢犖ム 犖犖о顕犖÷犖犖朽権犖犖犢犖犖犖迦牽犖犖項犖∇幻犖犖犖園 3. 犖犖項犢犖犖巌犖犖迦犖犖園犖犖迦権犢犖ム鍵犖犖犖巌 犖犖о牽犖犖犖犖迦牽犖÷元犢犖犖犖犖園検犖犖園犖犢 犖犖犖劇賢犖÷元犢犖犖犖犖園検犖犖園犖犢 犖犖∇犖迦犖犖ム賢犖犖犖園権犢犖犖∇犖犢犖犖伍犖∇顕犖犖犖犖迦検犖園権犢犖ム鍵犖犖伍検犖犢犖迦犖犖巌犖犖∇犖迦犢犖犖犢犖犖犖犖園 4. 犖犖迦犖÷元犖犖迦犖迦牽犢犖犢 犖犖犖劇賢犖犖項犖犖謹犢犖÷犖犖犖迦権 犢犖犢犢犖犢犖犖犖項犖犖園犖犖迦牽犖犖朽検 犖犖犖劇賢犢犖犖犖∇犖犖犖萎犢犖迦犖朽検 犖犖園犖犖 http://beid.ddc.moph.go.th/beid_2014/th/diseases/2078
犖犢犖迦犖犖萎犢犖迦犢犖迦犖犖伍犖犖迦犖犢犖迦見犖犖園犖犖園犖犖朽謙犖迦犖ム鍵犢犖犢犖迦見犖犢犖迦犖朽犖犖犖迦牽犢犖犢犖犖犖園 犖犖朽謙犖迦犖犖ム鹸犖÷犖巌 犖犖犖園犖犖 31 犖 犢犖÷厳犖犖犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犖ム険犖犖犖迦牽犢犖犖巌犖犖迦 犢犖犢犖犖犖園肩犖犖迦硯犖萎犖園犖犖朽犖朽犖ム険犖犖÷顕犖犖謹 犢犖犖劇賢犖犖園犖犖迦牽犖犖項犖ム犖朽犖犖÷顕犖萎肩犖 犢犖ム鍵犖犢 犖犖犖犖園犖犖迦牽 犢犖犖犢犖犖犖萎犖迦権犖犖犖犢犖犖劇賢犢犖о牽犖園肩犖犖巌犖迦犖朽犢犖迦犖犖о犖犖伍検犢犖犖 犖犖犖迦検犖犖巌犖犖伍硯犖犖犖犖犖項検犖 犢犖ム鍵 犢犖犢犖犖犖園肩犖犖迦硯犖萎犢犖迦賢犖朽犖犖犖園 犖犖ム険犖犖犖迦牽犢犖犖巌犖犖迦犖犖ム険犖犢犖ム犖 1 犖犖園犖犖迦見犢 (犖犢犖迦犖犢) 犖犖項犢犖犖巌犖犖迦犖犖ム険犖犖÷顕犖犖園犖犖迦権犢犖ム鍵犖犖犖巌 犖犖о牽犖犖犖犖迦牽犖÷元犢犖犖犖犖園検犖犖園犖犢 犖犖犖劇賢犖÷元 犢犖犖犖犖園検犖犖園犖犢犖犖∇犖迦犖犖ム賢犖犖犖園権犢犖犖∇犖犢犖犖伍犖∇顕犖犖犖犖迦検犖園権 犢犖ム鍵犖犖伍検犖犢犖迦犖犖巌犖犖∇犖迦 犢犖犖犢犖犖犖犖園 犖犢犖犢犖犖劇賢犖犖犖∇犖迦犖犢犖犖 3 犢犖犖劇賢犖 犖犖迦犖犖犖巌犖犖犖о犖迦犖園犖犖犖犖犢 犖犖犖劇賢犖犖迦権犖犖朽検犖 犖犖迦犖迦牽犢犖犢 犖犖犖劇賢犖犖劇 犢犖犢犖犖朽犖犖犢犖犖犖∇犖犖園犖犖 犢犖ム鍵犢犖犢犖犖犖犖萎硯犖園犖巌犖迦牽犢犖犖巌犖犖迦 犖犖項犢犖犖巌犖犖迦犖÷顕犖犖迦犖犖犖萎犖犖犖犖朽検犖朽犖迦牽犖犖萎犖迦犖犖犖犢犖犖犖犖巌犢犖犖劇賢犢犖о牽犖園肩犖犖巌犖 犖犖о検犖犖謹犢犖÷厳犖犖 犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犢犖犢犖犖犖犖犖巌犖迦犢犖ム見犖巌犢犖犢犖犢犖о献犖 4 犖犖園犖犖迦見犢 犖犖園犖犖園犢犖犢犖о険犖犖犖朽犖犖巌犖犖迦犖犖犖犖÷顕 http://beid.ddc.moph.go.th/beid_2014/th/diseases/2078
EBOLA VIRUS http://apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
Ebola Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever First appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo Severe fatal illness Case fatality rate of up to 90% http://www.who.int
Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species: Bundibugyo ebolavirus (BDBV) Sudan ebolavirus (SUDV) Zaire ebolavirus (EBOV) Ta誰 Forest ebolavirus (TAFV) Reston ebolavirus (RESTV) Ebola http://www.who.int
Emerging infectious disease
Transmission Virus is transmitted to people from wild animals and spreads in the human population through human-to- human transmission Infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest http://www.who.int
Transmission Transmitted by direct contact with the blood, body fluids and tissues of infected animals or people Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness http://www.who.int
Emerging infectious disease
Signs and Symptoms Sudden onset of fever, intense weakness, muscle pain, headache and sore throat Followed by vomiting, diarrhoea, rash, impaired kidney and liver function In some cases, both internal and external bleeding Incubation period is 2 to 21 days http://www.who.int
Diagnosis Diagnosed definitively in a laboratory through several types of tests: Antibody-capture enzyme-linked immunosorbent assay (ELISA) Antigen detection tests Serum neutralization test Reverse transcriptase polymerase chain reaction (RT-PCR) assay Electron microscopy Virus isolation by cell culture http://www.who.int
Ebola 2014 http://www.who.int
Treatment Supportive care-rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival There is as yet no proven treatment available for EVD Potential treatments including blood products, immune therapies and drug therapies are currently being evaluated No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing http://www.who.int/mediacentre/factsheets/fs103/en/
WHO Situation Report, June 10th, 2016 Ebola in West Africa was lifted on 29 March 2016 Confirmed cases = 28,616 Probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11,310 deaths Latest cluster = prefectures of NZerekore and Macenta in south-eastern Guinea, Monrovia in Liberia http://apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
WHO Situation Report, June 10th, 2016 In Guinea, the last case tested negative for Ebola virus for the second time on 19 April Guinea declared an end to Ebola virus transmission on 1 June On 9 June the World Health Organization (WHO) declared the end of the most recent outbreak of EVD in Liberia This follows 42 days since the last case tested negative for the second time on 28 April http://apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
MERS
The First Case 60-year-old Saudi man who was admitted to a private hospital in Jeddah on June 13, 2012 Fever, cough, expectoration, and shortness of breath Died 11 days later from progressive respiratory failure Human Coronavirus Erasmus Medical Center (HCoV-EMC) Infect Drug Resist. 2014 Nov 3;7:281-7
The Second Case and Afterward Qatar, a 49-year-old man, was diagnosed in September 2012 with the novel coronavirus He was transported to the United Kingdom for intensive care The isolated viruses from the Saudi and the Qatari cases were 99.5% identical Majority of cases (>80%) have been reported from Saudi Arabia Since then 1333 cases have been reported from 26 countriesInfect Drug Resist. 2014 Nov 3;7:281-7
MERS 2012 http://www.who.int/csr/disease/coronavirus_infections/mers-2012-2015-global-situation-2015-06-26.png?ua=1
Phylogeny Enveloped RNA virus Subfamily Coronavirinae Novel virus is a representative of a new, yet-to-be-established species in lineage C of the genus Betacoronavirus J Virol. 2013 Jul; 87: 77907792
Symptom Range of presentation Asymptomatic Mild respiratory symptoms Severe acute respiratory disease Death (36%) Typical presentation: Fever, cough and shortness of breath Pneumonia is a common finding, but not always present Gastrointestinal symptoms, including diarrhoea, have also been reported The virus appears to cause more severe disease in older people, people with weakened immune systems, and those with chronic diseases such as cancer, chronic lung disease and diabetes. http://www.who.int/mediacentre/factsheets/mers-cov/en/
Emerging infectious disease
Transmission Sporadic (community-onset) Intra-familial transmission Health-care-related transmission Infect Drug Resist. 2014 Nov 3;7:281-7
MERS 2013 http://www.who.int/csr/disease/coronavirus_infections/mers-2012-2015-global-situation-2015-06-26.png?ua=1
Emerging infectious disease
Study populations Number of cases Median age (range) Male : female ratio Asymptomati c (%) Severe case (%) Fatality rate (%) Saudi Arabia, May 2013 23 56 (2494) 2.8:1 0 100 65 Saudi Arabia Sept 2012 - June 2013 47 NA 3.3:1 0 100 60 9 countries, Mar 2012 - Sept 2013 133 NA 1.5:1 13.5 86.5 45 9 countries, Sept 2012 - Oct2013 161 50 (14-94) 1.8:1 11.1 63.4 - Saudi Arabia, April - June 2014 402 46 (0.75-94) 1.4:1 28.6 44.5 28.3 Saudi Arabia, May 2013 - Feb 2014 113 41 (0.25-89) 1.3:1 28.9 NA 30 Infect Drug Resist. 2014 Nov 3;7:281-7
MERS 2014 http://www.who.int/csr/disease/coronavirus_infections/mers-2012-2015-global-situation-2015-06-26.png?ua=1
Korea St. Mary Hospital (37) Asian Medical Center (1) Yoel Lin Hospital (1) Samsung Hospital (59
Treatment and Prevention No vaccine or specific treatment is currently available Treatment is supportive and based on the patients clinical condition Cysteine protease inhibitor K11777 targeting cathepsin- mediated cell entry1 Oral ribavirin (dose based on calculated creatinine clearance, for 8-10 days) and subcutaneous pegylated interferon alfa-2a (180 亮g per week for 2 weeks)2 14 (70%) of 20 patients in the treatment group had survived after 14 days, compared with seven (29%) of 24 in the comparator group (p=0揃004) 1 Antiviral Res. 2015 Feb 7;116C:76-84 2 Lancet Infect Dis. 2015 Jan 15;211:13
WHO update and clarification on recent MERS cases reported by the Kingdom of Saudi Arabia Between 19-22 June 2016, WHO published 3 reports on the Disease Outbreak News (DON) describing 25 cases of Middle East Respiratory Syndrome (MERS) 24 of the cases contacted with a probable, single index case who was diagnosed with MERS in a hospital in Riyadh City, Riyadh Region The 22 June 2016 DON reported that the index case had died http://www.who.int/emergencies/mers-cov/saudi-arabia-update/en/
WHO update and clarification on recent MERS cases reported by the Kingdom of Saudi Arabia As of 22 June 2016 twenty-four (24) contacts have tested positive for MERS including twenty (20) healthcare contacts and three (3) household contacts In addition, one case has been diagnosed in a household contact of a hospital patient who was diagnosed with the disease after exposure to the probable index case Twenty (20) of the twenty-four (24) have not exhibited any MERS symptoms http://www.who.int/emergencies/mers-cov/saudi-arabia-update/en/
Cumulative Cases Globally since September 2012 WHO has been notified of over 1,700 laboratory-confirmed cases of infection with MERS, in 27 countries, including more than 600 related deaths http://www.who.int/emergencies/mers-cov/saudi-arabia-update/en/

More Related Content

Emerging infectious disease

  • 1. Emerging Infectious Dieases August 31st, 2016 P. Damronglerd MD
  • 2. Outlines Definition Zika virus Ebola virus MERS
  • 3. Definition WHO An emerging disease is one that has appeared in a population for the first time, Or that may have existed previously but is rapidly increasing in incidence or geographic range = Re-emerging disease
  • 6. Epidemiology Family Flaviviridae Genus Flavivirus Mosquito-transmitted virus Aedes genus, mainly Aedes aegypti in tropical regions Usually bite during the day, peaking during early morning and late afternoon/evening Same mosquito that transmits dengue, chikungunya and yellow fever Sexual transmission of Zika virus is also possible Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
  • 8. Clinical Features 80% = asymptomatic Mild symptom and self- limiting Low grade fever & short term Some cases reported High fever up to 40oC Lymphadenopathy Severe abdominal pain Thrombocytopenia Enantema Hematoma Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
  • 9. Common Signs and Symptoms Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
  • 10. Neurological & Congenital Syndrome Guillan-Barr辿 syndrome Meningoencephalitis Acute myelitis Encephalopathy Microcephaly
  • 11. Situation As of 3 August 2016, 68 countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2007 65 of these countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2015 http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
  • 12. Distribution of Zika Virus, 2013-2016 http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
  • 14. Countries and Territories Reporting Mosquito-borne Zika Virus Transmission http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
  • 15. Microcephaly and/or CNS Malformation Cases Potentially Associated Report http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
  • 16. Guillain-Barr辿 Syndrome (GBS) Potentially Associated Report http://www.who.int/emergencies/zika-virus/situation-report/4-august-2016/en/
  • 17. Laboratory Diagnosis Can be detected in blood (plasma, serum), CSF, urine, saliva, breast milk, semen, vaginal secretion, amniotic fluid, tissues Viral genome: conventional or real-time RT- PCR Serology (anti-ZIKV IgM or IgG): ELISA, immunofluorescence, plaque-reduction test (PRNT) Curr Opin Infect Dis. 2016 Aug 4. DOI: 10.1097/QCO.0000000000000301
  • 18. Treatment Usually mild and requires no specific treatment Should get plenty of rest, drink enough fluids, and treat pain and fever with common medicines If symptoms worsen medical care and advice Currently no vaccine available http://www.who.int/mediacentre/factsheets/zika/en/
  • 19. 犖犢犖迦犖犖萎犢犖迦犢犖迦犖犖伍犖犖迦犖犢犖迦見犖犖園犖犖園犖犖朽謙犖迦犖ム鍵犢犖犢犖迦見犖犢犖迦犖朽犖犖犖迦牽犢犖犢犖犖犖園 犖犖朽謙犖迦犖犖ム鹸犖÷犖巌 犖犖犖園犖犖 31 犖 犢犖÷厳犖犖犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犢犖犖犖犖迦牽犢犖犖巌犖犖迦 1. 犖犖項犢犖犖巌犖犖迦犖犖犖巌犖犖о牽犖犖伍検犖犢犖迦犖犖巌犖犢 犖犖犖犖園犖犖迦牽犖犖園犖犖犖犖犢 犖犢犖犖犖犖迦牽犢犖犖巌犖犖迦 3 犢犖犖劇賢犖 犢犖ム鍵犢犖犖犖萎見犖о犖迦犖犖朽賢犖∇弦犢犢犖犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犖犖犖犖萎犖園犢犖犖巌犖犖迦 犖犖ム険犖犖犖犖犖÷顕犢犖ム犖о賢犖∇犖迦犖犢犖犖 3 犢犖犖劇賢犖 2. 犖犖犖巌犖犖園犖犖犖犖犢犖犖о牽犖犖犖犖迦牽犢犖犖巌犖犖迦犢犖犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 http://beid.ddc.moph.go.th/beid_2014/th/diseases/2078
  • 20. 犖犢犖迦犖犖萎犢犖迦犢犖迦犖犖伍犖犖迦犖犢犖迦見犖犖園犖犖園犖犖朽謙犖迦犖ム鍵犢犖犢犖迦見犖犢犖迦犖朽犖犖犖迦牽犢犖犢犖犖犖園 犖犖朽謙犖迦犖犖ム鹸犖÷犖巌 犖犖犖園犖犖 31 犖 犢犖÷厳犖犖犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犖萎見犖о犖迦犖犖朽賢犖∇弦犢犢犖犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 1. 犖犢 犖犖犖犖園犖犖犢犖犖犢犖÷犢犖犢犖犖項犖∇幻犖犖犖園 犢犖犖∇犖迦牽犢犖犢犖犖迦牽犢犖犖÷元犖犖朽/犖犢犖/犖犖迦犖迦検犢犖犖劇賢犖犢犖迦犖ム鍵 犖犢犖迦犖犖迦権 犖犖о検犢犖犖劇賢犖犢犖迦犖犖犖巌犖犢犖迦犖犖迦権犖÷鹸犖犖犖巌犢犖ム鍵犖犖о検犢犖犢犢犖犖劇賢犖犢犖迦犖朽検犖朽肩犖朽賢犢犖犖 犖犖迦絹犖園権 犖犖∇弦犢犢犖犖犢犖犖犖犖犖園犖犖迦犖迦絹 犖犖朽犖巌犖犖犖萎犖 犖犖巌犖犖犢犖迦犢犖迦 犖犖迦犢犖÷犖÷元 犖犖о牽犖犖犖犢犖犖÷幻犢犖 犢犖犖ム厳犖犖犖犖迦牽犖犢犖迦犖園犖∇幻犖 2. 犖犖ム元犖犢犖ム元犖∇犖犖迦牽犢犖犖巌犖犖迦犢犖犢犖迦犖犢犖犖犖劇犖犖朽犖朽検犖朽犖о顕犖÷犖犖犖園 犖÷元犖犢犖迦犖劇犢犖犖 犢犖犖劇賢犖ム 犖犖о顕犖÷犖犖朽権犖犖犢犖犖犖迦牽犖犖項犖∇幻犖犖犖園 3. 犖犖項犢犖犖巌犖犖迦犖犖園犖犖迦権犢犖ム鍵犖犖犖巌 犖犖о牽犖犖犖犖迦牽犖÷元犢犖犖犖犖園検犖犖園犖犢 犖犖犖劇賢犖÷元犢犖犖犖犖園検犖犖園犖犢 犖犖∇犖迦犖犖ム賢犖犖犖園権犢犖犖∇犖犢犖犖伍犖∇顕犖犖犖犖迦検犖園権犢犖ム鍵犖犖伍検犖犢犖迦犖犖巌犖犖∇犖迦犢犖犖犢犖犖犖犖園 4. 犖犖迦犖÷元犖犖迦犖迦牽犢犖犢 犖犖犖劇賢犖犖項犖犖謹犢犖÷犖犖犖迦権 犢犖犢犢犖犢犖犖犖項犖犖園犖犖迦牽犖犖朽検 犖犖犖劇賢犢犖犖犖∇犖犖犖萎犢犖迦犖朽検 犖犖園犖犖 http://beid.ddc.moph.go.th/beid_2014/th/diseases/2078
  • 21. 犖犢犖迦犖犖萎犢犖迦犢犖迦犖犖伍犖犖迦犖犢犖迦見犖犖園犖犖園犖犖朽謙犖迦犖ム鍵犢犖犢犖迦見犖犢犖迦犖朽犖犖犖迦牽犢犖犢犖犖犖園 犖犖朽謙犖迦犖犖ム鹸犖÷犖巌 犖犖犖園犖犖 31 犖 犢犖÷厳犖犖犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犖犖ム険犖犖犖迦牽犢犖犖巌犖犖迦 犢犖犢犖犖犖園肩犖犖迦硯犖萎犖園犖犖朽犖朽犖ム険犖犖÷顕犖犖謹 犢犖犖劇賢犖犖園犖犖迦牽犖犖項犖ム犖朽犖犖÷顕犖萎肩犖 犢犖ム鍵犖犢 犖犖犖犖園犖犖迦牽 犢犖犖犢犖犖犖萎犖迦権犖犖犖犢犖犖劇賢犢犖о牽犖園肩犖犖巌犖迦犖朽犢犖迦犖犖о犖犖伍検犢犖犖 犖犖犖迦検犖犖巌犖犖伍硯犖犖犖犖犖項検犖 犢犖ム鍵 犢犖犢犖犖犖園肩犖犖迦硯犖萎犢犖迦賢犖朽犖犖犖園 犖犖ム険犖犖犖迦牽犢犖犖巌犖犖迦犖犖ム険犖犢犖ム犖 1 犖犖園犖犖迦見犢 (犖犢犖迦犖犢) 犖犖項犢犖犖巌犖犖迦犖犖ム険犖犖÷顕犖犖園犖犖迦権犢犖ム鍵犖犖犖巌 犖犖о牽犖犖犖犖迦牽犖÷元犢犖犖犖犖園検犖犖園犖犢 犖犖犖劇賢犖÷元 犢犖犖犖犖園検犖犖園犖犢犖犖∇犖迦犖犖ム賢犖犖犖園権犢犖犖∇犖犢犖犖伍犖∇顕犖犖犖犖迦検犖園権 犢犖ム鍵犖犖伍検犖犢犖迦犖犖巌犖犖∇犖迦 犢犖犖犢犖犖犖犖園 犖犢犖犢犖犖劇賢犖犖犖∇犖迦犖犢犖犖 3 犢犖犖劇賢犖 犖犖迦犖犖犖巌犖犖犖о犖迦犖園犖犖犖犖犢 犖犖犖劇賢犖犖迦権犖犖朽検犖 犖犖迦犖迦牽犢犖犢 犖犖犖劇賢犖犖劇 犢犖犢犖犖朽犖犖犢犖犖犖∇犖犖園犖犖 犢犖ム鍵犢犖犢犖犖犖犖萎硯犖園犖巌犖迦牽犢犖犖巌犖犖迦 犖犖項犢犖犖巌犖犖迦犖÷顕犖犖迦犖犖犖萎犖犖犖犖朽検犖朽犖迦牽犖犖萎犖迦犖犖犖犢犖犖犖犖巌犢犖犖劇賢犢犖о牽犖園肩犖犖巌犖 犖犖о検犖犖謹犢犖÷厳犖犖 犖犖巌犖 犢犖 犖犖迦犖犢犖 犖犖迦犖迦牽犖犖犖園犖犖犖迦犖巌献 犢犖犢犖犖犖犖犖巌犖迦犢犖ム見犖巌犢犖犢犖犢犖о献犖 4 犖犖園犖犖迦見犢 犖犖園犖犖園犢犖犢犖о険犖犖犖朽犖犖巌犖犖迦犖犖犖犖÷顕 http://beid.ddc.moph.go.th/beid_2014/th/diseases/2078
  • 23. Ebola Ebola virus disease (EVD), formerly known as Ebola haemorrhagic fever First appeared in 1976 in 2 simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo Severe fatal illness Case fatality rate of up to 90% http://www.who.int
  • 24. Genus Ebolavirus is 1 of 3 members of the Filoviridae family (filovirus), along with genus Marburgvirus and genus Cuevavirus. Genus Ebolavirus comprises 5 distinct species: Bundibugyo ebolavirus (BDBV) Sudan ebolavirus (SUDV) Zaire ebolavirus (EBOV) Ta誰 Forest ebolavirus (TAFV) Reston ebolavirus (RESTV) Ebola http://www.who.int
  • 26. Transmission Virus is transmitted to people from wild animals and spreads in the human population through human-to- human transmission Infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest http://www.who.int
  • 27. Transmission Transmitted by direct contact with the blood, body fluids and tissues of infected animals or people Men who have recovered from the disease can still transmit the virus through their semen for up to 7 weeks after recovery from illness http://www.who.int
  • 29. Signs and Symptoms Sudden onset of fever, intense weakness, muscle pain, headache and sore throat Followed by vomiting, diarrhoea, rash, impaired kidney and liver function In some cases, both internal and external bleeding Incubation period is 2 to 21 days http://www.who.int
  • 30. Diagnosis Diagnosed definitively in a laboratory through several types of tests: Antibody-capture enzyme-linked immunosorbent assay (ELISA) Antigen detection tests Serum neutralization test Reverse transcriptase polymerase chain reaction (RT-PCR) assay Electron microscopy Virus isolation by cell culture http://www.who.int
  • 32. Treatment Supportive care-rehydration with oral or intravenous fluids- and treatment of specific symptoms, improves survival There is as yet no proven treatment available for EVD Potential treatments including blood products, immune therapies and drug therapies are currently being evaluated No licensed vaccines are available yet, but 2 potential vaccines are undergoing human safety testing http://www.who.int/mediacentre/factsheets/fs103/en/
  • 33. WHO Situation Report, June 10th, 2016 Ebola in West Africa was lifted on 29 March 2016 Confirmed cases = 28,616 Probable and suspected cases have been reported in Guinea, Liberia and Sierra Leone, with 11,310 deaths Latest cluster = prefectures of NZerekore and Macenta in south-eastern Guinea, Monrovia in Liberia http://apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
  • 34. WHO Situation Report, June 10th, 2016 In Guinea, the last case tested negative for Ebola virus for the second time on 19 April Guinea declared an end to Ebola virus transmission on 1 June On 9 June the World Health Organization (WHO) declared the end of the most recent outbreak of EVD in Liberia This follows 42 days since the last case tested negative for the second time on 28 April http://apps.who.int/iris/bitstream/10665/208883/1/ebolasitrep_10Jun2016_eng.pdf?ua=1
  • 35. MERS
  • 36. The First Case 60-year-old Saudi man who was admitted to a private hospital in Jeddah on June 13, 2012 Fever, cough, expectoration, and shortness of breath Died 11 days later from progressive respiratory failure Human Coronavirus Erasmus Medical Center (HCoV-EMC) Infect Drug Resist. 2014 Nov 3;7:281-7
  • 37. The Second Case and Afterward Qatar, a 49-year-old man, was diagnosed in September 2012 with the novel coronavirus He was transported to the United Kingdom for intensive care The isolated viruses from the Saudi and the Qatari cases were 99.5% identical Majority of cases (>80%) have been reported from Saudi Arabia Since then 1333 cases have been reported from 26 countriesInfect Drug Resist. 2014 Nov 3;7:281-7
  • 39. Phylogeny Enveloped RNA virus Subfamily Coronavirinae Novel virus is a representative of a new, yet-to-be-established species in lineage C of the genus Betacoronavirus J Virol. 2013 Jul; 87: 77907792
  • 40. Symptom Range of presentation Asymptomatic Mild respiratory symptoms Severe acute respiratory disease Death (36%) Typical presentation: Fever, cough and shortness of breath Pneumonia is a common finding, but not always present Gastrointestinal symptoms, including diarrhoea, have also been reported The virus appears to cause more severe disease in older people, people with weakened immune systems, and those with chronic diseases such as cancer, chronic lung disease and diabetes. http://www.who.int/mediacentre/factsheets/mers-cov/en/
  • 42. Transmission Sporadic (community-onset) Intra-familial transmission Health-care-related transmission Infect Drug Resist. 2014 Nov 3;7:281-7
  • 45. Study populations Number of cases Median age (range) Male : female ratio Asymptomati c (%) Severe case (%) Fatality rate (%) Saudi Arabia, May 2013 23 56 (2494) 2.8:1 0 100 65 Saudi Arabia Sept 2012 - June 2013 47 NA 3.3:1 0 100 60 9 countries, Mar 2012 - Sept 2013 133 NA 1.5:1 13.5 86.5 45 9 countries, Sept 2012 - Oct2013 161 50 (14-94) 1.8:1 11.1 63.4 - Saudi Arabia, April - June 2014 402 46 (0.75-94) 1.4:1 28.6 44.5 28.3 Saudi Arabia, May 2013 - Feb 2014 113 41 (0.25-89) 1.3:1 28.9 NA 30 Infect Drug Resist. 2014 Nov 3;7:281-7
  • 47. Korea St. Mary Hospital (37) Asian Medical Center (1) Yoel Lin Hospital (1) Samsung Hospital (59
  • 48. Treatment and Prevention No vaccine or specific treatment is currently available Treatment is supportive and based on the patients clinical condition Cysteine protease inhibitor K11777 targeting cathepsin- mediated cell entry1 Oral ribavirin (dose based on calculated creatinine clearance, for 8-10 days) and subcutaneous pegylated interferon alfa-2a (180 亮g per week for 2 weeks)2 14 (70%) of 20 patients in the treatment group had survived after 14 days, compared with seven (29%) of 24 in the comparator group (p=0揃004) 1 Antiviral Res. 2015 Feb 7;116C:76-84 2 Lancet Infect Dis. 2015 Jan 15;211:13
  • 49. WHO update and clarification on recent MERS cases reported by the Kingdom of Saudi Arabia Between 19-22 June 2016, WHO published 3 reports on the Disease Outbreak News (DON) describing 25 cases of Middle East Respiratory Syndrome (MERS) 24 of the cases contacted with a probable, single index case who was diagnosed with MERS in a hospital in Riyadh City, Riyadh Region The 22 June 2016 DON reported that the index case had died http://www.who.int/emergencies/mers-cov/saudi-arabia-update/en/
  • 50. WHO update and clarification on recent MERS cases reported by the Kingdom of Saudi Arabia As of 22 June 2016 twenty-four (24) contacts have tested positive for MERS including twenty (20) healthcare contacts and three (3) household contacts In addition, one case has been diagnosed in a household contact of a hospital patient who was diagnosed with the disease after exposure to the probable index case Twenty (20) of the twenty-four (24) have not exhibited any MERS symptoms http://www.who.int/emergencies/mers-cov/saudi-arabia-update/en/
  • 51. Cumulative Cases Globally since September 2012 WHO has been notified of over 1,700 laboratory-confirmed cases of infection with MERS, in 27 countries, including more than 600 related deaths http://www.who.int/emergencies/mers-cov/saudi-arabia-update/en/