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BURDEN of INFECTIOUS DISEASESINFECTIOUS DISEASES

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http://ucatlas.ucsc.edu/cause.php

Developed vs. Developing EconomiesTop causes of death, according to the WHO for the calendar year 2001

Causes of death indevelopED countries

Causes of death indevelopING countriesp p

Ischaemic heart diseases

Cerebrovascular diseases

COPD

LOWER RESPIRATORY INFECTIONSLOWER RESPIRATORY INFECTIONS

Lung cancer

C id tCar accident

Stomach cancer

Hypertensive diseases

TUBERCULOSIS

Suicide




Ischaemic heart diseases HIV-AIDS

Cerebrovascular diseases LOWER RESPIRATORY INFECTIONS

COPD Ischaemic heart diseases

LOWER RESPIRATORY INFECTIONS DiarrhoeaLOWER RESPIRATORY INFECTIONS Diarrhoea

Lung cancer Cerebrovascular diseases

C id t Childh d diCar accident Childhood diseases

Stomach cancer Malaria

Hypertensive diseases TUBERCULOSIS

TUBERCULOSIS COPD

Suicide Measles

AGEING WORLD



Percentage of total population aged 60 years or older20502050

The boundaries shown on this maps do not imply official endorsement by the United Nationshttp://www.un.org/esa/population/publications/ageing/Graph.pdf

European Union + European Economic Area + European Free Trade Association

EUEEAEEAEFTA

BURDEN f INFECTIOUS DISEASES BURDEN of INFECTIOUS DISEASES in the ELDERLY:

The INDUSTRIALIZED COUNTRIES PERSPECTIVESPERSPECTIVES

European Union + pEuropean Economic Area +

European Free Trade Association

In 2008, the total European populationthe total European population

= 880 4 illi880,4 million(11% of the world population)

170 million of 65+ adults« World Population Prospects »

UN — department of Economic and Social Affairs. http://esa.un.org/unpp. Retrieved on 2008-06-10.

MAJOR PUBLIC HEALTH BURDEN:INFECTIOUS DISEASES

• Lower respiratory infections

INFECTIOUS DISEASES

• Lower respiratory infections• Influenza• Pneumococcal infections

• Tuberculosis• Tuberculosis• Other vaccine preventable diseasesOther vaccine preventable diseases• Antimicrobial resistance• Healthcare-associated infections

Adapted from the European Centre for Disease Prevention and Control, 2008; ISBN 978-92-9193-137-8; ISSN 1830-6160; DOI 10.2900/22770

INFLUENZAINFLUENZA(Seasonal Flu)(Seasonal Flu)

SEASONAL FLUSEASONAL FLUIt has been estimated that

betweenbetween 40,000 and 220,000 excess deaths per year

i th Ein the Europe can be attributed to influenza,

depending on the virulence of the circulating strainthe virulence of the circulating strain

European Centre for Disease Prevention and Control 2008

Seasonal FLUepidemics in England & Walesepidemics in England & Wales

(winters between 1989 and 2001)

E h it l d i iExcess hospital admissions:> 50% of the excess winter admissions

i i 75 loccurring in 75+ people

Excess mortality Not only linked to the disease itself

BUT to Pulmonary tract surinfections ++

C &SAMSON SI et al Aging Clin Exp Res 2009; 21: 210-5 CISZEWSKI A et al Eur Heart J 2008; 29: 1350-8

Cardio- & neuro-vascular complications ++



INFECTIOUS DISEASES




Streptococcus pneumoniaeStreptococcus pneumoniae

INVASIVEPNEUMOCOCCAL DISEASE European Union + DISEASE (very partial data*)

pEuropean Economic Area +


Countries with notifications:UK (2004-2006): N = 18’204 casesBelgium (1999 2005): N = 9’305 casesBelgium (1999-2005): N = 9’305 casesNorway (1999-2006): N = 7’618 casesFinland (2004-2006): N = 2’226 cases

8 years:8 years:N = 77’778 cases

WHO – CISID – htpp:/data.euro.who.int/cisid/

European Centre for Disease Prevention and Control, 2008

Importance of herd immunity

Seasonal Flu favours the onset of the invasive pneunococcal disease ?


Respiratory tract infections Respiratory tract infections (seasonal flu and pneumococcus)(seasonal flu and pneumococcus)

represent th 4th f d ththe 4th cause of deathin developed countriesin developed countries



INFECTIOUS DISEASES




MYCOBACTERIUM TUBERCULOSIS

In 2006, EU and EEA/EFTA countries

reported 87 591 tuberculosis (TB) cases87 591 tuberculosis (TB) cases

with an overall notification rate of 17.6 per 100 00017.6 per 100 000

[range: 3.0 (Cyprus) to 126.4 cases per 100 000 (Romania)]

Atlas of Health in Europe 2008 WHO Regional Office for Europe,

Copenhagen, Denmark

European Centre for Disease Prevention and Control, 2008European Centre for Disease Prevention and Control, 2008

New cases of TuberculosisIn 2006,

19.5 % of cases inin

the EU and EEA/EFTA countries were

in persons of foreign originpe so s o o e g o g

The percentage ranged from p g g0 % to 81 %

across the Member States

European Centre for Disease Prevention and Control, 2008; ISBN 978-92-9193-137-8; ISSN 1830-6160; DOI 10.2900/22770

Multidrug-resistant TB u t d ug es sta tremains

an issue requiring attention. q g

Multi-drug resistancegwas present in

15 – 19 % of cases in the Baltic States, ,but ranged

from 0 to 2 % in other countries

European Centre for Disease Prevention and Control, 2008; ISBN 978-92-9193-137-8; ISSN 1830-6160; DOI 10.2900/22770



INFECTIOUS DISEASES




MEASLES

European Union + European Economic Area p p+ European Free Trade Association

WHO Vaccine preventable diseases - Global summary – Geneva - 2007

MEASLESMEASLESEuropean Union +




Within 10 years:Turkey: N = 91’670 casesUk i N 2 484Ukraine: N = 72’484 casesFrance: N = 39’312 casesItaly: N = 36’700 cases

10 year period:1999 N = 56’319 cases2008 N = 6’840 cases

10 year period:N = 301’635 cases

Importance of childhood vaccination!


p

European Union + European Economic Area + European Free Trade Association+ European Free Trade Association

WHO Vaccine preventable diseases - Global summary – Geneva - 2007

DIPHTHERIADIPHTHERIAEuropean Union +




Within 10 years:Russian federation: N = 5’148 casesU i d Ki d N 1 90United Kingdom: N = 1’790 casesLatvia: N = 625 cases

10 year period:1999 N = 1’306 cases2008 N = 184 cases


Importance of childhood vaccinationImportance of childhood vaccinationand adulthood booster!

PERTUSSIS

Photomicrograph of Bordetella (Haemophilus) pertussis bacteriawww.vaccineinformation.org/photos/pertcdc001a.jpg

Courtesy of Centers for Disease Control and Prevention

PERTUSSISPERTUSSISEuropean Union + p

European Economic Area + European Free Trade Association


Within 10 years:Netherlands: N = 59’915 casesNorway: N = 36’889 casesNorway: N 36 889 casesSwitzerland: N = 34’400 cases

10 year period:1999 N = 55’166 cases2008 N = 21’061 cases


Importance of childhood vaccinationEuropean Centre for Disease Prevention and Control, 2008

Importance of childhood vaccinationand adulthood booster!

TETANUSTETANUS

TETANUSTETANUSEuropean Union + p

European Economic Area + European Free Trade Association


Within 10 years:Turkey: N = 420 casesFederation of Russia: N = 285 casesFederation of Russia: N = 285 casesFrance: N = 173 casesItaly: N = 139 cases

10 year period:1999 N = 190 cases2008 N = 181 cases


European Centre for Disease Prevention and Control, 2008Importance of a Importance of a

life course vaccination programme



INFECTIOUS DISEASES




European Centre for Disease Prevention and Control, 1st report Stockholm 2007

Antimicrobial resistance=

A major public health concernThe extensive use or misuse of antibiotic to treat

infectious diseases

ANTIBIOTIC RESISTANCE (AB-R)

The use of vaccines the probabilty of infection with AB-Rp y the need of prescribing antibiotics

Prevent bacterial complication of a viral infectionp

GUSMANO M et MICHEL JP Aging 2009; 21: 258-63



INFECTIOUS DISEASES




837’810

Over four million people in the EU acquire aacquire a

healthcare-associated infection every year,of whom approximately

37 000 die as a direct

result of the infection.

BURDEN of INFECTIOUS DISEASESINFECTIOUS DISEASES

CONCLUSION


A GREAT NUMBERINFECTIOUS DISEASES

A GREAT NUMBER OFOF

INFECTIOUS DISEASES CAN BE AVOIDED BY

THE BETTER APPLICATION A LIFE COURSE

VACCINE PROGRAMVACCINE PROGRAM

Vaccine programs

PregnancyScientific

knowledgeVery effective

Precise guidelinesp gfor a better life ChildrenHow to improve their

growth ?

Precise guidelines

Well accepted

Are they healthy ?

Midlif d lt

Scientificknowledge

Continuity of the vaccine program !!

How to improve it ?Midlife adultsthe vaccine program !!

HEALTHY AGEING

Part ofScientific

knowledge

How good is their health ?

Part ofpreventivemedicine !

The target: old adults

H t i it ?

Maintenance of

How to improve it ?

How goodofQoL ++

How good is their health?

MANY THANKS for YOUR ATTENTIONYOUR ATTENTION






Ischaemic heart diseases

Cerebrovascular diseases

COPD

LOWER RESPIRATORY INFECTIONSLOWER RESPIRATORY INFECTIONS

Lung cancer

C id tCar accident

Stomach cancer

Hypertensive diseases

TUBERCULOSIS

Suicide




Ischaemic heart diseases HIV-AIDS

Cerebrovascular diseases LOWER RESPIRATORY INFECTIONS

COPD Ischaemic heart diseases

LOWER RESPIRATORY INFECTIONS DiarrhoeaLOWER RESPIRATORY INFECTIONS Diarrhoea

Lung cancer Cerebrovascular diseases

C id t Childh d diCar accident Childhood diseases

Stomach cancer Malaria

Hypertensive diseases TUBERCULOSIS

TUBERCULOSIS COPD

Suicide Measles

DEATHS BY BROAD CAUSE GROUPin DEVELOPED COUNTRIES

Communicable Diseases Non Communicable Conditionshttp://ucatlas.ucsc.edu/cause.php

Percent POPULATION aged 65 and over: 2008

An Ageing World 2008, International population Reports, US department of Health and Human Services, June 2009

Percent POPULATION aged 65 and over: 2040


Population in DevelopED and developING countries by age and gendery g g

1960


Population in DevelopED and developING countries by age and gender

20002000


Population in DevelopED and developING countries by age and gendery g g

2040


Advanced Age and Ri k f T b l iRisk of Tuberculosis

Natives ofNatives of Belgium

Natives of Belgium

Immigrants to Belgiumg g

VAN DEN BRANDE P Drugs Aging 2005; 22: 663-86

Proposed EUGMS and IAGG-ERvaccine programme for the old adultsvaccine programme for the old adults

By the 7th decade /Retirement (after a clinical assessment of the vaccine status)yage

- TdaP or Td vaccine- Influenza vaccine

- Pneumococcal vaccine- Herpes Zoster vaccineInfluenza vaccine Herpes Zoster vaccine

Each year after the retirement age (after assessment of the vaccine status)

- Influenza vaccine

New medical/injury event Multiple hospital stays(after assessment of the vaccine status) (after assessment of the vaccine status)

- Td or TT vaccine - Pneumococcal vaccine

- TdaP or Td or TT vaccine - Pneumococcal vaccine

By the 9 th decade of age / Nursing Home admission

TdaP or Td or TT vaccine- Influenza vaccine

Pneumococcal vaccine- Herpes Zoster vaccine*

MICHEL JP et al Rejuvenation Research 2009; 19: 127-35

Vaccine programs

PregnancyScientific

knowledgeVery effective

Precise guidelinesp gfor a better life ChildrenHow to improve their

growth ?

Precise guidelines

Well accepted

Are they healthy ?

Midlif d lt

Scientificknowledge

Continuity of the vaccine program !!

How to improve it ?Midlife adultsthe vaccine program !!

HEALTHY AGEING

Part ofScientific

knowledge

How good is their health ?

Part ofpreventivemedicine !

The target: old adults

H t i it ?

Maintenance of

How to improve it ?

How goodofQoL ++

How good is their health?

?

Possible impact of increased vaccine coverage

MANY THANKS MANY THANKS for

YOUR ATTENTION

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