health threats in the 21 st century sam stebbins, md, mph san mateo county health department
TRANSCRIPT
Health threats in the 21Health threats in the 21stst Century Century
Sam Stebbins, MD, MPHSam Stebbins, MD, MPH
San Mateo County Health DepartmentSan Mateo County Health Department
Disease Investigation….Disease Investigation….
….And Reporting
Masks and Isolation Procedure
2 types of Respiratory Isolation
Airborne via droplet nuclei (2-5 micron size).Remain suspended in air for hours. Particles inhaled.
• Use N95 mask• Use Negative Pressure Room• Indication: TB, varicella, measles, SARS
Droplet (large, visible particles). No spread beyond 3-6 feet. Requires close contact. Droplets spread from contact to mucous membranes of eye, nose or mouth
• Use surgical mask• Use Private Room. Do not need negative pressure room.• Indication: meningococcal infection, influenza, small pox, pneumonic plague
Which Mask Should I Use?
N95 Respirator (must be fit-tested*) Standard Surgical Mask (no fit-test)
Use for R/O TB, R/O SARS Use for R/O Meningococcal meningitis,pneumonic plague, and other diseases spread by the droplet route, PPE for body fluid
If You Have a Cough
Please ask the receptionist for a mask or box of tissuesWash your hands or use an alcohol-based hand rub to clean your hands
Covering your mouth when you cough and Covering your mouth when you cough and cleaning your hands afterward will help to cleaning your hands afterward will help to protect others from infectionprotect others from infectionThank You!Thank You!
Emerging DiseasesEmerging Diseases
SARSSARS HIV/AIDSHIV/AIDS Avian Influenza Avian Influenza
(two types)(two types) Mad Cow DiseaseMad Cow Disease Hoof and Mouth Hoof and Mouth
DiseaseDisease
Newcastle DiseaseNewcastle Disease West Nile VirusWest Nile Virus TuberculosisTuberculosis Anthrax, Plague, Anthrax, Plague,
Smallpox, Smallpox, Botulism, RicinBotulism, Ricin
Avian Influenza, Exotic Newcastle Disease
Avian InfluenzaAvian Influenza
Numerous Kinds H5N1 (2003-2004)Numerous Kinds H5N1 (2003-2004) Wiped out chicken and duck flocks in 8 Wiped out chicken and duck flocks in 8
Asian countriesAsian countries 34 confirmed human cases with 23 34 confirmed human cases with 23
deaths in 2 Asian countriesdeaths in 2 Asian countries Resistant to older flu drugsResistant to older flu drugs Previous outbreak in Hong Kong 1997Previous outbreak in Hong Kong 1997 Not known to be efficiently transmitted Not known to be efficiently transmitted
between humans (at present)between humans (at present)
1999 2000
2001 2002
West Nile VirusWest Nile Virus RESERVOIR HOSTS: Wild Birds RESERVOIR HOSTS: Wild Birds VECTORS: MosquitoesVECTORS: Mosquitoes INCIDENTAL HOSTS: Humans, horses, INCIDENTAL HOSTS: Humans, horses,
other mammalsother mammals
Birds that commonly carry Birds that commonly carry WNV:WNV:
CrowsCrows RavensRavens MagpiesMagpies JaysJays RaptorsRaptors SparrowsSparrows FinchesFinches BlackbirdsBlackbirds
Courtesy of Robert McLean, USDA
San Mateo County Mosquito San Mateo County Mosquito Abatement DistrictAbatement District
Located in BurlingameLocated in Burlingame Covers most of the CountyCovers most of the County
Extensive mosquito-control Extensive mosquito-control activities already underwayactivities already underway
Surveillance of various kindsSurveillance of various kinds Call 344-8592Call 344-8592
For AdviceFor Advice To report Mosquito To report Mosquito
infestationsinfestations To obtain free mosquito fishTo obtain free mosquito fish
Global TB BurdenGlobal TB Burden Every Day:Every Day:
25,000 people develop active TB25,000 people develop active TB 5,000 people die from TB5,000 people die from TB
In the next 20 years:In the next 20 years: Nearly one billion new TB Nearly one billion new TB infectionsinfections 200 million new cases of 200 million new cases of active diseaseactive disease 35 million 35 million deathsdeaths HIV and TB form a lethal combinationHIV and TB form a lethal combination
2002 World TB Rates (WHO)2002 World TB Rates (WHO)
2002 World prevalence HIV and TB co-infection2002 World prevalence HIV and TB co-infection
2002 Implementation of DOTS (WHO)2002 Implementation of DOTS (WHO)
TB EpidemiologyTB EpidemiologyInfection and Disease in CaliforniaInfection and Disease in California
Primary TuberculosisPrimary Tuberculosis
Post-Primary TuberculosisPost-Primary Tuberculosis
Healed TuberculosisHealed Tuberculosis
Electron Micrograph
SARS Coronavirus
Bioterrorism:Bioterrorism:The use of living microorganisms The use of living microorganisms
(bacteria, viruses and fungi) or toxins (bacteria, viruses and fungi) or toxins to produce death or disease in humans, to produce death or disease in humans, animals and plants that is designed to animals and plants that is designed to
cause panic and social disruption.cause panic and social disruption.
Cutaneous AnthraxCutaneous Anthrax
Photo: CDC
Man with smallpox. Public Health Images Library (PHIL) id# 131. Source: CDC/Barbra Rice
Smallpox: VaccinationSmallpox: Vaccination
1796 – Edward Jenner1796 – Edward Jenner Infected James Phipps, age 8 Infected James Phipps, age 8
with cowpoxwith cowpox No illness when deliberately No illness when deliberately
exposed to smallpoxexposed to smallpox Experiment repeated on other Experiment repeated on other
children, including his own children, including his own son.son.
Findings published in 1798Findings published in 1798 Concept spread rapidlyConcept spread rapidly
PlaguePlague
DETECTION CAPABILITIESDETECTION CAPABILITIES
DECONTAMINATIONDECONTAMINATION
Human Immunodeficiency VirusHuman Immunodeficiency Virus
Illness Antibiotic usually needed?
Cold NoFlu NoChest Cold (in healthy children and adults) NoSore Throats (except strep) NoBronchitis (in healthy children and adults) NoRunny Nose (with green or yellow mucus) NoFluid in the Middle Ear (otitis with effusion) No
2002 CDC STD Treatment Guidelines2002 CDC STD Treatment Guidelines
www.cdc.gov/std/treatment/www.cdc.gov/std/treatment/ Download it to your Palm Pilot!Download it to your Palm Pilot!
Comprehensive overview of common STD’s.Comprehensive overview of common STD’s. Prevention methods and messages.Prevention methods and messages. Addresses special situations of pregnancy, Addresses special situations of pregnancy,
adolescents, children, MSM, sexual assault.adolescents, children, MSM, sexual assault. 2002 California STD Treatment 2002 California STD Treatment
Guidelines.Guidelines. Note differences in GC treatmentNote differences in GC treatment Note legal permission to treat Chlamydia in Note legal permission to treat Chlamydia in
partners without exam.partners without exam.
Thank you!Thank you!
More Really Useful Information
Avian Influenza: www.cdc.gov/flu/avian/index.htmAvian Influenza: www.cdc.gov/flu/avian/index.htm Bioterrorism: www.bt.cdc.gov/Bioterrorism: www.bt.cdc.gov/ Influenza: http://www.cdc.gov/flu/Influenza: http://www.cdc.gov/flu/ SARS: www.cdc.gov/ncidod/sars/SARS: www.cdc.gov/ncidod/sars/ STDs: www.cdc.gov/STD/treatment/STDs: www.cdc.gov/STD/treatment/ Tuberculosis: www.ctca.orgTuberculosis: www.ctca.org West Nile Virus: West Nile Virus: http://westnile.ca.gov/links.http://westnile.ca.gov/links.htmhtm