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