Yellow Fever Presentation PDF

Objectives (Learning outcomes) Definition Yellow fever Mode of transmission Manifestation Prevention &control A communicable arthropod-borne viral hemorrhagic YELL...

Objectives (Learning outcomes) Definition Yellow fever Mode of transmission Manifestation Prevention &control A communicable arthropod-borne viral hemorrhagic YELLOW FEVER quarantinable acute disease of short duration & varying severity. Causative agent: Yellow fever virus.  How Egypt is protected from Yellow Fever: Reservoir: Sylvatic or Jungle yellow fever: main reservoir in forest area is vertebrates other than human mainly monkeys & vector is forest mosquitoes (haemagogus species). Human has no essential role in Absence of yellow fever in Egypt & its rarity in other areas transmission of yellow fever. {Sylvatic is a scientific term referring to diseases or pathogens affecting only wild such as Eastern Africa despite wide spread of vector aedes (sylvan means forest-dwelling) animals. Egypti may be due to cross immunity from other flavi virus The word "sylvatic" is also simply a synonym for "sylvan" = "of the forest“}. (e.g. dengue, west Nile, Japanese encephalitis) in population which may be providing an (ecological barrier). Urban yellow fever: reservoir is human & vector is Aedes aegypti mosquitoes. Period of communicability: No man-to-man transmission. Mode of transmission: Blood of man is infective to mosquito shortly during late IP & during Urban yellow fever: bite of infective female Aedes aegypti first 3-5 days of disease. mosquitoes. Sylvatic or jungle yellow fever: bite of several species of genus Haemagogus. In mosquitoes after biting an infected person there is 9-12 days extrinsic IP, then the mosquito becomes infective all over its life. There is also trans-ovarian transmission which may contribute to IP: 3-I0 days (6 days in international health regulation). maintenance of infection.  Transmission Susceptibility & resistance: 1-Age & sex: all ages & both sexes are susceptible. flaviviridea 2.Immunity: infection is followed by absolute immunity, 2nd attacks are unknown. Transient passive immunity to inborn infant of immune Virus mother occurs for up to 6 ms. Diana monkey 3.Occupation: Woodcutter, Hunter. Zoonotic virus IP Symptoms Clinical features: 3- 10 days - Mild form: sudden onset, fever,headach,maliase and anorexia (FHMA), chills, muscle pain, prostration, nausea & vomiting. Influenza like - Faget sign: slow pulse out of proportion of elevated temperature. Go to fullsize image - Jaundice is moderate early in disease & intensified later. - Albuminuria or anuria may occur, leucopenia. Hepatic - Most of the manifestations resolve after 5-7 days. - After a brief remission of hours to a day some cases progress to severe form (hemorrhagic symptoms including epistaxis, gingival bleeding, haematemesis (coffee ground or black) melena, liver & Death Hemorrhagic renal failure). 20-50% illness - Fatality rate of jaundiced cases may reach 20-50%.  Diagnosis: 1. Isolation of virus from blood by inoculation of suckling mice, mosquito or cell culture. 2. ELISA “viral antigen in blood”. 3. PCR “viral genome in blood & liver tissue”. 4. Serologic diagnosis “specific IgM in early sera or rise in titer of specific antibodies”. Prevention & control Prevention: General: 1) Environmental sanitation: A) Eradication or control of Aedes Aegypti: i. Anti-larval ii. Anti-adult measures iii. Jungle mosquitoes “impractical”. Personal protective B) Human protection against mosquitoes: e.g. protective clothing, Vaccine bed nets, repellents. 17 D vaccine measures 2) Health education: modes of transmission.  Specific: 1) Immunization: a) Active Immunization: “most effective preventive measure” Individual measures for control - 17 D vaccine: of mosquito bite Live attenuated vaccine “non virulent strain cultivated on chick embryo & subsequently freeze dried”. Vaccine is stored at -25°C. Single dose, 0.5ml, S.C. injection. 99% immunity: International health regulation considered vaccine effectiveness to start after 10days & persists for 10 years & then re-immunization is required. No or minimal reaction “1st 4 ms of life....vaccine associated encephalitis”. Given to: - International travelers coming from or going to endemic countries. - Since 1989 WHO has recommended that at risk countries in Africa that fall in the endemic belt should incorporate it into their routine childhood immunization program after 6 month. Dakar vaccine: - Live attenuated neurotropic virus. - It is produced in mouse brain & administered by cutaneous scarification. - It is not approved by WHO for international use as it leads to encephalitis.  International measures: It is one of quarantinable diseases & following measures should be done to prevent introduction of yellow fever from endemic area (Yellow Fever belt) into receptive area (areas free of yellow fever, but the vector is present & population is susceptible e.g. in Egypt): * Notification within 24 hs by governments to WHO. * Valid vaccination certificate: a. Is required from all international travelers including children coming from or going to endemic areas "Yellow Fever belt". ❑Disinfection of any aircraft leaving an endemic area for receptive area, by b. Validity starts 10 days after primo-vaccination & lasts for 10 ys. aerosol spray of suitable insecticide, shortly before departure and also on c. Validity starts on same day after re-vaccination & lasts for 10 ys. arrival. d. If no certificate is available: traveler is isolated for 6 days from date of leaving endemic area. ❑Quarantine of imported monkeys. e. If traveler arrives before 10 days of vaccination, i.e. certificate is not valid yet: traveler is isolated until certificate becomes valid or until end of international IP calculated from day of leaving last endemic area. f. Traveler is quarantined in mosquito-proof accommodation in airport. g. This certificate is required by many countries including Egypt.  Achievement of targeted LOs References ▪ defination √ 1.Last JM. A Dictionary of Epidemiology. New York: Oxford Press, 1988. 2. Robertson S. Yellow Fever; The Immunological Basis for Immunization 8. WHO/EPI/GEN/93.18. Geneva, ▪ Mode of transmission √ Switzerland, WHO, 1993. 3. Division of Epidemiological Surveilance and Health Situation and Trend Assessment. Global Health Situation and Projections: Estimates. Geneva, ▪ Manifestation Switzerland, WHO, 1992. 4. Monath T. Yellow Fever. In: Monath T, editor. The Arboviruses;Epidemiology and Ecology. Boca Raton, Florida: ▪ Prevention &controle √ CRC Press, 1988; 139-231. 5. Meegan JM. Yellow fever vaccine. WHO/EPI/GEN/91.06. Geneva, Switzerland, WHO, 1991. ▪ √ 6. Simpson DIH. Arbovirus infections. In: Cook GC, editor. Manson’s Tropical Diseases. Bath, UK: Saunders, 1996; 637-42. 7. Ministry of Health, Government of Kenya. Field Guide for Yellow Fever Surveillance. Nairobi, Kenya, 1996.  Non communicable diseases (HTN &I H D) By Ahmed Ezzat THANK YOU Assistant prof of community &industrial medicine Objectives Definition Definition characteristics of Non communicable diseases risks factors associated with non-communicable Non-communicable diseases are usually diseases Reason for increase of non-communicable chronic conditions that do not result from an diseases in Egypt infectious process. Not transmitted from Hypertension & clinical picture &complication person to person Ischemic heart diseases &clinical picture &complication - These conditions cause death, dysfunction, prevention of hypertension & ischemic heart or impairment in the quality of life, and they diseases usually develop over relatively long periods. Non communicable diseases Characterized The six leading risks factors associated with by: non-communicable diseases: - Non contagious origin 1. Tobacco Use - Multiple risk factors 2. Physical Inactivity - Long latency period 3. Overweight/Obesity - Prolonged course of illness 4. High Blood Pressure - Functional impairment or disability 5. High Cholesterol Levels 6. High Blood Glucose Levels Types of non-communicable diseases: Reason for increase of non-communicable diseases in Egypt 1- Cardiovascular diseases as hypertension, 1-Increase in the life expectancy. rheumatic heart and coronary heart disease 2-Increase incidence of the traffic injuries, 2- Tumors as breast cancer, lung cancer or 3- Life-style changes: smoking and cancer bladder malignancy. 4- Physical Inactivity: Lack of physical activity 3- Endocrinal diseases as diabetes mellitus. and sedentary life, obesity, 4- Accidents and injuries. 5- Social and Behavioral factors Nutritional deficiency diseases as 6- Cultural factors as Noise and osteomalacia and rickets. overcrowdings which may lead to  Hypertension and hypertensive heart disease Hypertension is a disease of high blood pressure Systolic B.P above average for age and sex for adult at rest. When the individual exceeded is considered Diastolic B.P hypertensive.