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Evolution of New and Old Disease

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Submitted By RahulKesavan
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Evolution of New and Old Communicable Diseases
According to Gordis (2004), epidemiology is defined as “the study of the distribution and determinants of health related states and event of diseases in specified populations and the application of this study to control of health problems”.
Severe acute respiratory syndrome (SARS) is contagious and potentially life threatening form of pneumonia which was first detected in February 2003 in Asia and it spread to various countries in Europe, North America and South America before it was declared as SARS 2003 global outbreak (Centers for Disease Control and Prevention, 2004).
SARS is an acute respiratory tract illness caused by an infectious virus transmitted from person to person. Various pathogens that cause acute respiratory diseases are respiratory syncytical virus, parainfluenza virus, influenza virus and severe acute respiratory syndrome-associated coronavirus (SARS-CoV) (WHO, 2007).

In 2003, various scientists across the world started investigating the virus with the help of electron microscopy and virus discovery microarrays. The new coronavirus was inoculated in monkeys which caused interstitial pneumonia similar to SARS (Holmes, 2003). This newly identified acute viral respiratory syndrome caused by a novel coronavirus is a positive-stranded RNA virus with genome containing nucleocapsid protein, membrane proteins and spike protein which forms the typical “coronavirus” structure (Lashley & Durham, 2007).
Spreading of the SARS virus is due to close human-to-human contact such as direct contact with respiratory secretions or body fluids of a patient infected with SARS and eating or drinking with them from the same utensil. The virus that causes SARS is thought to be transmitted most readily by respiratory droplets (droplet spread) produced when an infected person sneezes or coughs and the droplets get deposited on the mucous membranes of the nose, mouth or eyes of people in a close distance. Touching one’s mouth, nose or eyes after touching an object or surface contaminated with the infectious droplets can also spread the virus (CDC, 2004). This makes SARS CoV highly transmissible in health care settings. The incubation period lasts for about 5 days and can vary from 2-10 days (WHO, 2007).
Persons infected with SARS-CoV displayed symptoms such as high temperature (380C or more), chills, fatigue, headaches and diarrhea. These systems persist for around 3-7 days, after which the respiratory system starts getting severely affected. These persons should be immediately admitted to the hospital and kept in isolation under close observation (National Health Service [NHS], n.d.).
There were no vaccines or antiviral drugs available for the absolute cure of this disease, but scientists and virologists are in the ongoing research in developing the new drug (NHS, n.d.).
At the time, supportive treatment was given to infected SARS patients such as breathing assistance with the help of ventilators to deliver oxygen, antibiotics to treat pneumonia caused by the bacteria, high dose of steroids to reduce the swelling in the lungs (NHS, n.d).
In the Guangdong Province of China the Chinese healthcare officials reported 319 new cases of SARS and 9 deaths during February 2003 and within the span of six months the World Health organization officially reported that infected people during the epidemic had drastically increased to 8,500 with death toll about 813 worldwide. It shows that the virus had killed 1 in 10 infected people (WHO, 2007). The fatality rate of diagnosed patients infected with SARS coronavirus was 9 to 12% and was higher than 50 % in cases of adults over the age of 65, while it was milder in younger patients (WHO, 2003).

Technology has quickened the pace of globalization. WHO refers to globalization as “a process of growing interdependence that represents a fundamental change from a world of individual and independent states to a world of state interdependence” (WHO, n.d.).

The initial transmission of the SARS-CoV infection by the traveler from Taiwan had considerably infected a large number of people and health care workers working in close contact with him, spurring the epidemic in that country. This infection of the SARS virus continued to spread rapidly in different areas and eventually to 30 different countries across the world (Chan, n.d).

According to the WHO, travelling on an international voyage had been one of the main risks concerned with the transmission of SARS to the passengers and the crew in the aircraft from an area of a local transmission. The main factor in reducing the risk for the crew and the passengers is them being well aware about the major signs of SARS such as high fever, breathlessness and cough (WHO, n.d.).
WHO officials recommended that public health authorities initiate exit screening steps in the regions where the local transmission of SARS has recently occurred. These methods include temperature check for all passengers and crew, preventing infected or contacts of probable SARS cases to travel (international or national) within the period of 10 days following exposure. Handling of the baggage or goods does not spread the infection, as the major transmission route is close human to human contact with the SARS infected person (WHO, 2003).
The incubation period for different bacteria and viruses is larger than the travel time for the transcontinental aircraft trip. As a result in the modern era of air travel, infected people could possibly be asymptomatic during the journey or before reaching their destination. The various routes through which the pathogens may enter the population of the cities and the inhabitants of people have doubled due to the emergence of a dynamic interconnected network known as global cities (Ali & Keil, 2006)
SARS has caused significant disruption and economic loss to the world economy and reduced the worldwide gross domestic product income by 40 billion dollars in the 2003 outbreak (Lee & Mckibbin, 2004).
The outbreak of SARS had high impact on the public health. Various factors have been associated with the emergence of this infectious disease such as increased international travel and trade, sharing an environment with animals or birds, health expenditures and sanitary conditions, climatic changes in the environment and microbial adaption. These different factors can aid the transmission of infectious agents from human to human and from animal to human.
Standard precautions must be maintained for the early recognition, isolation and reporting of the spread of SARS infection. Infection control precautions such as maintaining proper hygiene and waste management, usage of personal protective equipment (PPE) like wearing gloves, gowns, aprons and facial mucosa protection, droplet and airborne precautions should be undertaken. Patient admitted in the hospital should have proper environmental ventilation and during the transportation of the patients inside health care facilities, the exposure to staff, other visitors or patients should be minimized. Standard precautions with the use of PPE during mortuary handling and post-mortem examination are also important after the death of the patient and must be followed by the health care worker. (WHO, 2007)
These precautions, control measures, isolation and reporting of the infected patients with SARS of potential concern are vital aspects for the containment of these infectious diseases. It is also important to maintain close surveillance of health care workers from the initial stage and during the outbreak of new infectious pathogens. It might be a major source of information about the mode of transmission both for the healthcare and community associated transmission (WHO, 2007).
It is extremely difficult to predict when or whether re-emergence of SARS epidemic might occur. The 2003 epidemic of the SARS infectious disease which was characterized by “superspreading actions” seeded the outbreaks in the People’s Republic of China, the Hong Kong, Taiwan, Canada, Viet Nam and Singapore (CDC, 2004).
Increased transmission of SARS overloaded the health care and public health organizations of not only the affected countries but also those which were not affected. In the coming future, if this infection recurs, early identification of affected individuals will be vital for the cessation of international spread of this disease.

Reference:
Ali, H., & Keil, .R.(2004). Global Cities and the Spread of Infectious Disease: The case of Severe Acute Respiratory Syndrome (SARS). Retrieved from http://www.yorku.ca/sars2003/GlobalCitiesAndTheSpreadOfInfectiousDisease.pdf

Chan, L.,W.(n.d.). The Social Impact of SARS: Sustainable Action for Rejuvenation of Society. Retrived from http://web.hku.hk/~bhealth/Documents/articles/YPSY0006/Social_Impacts_of_SARS.pdf

Center for Disease Control and Prevention,[CDC] (2004). Department of health and human service center. Retrieved from http://www.cdc.gov/sars/about/fs-SARS.pdf
Gordis , L., (2004). Epidemiology (3rd ed.). Pennsylvania, USA: Elsevier Saunders.

Holmes, K. V., (2003). SARS coronavirus: a new challenge for prevention and therapy. Journal of Clinical Investigation, 111(11), 1605-1609. doi: 10.1172/JCI18819.
Retrieved from http://www.jci.org/articles/view/18819

Lashley, F. R., Durham, J. D. (2nd ed.). (2007). Emerging infectious diseases: Trends and issues. New York, NY: Springer Publishing Company.

Lee, J. W., & Mckibbin, W. J. (2003). Globalisation and Disease: the case of SARS. Asian Economic Panel Meeting. Tokyo, Japan. Retrieved from http://www.brookings.edu/~/media/research/files/papers/2003/5/20development%20lee/20030520.pdf MedlinePlus (n.d.). Severe acute respiratory syndrome (SARS). Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007192.htm NHS Choices, (n.d.). SARS (severe acute respiratory syndrome). Retrieved from the website http://www.nhs.uk/conditions/SARS/Pages/Introduction.aspx World Health Organisation [WHO] (2007). Epidemic-prone and pandemic-prone acute respiratory diseases. Retrieved from http://www.who.int/csr/resources/publications/ICHC_booklet_FINAL.pdf
World Health Organisation [WHO](2007). Infection prevention and control of epidemic-and pandemic-prone acute respiratory diseases in health care. Retrieved from http://www.who.int/csr/resources/publications/WHO_CDS_EPR_2007_6c.pdf

World Health Organisation [WHO] (2004). WHO guidelines for the global surveillance of severe acute respiratory syndrome (SARS). Retrieved from http://www.who.int/csr/resources/publications/WHO_CDS_CSR_ARO_2004_1.pdf
World Health Organisation [WHO], (2003). Alert, verification and public health management of SARS in the post-outbreak period. Retrieved from http://www.who.int/csr/sars/postoutbreak/en/

World Health Organisation [WHO] (n.d.). Globalization Trade, foreign policy, diplomacy and health. Retrieved from http://www.who.int/trade/glossary/story043/en/index.html World Health Organisation, (2003). Summary of SARS and air travel Retrieved from http://www.who.int/csr/sars/travel/airtravel/en/

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