ANSWER THE FOLLOWING DISCUSSION QUESTIONS. EACH DISCUSSION QUESTION SHOULD BE AT LEAST 200 WORDS.

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COH 320

Week 3

Risk Factors for Asthma

Worldwide Prevalence of Asthma

Disability Adjusted Life Years, Asthma, WHO, 2004

Risk Factors of Asthma

  • Combinations of risk factors have been found to significantly heighten the risk of developing asthma.
  • Many asthmatic patients report genetic or familial predisposition coupled with environmental exposure to inhaled substances that provoke allergic reactions or irritate the upper airways.
  • Asthmatic attacks can be stimulated by a wide variety of allergens and environmental factors.
  • Indoor allergens include tobacco smoke, house dust mites, pet dander, cockroach allergens and biomass smoke.
  • Outdoor allergens include pollen, mold and motor vehicle exhaust.
  • Infectious agents, particularly respiratory viruses, can stimulate asthmatic attacks.
  • Other agents known to cause asthmatic attacks include chemical irritants in the workplace, cold air, emotional stress, physical exercise, drugs and drug interactions, and certain foods and food additives.

Environmental Tobacco Smoke & Asthma

  • Results of epidemiologic studies provide compelling evidence that environmental tobacco smoke increases the risk of asthma in children.
  • Estimates from meta-analyses suggest that maternal smoking increases asthma risk by 60% and household ETS exposure increases the risk by 45% (Vork et al., 2007).
  • Some studies suggest that maternal or paternal asthma or hay fever combined with exposure to environmental tobacco smoke synergistically increase the risk of asthma in young children (Jaakkola et al., 2001).

Asthma & Obesity

  • Several prospective studies have examined associations between weight gain, obesity and the development of asthma in children and adults.
  • Children with high body weight either at birth or later in childhood are at increased risk for the subsequent development of asthma.
  • Results suggest 2 to 3-fold increases in the risk of adult onset asthma in obese adults compared to those of normal weight (Beuther & Sutherland, 2007).
  • “Higher BMI is associated with worse asthma control and quality of life but not asthma severity” (Lavoie, et al 2006)

Food Allergy/Household Cleaning Products and Asthma

  • Consistent epidemiologic evidence has accrued suggesting that symptomatic food allergies, particularly to milk, eggs and peanuts, significantly increase the risk of asthma development in children.
  • Occupational studies have found that asthmatic risk is significantly increased by chronic exposure to aerosolized irritants such as cleaning solvents (Delclos et al., 2007).

Vaccination & Childhood Asthma

  • In recent years, the prevalence of asthma has risen dramatically throughout the world, most notably in children of developed countries.
  • Since childhood immunization is routinely practiced in the industrialized world, the emerging burden of asthma in children has prompted studies of a possible etiologic link with immunization.
  • However, two studies show there is no link between routine immunization and the risk of asthma development in childhood (Destefano, et al., 2002 and Balicer et al., 2007). http://www.medscape.com/viewarticle/ 439840

China and their growing asthma cases

  • “China's Asthma Problem Is Bad—and Growing Worse”
  • There has been a dramatic increase in the incidence of asthma in China over the last 20 years, and estimates that the rates are up by as much as 40 percent over the last five years.
  • Shockingly, prevalence in some cities (such as Beijing) is as high as 11 percent and continuing to increase.

Malaria 101

Malaria

  • Malaria is a zoonotic infectious disease transmitted to humans by Anopheles species of mosquitoes.
  • The disease is caused by a plasmodium (microscopic worm) that is carried in mosquito saliva.
  • Humans become infected when an infected female mosquito inserts her long hollow needle-like proboscis through the skin and sucks up blood.

Malaria

  • Four species of malaria infect and cause disease in humans.
  • Severe life threatening malaria is most commonly caused by Plasmodium falciparum.
  • Other species, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae generally cause infections with milder symptoms that are rarely fatal.
  • Parasitic Plasmodium species also infect birds, reptiles, monkeys, chimpanzees and rodents.

Malaria

  • Malaria is caused by the proliferation of malarial parasites within red blood cells (erythrocytes), typically producing fever and headache and in severe cases progressing to anemia, coma and death.
  • Malaria is most common in tropical and subtropical regions of the world near the equator, including much of sub-Saharan Africa, Asia and Central America.
  • Significant rainfall and warm temperatures enable mosquitoes that serve as vectors of malarial transmission to breed continuously.

Malaria and It’s Storied Past

History of Malaria

  • In 2700 BC, the symptoms of malaria were accurately described in ancient Chinese medical writings in the Nei Ching, the Chinese Canon of Medicine.

History of Malaria

  • In 1880, Charles Louis Alphonse Laveran, a French army surgeon stationed in Constantine, Algeria, was the first to detect parasites in the blood of a patient suffering from malaria.
  • In 1897, Ronald Ross, a British officer in the Indian Medical Service, demonstrated that malaria parasites are transmitted to and from humans by mosquitoes.

History of Malaria

  • In further work, Ross showed that bird malaria is transmitted by mosquitoes and that the life cycle of the parasite involves a sporogonic cycle (the time interval during which the parasite developed in the mosquito).
  • Ross also described in great detail the use of bed nets to protect against malarial transmission by mosquitoes.
  • Chloroquine was discovered by Hans Andersag in 1934 at Bayer laboratories in Germany.

History of Malaria

  • Chloroquine was established as an effective and safe anti-malarial drug after World War II and is still being used today.
  • Nevertheless, many malarial strains have now developed chloroquine resistance (Jensen & Melhorn, 2009).
  • Fred Soper, an American epidemiologist and public health administrator, was called the “General Patton” of mosquito eradication.

History of Malaria

  • During 1927-1962, Soper directed successful campaigns in several regions of the world to eliminate malaria and yellow fever by draining swamps and spraying insecticides to eradicate the mosquito population by reducing their breeding sites.
  • One of his early successes was the total eradication of the Anopheles gambiae mosquito population and elimination of malaria from certain regions of Brazil (Gladwell, 2001).
  • Fred Soper also spearheaded the Global Malaria Eradication Program that helped eliminate the disease from the developed world and from many parts of the developing world.

History of Malaria

  • He was a strong advocate of the judicious use of the insecticide, dichloro-diphenyl-trichloroethane (DDT), to selectively eliminate species of Anopheles mosquitoes, the vectors of malaria transmission.
  • Soper directed massive campaigns to eliminate malaria by the eradication of plasmodium-infected mosquitoes and his efforts undoubtedly spared the lives of millions of people (Gladwell, 2001).
  • In 1955, members of the World Health Organization submitted an ambitious proposal at the World Health Assembly for the eradication of malaria worldwide.

History of Malaria

  • This global program involved house spraying with insecticides (DDT), anti-malarial drug treatment, and surveillance.
  • Though the initial efforts of this program were successful in some populations, it was eventually abandoned due to lack of funding and various other reasons.
  • Strong opposition to the use of DDT was voiced in the book “Silent Spring” by Rachel Carson who emphasized its persistence in the environment and potential for causing long term damage to the ecosystem (Gladwell, 2001).

Malaria and where Transmission is in Epidemic Proportions

Global Burden of Malaria

  • In 2006, the World Health Organization conducted a survey of 109 of its member nations and territories to characterize the global incidence, prevalence and mortality of malaria.
  • Results revealed that malaria causes 250 million cases of fever and nearly one million deaths annually.
  • Most cases (98%) were diagnosed in sub-Saharan Africa (86%), Southeast Asia (9%) or the Eastern Mediterranean region (3%).

Global Burden of Malaria

  • It is notable that more than half of all cases occurred in just five African countries (Nigeria, Democratic Republic of Congo, Ethiopia, United Republic of Tanzania and Kenya) (WHO, 2008).
  • Of the 250 million cases, 230 million (92%) were due to Plasmodium falciparum, and in Africa, 98% of cases were due to this strain of malaria.
  • Based on WHO reports, the vast majority of malarial deaths (91%) occur in sub-Saharan Africa and 85% occur in children under the age of five years of age.

Global Burden of Malaria

  • Pregnant women, individuals with HIV/AIDS and elderly individuals (over 65 years of age) are especially vulnerable accounting for 8%, 5% and 2% of malarial deaths, respectively.
  • Southeast Asia and the Eastern Mediterranean region each contribute about 4% of malarial deaths (WHO, 2008).
  • Using different methodology, Robert Snow and colleagues estimated the number of incident cases of Plasmodia falciparum malaria during 2002 to be 515 million, more than double the number reported by WHO in 2006.

Global Burden of Malaria

  • These investigators also suggest that a higher fraction of new cases (30%) occur outside of Africa.
  • They point out that the risk of death after a clinical attack of Plasmodium falciparum may be 10-fold higher in sub-Saharan Africa than nations outside of Africa, likely because of lack of access to prompt treatment (Snow et al., 2005).

Malaria
Disability Adjusted Life Years (DALY)

  • The Disability Adjusted Life Years (DALY) lost from malaria reflects the high burden of deaths in early childhood plus disability due to chronic infection, particularly neurological deficits due to cerebral malaria.
  • The highest DALY are evident in sub-Saharan Africa, similar to other infectious diseases of poverty such as tuberculosis and HIV/AIDS (WHO, 2008).

Disability Adjusted Life Years Malaria, 2007

Malaria and Those Greatest At Risk

Malaria
Identification of High Risk Groups

  • Some population groups are at considerably higher risk of contracting severe malaria than others. High risk groups include pregnant women, patients with HIV/AIDS, non-immune travelers, and in high transmission areas, children less than five years of age.
  • Such individuals warrant special measures for prevention and treatment of malaria and to mitigate their risk, consideration should be given to their specific circumstances and the tools and strategies available.

Malaria
HIV Co-infection

  • Co-infection with HIV has been found to increase the severity and case fatality of malaria in a number of studies.
  • A team of international investigators recently assessed the impact of co-infection by HIV-1 and malaria in 41 countries of sub-Saharan Africa.
  • Overall, the data suggest that the HIV-1 epidemic has increased the incidence of malaria by 1.3% and malarial deaths by 4.9%.

Naeglerwi fowleri 101

  • A freshwater ameba (single-celled living organism)
  • Rarely seen- 37 cases in a 10 yr. span
  • Commonly found in warm environments like lakes, rivers, and hot springs including manufactured water settings.
  • No set risk according to the CDC
  • One type attacks humans

N.f. continued

  • Cannot infect humans through the drinking of contaminated water.

  • Typically enters through the nose as its way into the body to go to the eventual end point- the brain

  • Not found in salt water

  • Cause of Primary Amebic Meningoencephalitis

N.f. continued

Naeglerwi fowleri- what it does to the body?

  • It goes after the central nervous system

  • Once in the brain, it goes after the brain tissue which causes massive swelling

  • The main issue is consumption of brain cells that make it almost impossible for modern medicine to use any type of effective treatments.

N.f.- How do we win the battle?

  • New treatments-
  • Miltefosine- an experimental drug that has had some effectiveness in fighting microbials. Unfortunately, it was used in vain with a young boy who did not make it.

  • Higher priority-
  • With only 130 cases since 1962, a greater regional declaration by local health departments to create a surveillance program of areas that could be possibly at risk may be the only way more emphasis is put on this deadly disease.

  • Increase awareness-
  • The majority of the cases have been seen in young people who were unaware of the possible dangers out there.