and PREVENTION Prof Dr Levent AKIN Faculty of Medicine Public Health Dept E mail leventahacettepeedutr Figure 142 Normal Microbiota Of The Human Nasal Cavity 8222017 ID: 1034657
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1. BIologIcal rIsk factors and PREVENTIONProf. Dr. Levent AKINFaculty of MedicinePublic Health Dept.E mail: leventa@hacettepe.edu.tr
2. Figure 14.2 Normal Microbiota Of The Human Nasal Cavity
3. 8/22/20173
4. AgentHostEnvironment Age Sex Genotype Behaviour Nutritional status Health status Infectivity Pathogenicity Virulence Immunogenicity Antigenic stability Survival Weather Housing Geography Occupational setting Air quality FoodFactors Influencing Disease Transmission8/22/20174
5. Factors That Influence ExposureBehavioral factorsFamilial exposureHospitalizationHygienic habitInstitutionalization ( nurseries, day care center )Military serviceOccupationRecreation, sportsSexual activitySocioeconomic levelTravel8/22/20175
6. Factors That Influence Infection Occurrence and Severity of DiseaseAge at time of infectionAlcoholismAnatomic defectAntibiotic resistanceAntibiotin in tissueCoexisting disease, especially chronic diseasesEntry portal of organismPresence of trauma Genetic makeupImmune state at time of infectionNutritional statusReceptors for organism on cell needed for attachment 8/22/20176
7. BacteriaVirusesRickettsiaeFungiParasitesInfectious Agents (Mainly)8/22/20177
8. BACTERIASimple, one-celled organismsCocci, bacilli, spirillaSome are pathogenic, some are harmless, some are even useful8/22/20178
9. VIRUSES8/22/20179Smallest known organismsLiving (?) non-cellular entitiesAre “obligate parasites” & cannot survive without living cells
10. RICKETTSIAE8/22/201710Bacteria-like but smallerAre obligate parasitesTransmitted to humans via bloodsucking arthropods (fleas, ticks & lice) or through the air
11. FUNGI8/22/201711Broadest spectrum among biological agentsAre either parasitic or saprophyticHypersensitivity due to inhaled fungal antigensFungal disease is rare but includes ringworm & athlete’s foot
12. PARASITESParasitic to plants or animalsDiseases include malaria and other blood and gastrointestinal infectionsDermatitis and other skin-related ailments due to mites and chiggers, etc.8/22/201712
13. Important Communicable Disease ThreatsAir-borne Diseases:Tuberculosis (TB)MeaslesInfluenzaHantavirusesChickenpoxLegionellaVarious types of meningitisPlague (Pneumonic)Food/Water borne DiseasesHepatitis A, ETyphoid FeverSalmonellosis, ShigellosisCholeraAmebiasis, GiardiasisPolioIntestinal parasitesAcute gastroenteritis8/22/201713
14. Important Communicable Disease Threats ..Blood-borne DiseasesHepatitis B,CHIV/AIDHemorahagic feverEbola-Crimean CongoPlague (Septicemia)Vector-borne DiseasesPlague (Bubonic)RabiesMalariaDengue FeverYellow FeverEncephalitisLyme Disease8/22/201714
15. The Following Agents Are Classified AsCarcinogenic To Human (Group 1) By The IARC (The International Agency For Research On Cancer):1) Clonorchis sinensis 2) Epstein-Barr virus;3) Helicobacter pylori 4) Hepatitis B virus;5) Hepatitis C;6) Human immunodeficiency virus type 17) Kaposi sarcoma herpesvirus;7) Human papillomavirus types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 (in order of magnitude in risk for cervical cancer);8) Human T-cell ymphotropic virus type 1;9) 10) Opisthorchis viverrini 11) Schistosoma haematobium 8/22/201715
16. Dynamics of Disease Transmission (Chain of Infection) Disease is the result of forces within a dynamic system consisting of:SourceTransmissionSusceptible host 8/22/201716SourceHostTransmission
17. There are actually many professional activities involving a biological hazard in various fields Health care,Agriculture, Forestry, Zoo technology, Food, veterinary, Biotechnology, Treatment and waste disposal8/22/201717
18. Safety and health at work has identified the following ten emerging biological risks:1) Occupational risks related to global epidemics;2) Difficult assessment of biological risks;3) Workers exposure to drug-resistant microorganisms;4) Lack of information on biological risks;5) Poor maintenance of air-conditioning and water systems;6) Inadequate OSH (occupational safety health) training of local authorities staff;7) Biohazards in waste treatment plants;8) Combined exposure to bioaerosols and chemicals;9) Endotoxins;10) Moulds in indoor workplaces.8/22/201718Kaynak: European Union (EU) Expert forecast on emerging biological risks related to occupational safety and health (OSH). http://riskobservatory.osha.europa.eu/risks/ forecasts/biological_risks. Accessed June 13, 2017.
19. Becoming Established: Step One- Portals Of EntryMicrobe enters the tissues of the body by a portal of entryUsually a cutaneous or membranous boundaryNormally the same anatomical regions that support normal biotaSource of infectious agentExogenousEndogenous8/22/201719
20. Infectious Agents that Enter the SkinNicks, abrasions, and puncturesIntact skin is very tough- few microbes can penetrateSome create their own passageways using digestive enzymes or bitesExamplesStaphylococcus aureusStreptococcus pyogenesHaemophilus aegyptiusChalmydia trachomatisNeisseria gonorrhoeae8/22/201720
21. The Gastrointestinal Tract as PortalPathogens contained in food, drink, and other ingested substancesAdapted to survive digestive enzymes and pH changesExamplesSalmonella, Shigella, Vibrio, Certain strains of Escherichia coli, Poliovirus, Hepatitis A virus, Echovirus, Rotavirus, Entamoeba hitolytica, Giardia lamblia8/22/201721
22. Slide 22The fecal-oral route is the primary route of infection for foodborne microorganisms
23. The Respiratory Portal of EntryThe portal of entry for the greatest number of pathogensExamplesStreptococcal sore throat, Meningitis, Diphtheria, Whooping cough, Influenza, Measles, Mumps, Rubella, Chickenpox, Common cold, Bacteria and fungi causing pneumonia8/22/201723
24. Exposure to bioaerosols* is considered very dangerous in workplaces. Bioaerosols contain a variety of airborne microorganisms, including moulds and endotoxins, and various inflammatory and allergic diseases in exposed workers are attributed to their inhalation. *: a tiny, airborne particle that is composed of or derived from biological matterRef: (Biological Risk and Occupational Health, Industrial Health 2012, 50, 326–337)8/22/201724
25. Urogenital Portals of EntrySexually transmitted diseases (STDs)Enter skin or mucosa of penis, external genitalia, vagina, cervix, and urethraSome can penetrate an unbroken surfaceExamplesSyphilisGonorrheaGenital wartsChlamydiaHerpes8/22/201725
26. Pathogens that Infect During Pregnancy and BirthSome microbes can cross the placenta (ex. the syphilis spirochete)Other infections occur perinatally when the child is contaminated by the birth canalTORCH (toxoplasmosis, other diseases, rubella, cytomegalovirus, and herpes simplex)8/22/201726
27. Slide 27A healthy human is covered with microorganismson hair (incl. beards and mustaches)in the nosein the mouthon the skinunder the nails8/22/2017
28. Slide 28The Human Gastro-intestinal Tract Excretes Microorganisms1 kgexcretion8/22/2017
29. The Portal of Exit: Vacating the HostFigure 13.88/22/201729
30. Exit Portals Respiratory and Salivary PortalsCoughing and sneezingTalking and laughingSkin ScalesFecal ExitUrogenital TractRemoval of Blood or Bleeding8/22/201730
31. Bloodborne Pathogens SourcesBloodBody Fluids:semen, vaginal secretions, spinal & joint fluids, fluids contaminated with blood, human tissue other then intact skin.TearsVomitUrineFeces8/22/201731
32. Routes of TransmissionDirect Skin-skin Herpes type 1 Mucous-mucous STI Across placenta toxoplasmosis Through breast milk HIV Sneeze-cough InfluenzaIndirect Food-borne Salmonella Water-borne Hepatitis A Vector-borne Malaria Air-borne Chickenpox(www)8/22/201732
33. InfectionSusceptibleSusceptibleDynamics of infectiousnessDynamics of diseaseIncubation periodSymptomaticperiodNon-diseasedLatentperiodInfectious periodNon-infectious InfectionTimeTime(www)Timeline for Infection8/22/201733
34. Symptoms of InflammationFever, pain, soreness, swellingEdemaAbscessesLymphadenitisLesion: the site of infection or diseaseSigns of Infection in the BloodChanges in the number of circulating white blood cellsLeukocytosisSepticemia: general state in which microorganisms are multiplying in the blood and are present in large numbersBacteremia or viremia: microbes are present in the blood but are not necessarily multiplying8/22/201734
35. 35The Public Health Agency of Canada (PHAC) has defined 4 levels of risk in classification of organisms:RISK GROUP 1 (low community and low individual risk of disease) Any biological agent that is unlikely to cause disease in health workers or animals. Agents that pose little or no risk are assigned to Risk Group 1. Examples: Lactobacillus spp., Bacillus subtilis, Naegleria gruberi, Micrococcus spp., E. coli K128/22/2017
36. 36RISK GROUP 2 (low community risk and moderate individual risk to disease) can cause human disease, but under normal circumstances is unlikely to be a serious hazard to laboratory workers, the community, livestock or the environment lab exposures rarely cause infection leading to serious disease, effective treatment and preventive measures are available and the risk of spread is limited.Examples: Escherichia coli 0157:H7, Hepatitis B virus, Toxoplasma spp, HIV (non-cultured), Salmonella typhimurium, Measles, Mumps, Adnoviruses, Influenza viruses
37. 37RISK GROUP 3 (low community risk and high individual risk to disease)causes serious human disease or can result in serious economic consequences but does not ordinarily spread by casual contact from one individual to another, or that causes diseases treatable by antimicrobial or antiparasitic agents.Examples: Hantavirus, Yersinia pestis, Bacillus anthracis, HIV (cultured isolates) Bacillus anthracis, Mycobacterium tuberculosis, Creutzfeldt-Jakob
38. 38Risk Group 4 (agents with extremely high community and individual risk pose the greatest risk are assigned to Risk Group 4. usually produces very serious human disease, often untreatable and may be readily transmitted from one individual to another or from animal to human or vice-versa directly or indirectly or by casual contact. Examples: Marburg virus, Ebola virus, Crimean-Congo hemorrhagic fever virus8/22/2017
39. GENERAL MEASURES for the PREVENTION and CONTROL of INFECTIOUS DISEASES Primary prevention: All precaution before exposure to agentHealth promotionSpecific preventionSecondary prevention: All interventions after exposure to eliminate the agent from the body and to prevent illness8/22/201739
40. Primary preventionPrimary prevention can be defined as the action taken prior to the onset of disease, which removes the possibility that the disease will ever occur.Primary prevention may be accomplished by measures of “Health promotion” and “specific protection”8/22/201740
41. 8/22/201741Primary preventionSpecific protectionHealth promotionAchieved byHealth educationEnvironmental modificationsNutritional interventionsLife style and behavioral changesImmunization and seroprophylaxisChemoprophylaxisUse of specific nutrients or supplementationsProtection against occupational hazardsSafety of drugs and foodsControl of environmental hazards, e.g. air pollution
42. Secondary preventionIt is defined as “ action which halts the progress of a disease at its incipient stage and prevents complications.”The specific interventions are: early diagnosis (e.g. screening tests, and case finding programs….) and adequate treatment.8/22/201742
43. Prevention & Control ElementsSecure & maintain sources of clean waterProper sewage & infectious waste disposalAdherence to safe food practicesEducationPPE: Personal Protective Equipment (respirators, gloves, outer clothing)Conscientious Personal Hygiene Appropriate immunizations Universal Precautions8/22/201743
44. EXAMPLE:BLOOD-BORN EXPOSURE8/22/201744
45. Bloodborne Pathogens ExposuresBlood or body fluid must be contaminatedSkin breakscuts, scraps, dermatitis, acneSplasheseye, mouth, nosePenetration (injection)needle stick8/22/201745
46. Bloodborne Pathogens PPEs*GlovesEye protection (goggles)Face shieldsRespirator protectionProtective clothinggowns, coveralls, apronsHand washing* Personal Protective Equipments 8/22/201746
47. Universal PrecautionsFor Bloodborne PathogensAll blood & body fluids are considered potentially infectious.Use of Personal Protective Equipment (PPE)Disposal of sharps in approved containers.No eating, drinking, smoking, applying cosmetics, handling contact lens.Separate food and potentially infectious materials.8/22/201747
48. Further ReadingHalk Sağlığı Temel Bilgiler. Ed: Çağatay Güler, Levent Akın, Hacettepe Üniversitesi Yayını. 2015.Control Of Communicable Diseases Manual, APHA, G. C. Benjamin, Published Online: January 19, 2016 Controlling exposure : protecting workers from infectious disease. Workers’ Compensation Board of British Columbia, RA450.B7C66 20098/22/201748