Epidemiology for Amoebic Dysentery and Cancer- myassignmenthelp

Question: Discuss about theEpidemiology for Amoebic Dysentery and Cancer. Answer: A Notifiable disease can be any disease that has a legal obligation to be reported to the government/ public health authorities, when it is diagnosed since the disease can be potentially harmful to health (Gibnet et al., 2016). It is also known as reportable disease. Collected reports of this disease can allow its monitoring, and provide an early warning if an outbreak is imminent. Several governments have laws being enacted and enforced that stipulates reporting of diseases in both Humans and Animals (or livestocks). Some of the notifiable diseases (caused by bacteria and viruses) in Australia are: Anthrax, Botulism, Brucellosis, Cholera, Diphtheria, Leprosy, Leptospirosis, Pertussis, Plague, Salmonellosis, Shigellosis, Syphillis, Tetanus, Tuberculosis, Typhoid fever, AIDS, Arbovirus infections, Hepatitis, (A-E), HIV, Influenza, Measles, Poliomyelitis, Rubella, Small Pox and Yellow Fever. Other disease includes: Amoebic Dysentery, Cancer, Dysentr, Malaria, Giardiasis and Trichinosis , to name a few (Gibney et al., 2017). List of Australian websites that acts as repositories for information related to Notifiable disease: Department of Health, Australia (https://www.health.gov.au/casedefinitions) Department of Agriculture, Australia (https://www.agriculture.gov.au/pests-diseases-weeds/animal/notifiable) Database of notificable diseases, Australia (https://data.gov.au/dataset/national-notifiable-diseases-surveillance-system) Department of Health, Australia (https://ww2.health.wa.gov.au/Silver-book/STI-or-HIV-notification/Australian-national-notifiable-disease-case-definitions) Government of South Australia (https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/health+notifications/notifiable+disease+reporting) Northern Territory Government (https://health.nt.gov.au/professionals/centre-for-disease-control/cdc-programs-and-units/notifiable-diseases) Federal Register of Legislation, Australian Government (https://www.legislation.gov.au/Details/F2008L00800) Department of Agriculture and Fisheries, Australia (https://www.daf.qld.gov.au/animal-industries/animal-health-and-diseases/notifiable) Livestock Biosecurity Network, Australia (https://www.lbn.org.au/farm-biosecurity/notifiable-diseases/) Signs and symptoms of Tuberculosis (TB): Tuberculosis is a bacterial disease which can be fatal if not treated properly (Fogel, 2015). The bacterium (Mycobacterium tuberculosis) spreads via tine droplets released while coughing or sneezing, and affects the lungs. However tuberculosis infection can exist in a Latent or Active state. In the Latent stage, the bacteria remain in the body in an inactive and non-contagious stage, and exhibit no symptoms. However, the latent bacterium can become active in the body, causing the onset of symptoms (Getahun et al., 2015). In the Active stage, the bacterium is infective and can spread from person to person. The typical signs and symptoms at this stage includes: Cough that lasts for more than three weeks, discharge of blood during cough, pain in the chest and difficulty in breathing, weight loss, fatigue, fever, nocturnal sweats, chills and appetite loss. Symptoms of primary pulmonary tuberculosis include fever or dry cough, and are often temporary. People suffering from pulmonary disea se from Tuberculosis can develop Tuberculosis Pleuritis. The pleural disease can occur when the diseased area ruptures into the space between the lining of abdominal cavities, chest and lungs, causing chest pains (Khan et al., 2013). The TB bacterium can also spread to different parts of body via blood, in immune-compromised patients, causing military tuberculosis (symptoms: fever, weakness, appetite and weight loss, cough and difficulty breathing). Infections of the upper respiratory system causes symptoms like frequent coughs, with a progressively increasing amount of mucous produced, coughing of blood, fever, loss of appetite and weight, and nocturnal sweats. In rare cases, the bacterium can also develop in other organs like Lymph Nodes, Bones and Joints, Genitourinary tract, Meninges and the lining of GI tract. Disease Burden of Tuberculosis: Studies from 2012 and 2013 shows the rate of TB occurrence in Australian born population at 0.9 to 1.0 per 100,000 individuals. Indigenous Australians have shown to experience a greater burden (4.5 to 4.6 per 100,000 individuals) of the disease, compared to Non Indigenous Australians (0.7 to 0.8 per 100,000), showing an incidence that is six times higher. Compared to to other countries, the disease burden of Tuberculosis in Australia is low (that is, less than 10 reported cases per 100,000) along with Western Europe, USA, Canada and New Zealand (https://www.who.int, 2017). Data collected by National Notifiable Disease Surveillance System showed 1317 reported cases as of 2012 and 1263 as of 2013 (rate of 5.8 to 5.2 per 100,000). The overseas-born Australians however showed a much higher incidence of TB at 19.5 to 18.4 per 100,000 cases. Multi Drug resistant TB also shows a lower prevalence in Australia at 20 cases reported as of 2012 and 22 as of 2013, most of which were reported in t he overseas born Australians. Also, the disease burden of TB tends to be higher among children than healthy adults (Seddon Shingadia, 2014). Overall, Australia shows an excellent and sustained control of TB, and proves its commitment to alleviate the global burden of this disease. Contact Tracing- In the context of epidemiology, Contact Tracing refers to the process of identification follow up and diagnosis of individuals who came in contact with the infected individual(s) (Begun et al., 2013). This is a useful means of controlling infectious disease (like TB, HIV and STDs) and their epidemiologic investigation and surveillance (Sabat et al., 2013). The purpose of contact tracing is to detect the early symptoms in the contacts, monitor and treat them for disease. It can help in secondary prevention (preventing disease in the individuals exposed to it) tertiary prevention (preventing severe outcomes) and prevent or contain outbreaks. Contact tracing is done when mode of contact is direct contact (casual or sexual). A pre-test tracing of contact is needed when there is high level of concern for the patient, and waiting for the laboratory reports can be detrimental. A post test tracing of contact is done after diagnosis have been confirmed, and can reduce adverse effects to the e xposed contacts. Steps of contact tracing: Step 1: Clarifying the reasons to trace contacts- The patients needs to be made aware of asymptomatic infection, possible complications if not tested, risk of infection. This can ensure proper participation from the infected, and uphold the basic human rights. While clarifying the reasons, information must also be justified with currently known knowledge, keeping the individuals up to date. Step 2: Help to identify whos who needs notifications of the disease- The mode of transmission, and the duration of infective stage needs to be discussed. Tracing back of contacts since the relevant time period. This will allow understanding the extent of the spread, and finding ways to control it. Also, depending upon the proximity to those contacts, a proper method to communicate with them must also be devised. The mode of transmission can allow understanding how the infection spreads through the population, so that the risks can be managed. Once the possible infection cases are identified they can be screened to check if they are test positive for TB. Step 3: Explanation of the methods involved and offering choice- Notification of patients can be done by patient or provider referral. Working with patients to identify appropriate methods applicable to each of the listed contacts. Patient referral involves personal notification by the index patient to his/her contacts. Provider referral involves the healthcare providers advising the patient directly or through an agency. Referring the patients can allow the screening of these contacts for exposure and infection. It can also check if any further infection was spread by those individuals. Step 4: Support to the patient, and providing patient referral for future contact. Since the patient undergoing screening and treatment requires medical expertise, and improper treatment can lead to complications or re exposure, it is important to educate the contacts about the right procedures, and provide support to them when needed (https://www.health.gov.au, 2017). Identification of contacts allows identifying the initial case, identifying additional incidents among individuals in contact with the initial case, identifying individuals who might be infected due to contact with the initial case, providing counseling and assessment to those diagnosed with TB. Categorization of the case is needed as per the degree of infectiousness. Also categorization of contacts depending upon the risk of exposure allows identifying the high risk cases. Examination of medium risk cases should follow next if there is any evidence of transmission. Investigation of contacts requires noting down of the history, performing IGRA and/or TST or radiographic investigation when indicated (Balmelli, 2014). All the contacts tested positive for TST or IGRA needs to be referred to healthcare practitioners involved in diagnosis and treatment of TB, and treatment for LTBI should be considered. Young children with a history of immuno-supression and TST below 5 should be referred for TB diagnosis and treatment. Children below 5 years in household contact with individuals tested smear positive should be evaluated for infection. In special cases like in exposure inside Aircraft, schools, hospitals or healthcare centers, or during pregnancy, factors like the infectiousness of the initial or index case should be analyzed. Also the duration of exposure (like the travel time in aircraft, or school hours, or the time admitted in hospital where the infection occurred must be noted). Susceptibility of those who might have been infected must also be taken into consideration. A list of possible consequences that might ensue, must be made and shared with the concerned individuals. Any delay between the infection and screening should be taken into account, as with increased delays, the chances of further exposure also increases. In Australia, contact racing needs to adhere to section 71 of Public Health Act 1991. The sensitivity and circumstances that dictates contact tracing, as well as its scope must be clarified. Advice must also be sought from NSW Department of Health. Next the degree of infectiousness must be noted, based on clinical, bacteriological, radiological and nucleic acid tests. The degrees of infectiousness can be categorized as High Infectiousness (positive for sputum smear/ laryngeal involvement/ x ray of chest/ evidence of transmission to others), Medium Infectiousness (smear negative but positive for sputum culture or nucleic acid test, pleural disease, positive smear for bronchial wash) and Low Infectiousness (negative for sputum smear and culture). Determination of the infective period is important to identify the high risk groups for tracing. The infective period needs to be considered 3 months prior to the TB diagnosis, unless a clear set date of the onset exists. Assigning priority can be done based on naming risk groups (high risk, medium risk and low risk). High Risk groups would be those who have had regular and long contacts inside a closed environment during the infective period, and can include individuals in the same household, close relatives, friends, colleagues who are working closely in a small work area (Gao et al., 2016). Medium Risk groups would be those who would have frequent but lesser time spent with the infected and can include relatives, friends, schoolmates, colleagues, neighbors who are not in high risk group. Low Risk group would be the other contacts in workplace or school or other places that are not in High or Medium Risk groups. Risk groups for Tuberculosis also need to be identified. The chances of TB progressing from latent to infective stage is considerably higher in children who are below 5 years, who are suffering with HIV; people receiving 15mg or more of prednisone (or equivalent) for four or more weeks; people on immunosuppressive medication; people suffering from cancer/ diabetes mellitus/ silicosis/ and kidney failure; and people who underwent jejunoileal surgery or gastrectomy. The high risk contacts are to be screened the first. General Information on TB: Tuberculosis is caused by the bacterium Mycobacterium tuberculosis. The bacterium generally invades the lungs, but is also capable of infecting other organs. In its latent form, TB shows no symptoms, but has a 10% chance of progressing to active or infective form. The most common symptoms include chronic cough, sputum with blood, night sweats and fevers accompanied by loss of weight. The disease spreads via air (by sputum droplets discharged due to cough, sneeze or while speaking) from individuals who have infective stage of the bacterium in their lungs. According to WHO report on Tuberculosis in 2016, a total of 1376 cases (new and relapse) were reported in Australia. The rate of mortality from TB+ HIV were reported at 0.02 (per 100,000), and incidence of TB+HIV at 0.12 (per 100,000). Overall the disease burden of TB is Australia is very low, with the highest reported cases found among Overseas born or Non residential Australians. Infectiousness and Risk Factors of Tuberculosis: Tiny aerosol droplets (0.5 to 5.0 microns) up to 40,000 in number can be discharged while coughing or sneezing. With a small dose of infection (less than 10 bacterium to fully develop the disease), each of the infective droplet can potentially cause or spread the disease. People in constant contact with the infected are at a high risk of developing TB symptoms (Fox et al., 2013). An infected person can potentially spread the disease to an average of 10-15 people or more in a year. Transmission occurs only from only those people who have active TB, and the latent form is not contagious. The chances of the spread of infection depends upon several factors, like the number of infective droplets released, the ventilation condition inside the place where the droplets were released in the air, the length of exposure, the level of virulence of the bacterium (drug resistant/ multi drug resistant) and the immune condition of the individuals exposed. Risk Factors: People suffering with HIV are at the highest risk globally (Sester et al., 2014). Also, the disease is related closely in overcrowded places, especially when people are suffering from malnutrition, thereby making it a disease of poverty. Other risk factors includes people involved in drug abuse, those in contact with or working the infected individuals, economically poor or underprivileged societies, children who are exposed to the pathogen, ethnic minorities, healthcare professionals involved in TB treatment and management (Narasimhan et al., 2013). Chronic lung disease can also increase the chances on TB infection along with Silicosis and tobacco smoking. Certain diseases like diabetes mellitus can also be a risk factor for TB. In addition genetic susceptibility, medications like corticosteroids and alcoholism can increase the prevalence of the disease. High Risk groups: The high risk groups of contact tracing includes those who have had regular and long contacts inside a closed environment during the infective period, like individuals in the same household, close relatives, friends, colleagues who are working closely in a small work area. Foreign nationals who have emigrated from a country with high disease burden of TB in the last 5 years. Residents living in high risk settings (prisons, homeless shelters, nursing home, rehabilitation centers, healthcare centers). Healthcare professionals who are treating infected individuals. Low income groups or other groups who might be under serviced medically and high risk ethnic minorities. Children or infants or adolescents exposed to the disease. Also the risk of the disease progressing from the infective to non infective stage is higher in people with HIV infection, people already infected with TB in the last 2 years (specially infants or young children), people with existing medical conditions, people who were improperly treated for TB previously, and drug users (van Hest de Vries, 2016). Procedures for Household contacts: The Household contacts are at a high risk of developing the disease. Those exposed to highly infectious case needs to be screened in the span of 7 days from diagnosis. Those exposed to low or medium infective cases be screened by 2 weeks from diagnosis. Tracing of TB cases which are extra pulmonary can be done to identify the source or initial case. Contact screening should also be done when the infection is thought to be transmitted in the past. On the first visit, a clinical history needs to be recorded to clarify the risk of exposure, record the vaccination status for BCG, identifying symptoms related to TB, identifying any pre existing medical condition that can increase the risk of the disease, and identifying situations that can interfere with the result of TST. In the current scenario, the following measures are needed to screen contacts of the source case: The family members by screened for TB. Their BCG vaccination status and reported symptoms be noted. Any pre existing medical condition is noted. Rest period and chances of re infection: The patient would need a resting period of 6 months, during which he will have minimal contacts with the outside world, preferably in a private room, with sufficient ventilation. The isolation needs to be continued as long as 3 consecutively negative results occur in sputum smear test. During the resting period, contacts of the index case will still be at high risk, and therefore would have to undergo regular screening for the infection. Once the disease is successfully cured from the index case, there will be no chances of re infection. Therefore teachers and parents need not worry about being reinfected, once the recommended treatment procedure has been complied with (Horsburgh, Barry Lange, 2015). Guidelines for the control of Tuberculosis in Northern Territory and Victoria: The jurisdiction of Northern Territory comprises of Disease Control units in Darwin, Tennant Creek, Alice Springs and Nhulunby. The jurisdiction of Victoria is in the state of Victoria. In the Northern Territory jurisdiction, the cases are first categorized based on infectiousness. After this a list of contacts are obtained from the infected patients and arranged according to their risks. The high risk contacts are next identified, followed by medium and low risk individuals. If the case diagnosis is from an indigenous community, the treating staff needs to travel to such areas and help to educate the community, and assist contacts whenever necessary (https://digitallibrary.health.nt.gov.au, 2017). In the Victoria Jurisdiction, public nurses from The Victorian Tuberculosis Program are responsible for both contact tracing and investigation. The practices follow the protocols set by the Communicable Diseases Network of Australia (CDNA) via a series of National Guidelines, and are endorsed by AHPPC (Australian Health Protection Principal Committee (2013). The index case is identified by clinical presentations, symptom duration, disease site, bacteriological report and radiological report. Once the index case is identified, the high risk contacts are then identified, followed by medium and low risk contacts. The contacts have to then undergo clinical evaluation, tuberculin skin test (TST) or Interferon Gamma Release Assay (IGRA). The TST also needs to be repeated after 8-12 weeks. A chest X ray is done next, followed by contact follow-ups and any special categories also need to be identified (www.thermh.org.au, 2017). So, it can be seen that the northern territory employs an additional role of educating indigenous communities who are at high risk of TB, and providing support to them in their treatment. References: Balmelli, C., Zysset, F., Pagnamenta, A., Francioli, P., Lazor-Blanchet, C., Zanetti, G., Zellweger, J. P. (2014). Contact tracing investigation after professional exposure to tuberculosis in a Swiss hospital using both tuberculin skin test and IGRA.Swiss medical weekly,144, w13988-w13988. Begun, M., Newall, A. T., Marks, G. B., Wood, J. G. (2013). Contact tracing of tuberculosis: a systematic review of transmission modelling studies.PloS one,8(9), e72470. Dean, A., Zignol, M., Mecatti, F. (2015).Guidelines for surveillance of drug resistance in tuberculosis. World Health Organization WHO Press. 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Sociodemographic and geographical inequalities in notifiable infectious diseases in Australia: a retrospective analysis of 21 years of national disease surveillance data.The Lancet Infectious Diseases,17(1), 86-97. Horsburgh Jr, C. R., Barry III, C. E., Lange, C. (2015). Treatment of tuberculosis.New England Journal of Medicine,373(22), 2149-2160. https://digitallibrary.health.nt.gov.au. (2017).Cite a Website - Cite This For Me.Digitallibrary.health.nt.gov.au. Retrieved 2 November 2017, from https://digitallibrary.health.nt.gov.au/prodjspui/bitstream/10137/696/4/TB%20Guidelines%20May%202016.pdf https://www.health.gov.au. (2017).Department of Health | Tuberculosis notifications in Australia, 2012 and 2013.Health.gov.au. Retrieved 1 November 2017, from https://www.health.gov.au/internet/main/publishing.nsf/content/cda-cdi3902f.htm https://www.who.int. (2017).Cite a Website - Cite This For Me.Who.int. 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