29/06/2014

Prevention is better than cure:

The transmission and control of infection - the
application of knowledge

Prof. J.M. Goldsmid

Discipline of Pathology
University of Tasmania
CAM 305 2/7/14

Transmission and control of

tropical infections
The aim of this lecture is
to have an interactive
discussion on the ways
in which infections are
transmitted and how this
knowledge can be used
to control them in the
tropics.

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Introduction
A knowledge of the epidemiology of an
infectious disease (including how it is
transmitted) is crucial when devising a
control strategy.
Infectious disease - any disease caused by a
microorganism (not necessarily
transmissible)
Contagious disease - transmissible
infectious disease
Transmissible disease - disease which is
transmissible (not necessarily infectious eg
TDFTD; BSE)

Note
Endogenous infections are non-contagious
diseases caused by micro-organisms and
which arise from the hosts own normal flora
either by overgrowth or by colonisation of an
abnormal site.

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Life cycles 1
Direct / indirect
Species A

Species A

Species A
Direct

Species B
Indirect

Life cycles 2
Complex indirect

Species A

Species C

Species B

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Definitions 1
Aetiological agent - causative microbe
Final (definitive) host - Host which harbours the sexual stages
of the parasite.
Intermediate host - host which harbours the asexual/larval
stages of the parasite
Vector - Carrier/ transmitter of the pathogen
Reservoir host - host which serves as a reservoir of a pathogen
of medical/veterinary significance
Domestic reservoir - reservoir in domestic/companion animals
Sylvatic reservoir - reservoir in wild animals

Definitions 2
Vector transmission

Mechanical transmission
Biological transmission
Transoval transmission
Infective (environmental) transmission

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Transmission 1
Infections can be transmitted by:
Person-to-person transmission
Nosocomial and iatrogenic transmission
Contact with animals
With food
With or via soil or water
Poor sanitation and hygiene
Vectors

Person-to-person transmission

Person-to-person
spread can occur by
direct contact
(including STIs) or
droplet (including via
air conditioners)

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Nosocomial/ iatrogenic spread

Direct spread from
person to person can
include infections
spread within the
hospital environment
(nosocomial
infections) and from
contaminated medical
instruments
(iatrogenic infections)

Questions 1

Name some diseases spread directly from

person to person - including direct contact;
sexual contact; droplet; nosocomial;
iatrogenic.

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Person-to-person spread
Common cold
Influenza
Measles
Chicken pox
Pertussis
MRSA
Athletes Foot

Meningococcal meningitis
Impetigo
STIs (incl. HIV; HepB)
Giardiasis
Enterobiasis
Headlice
Scabies

Spread by animal contact

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Questions 2

Name some diseases acquired from animals

(zoonotic diseases) and give their animal
reservoir hosts

Acquired from animals

Zoonotic infections

Rabies
Lyssa virus
ORF
Marburg virus
Brucellosis
Bovine TB
Anthrax
Q Fever
Leptospirosis

Zoophilic mycoses
Giardiasis
Toxoplasmosis
Trichinosis
Larva migrans
Hydatid
Taeniasis

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Spread with food

Questions 3

Name some diseases spread via food

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Acquired from food

Rotavirus
Typhoid
Norovirus
Esch. coli
(Norwalk agent)
pathotypes
Bacillus cereus
Toxoplasmosis
Staph aureus fd. Poison. Cryptosporidiosis
Listeriosis
Giardiasis
Botulism
Clonorchiasis
Bovine TB
Taeniasis
Salmonellosis
Trichinosis

Spread via soil and water

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Questions 4

Name some diseases spread via soil and

water.

Spread by water
Water
Hepatitis A
Cholera
Typhoid
Leptospirosis
ETEC
Giardiasis
Amoebiasis
Schistosomiasis

Soil
Melioidosis
Hookworm
Strongyloidiasis
Cut. Larva Migrans
Tungiasis

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Spread by poor sanitation and hygiene

Questions 5

Name some diseases spread by poor

sanitation and hygiene

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Spread by poor sanitation and

hygiene
Hepatitis A
Cholera
Typhoid
Amoebiasis
Giardiasis
Schistosomiasis
Trichuriasis

Ascariasis
Hookworm
Strongyloidiasis
Enterobiasis
Cysticercosis

Spread by vectors

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Questions 6

Name some diseases spread by:

Insects
Mites
Ticks
Snails

Vector-borne infections
Insects: Yellow Fever; RRV; MVE; Dengue
JapB enceph.; Typhus; Bubonic
Plague
Leishmaniasis; African Sleep. Sick.,
Malaria; Filariasis
Mites: Scrub typhus
Ticks: Tick-borne encephalitis; Spotted
Fevers; Relapsing Fever
Snails: Fascioliasis; Schistosomiasis

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Theory of controlling infection 1

Theory of controlling infection 2

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Control of infection
Treatment of cases
Immunization
Human contact protection
Food inspection
Reservoir host control
Vector control
Public health measures
Education

Control by antimicrobial therapy

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Control by immunization

Control by host protection

This can be achieved by
the use of nets, skin
repellants, protective
clothing etc

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Control by food hygiene

Reservoir host control

Infections in reservoir
hosts can be controlled
by culling; treatment
or immunization of
these hosts to
eliminate the reservoir
for human infection

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Vector control
Vector control may
involve:
Chemicals:
insecticides;
molluscicides
Biological control
Naturalistic (environmental)
control
Vector sterilization
Genetic manipulation of
vectors

Public health measures

for improved sanitation

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Education

Emeritus Professor John Goldsmid delivers the keynote address on Custom, Culture,
Behaviour and Infection at the CDC Conference in Alice Spr ings on November 1, 2006

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Hydatid in Tasmania
A lesson in successful eradication

Up to the 1960s
Tasmania had a
serious hydatid
problem

The hydatid problem in Tasmania

-why?

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Hydatid solution
Dog (dingo)

Egg

Human

Sheep (wallaby)

Hydatid control
Formation of THEC
Community involvement
Sheep offal banned for dogs
Dead sheep on pastures to be buried
Abattoir inspection - quarantine
Hydatid test strips - quarantine
Education

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Tasmania hydatid control

Problems

Now follow 10
disease scenarios
which will need to be
solved:

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Problem 1
This was one of a number
of cases from an epidemic
of severe, watery
diarrhoea which occurred
in a refugee camp in
Bangladesh.
What particular disease
poses severe problems in
such situations in Asia?

Problem 1
Although many pathogens can cause
outbreaks of diarrhoeal disease in these
situations, cholera is of particular
importance.

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Problem 1
The organism isolated
from the faeces of the
patients was a Gram
negative rod which
grew on TCBS
medium giving yellow
colonies.
What is the likely
organism?

Problem 1
The appearance of this organism on TCBS
is strongly suggestive of Vibrio cholerae
What are the important epidemiological
features of this infection?
At which points in the infection cycle can
we attempt to break the transmission cycle?

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Epidemiology & control of cholera

Human

Cholera control
Measures which might be considered:
Antibiotic treatment of infected cases
Sanitation and hygiene
Boiling water
Immunization
Education

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Problem 2
This outbreak involved
an epidemic of severe
dysentery. A
significant number of
victims died and some
were noted to have
one or more liver
abscesses

Problem 2
Stool examination of
fresh faeces from the
patients revealed
microscopic motile
organisms moving by
means of pseudopodia
and containing RBCs
What is your diagnosis?

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Problem 2
The diagnosis here is amoebiasis due to
Entamoeba histolytica
What is the life cycle of Ent. histolytica ?

Epidemiology & control of

amoebiasis

Human
Cyst in faeces

cyst ingested

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Amoebiasis control
Control measures to be considered:
Treatment of infected humans
Sanitation (toilets)
Hygiene (hand washing)
Boiling of water (chlorination ineffective)
Education

Problem 3
A significant number
of cases of chronic
diarrhoea have been
noted and stool
examination was
requested. The cases
involved both
bushwalkers and urban
residents

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Problem 3

Stool examination
showed the following
- what is your
diagnosis?

Problem 3

The diagnosis here is giardiasis due to

Giardia duodenalis

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Problem 3
Some features of the epidemiology of giardiasis

Epidemiology & control of giardiasis

Animal host

cyst

human

human

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Giardiasis control
Treatment of humans and ? domestic/companion
animals.
Boiling of drinking water (chlorination
ineffective)
Cooking vegetables if contaminated with
animal/human faeces
Education

Problem 4

This patient died of

intestinal obstruction.
What type of worm is
it?

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Problem 4

The worm is a
tapeworm and the
scolex is shown in the
figure opposite.
What species is it?

Problem 4

The worm is the beef tapeworm, Taenia

saginata

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Epidemiology & control of taeniasis saginata

Human

Egg

Cow

Taeniasis saginata control

Treat humans
Sanitation
Beef inspection at abattoir
Cooking of beef
Education

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Problem 5
You are asked to
devise a control
programme for an
Aboriginal community
with a long-standing
hookworm problem

Epidemiology & control of hookworm

Human
Infective larva
through skin

Egg

Free-living larva

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Hookworm control
Treat humans
Sanitation
Soil treatment (salt)
Shoes
Education

Problem 6
Toxoplasmosis is an infection with serious potential
clinical effects for the immunocompromised and the
foetus

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Epidemiology of Toxoplasmosis

Central to transmission is thus that fearsome predator the cat!

The domestic cat

The feral cat

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Epidemiology &
control of
toxoplasmosis

Toxoplasmosis control
Wash hands after handling cat boxes (?cats)
Cull feral cats
Dont feed cats raw mutton; pork
Wash/cook vegetable/salad plants
Boil/chlorinate water if liable to cat faecal
contamination
Cook meat
Education
Treat pregnant women with currently acquired
infection

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Problem 7
The problem which arises
here is that a developer in
Sydney wishes to build a
canal development at
Ralphs Bay, near
Lauderdale - a known
potential area for RRV
which is spreading down
the Tasmanian East coast

Epidemiology & control of RRV

Marsupial

Human

Mosquito

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RRV solutions
Prevent building of this unnecessary development
(unbiased assessment??)
Kill mosquitoes - sprays - toxic
Cull wild mammals (human/ domestic animal
reservoir?)
Ensure canals are well flushed by tidal flow
Mosquito repellants/nets/clothes etc
Education of politicians - is this possible??

Problem 8

A number of cases of
Japanese B
encephalitis were
recorded in a remote
area of the Northern
Territory.

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Epidemiology & control of Japanese B

encephalitis

Pig

Human

Mosquito

Jap B encephalitis control

Immunize community members
Remove pig pens from being too
close to human dwellings
Mosquito control
Surveillance humans and anmals
Education

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Problem 9
This patient from a village
in Zimbabwe presented
with massive
hepatosplenomegaly,
portal hypertension, and a
marked eosinophilia.
A stool specimen was
examined in the
laboratory.

Problem 9

On stool examination,
the following egg was
seen.
What is your
diagnosis?

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Problem 9

The diagnosis here is intestinal bilharziasis

due to Schistosoma mansoni

Schistosomiasis epidemiology

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Epidemiology & control of

schistosomiasis

Human

Snail

Schistosomiasis control
Treat humans
Sanitation
Snail control
Chemical - effect on water and water life
Biological
Naturalistic
Safe water
Education

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Problem 10
10 patients admitted with
fever and buboes in
groin.

Problem 10

Four died and at autopsy found Gram negative, bipolar

staining bacilli in spleen smear.

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Problem 10

What is the likely diagnosis?

Problem 10

The probable diagnosis here is Bubonic

Plague due to Yersinia pestis

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Bubonic plague - epidemiological

features

Bubonic plague epidemiology & control

Sylvatic * linking *

domestic *

Wild rodent - commuting rodent - house rat

flea

flea

flea

human
-

human

flea droplet

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Bubonic plague control

Treat humans at risk
Immunize community at risk
Kill fleas in environment
Kill rodent reservoir
Education

Conclusion
The effective control of infectious diseases is
thus all about having a thorough knowledge of
the epidemiology of the micro-organism and
then applying this knowledge in a logical
fashion to prevent the transmission and spread
of the disease
Remember:
Prevention is always better than cure

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