Emerging/re-emerging infectious diseases 1996 to 2001 Legionnaire s Disease Cryptosporidiosis Lyme Borreliosis Venezuelan Equine Encephalitis Dengue haemhorrhagic fever E.coli O157 BSE nvcjd West Nile Virus Reston virus Lassa fever Yellow fever Buruli ulcer Ebola haemorrhagic fever Cholera Multidrug resistant Salmonella E.coli non- O157 Malaria West Nile Fever Typhoid Echinococcosis Cholera 0139 RVF/VHF O nyong-nyong fever Human Monkeypox Cholera Diphtheria Equine morbillivirus E.coli O157 Dengue haemhorrhagic fever Influenza A(H5N1 ) Nipah Virus Reston Virus Ross River virus Hendra virus
20011130
막대한 사회경제적 손실 초래 United States: E. coli O157 Malaysia: Nipah virus Food recall / destruction Pig destruction US$ 540 millio Periodic United Kingdom: BSE 1999 US$ 9 billion United States: India: Plague 1990 1998 Anthrax US$ 2 billion US$? million 1994 2001 UR Tanzania: Cholera Peru: Cholera Hong Kong SAR: US$ 36 million US$ 770 million influenza A (H5N1) 1998 1991 Poultry destruction US$ 22 million 1997 & 2001
백일해홍역홍역 백일해말라리아홍역홍역 유행성이하선염홍역홍역 말라리아콜레라 '49 '60 '67 '70 '81 '96 '98 '99 '02 '04 장출혈성대장균감염증브루셀라증보툴리눔독소증 S A R S DPT BCG MMR B ~ 레지오넬라 렙토스피라증 H I V '69 78 4 ~ '46 49 8 신증후군출혈열 10 250 200 150 100 50 0 '54 '58 '62 '66 '70 '74 '78 '82 '86 '90 '94 '98 '02 '04
Year Country/area Domestic birds affected Strain 1959 Scotland chicken H5N1 1963 England turkey H7N3 1966 Ontario(Canada) turkey H5N9 1976 Victoria(Australia) chicken H7N7 1979 Germany chicken H7N7 1979 England turkey H7N7 1983 1985 Pennsylvania(USA)* chicken,turkey H5N2 1983 Ireland turkey H5N8 1985 Victoria(Australia) chicken H7N7
Year Country/area Domestic birds affected Strain 1991 England turkey H5N1 1992 Victoria(Australia) chicken H7N3 1994 Queensland(Australia) chicken H7N3 1994 1995 Mexico* chicken H5N2 1994 Pakistan* chicken H7N3 1997 NewSouthWales(Australia) chicken H7N4 1997 HongKong(China)* chicken H5N1 1997 Italy chicken H5N2 1999 2000 Italy* turkey H7N1 2002 HongKong(China) chicken H5N1 2002 Chile chicken H7N3 2003 Netherlands* chicken H7N7
Onset of Symptom Hospitalization First 48 hr after admission Recovering (2) Death (8) Respiratory failure, Acute respiratory distress syndrome, Pneumothorax
conjunctivitis sputum blood tinged sputum pleuritic chest pain diarrhea bleeding from nose and gum sore throat rash Symptoms cough fever shortness of breath Percentage of Symptomatic Pt
Physical Exam(9/10) Fever Rapid respiration(median, 55 breath/min, range 28 to 70) Respiratory distress Crackles
Leukocyte count on admission median, 2,100/(range, 1,200~3,400) Lymphocyte count median, 700/(range, 250~1,100) CD4/CD8 median, 0.07 (range, 0.59~1.08) Platelet count median, 75,500/(range, 45,000~174,000) ALT, AST level elevation : 50% Cr elevation : 10% Hyperglycemia : 30%
1850 1847 42 1900 1889 1918 29 39 30 40 1950 1957 1968 11 2000 35
NA (neuraminidase) 2 HA (hemagglutinin)
H1 H2 : H, N H1N1 H2N2 H3N2 (Karl G Nicholson, et al Lancet 2003; 362: 1733-45) H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 N1 N2 N3 N4 N5 N6 N7 N8 N9
1918: Spanish Flu 1957: Asian Flu 1968: Hong Kong Flu H1N1 H2N2 H3N2 H1N1
(IVC)
( ) Whole Virus Split Subunit Virosomal * Aventis ( ) * Chiron ( ) * Berna ( ) * Shire ( ) * ( )
10 km 10 km 30 1 20 2,880 : 10 1 2 1: 24 10 11 12