COMMON INFECTIOUS

DISEASE IN MALAYSIA

DEFINITION
Any of many diseases or illness :
Cause by pathogenic organisms.
Bacteria, viruses, fungi or protozoa
Also known as communicable disease
Can be transfer or transmitted from person to
person or from organism to organism.

Modes of transmission

Which mode of transmission?

TERMINOLOGY
Epidemic : large scale, temporary
increase in the occurrence of a disease in
community of region.
Eg : smallpox killed Aztec (central mexico)
population,

Pandemic : occurrence of disease

widespread over a geographical area
Eg : outbreak influenza 1919 (spanish influenza)
and HIV/AIDS.

 Endemic : epidemic become endemic

when disease constantly present within
given location.
Eg : malaria in tropical region.

Vaccine : preparation of killed or

weakened m/o, inactivated toxins or
components of m/o that administered to
stimulate an immune response.

Types of vaccine
LIVE, ATTENUATED VACCINES
contain living microbe that has been weakened in the lab
so it cant cause disease.
closest thing to a natural infection, these vaccines are
good teachers of the immune system
They elicit strong cellular and antibody responses and
often confer lifelong immunity with only one or two doses.
Downsides are microbe in the vaccine could revert to a
virulent form and cause disease. Also, not everyone can
safely receive live, attenuated vaccines.
people who have damaged or weakened immune
systemschemotherapy or have HIV, for example
cannot be given live vaccines.

INACTIVATED VACCINES
killing the disease-causing microbe with chemicals, heat,
or radiation.
more stable and safer than live vaccines: The dead
microbes cant mutate back to their disease-causing
state.
stimulate a weaker immune system response than do
live vaccines. So it would likely take several additional
doses, or booster shots, to maintain a persons immunity.
This could be a drawback in areas where people dont
have regular access to health care and cant get booster
shots on time

SUBUNIT VACCINES
Made from antigens that best stimulate the immune
system.
Because subunit vaccines contain only the essential
antigens and not all the other molecules that make up
the microbe, the chances of adverse reactions to the
vaccine are lower.
Subunit vaccines can contain anywhere from 1 to 20 or
more antigens.
identifying which antigens best stimulate the immune
system is a tricky, time-consuming process.

TOXOID VACCINES
Used when a bacterial toxin is the main cause of illness.
Scientists have found that they can inactivate toxins by
treating them with formalin, a solution of formaldehyde
and sterilized water.
Detoxified toxins, called toxoids, are safe for use in
vaccines.
When the immune system receives a vaccine containing
a harmless toxoid, it learns how to fight off the natural
toxin.
The immune system produces antibodies that lock onto
and block the toxin.
Vaccines against diphtheria and tetanus are examples of
toxoid vaccines.

CONJUGATE VACCINES
Polysaccharide coatings disguise a bacteriums antigens
so that the immature immune systems of infants and
younger children cant recognize or respond to them.
When making a conjugate vaccine, scientists link
antigens or toxoids from a microbe that an infants
immune system can recognize to the polysaccharides.
The linkage helps the immature immune system react to
polysaccharide coatings and defend against the diseasecausing bacterium.
The vaccine that protects against Haemophilus
influenzae type B (Hib) is a conjugate vaccine

DNA vaccines
DNA vaccines use the genes that code for those allimportant antigens.
Researchers have found that when the genes for a
microbes antigens are introduced into the body, some
cells will take up that DNA.
The DNA then instructs those cells to make the antigen
molecules. The cells secrete the antigens and display
them on their surfaces.
In other words, the bodys own cells become vaccinemaking factories, creating the antigens necessary to
stimulate the immune system.

Recombinant vector vaccines

similar to DNA vaccines, but they use an attenuated virus
or bacterium to introduce microbial DNA to cells of the
body.
Vector refers to the virus or bacterium used as the
carrier.
In nature, viruses inject their genetic material into them.
In the lab, scientists have taken advantage of this
process. The carrier viruses then ferry that microbial DNA
to cells
In this case, the inserted genetic material causes the
bacteria to display the antigens of other microbes on its
surface.
In effect, the harmless bacterium mimics a harmful
microbe, provoking an immune response.

AIDS

The Red ribbon is a symbol for solidarity with HIV-positive

people and those living with AIDS.

WHAT IS AIDS ?
AIDS Acquired Immunodeficiency Syndrome
Collection of symptoms and infections
Caused by HIV (Human Immunodeficiency Virus)
[ HIV-1]
Damage the immune systems
Destroys CD4-positive T cells subset of T cells.
Diagnosis for AIDS ( < 200 CD4+ T cells
per microliter of blood) normal =
1000microliter
Lost cellular immunity

How HIV infect immune system

Human immunodeficiency virus (HIV) infects the cells
of the immune system.
HIV attacks and destroys the T helper lymphocytes, or
T-cells, which are crucial to the immune system and
immune response. (These cells are also called CD4positive lymphocytes because HIV uses the protein CD4,
present on the surface of the cell, to attach itself and
pry its way into the cell.)
T-cells coordinate immune regulation and secrete
specialized factors that activate other white blood cells
to fight off infection. In healthy individuals, the number of
CD4 cells normally ranges from 700 to 1500 cells per
micro liter of blood (this measurement is known as the Tcell count).

 HIV is a retrovirus, a type of virus that stores its genetic

information on a single-stranded RNA molecule. After a
retrovirus penetrates a cell, it creates a DNA version of
its gene, which then becomes part of the infected cells
DNA.
Each day, your body produces millions of CD4+ T-cells to
help maintain your immunity and fight off invading
viruses and germs.
Once HIV is in your body, the virus is able to copy itself
over and over, increasing its ability to kill CD4+ T-cells.
Soon, infected cells outnumber healthy T-cells.
The lower a persons CD4+ T-cell count goes, the more
susceptible the person is to viruses and infections that
an otherwise healthy body could fight.

 In the initial stages of the infection, the decline in T-cell

count is gradual. The first few months and years after a
person is infected, T-cell counts may remain very near
normal or only slightly decreased.
Its when T-cell numbers begin to dip dramatically that
patients with HIV begin noticing additional, worsening
symptoms of the infection.
An infected persons body tries to fight off HIV infection
by aggressively manufacturing antibodies, which are
tiny bits of protein designed to bond with HIV particles
and neutralize them before they can infect more cells.
Most HIV tests actually detect the presence of these
antibodies, not HIV itself

 Late stage of infections increase individual

susceptible to opportunistic infections and
tumors.
eg : Kaposis sarcoma,
candidiasis, lymphomas.

Kaposis Sarcoma

cervical

cancer,

HOW IS HIV/AIDS TRANSMITTED

SEXUAL
INTERCOURSE

DIRECT CONTACT WITH

INFECTED BLOOD

THROUGH DIRECT CONTACT

WITH BODILY FLUIDS

FROM MOTHER TO
UNBORN CHILDS

Semen, blood, vaginal

fluid, pre-ejaculate,
breast milk.

SEXUAL INTERCOURSE
Spread most commonly by sexual contact
with an infected partner.
Virus enter body through the lining of vagina,
penis, rectum or mouth.

Sexual activities :
Anal sex (highly risk).
Oral sex.
Vaginal sex.

DIRECT CONTACT WITH INFECTED

BLOOD
Spread through injection drug users
Sharing contaminated syringes.

In health care setting

Health care worker handling equipment.

Blood transfusions

FROM MOTHER TO UNBORN

CHILD
Occur in utero during pregnancy
Child birth (during labor)
Through breast feeding

HIV/AIDS PREVENTION
Avoiding risk sexual relationship
Receive
persons

blood

from

only

uninfected

Avoid sharing personal equipment and

syringes.

HEPATITIS
Hepar liver.
titis inflammation.
Hepatitis occurs due to any agent that
caused inflammation of liver.
Viral hepatitis and non-viral hepatitis.
Acute or chronic.

NONVIRAL HEPATITIS
ALCOHOLIC HEPATITIS :
Ethanol in alcoholic beverages. These chemicals
can injure the liver cells. This injury then leads to
inflammation
Most common precursor of cirrhosis in Western
countries (US).
Common in patients with long term alcohol
consumption.
hepC + alcoholic hepatitis accelerate the
development of chronic cirrhosis.

 TOXIC/DRUG INDUCED HEPATITIS :

Cause by inhalation or digestion of toxin
substances or usage of large number of
drugs. (cause adverse liver reaction)
Amatoxin : from mushroom (Amanita sp.)
White phosporus : industrial toxin
Pain killer, fever reducers, NSAIDs
Paracetamol : if taken overdose

 ISCHEMIC HEPATITIS (Shock Liver):

Cause by decrease circulation to liver cells
maybe cause by low blood pressure (heart
failure, dehydration, severe bleeding)

AUTOIMMUNE HEPATITIS :
Autoimmune diseases are disorders in which
the body's immune system attacks the body's
own cells and organs. More likely cause by
genetics

GRANULOMATOUS HEPATITIS :
Condition which abnormal collections of white
blood cells collect in the liver.

 NONALCOHOLIC STEATOHEPATITIS :
Resembles alcoholic hepatitis but occur in
non alcoholic person
Related with obesity (fatty liver)

HEREDITARY :
Certain hereditary disorders
Eg: Wilsons disease acute damage to liver.
Excess copper in the liver because liver
cannot filter copper correctly.

DENGUE
Usually found in tropical region (usually urban
areas).
Dengue fever (DF) is caused by any of four
closely related viruses, or serotypes: dengue 14.
Around 2.5 billion people, or 40% of the world's
population, live in areas where there is a risk of
dengue transmission
Host : Aedes aegypti / Aedes albopictus. (female
mosquitoes)

 Endemic in at least 100 countries in Asia, the

Pacific, the Americas, Africa, and the Caribbean.
WHO estimates that 50-100 million infections
occur yearly, 500,000 are dengue hemorrhagic
fever (DHF) cases and 22,000 deaths, mostly
among children.
Dengue fever is flu like viral disease cause by
any of dengue family viruses spread by bites of
mosquitoes.

 Diseases transmitted by mosquitoes in Malaysia:

There are 5 human diseases transmitted by
mosquitoes in Malaysia: Malaria, Dengue,
Filariasis,
Japanese
Encephalitis
and
Chikungunya

Statistics
The first epidemic occurred in 1962 in Penang,
and the second major epidemic in 1974 in
Selangor.
The number of dengue fever cases reported in
Malaysia continues to increase year after year
since 2011 and in 2015, highest number of
cases and deaths as the southeast Asian
country topped 120,000 cases. More than half
the cases were reported from Selangor state
alone (62,000+).

 In addition, 322 dengue related fatalities were

reported nationally as of Dec. 28, more than 100
more than the previous year.
If we look at dengue fever in Malaysia since
2011, we see a steady climb each year. That
year there were 19,884 cases/36 deaths. In
2012, it increased to 21,900/35; in 2013 it was
43,346/92 and 2015 increase to 108,698/215.

TRANSMISSION
Aedes mosquitoes active during dawn and
dusk.
Breeding areas stagnant water.
Mosquitoes human mosquitoes
human.
Dengue fever last approximately for
7days.
No treatment for dengue fever and
dengue hemorrhagic fever.

 After virus incubation for 410 days, an infected

mosquito is capable of transmitting the virus for
the rest of its life.
infected with the dengue virus can transmit the
infection (for 45 days)
Symptoms appear 3-7 days after infection,
usually last for 27 day

DENGUE FEVER SYMPTOMS

- High fever (104 F, 40C)
- Chills
- Headache
- Skin rash (2-5 days after fever s
- Red eyes, pain in the eyes
- Enlarged lymph nodes
- Deep muscle and joint pains (during first hours
of illness)
- Loss of appetite
- Nausea and vomiting
- Low blood pressure and heart rate
- Extreme fatigue
- Thrombocytopenia.

WHAT IS DENGUE
HEMORRHAGIC FEVER
Occurs when the dengue virus re-infects a
person who previously has dengue fever
or severe stages progress from dengue
fever.
Immune systems recognize the virus,
resulting the immune systems to over
reacting.
Also known as Dengue Shock Syndromes
(DSS).

DHF SYMPTOMS
- Abdominal pain
- Hemorrhage (severe bleeding)
- Circulatory collapse (shock)
- Nausea and vomiting
- Bleeding of the nose and gums
- Sore throat and cough
- Pneumonia
- Inflammation of the heart
- High fever (40 -41 C)
- Severe skin bleeding with spots of blood on
the skin (petechiae) and large patches of blood
under the skin (ecchymoses)

MEDICATION
There are no specific medications to treat
a dengue infection.
Prevention the most important step, and
prevention means avoiding mosquito bites.
If a clinical diagnosis is made early, a
health care provider can effectively treat
DHF using fluid replacement therapy.
To alleviate the signs and symptoms.

 Aspirin should not be given (cause

severe bleeding).
Use paracetamol to relieve muscle and
joint aches, fever and headaches.
Sponged down with water to help lower
down body temperature.
Bed rest for speedy recovery.

 Consume plenty of water.

Keep away from mosquitoes to prevent
the disease from spread to other persons.
Some patients need transfusions to
control bleeding.

PREVENTION / CONTROL OF
MOSQUITOES
In late 2015 and early 2016, the first dengue
vaccine, Dengvaxia (CYD-TDV) by Sanofi
Pasteur, was registered in several countries for
use in individuals 9-45 years of age living in
endemic areas.
Other tetravalent live-attenuated vaccines are
under development in phase II and phase III
clinical trials

 The only method of preventing and controlling

dengue fever is to eradicate the mosquito
population.
Improved
water
storage
practices
and
implement proper solid waste disposal.
Avoid wearing dark and tight clothing.
Breed small mosquito-eating fishes
Covering, emptying and cleaning of domestic
water storage
Applying insecticides as space spraying during
outbreaks.

 Apply mosquito repellants.

Reduce outdoor activities during mosquitoes
active time.
Sleep under mosquito netting

RESURGENCE OF DENGUE
FEVER
No effective mosquito control efforts
Public health systems to detect and control
epidemics are deteriorating around the world
Rapid growth of cities in tropical countries
The increase in non-biodegradable
packaging and discarded tires

plastic

Increased jet air travel is helping people infected

with the dengue viruses more easily from city to
city