Ebola (social preventive pharmacy)

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manifestations of AIDS. Primary prophylaxis against P. 15. Internet website : www. naco. nic. in/vsnaco/i ndiascen e/u pda te.

carinii pneumonia should be offered to patients with CD4 16. WHO ( 1 9 8 5 ) . WHO Chronicle 39 (6) 2 0 7 – 2 1 1 .

17. British Medical Journal, 1992, 3 0 4 : 8 0 9 – 8 1 3 .
count below 200 cells/µL. The regimens available are
18. WHO ( 1 9 8 6 ) . Guidelines on AIDS in Europe, WHO, Copenhagen.
trimethoprim – sulfamethoxazole, aerosolized pentamidine
19. P.N. Sehgal Health For The Millions Aug. 91 P – 1 , 8, 26. ·
and dapsone. Patients who develop P. carinii infection on a
20. Current Medical Diagnosis and Treatment, 47th Ed., 2008, Edited by
particular prophylactic regimen should be switched to the
Lawrence M. Tierney et al., A Lange Medical Publ.
other drug or should receive a combination regimen.
21. WHO ( 1 9 9 4 ) , Weekly Epidemiological Record, No.37, 16 Sept. 1994.

M. avium complex occurs in at least one-third of AIDS 22. WHO (2004), TB I HIV, A Clinical Manual, 2nd Ed., Stop TB

patients. Rifabutin has been shown in a randomized trial to Department, Department of HIV I AIDS & Department of Child and

Adolescent Health and Development.
decrease the incidence of disseminated Mavium­
23. WHO ( 2 0 1 0 ) , Antiretroviral therapy for HIV infection in Adults and
intrace/lulare in persons with less than 200 CD4 cell/µL.
Adolescents, 2 0 1 0 Revision, Recommendations for a Public Health
Clinicians should make certain that patients do not have
active M. tuberculosis infection before starting Rifabutin.
24. Current Medical. Diagnosis and Treatment, Edited by Lawrence M.
Prophylaxis against M. tuberculosis is 300 mg isoniazid daily Tierney, Jr., Stephen J . McPhee, and Maxine A. Papadakis, 34th

for 9 months to one year. It should be given to all HIV­ Edition ( 1 9 9 5 ) , A LANGE medical block.

infected patients with positive PPD reactions (defined for 25. WHO (2013), Consolidated guidelines on the use of antiretrovira/

drugs for treatment and preventing HIV infection, Summary of Key
HIV-infected patients as more than 5 mm in induration).
Features and recommendations, June 2 0 1 3 .
Kaposi’s sarcoma might be treated in some stage with
26. WHO ( 2 0 1 4 ) , Guidelines on post-exposure prophylaxis for HIV and
interferon, chemotherapy or radiation. Cytomegalovirus
use of co-trimoxazole, December 2 0 1 4 .
retinitis can be controlled by ganciclovir, cryptococcal

meningitis with fluconazole. Esophageal candidiasis or

recurrent vaginal candidiasis can be treated by fluconazole EMERGING .AND RE-El\fEJiGIN�.
or ketoconazole. Herpes simplex infection and herpes zoster INFECTIOUSDISEASES,.
can be treated with acyclovir or foscamet.

Today the world stands on the threshold of a new era in

4. Primary health care
which hundreds of millions of people will be safe from some

Because of its wide-ranging health implications, AIDS of the most terrible diseases. Soon poliomyelitis, neonatal

touches all aspects of primary health care, including mother tetanus, leprosy, guineaworm disease, river blindness,

and child health, family planning and education. It is Chagas’ disease will join smallpox as diseases of the past.

important, therefore, that AIDS control programmes are not On the other hand, the world also stands on the brink of a

developed in isolation. Integration into country’s primary global crisis in infectious diseases. No country is safe from

health care system is essential. them and no country can afford to ignore their threat any

longer. The optimism of a relatively few years ago that many
National AIDS Control Programme
of these diseases could easily be brought under control has

Refer to chapter 7, page 431 for details. led to a tragic complacency among the international

community. This complacency is now costing millions of
The WHO launched a “Global Programme on AIDS” on
lives. Today the infectious diseases are not only a health
Feb. 1 1987 to provide global leadership and to support the
issue; they have become a social problem with tremendous
development of national AIDS programmes.
consequences for the well-being of the individual and the

world we live in.
Some infectious diseases once thought to be all but
1. WHO ( 1 9 8 6 ) . Techn. Rep. Ser., 736.
conquered, have returned with a vengeance. Others have
2. UNAIDS ( 2 0 1 3 ) , Global Report, UNAIDS Report on the Global AIDS

Epidemic 2013. developed stubborn resistance to antibiotic drugs. New and

3. UNAIDS (2012), Global Report, UNAIDS Report on the Global previously unknown diseases continue to emerge (Table 1 ) .
Epidemic, 2 0 1 2 . Together, these trends amount to a crisis for today and a
4. U . S . Global Health Policy ( 2 0 1 2 ) , The Global HIV/AIDS Epidemic,
challenge for the future.
Fact Sheet, July 2 0 1 2 .
The factors responsible for emergence and re-emergence
5. WHO (2008), Priority interventions, HIV/AIDS Prevention treatment

and care in the health sector, August 2008, WHO HIV/AIDS of infectious diseases are : (1) unplanned and under­
Department. planned urbanization; (2) overcrowding and rapid
6. WHO, UNICEF and UNAIDS ( 2 0 1 3 ) , Global Update on HIV Treatment
population growth; (3) poor sanitation; (4) inadequate
2013, Results, Impact and Opportunities, WHO Report, June 2 0 1 3 .
public health infrastructure; (5) resistance to antibiotics;
7. UNAIDS, WHO ( 2 0 1 1 ) , Global HIV/AIDS Response-Epidemic update
(6) increased exposure of humans to disease vectors and
and health sector progress towards Universal Access – Progress Report

2011. reservoirs of infection in nature; and (7) rapid and intense

8. WHO ( 2 0 1 2 ) , HIV/AIDS, Fact sheet No. 360, July 2 0 1 2 . international travel.

9. WHO (2004), The World Health Report 2004, Changing History.

10. Govt.of India ( 1 9 9 9 ) , The National Response To HIV/AIDS in India, Emerging diseases
National AIDS Control Project Phase – II, NACO, Ministry of Health
During the past 30 years, at least 30 new diseases have
and Family Welfare, New Delhi .
emerged to threaten the health of hundreds of millions of
1 1 . · Govt. of India ( 2 0 1 2 ) , Annual R e p o r t 2 0 1 1 – 1 2 , NACO, Department of

· AIDS Control, Ministry of Health and Family Welfare, New Delhi. people. For many of these diseases there is no treatment,

12. Govt. of India ( 2 0 1 4 ) , A n n u a / R e p o r t 2 0 1 3 – 1 4 , NACO, Department of cure or vaccine and the possibility of preventing or
AIDS Control, Ministry of Health and Family Welfare, New Delhi. controlling them is limited.
13. WHO (1994), AIDS, images of the epidemics.
Emerging infectious diseases are those whose incidence
14. Population Reports ( 1 9 8 6 ) . AIDS: A Public Health Crisis, Sr. L, No.6,
in humans has increased during the last two decades or
July-Aug 1986. The John Hopkins University, Baltimore, Maryland,

USA. which threaten to increase in the near future. The term also


refers to newly-appearing infectious diseases, or diseases occur every 20 years or so, triggering large epidemics in

that are spreading to new geographical areas – such as many parts of the world, and causing many thousands of

cholera in South America and yellow fever in Kenya. deaths. The next such shift is expected to take place very

soon. Epidemic strains of influenza viruses originate from
The diseases in question involve all the major modes of
C h i n a . The influenza virus is carried by ducks, chickens and
transmission – they are spread either from person to person,
pigs raised in close proximity to one another on farms. The
by insects or animals, or through contaminated water or
exchange of genetic material between these viruses
food. The most dramatic example of a new disease is AIDS,

caused by the human immunodeficiency virus (HIV). The produces new strains, leading to epidemics of human

existence of the virus was unknown until 1983. Presently, influenza, each epidemic being due to a different strain.

estimated 2 . 3 million cases occur every year worldwide. For Currently avian HSN! is the strain with pandemic potential,

more details, please refer to page 343. since it might adapt into a strain that is contagious among

humans. Since 1 9 9 7 , 4 78 cases with 286 deaths have been
A new breed of deadly haemorrhagic fevers, of which
reported to WHO. The first case was from Hong Kong. Other
Ebola virus disease (previously known as Ebola
countries involved are Cambodia, Indonesia, Thailand and
haemorrhagic fever) is the most notorious, has struck in
Viet Nam (4). In late 2002, a new disease called SARS was
Africa. Ebola appeared for the first time in Zaire and Sudan
reported from China with rapid spread to Hong Kong,
in 1 9 7 6 . Since then it has appeared periodically. Ebola virus
Singapore, Viet Nam, Taiwan, and Toronto. During 2003,
is a member of Filoviridae family and comprises of 5 distinct
8,422 SARS cases were reported from 30 countries with 9 1 6
species – Zaire ebolavirus; Reston ebolavirus; Sudan
fatalities (5). More recently, pandemic due to influenza A
ebolavirus; Tai ebolavirus; and Bundibugyo ebolavirus. The
( H l N l ) 2009 strain is continuing worldwide involving 2 1 4
recent epidemic started in December 2 0 1 3 in Guinea and
countries, already taking 1 8 , 156 lives. New strains such as
spread to South Africa. By 28th Sept. 2 0 1 4 , a total of 7 , 1 9 2
those of cholera and influenza do not follow the usual
cases have been reported with 3,286 deaths. Case fatality
pattern of being more common in younger people. They
rate may be as high as 70 per cent. Ebola has incubation
affect all age groups, since older people have not acquired
period of 2-21 days, and is not infective during this period.
immunity to them from previous infection.
Asymptomatic cases are also not infective. The virus is

transmitted through direct contact with the blood, organs, Table 1 summarizes the aetiological agents and infectious
body secretions or other body fluids of infected animals like diseases in humans and/or animals recognized since 1973.
chimpanzees, gorillas, monkeys, fruit bats etc. Human to The year may differ from first appearance and first
human transmission is through blood or body fluids of an identification of cases.
infected symptomatic person or through exposure to objects

(such as needles) that have been contaminated with infected Re-emerging diseases
secretions. It is not transmitted through air, water or food.
The term re-emerging diseases refers to the diseases
The illness is characterized by sudden onset of fever, intense
which were previously easily controlled by chemotherapy
weakness, muscle pain, headache, sore throat, vomiting,
and antibiotics, but now they have developed antimicrobial
diarrhoea, rash, impaired kidney and liver functions and in
resistance and are often appearing in epidemic form.
some cases both internal and external bleeding. Currently

there is no specific treatment for this disease. However, by The emergence of drug-resistant strains of

intensive supportive care, the mortality can be reduced and microorganisms or parasites is promoted by treatments that

spread of the disease can be prevented by instituting specific do not result in cure. The increasing use of antimicrobials

infection control measures. There is no vaccine against worldwide, often in subtherapeutic doses and sometimes in

ebola ( 1 ) . counterfeit form, indicates that this problem will increase in

the foreseeable future. Changes in lifestyle, behaviour
The United States has seen the emergence of hantavirus
(including injecting and non=injectinq drug use) and cultural
pulmonary syndrome, characterized by respiratory failure
or social values are behind the emergence of some infectious
and a case fatality rate of over 50%. Since it was first

recognized in 1993, this type of hantavirus infection has diseases such as syphilis. Increases in the number of sexual

been detected in more than 20 states in that country, and partners have been the main factor in the spread of HIV

has also surfaced in Argentina and Brazil. This hantavirus is infection and other sexually transmitted diseases. Travel,

carried by rodents, particularly deer mice. Other including tourism, also plays a role. The spread of syphilis in

hantaviruses have been recognized for many years in Asia, the 18th and 19th centuries was related to the movement of

where they cause haemorrhagic fever with renal armies. Today, the introduction of HIV in many parts of the

involvement in humans. world is due to greatly increased human mobility. Studies

show that whereas only a few generations ago most people
Epidemics of foodborne and waterborne diseases due to
in their lifetime travelled no further than 40 kilometres from
new organisms such as cryptosporidium or new strains of
their birthplace, many today go up to 1 , 0 0 0 times further,
bacteria such as Escherichia coli have hit industrialized and
travel!ing the whole world.
developing countries alike. The 0157:H7 strain of E.coli

was first reported in 1982 and has since then been The practices of modern medicine also contribute. The

implicated in many serious outbreaks of diarrhoeal illness, spread of viral hepatitis is related in part to techniques such

sometimes leading to kidney failure. The strain has been as kidney dialysis and multiple blood transfusions, as well as

linked to undercooked hamburger beef and unpasteurized to other forms of transmission. Relaxation in immunization

milk. A completely new strain of cholera, 0 1 3 9 , appeared in practices can quickly result in the resurgence of diseases, as,

south-eastern India in 1992 and has since spread north and for example, the recent spread of diphtheria in the Russian

west to other. areas of India, into western China, Thailand Federation and other former republics of the USSR.

and other parts of South-East Asia. New animal diseases pose potential foodborne risks to

The threat of a new global influenza pandemic is human health that are sometimes difficult to evaluate or

increasing. Major shifts in the make-up of influenza viruses predict. An example that has caused much public concern in



New infectious diseases recognized since 1 9 7 3


·Year .· Agent Type Disease/Comments
‘ . . –


1973 Rota virus Virus Major cause of infantile diarrhoea worldwide

1975 Parvovirus 819 Virus Aplastic crisis in chronic haemolytic anaemia

1976 Cryptosporidium parvum Parasite Acute and chronic diarrhoea ,

1977 Ebota virus Virus Ebola haemorrhagic fever

1977 Legionel/a pneumophi/a Bacterium Legionnaires’ disease

1977 Hantaan virus Virus Haemorrhagic fever with renal syndrome (HRFS)

1977 Campylobacter jejuni Bacterium Enteric pathogen distributed globally

1980 Human T-lymphotropic virus 1 (HTLV-1) Virus ‘f-celllymphoma-Ieukaemta

1981 Toxin-producing strains of Staphylococcus aureus . Bacterium Toxic shock syndrome

1982 Escherichia coli 0157:H7 Bacterium Haemorrhagic colitis; haemolytic uraemic syndrome

1982 · . Borrelia burgdorferi Bacterium Lyme disease

1982 HTLV-2 Virus Hairy cell leukaemia

1983 Human immunodeficiency virus (HIV) Virus Acquired immunodeficiency syndrome (AIDS)
. .


1983 Helicobacter pylori Bacterium Peptic ulcer disease

1985 Enterocytozoon bieneusi Parasite Persistent diarrhoea

1986 Cyclospara cayetanensis Parasite Persistent diarrhoea·

1986 BSE agent? Non-conventional agent Bovine spongiform encephalopathy in cattle

(Mad cow disease)

1988 Human herp_es virus 6 (HHV-6) Virus Exanthem subiturn

1988 Hepatitis E virus Virus Enterically transmitted non-A, non-B hepatitis

1989 Ehrlichia chaffeensis Bacterium Human ehrlichiosis

1989 Hepatitis C virus Virus Parenterally transmitted non-A, non-B liver hepatitis

1991 Guanarito virus Virus Venezuelan haemorrhagic fever

1991 Encephalitozoon hellem Parasite Conjunctivitis, disseminated disease

1991 New species of Babesia Parasite Atypical babesiosis

1992 Vibrio cholerae 0139 Bacterium New strain associated with epidemic cholera

1992 Bartonella henselae Bacterium Cat-scratch disease; bacillary angiomatosis ·

1993 Sin Nambre virus Virus Hantavirus pulmonary syndrome

1993 Encephalitozoon cuniculi . Parasite Disseminated disease

1994 Sabia virus Virus Brazilian haemorrhagic fever

1995 Human herpes virus 8 Virus Associated with Kaposi’s sarcoma in AIDS patients

1996 nvCJD’ Australian bat lyssavirus Virus

1997 H5Nl Virus Avian flu (Bird flu)

1999 Nipah virus Virus

2003 Corona virus Virus SARS

2009 HlNl Virus Pandemic A ( H l N l ) 2009 influenza


Source : (2, 3)


Europe is bovine spongiform encephalopathy ( “mad cow stop their spread. Without doubt diseases as yet unknown,

disease”). Fears have grown that the infectious agent but with the potential to be the AIDS of tomorrow, lurk in

responsible may be passed through the food chain to cause the shadows.

a variant of the incurable Creutzfeldt-Jakob disease in
Antimicrobial resistance
humans, in which the brain is attacked. The British beef

market has been seriously affected and stringent public Resistance by disease-causing organisms to antimicrobial

health safeguards have been introduced. drugs and other agents is a major public health problem

worldwide. It is making a growing number of infections
The reasons for outbreaks of new diseases, or sharp
virtually untreatable, both in hospitals and in the general
increases in those once believed to be under control, are
community. It is having a deadly impact on the control of
complex and still not fully understood. The fact is however,
diseases such as tuberculosis, malaria, cholera, dysentery
that national health has become an international challenge.
and p n e u m o n i a .
An outbreak anywhere must now be seen as a threat to

virtually all countries, especially those that serve as major · Antimicrobial resistance is not a new problem, but it has

hubs of international travel. Despite the emergence of new worsened dramatically in the last decade. During that time,

diseases in the last 30 years, there is still a lack of national the pace of development of new antimicrobials has slowed

and international political will and resources to develop and down while the prevalence of resistance has grown at an

support the systems that are necessary to detect them and alarming rate. The increase in the number of drug-resistant


bacteria is no longer matched by a parallel expansion in the with vancomycin, an expensive intravenous drug. Even

arsenal of agents used to treat infections. There is strong resistance to vancomycin has developed in the last 1 0 years

evidence that a major cause of the current crisis in or so. Staphylococci, which can contribute to skin infections,

antimicrobial resistance is the uncontrolled and endocarditis, osteomyelitis, food poisoning and other

inappropriate use of antibiotic drugs, in both industrialized serious disorders, have developed resistance to all

and developing countries. They are used by too many antibiotics except vancomycin. If vancomycin-resistant

people to treat the wrong kind of infection, in the wrong strains were to emerge, some of the most prevalent hospital­

dosage and for the wrong period of time. The implications acquired infections would become virtually untreatable.

are awesome : drugs that cost tens of millions of dollars to
Streptococci have become increasingly resistant to some
produce, and take perhaps 10 years to reach the market,
antibiotics. They are among the most common disease­
have only a limited life span in which they are effective. As
causing bacteria, responsible for infections of the throat,
resistance spreads, the life span shrinks; as fewer new drugs
middle ear, skin and wounds, and also necrotizing fasciitis
appear, the gulf widens between infection and control. So
and gangrene. Pneumococci and Haemophilus inf/uenzae
far, the pattern of excessive or inappropriate use and the
are the most common bacteria causing acute respiratory
development of resistance has been repeated after the
infections in children, particularly pneumonia. Both of these
introduction of each new antimicrobial. The over-use of
organisms are becoming more and more resistant to drugs.
expensive drugs designed to cover a range of infections is a
Strains of pneumococci, once uniformly susceptible to
particularly serious problem in industrialized countries. In
penicillin, are currently resistant to it in up to 1 8 % of cases
developing countries, the problem is compounded by the
in the United States and, 40% in South Africa. In addition,
ready availability of over-the-counter drugs. This allows
they are becoming resistant to many other commonly used
patients to treat themselves, either with the wrong medicine,
antibiotics, including cotrimoxazole, the drug recommended
or in quantities that are too small to be effective. Sub- ·
by WHO for treatment of pneumonia. The most virulent
standard and counterfeit drugs which lack adequate
type of Haemophilus influenzae is today frequently resistant
amounts of active ingredients further exacerbate the
to ampicillin, and strains have been identified that are
resistance problem.
resistant to other drugs, including cotrimoxazole. In brief,

doctors worldwide are losing some of the most useful and
The examples of bacterial resistance are as
affordable antibiotics against the two bacteria which are the
major cause of death in children.

Strains of M. tuberculosis resistant to anti-tuberculosis Neisseria gonorrhoeae, cause of one of the most common
drugs are widespread, although attention has recently sexually transmitted diseases, has acquired such resistance
focused on the alarming outbreaks of tuberculosis caused by to penicillin and tetracyclines in most countries that the use
multidrug-resistant strains in the United States. Drug of these antibiotics to treat it has become unacceptable and
resistance is the result of poor prescribing practices, or poor this infection now requires the use of much more expensive
patient compliance with treatment. It is low in the few drugs which are often unavailable.
countries with effective tuberculosis programmes. The most
Shigella dysenteriae has been causing outbreaks of
dangerous form of the multidrug-resistant disease occurs
severe diarrhoeal disease in central and southern Africa in
when cases become virtually incurable and doctors face
recent years, including those in refugee camps, with the
situations similar to those of the pre-antibiotic era.
epidemic strain acquiring increasing resistance to standard

Malaria presents a double resistance problem : resistance antibiotics. Epidemic dysentery caused by this strain results

of the Plasmodium parasites, which cause the disease, to in the death of up to 15% of those infected. Salmonella

antimalarial drugs; and resistance of the Anopheles typhi, the bacterium responsible for typhoid fever, has

mosquitoes, the vectors of the disease, to insecticides. The developed resistance to antibiotics commonly used in the

arsenal of antimalarial drugs is limited. Most of them act by past for treatment. Resistant strains have caused outbreaks

killing parasites when they are multiplying in the blood of the disease in India and Pakistan. Without effective

stream of the human host. Unfortunately, due to inadequate antibiotic treatment, typhoid fever kills almost 10% of those

regimens, poor drug supply, and poor quality and misuse of infected. In South-East Asia, 50% or more of the strains of

drugs, rapid development of drug resistance has occurred in the bacteria may already be resistant to several antibiotics.

most areas of the world. Drug resistance is particularly More than half of the- antibiotics produced worldwide are
important in falciparum malaria, the most severe form of the used in animals, largely in subtherapeutic concentrations
disease. Resistance to chloroquine, the most commonly used which favour the onset of drug resistance. As a result, two
drug, has been found in all endemic countries except those important human· pathogens of animal origin, E.coli and
of Central America and the Caribbean. Resistance to salmonellae, are today highly resistant to antibiotics in both
multiple drugs is common in South-East Asia. This serious industrialized and developing countries. For instance, in the
obstacle to malaria control efforts is further complicated by United Kingdom, the increase of multidrug-resistant strains
mosquito resistance to insecticides. Many mosquitoes are of Salmonella typhimurium isolated from cattle is paralleled

reported to be resistant to the three classes of insecticides by increasing resistance among strains of human origin. In

available for public health use, and some are becoming Thailand, salmonellae isolated from food animals are also

resistant to pyrethroids, widely promoted for bed-net and highly resistant to t h e · common antibiotics. These bacteria

curtain impregnation. cause diarrhoeal disease and can lead to · life-threatening

complications. Due to the globalization of food supply and
Enterococci contribute to some of the most common
international travel, antimicrobial resistance among animal
infections acquired in hospitals, causing intra-abdominal
bacteria can affect consumers anywhere in the world.
abscesses, endocarditis, and infections of the urinary tract

and soft tissues. In some countries, infections resulting from Together, these factors have created perhaps the richest

strains resistant to the main groups of antibiotics, such as the opportunities ever for the spread of infections, many of

beta-lactams and the aminoglycosides, can only be treated which become global problems that make the first line of



defence – early recognition and adequate and timely Nosocomial infections may also be considered either

response – essential. endemic or epidemic. Endemic infections are most c o m m o n .

Epidemic infections occur during outbreaks, defined as an
R e s p o n d i n g to e p i d e m i c s
unusual increase above the baseline of a specific infection or

The process of response encompasses a multitude of infecting organism.

activities including : diagnosis of the disease; investigation to
Changes in health care delivery have resulted in shorter
understand the source of transmission; implementation of
hospital stays and increased outpatient care. It has been
control strategies and programmes; research to develop
suggested that the term nosocomial infections should
adequate means to treat the disease and prevent its spread;
encompass infections occurring in patients receiving
and the production and distribution of the necessary drugs
treatment in any health care setting. Infections acquired by
and vaccines.
staff or visitors to the hospital or other health care setting

The strategy for controlling re-emerging diseases is may also be considered nosocomial infections.

through available cost-effective interventions such as early
Simplified definitions may be helpful for some facilities
diagnosis and prompt treatment, vector control measures
without access to full diagnostic techniques. Table 1
and the prevention of epidemics, for malaria; and DOTS­
provides definitions for common infections that could be
directly observed treatment, short-course – for tuberculosis;
used for surveys in facilities with limited access to
by launching research initiatives for treatment regimens and
sophisticated diagnostic techniques.
improved diagnostics, drugs and vaccines; and above all by

strengthening epidemiological surveillance and drug­ TABLE 1
resistance surveillance mechanisms and procedures with
Simplified criteria for surveillance of nosocomial infections
appropriate laboratory support for early detection,

confirmation and communication.

The category of diseases – “new diseases – new
,��lJ�t���ti!i�;{f f’�-�!�#iW�ifriie’ri�;,�?�tf \,iir\-?itl?1¥t�
problems”- such as Ebola and other viral haemorrhagic Surgical site infection Any purulent discharge, abscess, or

fevers, is probably the most frightening. The need, therefore, spreading cellulitis at. the surgical site

is for expanding research on infectious disease agents, their during the month after the operation.

evolution, the vectors of disease spread and methods of Urinary infection Positive urine culture (1 or 2 species) with
controlling them, and vaccines and drug development. Much at least 10 bacteria/ml, with or without

clinical symptoms.
of this already applies to HIV/AIDS, one of the most serious

diseases to emerge in recent decades. Repiratory infection Respiratory symptoms with at least two of

the following sighs appearing during

hospitalization : ·
– cough
1. WHO (2014), Fact Sheet on Ebola Viral Disease, No. 103, Sept. 2014.
– purulent sputum
2. WHO ( 1 9 9 6 ) , The World Health Report 1996.
– new infiltrate on chest radiograph
3. WHO ( 1 9 9 9 ) , Removing Obstacles to Healthy Development, WHO consistent with. infection.
Report on Infectious Diseases.
Vascular catheter Inflammation, lymphangitis or purulent
4. WHO (2005), Weekly Epidemiological Record No. 49/50, 14th Oct.,
infection discharge at the insertion site of the
5. WHO (2003), World Health Report 2003, Shaping the future.
Septicaemia Fever or rigors and at least one positive

blood culture.

Source : (1)

Hospital-acquired infection is cross infection of one
According to a French National Prevalence Survey the
patient by another or by doctors, nurses and other hospital
distribtution of sites of nosocomial infection are as shown in
staff, while in hospital. A high frequency of nosocomial
Fig. 1 .
infection is evidence of a poor quality of health service

delivery. Many factors contribute to the frequency of
Lower respiratory
nosocomial infections: hospitalized patients are often
site S
tract RI
immunocompromised, they undergo invasive examinations

and treatments, and patient care practices and the hospital

environment may facilitate the transmission of
microorganisms among patients. The selective pressure of
tract (other)
intense antibiotic use promotes antibiotic resistance. While
progress in the prevention of nosocomial infections has been
Bacteraemia Urinary tract
made, changes in medical practice continually present new
B u
opportunities for development of infection.

D e f i n i t i o n of n o s o c o m i a l infections

Nosocomial infections, also called “hospital-acquired

infections”, are infections acquired during hospital care
Catheter site C
which are not present or incubating at admission. Infections

occurring more than 48 hours after admission are usually

considered nosocomial. Definitions to identify nosocomial FIG. 1

infections have been developed for specific infection sites Sites of the most common nosocomial infections

( e . g . urinary, pulmonary). Source : (1)