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Thursday, December 27, 2012
Vaccination programmers
Vaccination
programmers
Children
in the UK can be given a series of vaccine to protect them against a range of
disease (P1). In some countries vaccination is a legal requirement. Vaccination
programmers have been particularly successful in virtually eliminating polio (poliomyelitis)
and diphtheria in develop countries. Polio my soon become extinct worldwide.
Diphtheria is vary rate in the UK, reduced to only 13 cases and no death
between 1986 and 1991.
By 1984 the world health organization’s programme of
vaccination, which is targeted against six major diseases (measles, pertussis,[whooping,
cough], tetanus, polio, tuberculosis, diphtheria) had immunized some 50% of the
children in the world and this has risen to 80% by the mid 1990. It has been
estimated that this programme prevented more than one million deaths annually
between 1974 and 1984. However, despite great progress, by 1990 about 3 million
were still dying each year from these diseases and about 4.6 million were still
fully vaccinated. Measles was killing 1.4 million annually (one every 20
seconds). Another 490,000 died of pertussis annually and 450,000 of TB. The
manual cost, one-third of which is given in aid, is about US$1.5 thousand
million.
The
world health organization expanded programme of
Immunization (EPI) aims to immunize more than 90% of the world’s new
born against a number of viral and
bacterial diseases by the year 2000. Hepatitis B is now also being targeted and
it is hoped to eradicate polio by the year 2000.
There is still a need for new
vaccines, for example against malaria, dengue fever, sleeping sickness, warm
infection, HIV, leprosy and others. Not only are new vaccines required, also
more effective and safer vaccines than those in used at the present time are
needed. For example the vaccine for cholera is only effective in 50% of patents
and the duration of immunity is relatively short. The flu vaccine also needs
improvement to make it more effective.
Vaccination
Role of
vaccination
Over 10
million deaths worldwide per year are due to infectious disease. To combat this
terrible of life, vaccination is a powerful weapon and has been one of the
great success stories of human medicine. Vaccination is the givens of antigens
from a disease-causing organism, either by injection or orally, with the aim of
causing the body’s immune system to learn to make antibodies against the
disease. The body should then be able to respond fast enough to infection by
that disease to eliminate it before symptoms develop.
For
vaccination to be successful as a strategy, it must be administered to as great
a number of people as possible, and must continue to be used until the disease
is eradicated. Vaccination is not compulsory in Britain because high enough up
takes can be achieved by government-backed education of the public. Providing a
certain high percentage of the populations are protected, epidemic can be
prevented. Isolated cases can quickly be ‘ring vaccinated’ if necessary,
whereby contact and every one in a giving area around and outbreak of the
disease can be vaccinated. However, it is important not to become complacent.
Whooping cough began to increase in Britain again because many people stopped
having their children vaccinated after scares about the safety of the vaccine
Another factor which must be taken in to account is that disease can
spread across international boundaries, so it is important to have, in
additional to national polices, a worldwide coordinate approach this. This is
one of the roles of the World Health Organization.
The smallpox story,
The most successful example of the
effectiveness of vaccination is the elimination of smallpox. Up to the late
1960s a combined total of some 15 million cases of smallpox occurred annually
in 33 different countries. The world health organization started and education
programme in 1956 and 1997 the last case was reported in Somalia and the disease
was effectively extinct. The USA and Russia, although there have been call for
the last sample to be destroyed.
Factors
which contributed to the successful education of smallpox were:
Vaccination,
- The virus did not keep changing its surface antigens, so the vaccine remained highly effective. Some organism, such as those causing influenza and malaria, occasionally change their antigens by mutation, thus ‘fooling’ the immune system of those who have develop antibodies against them as a result of infection or vaccination.
- A heat stable vaccine was developed for work in tropical and sub tropical climates.
- The vaccine was easy to administer by a scratch technique on the arm, so that assistants could easily be trained.
- The vaccine was very reliable and effective.
Surveillance,
- Infected people wearer easily identified.
- Rewards were offered to people who reported new case.
Containment,
- ‘Ring vaccination’ was used in the final stage of education whereby everyone in the area around any site of infection was vaccinated.
- Suffers were kept in isolation until they were non infectious.
- Efforts were made to trace all contact of those with the disease.
- International restrictions were made on the travel of those who had not been vaccinated.
All these required great
international cooperation and financial support.
Tuesday, December 25, 2012
Global distribution of disease.
Global distribution of disease.
When the
distribution of disease worldwide is studied. the most striking feature to
emerge is the difference between develop and developing countries.(Pic 01) show
the number of death and the percentage of death due to different causes in
developed (industrialized) countries and developing (third world) countries.
Infectious and parasitic disease represent a relatively high proportion of
disease in developing countries, whereas circulatory and degenerative disease
are, relatively speaking, the most important in developed countries. The
infectious disease measles, for example, is still an important killer disease
in many developing countries (Pic01) although it is declining rapidly as a
result of vaccination programs. Measles is amore series disease than
most people think. It can cause pneumonia, blindness, deafness and inflammation
of the brain which in turn may cause brain damage. It use to be an important
killer in developed countries (Pic02),4188 people died of measles in England
and wales in 1930, but only 26 in 1980.
Why have these change come
about and why are there such striking difference between developed and
developing countries? The temptation is to suggest that medical intervention is
responsible, but that death rates from measles were declining rapidly in
England and wales long before medical intervention. Vaccination against measles
was not introduced in Britain unit 1968. The same is true of some other
infectious disease which have been killers in
the past, such as whooping cough and tuberculosis. The truth is that, in
fighting disease, social and economic factor are just as important medical
intervention.
Some important infectious disease are
transmitted by faecal contamination of water and food. Example are cholera,
diarrhea, typhoid and dysentery. These declined rapidly in England and wales
after the public health act, 1875 which introduced public hygiene measures for
the proper disposal and treatment of sewage, and the purification of water.
When considering infectious disease in general, improvements in living
standards have been just as important. These increase resistance to disease.
particularly important are good nutrition and housing. Tuberculosis, a
respiratory infection, began to decline as living standards improved since it
is typically spread when people live in close contact, such as several people
living in one room, and also when people are malnourished. measles is a
particularly important disease in developing countries because it tends to
affect very young children, often under the age of one year before they have
been vaccinated, and when the body is less able to fight infection. If the body
is weakened by maturation, or by other infectious disease much more dangerous.
Most measles death are caused by secondary infections.
To summaries, infectious
disease have been brought under control in the UK and other developed countries
by improvements in hygiene, housing and nutrition as well as by direct medical intervention.
The latter includes improvements in prevention, such as vaccination, and in
treatment, such as the use of antibiotics(considered in more detail later).
Overall social, economic and medical factor are all important and all interact
in a complex way.
As vaccination programmers are extended
to developing countries, so the incidence of infectious disease is declining in
them. Measles is one of six major diseases targetted by the World Health
Organization (WHO) for prevention by means of vaccination in its Expanded
programme on immunization. The five others are tetanus, pertussis (whooping cough)
and polio, tuberculosis and diphtheria.
As infectious disease has been
virtually eliminate as a major killer in develop countries, so other diseases
have taken their place (Pic 1,2).Notable among the circulatory disease and
strokes. The emergence of circulatory disease and cancer as leading cause of
death in developed countries is partly related to change in lifestyle. These
disease are regarded as modern epidemic and will probably be brought under much
greater control as societies develop strategies to tackle them. It can be
argued that they are self-inflicted. Some major disease of developed countries
however are not related to lifestyle. They are due to an increasing length of
life(longevity). As we age, so the body begins to degenerate. A whole range of
degenerative disease exists. Cancer for example, become more common as we
age.
Pic2 compares cause of death in England
and wales for 1851 and 1990. Such data give an indication of the change that
can be expected as countries tackle infectious disease.
pic 1
pic1
picv1
Pic 1
pic 1
pic 2
Monday, December 24, 2012
Classification of disease
It is convenient to classify disease into the following six main groups.
1.
1.Disease caused by other living organisms.
Disease-causing organisms typically include viruse, bacteria ,fungi,
protozoans, flatworms and round worms.Thesem
organisms live as parasites in or on the human body and the interfere with is
normal working. Disease which are caused by bacteria ,virus and fungi are
commonly referred to as infectious disease or communicable disease ,such as
cholera and measles.Disease caused by other organisms are more commonly
referred to as parasitic disease ,such as malariya
.
2.
2. Disease are that are ‘human-induced’
or ‘self –infected’. These disease are brought by human on themselves .either
as individuals or collectively as a society. They could also be described as
social disease. Many are particularly associated with modern industrialized
societies and include coronary heart disease ,alcoholism ,drug abuse ,lung
cancer ,domestic and industrial accidents, industrial disease such as
asbestosis, and pollution-related disorders. The latter include brain damage
brought on by lead or mercury poisoning, some case of asthma and possibly same
cases of cancer found in people living near nuclear power stations.
3.
3. Deficiency disease. There are related to
the absence of certain nutrients in the diet. They may be due to the absence of
one of the main food group such as protein which results in kwashiorkor and
marasmus. The absence of specific vitamin may result in a number of disease
such as pellagra (vitamin B),scurvy (vitamin) or rickets (vitamin D).Deficiency
of minerals in the diet may also result in disease ,such as calcium and
phosphate deficiency causing rickets or lack of iodine causing thyroid goiter
.
4.
4. Genetic and
congenital disorders. These disorders are raisin increasing concerns in the
medical service and society in general. Example of genetic disorders are cystic
fibroses ,Huntington’s, disease and Down’s syndrome. Advance in medical science
ensure that many children who would in the past have died in infancy from such
disorders are surviving and living to adulthood. These means that as a society we
must provide means whereby adults with mental or physical handicaps ,often
severe , can lead fulfilling lives. On the other side of the coin ,genetic
screening can increasingly provide the information before birth whereby babies with
genetic disorders can be aborted. This raises many social and ethical issues
which provoke controversy in society.
5.
5. Ageing
and degenerative diseases. Degeneration of the body tissues can also cause
disease. for example ,weakening of the eye muscles causes long-sightedness in
many older people, and disease of the circulatory system, such as arteriosclerosis(hardening
of the arteries) result from ageing. Ageing of the joint and bone tissues often
leads to arthritis
.
6.
Mental illness mental illness cover a wide
verity of disorders. Example are schizophrenia. Senile dementia and depression.
certain drugs have been developed that control or reduce various forms of
mental illness. The treatment of this illnesses changed dramatically during the
twentieth century from lifelong confinement in ‘lunatic asylums’ to ‘care in
the community’.
This sex groups described above may also be grouped in to
the following categories.
·
Infectious
or communicable disease. Many
diseases are passed on from one organism to another, that is they are
transmitted and are thus said to be infectious, contagious, communicable or
transmissible. many of the diseases in group one above are infection and are
transmitted by way of droplets of liquid ,in the air ,food or water , by
sexually intercourse or simply by touch. Many are transmitted by way of an
intermediate organisms call a victor ,for example malaria by way of the
mosquito , or bubonic plague by way of the rat flea.
·
Non
infections disease. Disease group 2 to 6 above are describe
as non-infection or non transmissible. It could be argued that group 4 is a
special case of transmission because genetics disorders are transmitted from
parents to offspring due to the presence or absence of one or more inherited
genes.
It is clear from
the discussion above that there are no rigid boundaries between the disease
categories for example, many disease involve a genetics predisposition and
therefore an overlap between group 4 above and other categories., such as heart
disease (group 2) and some mental illness
(group 6).like health, disease has physical ,mental and social damnations. some diseases, for example ,are associated with poverty, such as tuberculosis, and may therefore be describe as having an important social dimension.
(group 6).like health, disease has physical ,mental and social damnations. some diseases, for example ,are associated with poverty, such as tuberculosis, and may therefore be describe as having an important social dimension.