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.


http://www.jgid.org/articles/2011/3/1/images/JGlobalInfectDis_2011_3_1_63_77298_f4.jpg
 

                                                        P1                          

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Vaccination


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.





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                                                         Pic 1


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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.

 
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