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MMI Exam Two
Terms in this set (57)
What are four ways HIV is transmitted?
1. sex w/o a condom
2. passed from mother to baby
3. sharing injecting equipment
4. contaminated blood transfusions and organ transplants
What types of medications are now available for HIV?
-usually 2-3 medications in a single pill
Who is most at risk for new HIV infection in the US?
black males with sexual contact with other males
What are prevention strategies for HIV?
condoms, circumcision (lowers change of acquisition), pre-exposure prophylaxis (PreP)
Which two races are not receiving nearly enough doses of PreP?
African Americans and Latinos
What came of Fauci's plan for HIV in Feb 2019?
-State of the Union promise to increase funding for HIV prevention
-85% HIV patients HRSA centers
what is the largest gap in care for HIV patients in the US?
from linkage to care (80%) and engagement in care (40%)
what are the disadvantages associated with a theoretical cure of an individual with HIV?
-monitoring for relapse may require more resources than continuing therapy
-are the risks of reservoir reduction worth it?
what are the advantages associated with a theoretical cure of an individual with HIV?
-truly returns immune system to "normal state"
-time defined treatment facilitates eradication
what would be a cure for HIV come faster?
intervening with reservoir cells
what are some factors associated with low reservoirs?
-women (related to estrogen)
-early treatment (<6 weeks)
-lack of inflammation
-lack of other infections (i.e. CMV, HepC, tuberculosis)
-lack of smoking
what is the average rate of reservoir decline in HIV?
early treatment means a small reservoir but does NOT increase the rate of reservoir decline
What is the WHO goal for HIV treatment?
90% aware of their status of which 90% on HIV treatment of which 90% virally suppressed
who are the traditional federal partners in public health?
CDC, FDA, EPA, USDA
who are the traditional state partners in public health?
WSLH, DNR, clinicians, local health depts, state health dept
what event caused the expansion of public health measures?
anthrax scares of 9/11
what is the laboratory response network (LRN)?
network of state and local public health, clinical, federal, military, and international laboratories to respond to bioterrorism, chemical terrorism, and other public health emergencies
what are the key laboratory elements of the laboratory response network (LRN)?
-national labs (CDC, USAMRIID, NMRC)
-reference labs (state and local PHLs, state agency labs)
-sentinel labs: community clinical hospital labs
prior to anthrax scares, what were the targets of public health and labs on emerging infectious diseases?
-surveillance and response
-infrastructure and training
-prevention and control
prior to anthrax scares, what were the outcomes of public health and labs on emerging infectious diseases?
-raised awareness of public health deficiencies
-understood what needed to be done, however, minimal funding
what is the "all hazards" idea?
laboratory capacity and capability and epidemiological surveillance needed for recognition of bioterrorism events are the same as for naturally occurring emerging infectious diseases
what are some non-traditional laboratory response capabilities that can be deployed during public health or environmental emergencies?
Biowatch (airfilters to collect samples to be PCR'ed for anthrax, plague, smallpox, and tularemia), USPIS (anthrax detection- continuous air sample), national guard civil support teams, hazmat
what is a virus?
a foreign nucleic acid that must infect a cell to propagate... once the cell is infected the virus hijacks varying amounts of cellular machinery to copy itself... often this means upregulated nucleic acid synthesis in a way that the cells themselves increase cell division
what are the three general classes of viruses?
1. DNA viruses: viruses encoded by human DNA (i.e. HPV)- most do NOT insert into the host genome; a few can (i.e. Hep B)
2. RNA viruses: viruses encoded by RNA (i.e. Hepatitis C); they never integrate but can cause cancer through other mechanisms
3. retrovirus: viral particle has RNA in it but it is "reverse attached" to DNA.. this DNA can integrate
what is the field effect?
a field of pre-malignant tissue in which new cancer is likely to arise
what is the most common cause of liver cancer in the US?
what three viruses are able to infect the liver for decades and cause cancer?
hepatitis B, C and delta
*delta only if Hep B is present
what outside factor increases risk of cirrhosis and cancer?
what is the only cause of cervical cancer?
how many new HPV infections occur annually? what age are most of them under?
6 million new infections annually; most < 24 years old
what are the vaccine age recommendations for HPV?
both doses given by 11-12; so immune response is developed before first sexual activity
what are 5 ways Endemic Burkitt's Lymphoma develops?
1. infection w/ Epstein-Barr Virus yielding B cell proliferation
2. chronic stimulation of antibody producing B cells by malaria
3. activation of proto-oncogene; usually transcription factor cMyc
4. turn off of most of EBV's transforming genes
5. mutations in tumor supressor genes-oncogene
how does Epstein-Barr virus cause cancer?
provides cancers one or more selective advantages
(these include inhibiting apoptosis and fostering proliferation)
what characteristics does a virus generally have to be associated with cancer?
-causes chronic infection
-infects the organ that develops cancer
-causes inflammation (facilitated by immunosuppression)
-inserts into genome (facilitated by immunosuppression)
what is the incidence of foodborne disease in the US?
1/6 Americans get sick annually and ~3,000 die as a result
how much money would be saved by preventing a single fatal case of E.coli?
what does FSIS oversee?
all domestic and imported meat and poultry related products
what does CFSAN oversee?
all domestic and imported food sold in interstate commerce
what does EPA oversee?
what does CDC oversee?
investigates sources of food-borne disease outbreaks
what are the reasons for continuing infectious disease threats to our food supply?
-number of different pathogens; often zoonotic
-global food supply
-complexity of the food chain
-intensive food production practices and centralization of processing and distribution
-human demographics and behaviors
-inadequate preventative measures + surveillance
what is the safest way to get food?
grow it yourself, local farmers market
what are some key issues with our food safety system?
-need for modernization of US food safety system
-inspection efforts are fragmented- no ultimate authority
-focus is on inspection after production
-disparity b/w FDA and USDA in funding and staffing
-only 1-2% of imported foods are inspected
-state and locals are not required to meet uniform national standards for food safety
what are recommendations to fix food safety system?
-utilize preventative strategies (HACCP)
-better monitoring of foreign imports and international practices
-integrate federal food safety agencies into a single agency
what are the different categories of food safety infrastructure in the US?
federal agencies, state agencies, local agencies
how many human disease have arise from wildlife?
~60% of all human diseases and 75% of all recently emerged zoonotic pathogens have come from wildlife
what does "one world one health" mean?
means disease between humans, domesticated animals, and wild animals can all intertwine and it is important to focus on all aspects as one
what is Milton's disease triangle?
environment is everything- host and agent are within them; disease overlaps host and agent
what are the 5 things Milton said wildlife serve as?
-"one health" component
what are the 5 neglected parasitic infections in the US that were discussed in Milton's lecture?
-in dogs, adult worms are free in upper intestine; in humans, larva can be found in any tissue
-def host: dogs and cats
-incidental host: humans
-passed to humans but ingestion of larval eggs from dogs
-heavy worm loads can lead to severe necrosis; enlarged liver, pulmonary complications
-no eggs in stool
-history of eating dirt and exposure to dogs
what is an emerging infectious disease?
1. newly discovered pathogen
2. spread of pathogen into a new region
3. change in pathogen resulting in widespread disease
4. pathogen crossing species ("species jump")
5. re-emergence of a known pathogen
what are the three important factors of disease emergence?
what are some examples of human factors contributing to EID?
2. population density
5. immune status of population
6. farming and food production strategies
what are some pathogen factors in EID?
what are some environmental factors in EID?
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