Category: Infectious Disease

To answer the question if infectious diseases influence the risk of civil conflict it is necessary to measure the exposure to infectious disease pathogens and the number of civil conflict incidences. MHV-pathogens are utilized to measure the exposure to infectious diseases. Pathogens can be divided into three different host categories. If only humans can serve as host like with HIV, it is human only. If only animals serve as host, like plague, the pathogen is classified as zoonotic. If both humans and animals can be host, it falls under the category of multi-host pathogens. The transmission of pathogens can be divided into two categories. One being transmission through a vector like mosquitos, malaria is an example, and the other being pathogens like influenza, which are transmitted from human to human.

MHV-pathogens are used because they have some distinct features that make them especially suitable for this analysis. First, they are very hard to control because they use different vectors to spread. Also, the treatment of this kind of pathogens is very difficult, since vaccines are mostly unavailable. For this reasons, MHV-pathogens, apart from malaria, are not eliminated on a greater geographical stage. This means that if a specific pathogen has been present in a country it is most likely still there. Second, MHV-pathogens can only be transmitted from one human to another through specific vectors. Consequently, for a pathogen to be present, a country needs suitable biological and climatological conditions for the vector. For this reason, MHV-pathogens are not much affected by globalisation, since for example migration and trade cannot spread the pathogen to countries that do not provide conditions for the vectors to survive. The third reason that makes this class of pathogens suitable, is that the consequences for the health of effected individuals are serious and often deadly.

Two count indices are constructed to measure the exposure to MHV-pathogens in a country. The first count index measures whether a pathogen has ever been present, if it has been reported or diagnosed, in a country. The twelve different types of MHV-pathogens that this analysis uses are dengue, yellow fever, leishmaniasis visceral, relapsing fever, typhus epidemic, angiomatoses, filariasis-brugia malayi, leishmaniasis (mucocutaneous and cutaneous), malaria, onchocerciasis, trypanosomiasis africanis and trypanosomiasis. A specific number of this pathogens can be detected for each country.

The data on the number of pathogens in a country comes from the Global Infectious Disease and Epidemiology Online Network (GIDEON) database, where high quality data is available for most countries. The reason for this is, that the health consequences of these pathogens are severe and therefore they are observed closely in the whole world. Moreover, the index only uses data on the presence of a pathogen for two reasons. First, the possible error in measurement is lower than with data on the current state of a pathogen because this form of data is for example dependent on the health system or ongoing conflicts. Second, the data is more comparable since the current state of a country, like a functioning health care system, does not influence the presence of a pathogen.

A disadvantage of only using information on the sole presence of a pathogen is that it also measures single cases like migrants or tourists. Furthermore, this form of measurement does not consider the possibility of eradication. If a pathogen has been present in the past it is measured as present in a country, regardless of eradication. Therefore, the second count index measures whether a pathogen is endemic in at least parts of a country now, according to the GIDEON data. To be classified as endemic by GIDEON, the pathogen must be capable of replicating itself without help.

Since the disadvantages of the first index are mostly counteracted by the distinct features of MHV-pathogens, both indices lead to a high resemblance in their results.

The measurement of civil conflict uses information of the UCDP/PRIO Armed Conflict Data set for the period 1960–2007 (version v4, 2012). This data set is offered by the Peace Research Institute of Oslo (PRIO). The dependent variable is called ‘Civil Wars’. This variable includes armed conflicts within a state, that either account for a minimum of 25 deaths per year or over 1000 deaths over the time of the conflict, that are connected to the violence. Armed conflicts within a state are all conflicts, challenge the compatibility regarding government and/or area with the participation of armed forces between two groups. Moreover, one of this groups must be the governing body of a state. Around 140 countries are included in the used data set. At last, many time invariant and time-varying covariates are used in this analysis. They are utilized as control variables and to check the robustness

Abstract

New challenges of 21st century such as rapid globalization, increased trades and hyper mobility of people; can spread infectious disease faster than ever before. Vigilant practice is vital to slow down the chain of transmission and quarantine is one among them. Quarantine is a measure used by the global health agencies to prevent the further spread of disease during an outbreak. Quarantine is usually done by restraining or separating human being and other living organism; who came into contact with contagious pathologies either actually or potentially.

Background

Historically the term ‘quarantine,’ signifies forty days separation of suspected human being, goods and others from the healthy person and community; but now a day’s due to changes in contributory factors of disease emergence, there are variable time interventions for various transmissible diseases based on the incubation period of particular disease and these diseases has capacity to spread speedily from one country to another country.

Quarantine is considered as one of the oldest, simplest and valuable health measures to halt the disease progress. It helps to safeguard the public health from contagious diseases of various origins. The word quarantine emerges from Italian variant Quaranta giorni which means 40 days (forty days compulsory confinement before entering to other nation)

Evolution of quarantine

• 1377- During Black Death at Dubrovnik (place known for origin of Quarantine) person had to spend thirty days (Trentine) in a restricted area
• 1431- At Edirne self quarantine was done to control the leprosy cases in general hospitals
• 1492- Quarantine measures were directed towards the prevention of plague epidemics in coastal cities at Venice
• 1878- Following an outbreak of yellow fever at Mississippi valley local and state government pass quarantine legislation
• 1892- Quarantine laws had been changed after cholera outbreak at Europe
• 1944- Public health service act (PHS) was initiated by U.S government to prevent the transmission of infectious diseases
• 1967- Centers for disease control and prevention take up the responsibility of quarantine
• 1980- CDC restructured with establishment of 55 quarantine station
• 2003- System of quarantine station has been expanded after the outbreak of SARS epidemic at Foshan
• 2009- Outbreak of influenza H1N1 at Mexico; pandemic surveillance and quarantine has been applied
• 2014- Home based quarantine and Intercontinental travel control was imposed following outbreak of Ebola epidemics at western Africa
• 2019-2020- Mass quarantine and lockdown has been applied to all over the globe to stop the corona virus outbreak, which was first noted at Wuhan city

Types of quarantine

Control measures at community level are considered as essential way to reduce the contact between sick person and susceptible person. Following four kind of quarantine can be beneficial to cut down the disease transmission:-

• i) Mandatory quarantine- lockdown of cities and discontinuation of travel to infected area by legal order; which eventually leads people to stay at their homes
• ii) Voluntary quarantine- person who exhibit symptoms of being infected; willingly follows restriction of activities
• iii) Self quarantine- avoid needless contact with family as well as friends or maintain social distancing
• iv) Sequestering- limiting the face to face contact of healthy population and the length of quarantine was determined by incubation of particular infectious agent

Contributory factors of disease spread

Globally; Individual’s health can be determined by various factors such as rapid globalization, changes in environment, availability of health services, nutritional status of the population etc. following are the major contributory factors for disease spread:-

1. Earlier mobility of people was localized to state or nation. People started travel to long distance and become hyper migrated due to which infectious diseases are spreading faster than ever before. COVID-19 took only 6 days to spread around the globe. Future diseases are expected to take hardly few hours to infect numerous countries worldwide
2. Unexpected level of goods trades throughout the globe increases the opportunities for disease transmission
3. Environmental Deterioration happening at greatest speed which leads to climate changes. Travellers come across unexpected and significant changes in temperature, humidity and other factors; that eventually cause increased risk for transmittable diseases.

Qurantinable diseases

Various national as well as international agencies are working to get better surveillance and reporting of emergencies of international concern; such agencies identified many infectious diseases in the past decades. Following diseases need constant monitoring and supervision at every level:-

• i) Always notifiable diseases- several diseases such as Smallpox, Poliomyelitis, Human influenza, SARS always need to be notify irrespective of its time and place of origin.
• ii) Potentially notifiable diseases- biological and chemical events, cholera, hemorrhagic fever, yellow fever, plague needs attention when they characterize potential risk or situation.
• iii) Public health emergencies of international concern (PHEIC) – diseases that started spreading into many countries and require international response to control the outbreak of such diseases. i.e. Swine influenza(2009), polio virus(2014), Ebola(2016), Zika virus(2016), Nipha virus (2018), Corona virus(2019)

Quarantine Measures to halt disease spread

Due to insufficient knowledge about disease facts and floating rumours community members can easily get panic and anxious. Quarantine measures can be helpful in prevention of community transmission and can halt the disease progress to become pandemic:-

• Hold-up public gathering
• shutting down of public places i.e. Schools, colleges, cinema, malls
• Maintain social distancing by staying at home
• Restriction on mobility into or out of infected area (Cordon sanitaire)
• Avoid unnecessary visiting to health facility
• Regular monitoring of suspected and infected person’s Health status

Impacts of quarantine

Although quarantine is very good measure to control disease transmission but it may result in psychological distress, uncertainty and feeling of helplessness due to social distancing. The persons who required quarantine need to monitor regularly and should be well equipped with clear picture of the situation.

Conclusion

Future epidemics are still undecided. Traditional public health tool such as quarantine can be useful to control communicable disease outbreak and people’s anxiety globally. All the countries should be prepared for the upcoming epidemics and build up strong health care system to minimize the disease.

A disease is a specific abnormal condition that negatively affects the structure or function of part all an organism and there is different type of diseases including tuberculosis the most dangerous is the disease. This disease killed more people in the world, the research tells us about tuberculosis that who were killed form this disease.

The focus is the development of new drugs to treat TB because it has become resistant to drugs that has been used in the past. It kills more people in the world than any other infectious diseases Collaboration between scientists and other groups is very important to develop new and improved drugs/treatments for TB because it allows greater progress to be made.

TB is an infectious disease caused by mycobacteria. It affects the lungs and it can cause death if not treated. Approximately one third of the world’s population is infected with TB. Unfortunately, TB bacteria have become resistant to the two most commonly used TB drugs, isoniazid and Mycobacterium avium.

Bacteria become resistant to antibiotics because some mutant bacteria have a natural resistance to the drugs. Bacteria breed very quickly. When treated with antibiotic the normal cells are killed but the mutant cells are not killed. Eventually the mutant cells replace the normal cells in the population. For example, drug resistance can be increased if people do not complete a full course of TB treatment, health care providers prescribe the wrong treatment (the wrong dose or length of time), and drugs for proper treatment are not an available and drugs of poor quality. (News, Drug-resistant tuberculosis reversed in lab, 2019 )

The scientific groups/ specialists connected all facets of Tuberculosis are; Infectious Diseases, pulmonary Medicine and research. The history of tuberculosis and treatment has been documented since 1944, these treatments have been discovered through trial and error.( past, present and future 2002 and 2019)

The Journal of Preventive Medicine and Hygiene Egyptian mummies, dating back to 2400 BC, reveal skeletal deformities typical of tuberculosis; characteristic Pott’s lesions are reported and similar abnormalities are clearly illustrated in early Egyptian art. (OAIP 2017)

Tuberculosis has evolved thought history to defy rules of treatment. The data collected states that 558 000 people resistance to rifampicin (the most effective first-line drug) globally in 2017, of which 82% had Multidrug-resistant Tuberculosis (MDR-TB). 54 million lives were saved through effective diagnosis and treatment, between the years of 2000-2017.

This article by Editorial Board tell us about the world health organization that about 10 million people globally developed active tuberculosis, which is caused by bacterium mycobacterium tuberculosis and that is caused 1.6 million died from the illness. Who has identified big and persistent gaps in discovery and treatment, and another factor is the rise of drug resistant strains that was more difficult to treat, it can be effective new antibiotic that might help save lives among those with the most highly drug resistant strains.

How new treatment has been developed

In February 2000 representatives from universities, industry, governments, donors and others gathered in Cape Town, South Africa, to discuss the need for new TB treatments. The group came up with the Cape Town Declaration which described a way of encouraging the development of new drugs for the treatment. The group still the exists today and is known as the TB Alliance. Some of the member of this group include the American Lung Association, American Society for Tuberculosis Education and Research, American Thoracic Society, Association of the British Pharmaceutical Industry, Bill & Melinda Gates Foundation, Boston Consulting Group, European Commission, Global Forum for Health Research, International Union Against Tuberculosis and Lung Disease, Lupin Laboratories, Médecins Sans Frontières, Medical Research Council of South Africa, Novartis India Ltd, Partners in Health, Research Triangle Institute, Rockefeller Foundation, Royal Netherlands Tuberculosis Association (KNCV), Sequella Global Tuberculosis Foundation, Stop TB Initiative , TDR (Tropical Diseases Research), U.K. International Development Secretary, U.S. Agency for International Development , U.S. Centers for Disease Control, U.S. National Institutes of Health, U.S. National Tuberculosis Center, Wellcome Trust, World Bank , and the World Health Organization. (Alliance, 2019)

The following diagram shows how the various members were connected to form the TB Alliance. On August 14, 2019) the U.S. Food & Drug Administration (FDA) approved the use of Pretomanid, a drug developed by the TB Alliance to help in the treatment of people suffering from highly drug-resistant forms of TB. Pretomanid is used together with bedaquiline and linezolid to from a treatment known as the BPaL regimen.

Conclusion

Recent collaboration between scientists and the development of research networks have resulted in the production of new effective treatments for TB. it is important to get new treatments because the TB kills more than a million people worldwide every year. A number of new drugs have been developed which have been shown to be more effective against TB than isoniazid, a decades old drug which is currently one of the standard treatments. As well as, scientists have a lot of treatment to provide to treat tuberculosis and the scientists tried to developed. Communicating and collaborating to develop to treatment in this report the information about commination and collaboration between scientists to provide a good treatment and how to develop treatment will be providing.

Introduction

Based on the original broad claim, initial research was conducted to establish specific diseases that were common in Asian countries as well as certain geographic factors within Asia that affect infectious disease susceptibility; it was found that malaria cases notably increased in areas near deforestation. Thus, the original research question was formulated: “Does an increase in deforestation cause an increase in cases of Malaria?” Refinements to the research question were necessary to further developing the question, these refinements considered specific geographical factors as well as specific areas within Asia that were particularly affected by deforestation. There is a high occurrence of malaria cases within Southeast Asia as it is a tropical area with ideal climate a specific species of malaria – Plasmodium Knowlesi – has grown in prevalence.

Within Southeast Asia, specifically Malaysian Borneo, the spread of the malaria species Plasmodium Knowelsi has “…become the main cause of human malaria… Deforestation and associated environmental and population changes have been hypothesized as main drivers of this apparent emergence” (Grigg, M.J., 2016) Originally the P. Knowlesi parasite exclusively infected macaques that inhabited forests, but an increasing amount of human cases have emerged. As mosquitoes are common vectors for malaria, deforestation causes the displacement of mosquitoes, leading them to populate regions in closer proximity to humans. “Changes in vegetation, microclimate, and soil composition can affect the species composition and abundance of mosquito populations.” (Fornace, K.M., 2016) In Malaysian Borneo, the incidence of deforestation is increasingly high, a study found that “Eighty percent of the rainforests [in Malaysian Borneo] have been heavily impacted by logging…” (Butler, R., 2013) The rainforests are primarily cleared for the production of palm oil.

There have been multitudes of research papers regarding the correlation between areas of high deforestation and cases of Plasmodium Knowlesi, these papers often corroborate with other research papers, amounting to the essentially the same conclusion.

Justified Arguments and Evidence

The number of hectares deforested in Borneo annually from 2001 to 2012. There is a prominent spike in deforestation in 2009 when there was a recorded amount of around 400,000 hectares deforested. This spike in deforestation can be correlated to the increase of P. Knowlesi incidents, in which there was a peak in cases of Plasmodium Knowlesi malaria in humans. Within the years of 2004 to 2008, the average rate of deforestation was 12,500 hectares per year. Whereas within the span of 1 year (from 2008 to 2009) there was an increase of 150,000 hectares per year. This increase in deforestation directly correlates to the increase in malaria cases as P. Knowlesi only became prevalent in 2008. The general positive trend of this graph indicates that the number of hectares deforested continues to increase beyond the labelled years.

The occurrence of human infections with different species of Malaria over the 14-year span decreased immensely from the initial recording in 1997. However, it is not until 2008 that the Plasmodium Knowlesi Malaria species is recorded. The occurrence of P. Knowlesi reached roughly 1000 cases in 2009, this peak can be related to the peak in deforestation in Malaysian Borneo in 2009 . This relationship can be further defined through the decrease in P. Knowlesi cases in 2010, reaching approximately 500, as a result of the decrease in hectares deforested in that same year. A contradiction to this correlation however is the number of cases in 2011 reaching almost the same number as in 2009, there was a decrease in deforestation in that year.

I is clear that the amount of forest cover in Malaysia is linked to the incidence rates of Plasmodium Knowlesi malaria. The recordings of high reported incidents (red) occur in areas of no forest cover. These results are likely due to an increase in macaque population density due to dwindling forest area to inhabit, forcing the population to relocate in regions closer to humans. In 2009 there was a recording of high incidence, this high recording in which there is a notably high spike in deforestation, as well as an increase in reported cases of P. Knowlesi malaria.

Conclusion

The conclusion that can be drawn from the data is that an increase in land degradation in the form of deforestation results in an increase of Plasmodium Knowlesi malaria cases in Malaysian Borneo. This conclusion is in support of the claim in that geographical factors in Asia do increase the susceptibility of infectious diseases. The evidence supports this conclusion as there is a positive relationship between the number of hectares deforested and the number of reported cases of Plasmodium Knowlesi malaria in Malaysian Borneo. This correlation is due to the fact that deforestation displaces carriers of the disease – the macaques that inhabit the forests – as well as the mosquito population, vectors of P. Knowlesi malaria. This displacement leads to an increase of human cases of malaria within regions close to deforestation.

Evaluation of the Claim and Recommendations

The data gathered definitively supports the claim that geographical factors in Asia make the region more susceptible to infectious disease. Research in regard to the relationship between deforestation and different strands of malaria has been well documented within the region of Malaysian Borneo by medical researchers specialised in the study of infectious disease. The data between different sources remained relatively consistent, supporting the reliability of the data. However, whilst the data sets maintain a high level of corroboration, some of the evidence displayed data from Malaysia, which is a larger region than Malaysian Borneo, this placed a limitation on the data as the research question focussed on a more precise region. Without data from the exact region in the research question, the claim can still be supported, but the research question cannot be answered with exact certainty. Further data concerning the specific area of Malaysian Borneo would be required to draw a valid conclusion. A further limitation on the data is that most of the cases of Plasmodium Knowlesi malaria were only the reported cases, there may be a much higher prevalence of the disease than displayed as the reported cases are representative of only a percentage of malaria cases. This limitation is based on the methods by which the data was collected. In most cases, the research was performed by medical researchers in the field of infectious diseases, the data was collected via hospital records of infected patients. However, the diagnosis of P. Knowlesi is commonly misdiagnosed as other species of human malaria, resulting in uncertainty of the true number of cases in that area.

This investigation has only considered the fact that there may be multitudes of other factors that affect the prevalence of P. Knowlesi cases such as population density of humans as well as mosquitoes and macaques, time of year, elevation of the land. These are all factors that limit the reliability of the data as deforestation is not the only independent variable.

Bibliography

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Increasing globalisation and continued human induced environmental degradation is enhancing the ability for infectious diseases to emerge and spread. Globalisation, climate change, urbanisation and livestock intensification are all features of the modern human society disrupting the natural ecological system and altering disease transmission (Patz, J.A. et al 2000). Changes in population size, density and distribution, aided by international migration and mobility further emphasises the likelihood emerging diseases will traverse entire continents and rapidly spread in short periods of time. Dengue Fever is a recent successful outbreak directly relating to environmental changes. The history of SARS (Severe Acute Respiratory Syndrome) and HIV/AIDS also reflect the link between increasing modern globalisation and risk of exposure to emerging diseases.

Ecological changes due to human intervention can influence the emergence of infectious diseases (Patz, J.A. et al 1998). A warming and unstable global climate for example, can be linked to the increasing emergence of vector-borne diseases (VBDs) over the past decade, by influencing the survival and transmission of vectors and pathogens within the environment (E.A Gould & S. Higgs). Tests demonstrating the effects of ambient temperatures between host-parasite interactions revealed that lower temperatures reduces the host’s susceptibility to infection, but not higher (Murdock, C.C., et al, 2012). Effects of warming temperatures have been suggested to increase egg laying/replication, egg development/maturation and mass gain in parasites, in association with shortening of incubation periods in mosquitoes (Patz, J.A., et al. 1998) (Paaijmans, K.P., et al. 2012). Infected species of mosquitoes, ticks and sand flies are therefore more active and reproduce in warmer climates, and parasites mature in time to cause infection (Shuman, E.K., 2010). Further, dynamic models suggest a warming climate will expand the area range in which infectious transmission is capable of surviving (Martin. P., 1995).

Increased heating leads to greater evaporation, dryer land surfaces and more intense droughts. Warming causes greater water vapour in the atmosphere, lending to more intense precipitation events (Trenberth, K.E., 2011). Studies demonstrate mosquito outbreaks and vectorial competence coincide with natural droughts and rainy seasons (Chase, J.M. & Knight T.M., 2003). The emergence of infectious diseases may increase in these anomalously wet or dry periods, depending on the type of disaster. For example, Dengue Disease is a mosquito borne disease associated with stagnant stored water in highly populated areas experiencing hot, dry climatic conditions. Severe drought and high temperatures create breeding grounds in water containers for mosquitoes within or near households. (Anyamba, A., et al. 2014). Previously, In the 1990’s Aedes aegypti , the main vector in the Dengue transmission vastly increased in quantity across South and Central America (Oaks Jr, et al, 1992). Currently, more than 2 billion people are at risk.

Rising urbanisation in developed industrialised countries has generally contributed to an overall improvement of health, and allows cities to grow economically. It is in developing low income countries that rising urban populations see the most detrimental consequences. As these cities are becoming more densely populated, whether it be due to migration or natural population, economic growth does not keep pace with urban growth. As a result, many governments do not have enough resources to support these populations and they live in poor conditions. The poor health of urban dwellers, unsanitary living conditions and high rate of contact allows a high risk of infectious diseases to be transmitted. Built up over time, these diseases can potentially circulate to other more cleaner parts of the cities and worldwide (Alirol, E, et al. 2011).

As global transport networks and the ease of migration between countries expand, we are offering new pathogens, previously obscure, the opportunity to infect new host populations (Tatem, A.J., et al, 2006). Prior to recent centuries, pathogen infection remained confined to regional and continental populations, where humans were relatively isolated from one another (Dobson,A.P., and Carper, E.R., 1996). Now, the emergence, efficiency and extensive use of trains, cars, planes in modern transport by air, land and sea can facilitate global pandemics for communicable diseases. In particular, the global air transportation network has grown exceedingly and largely influences local, national and international economies (Guimera, R., et al, 2005). Almost 700 million people fly each year, with passenger numbers growing nearly 9% each year since 1960 (Tatem, A.J., et al, 2006). Aviation is also indirectly responsible for the propagation of diseases such as severe acute respiratory syndrome (SARS). SARS is an animal based coronavirus that was responsible for a pandemic in 2003. Originating in Guangdong Province, China, the virus spread within weeks to infect 8,448 people over 37 countries and 5 continents, killing 774 people (Peiris, J.S.M., et al, 2004). The spread could be aided by tourists entering the country where they were exposed to illnesses to which they have no resistance. Though small in mortality compared to historic pandemics, and mainly damaging the economy, the speed and extent in which SARS traveled in such a short time emphasised the potential for increasing global air transport networks to spread diseases. However, a significant factor facilitating the response and management of the SARS outbreaks was modern technology and humans ability to communicate through globalisation. As fast as the virus spread, the international public health community responded to contain disease spread and impact. Modern interventions enhanced infection control by measures such as finding and isolating patients, implementing ‘social distancing,’ and encouraging better personal hygiene. Domestic and international travelers were issued travel advisories and screened at borders (Bell, D.M., 2004). Globalisation plays a role in both enhancing and reducing the emergence and spread of infectious diseases.

Migration groups such as refugees, immigrants and asylum seekers are part of migratory groups socially disadvantaged and contributing to an increasing global movement. Some migrants undergo harsh transitional periods and experience refugee camps, trafficking or smuggling in order to move to a new geographical location, all greatly affecting their health. Should the health and disease parameters that influence the rate of infection in these transitional periods be different from those at the destination, the process of migration can act as a method for infection transfer between regions. Infectious diseases can manifest in susceptible migrant populations after moving to new destinations. For example, there is concern Mexican migrants into California are at an increased risk for HIV infection (Sanchez, et al. 2004). Migration related factors such as continual mobility, limited access to health care services, poor education and knowledge, poverty, discrimination and low quality housing all increase the liklihood they are to engage in unsafe sexual acts. Use of drugs and alcohol, and exchanging sexual favours for money and food all increase the risk of an HIV/AIDS outbreak in these population settings.

Commercial globalisation and the rising movement and use of livestock greatly enhance the dissemination of exotic pathogens into new populations. The introduction of infected animals otherwise foriegn into a naive geographical area, is an important driver of emerging diseases (Gummow, B., 2010). The United States is amongst the largest importers of wildlife, importing >1 billion individual animals in 2000-2004 (Palvin, B.I., et al, 2009). Limited disease testing is conducted; only wild birds and primates require quarantine, and mandatory tests exist for only a few diseases. Furthermore, the process of importation often involves containing large quantities of animals in unnatural groupings of species. Combined with poor sanitation measures, this provides the opportunity for cross-species contamination and rise of pathogens to be imported into the country. For example, imported animals like hogs, cattle and poultry can be contaminated with Salmonella enteritidis and E. coli microbes when they are crowded in facilities without proper waste disposal systems.

Advances in medical treatments has led to an increasing number of immunosuppressed individuals, such as those undergoing organ transplantation or cancer chemotherapy. Immunosuppression lowers the body’s resistance to infections, making people more susceptible to the development of opportunistic infections. Similarly, malnutrition increases the risk of people contracting infectious diseases, seen in socioeconomically disadvantaged countries and especially their children (Ibrahim, M.K., et al, 2017). Immune responses require energy to execute defense functions; energy acquired from micronutrients such as vitamins, fatty acids and amino acids. Malnutrition results from an inadequate intake of energy requirements. An imbalance between nutrient intake, energy consumption, and ability to perform bodily functions persists, impairing immune function, leaving children underweight, weak and vulnerable to infections (Schaible, U.E. and Stefan, H.E., 2007). Families living in low income households increase the likelihood children will be underfed and malnourished. These children are least likely to have access to proper healthcare and sanitation. Mothers who are underweight are more likely to have a child who is stunted. Her child will less likely grow to be strong and healthy, complete school, gain a job and earn economic opportunities. The child is more likely to remain in poverty and get sick. A constant cycle of poverty persists with malnourishment and sickness. The increased susceptibility of the malnourished host to infectious diseases can be supported by studies regarding children under the age of five. For example, a study on children in the Philippines with a median age of 1.8 years and were underweight, were at a higher risk of severe lower respiratory tract infections like Respiratory Syncytial Virus (RSV)(Paynter et al, 2014). Nutrition therefore plays a key role in the development of the immune functions during childhood and their consequential ability to ward infections and disease.

Therefore, there are many factors of the modern human society that may increase the risks of emerging diseases. Population growth in an increasingly mobile and commercial world is allowing infectious diseases like SARS and AIDS the opportunity to spread from person to person more easily than ever. Climate change is causing extreme weather events that influence pathogen population and poor living conditions for an exceedingly large number of low income populations, results in greater exposure to emerging diseases in the future.

References

1. PATZ, J. A., GRACZYK, T. K., GELLER, N. & VITTOR, A. Y. 2000. Effects of environmental change on emerging parasitic diseases. International journal for parasitology, 30, 1395-1405.

Diagnostic tests play an important role in the detection of infectious agents, the finding of a new agent, direct an appropriate therapy, observing the response to treatment, estimating prognosis, and disease analysis. The inadequate diagnostic services against infectious diseases is a serious problem in developing countries and one of the major issue that a nation must face at the start of this century. Diagnostic and screening of an infectious disease are mandatory for monitoring the identification of etiology of the disease and for effective treatment as well. A large number of people infected from communicable diseases for which patients are not getting treatment in spite of the presence of treatments. For example, the majority of patients for HIV infection are living in such countries where they are not able to approach for any treatment or therapy (1).

Diagnostic centers in developing countries are often less, and access is limited due to their location or economic factors. In addition, due to the high cost, some specific diagnostic tests are not available to the majority population. Furthermore, many clinical laboratories lack sufficient resources and facilities such as electricity supply and water management may be irregular. Unavailability of skilled technical staff is also a big issue in some nations, mainly in rural regions. For certain tropical neglected diseases, suitable testing has not yet been developed. In the developing states, investment in diagnostic tests is often a negligible fraction of healthcare expenditure and some manufacturers have little interest for investing in the production of diagnostic products, because of uncertainty that profit on their investment will likely to be low. Disease patterns in developing countries often variate from those of wealthiest countries and when developing a new test, manufacturers must take into consideration the regional epidemiology at the point of intended use(2).

Technological advancements and the production of innovative devices that can be utilized outside of the diagnostic lab and have the ability to reduce some of the hurdles faced by healthcare personnel in developing countries. Quick tests for practice at the point-of-care (POC) provide novel solutions for recognizing transmissible diseases. In past, there have been less funding for POC tests for infections that are frequent in developing countries, but the trend is now changing. The absence of regulation of diagnostic services in many countries has resulted in the extensive use of sub-optimal POC tests, particularly for malaria. Recently technological advancement and understanding of the significance of definitive diagnostics has followed rapid progress of POC tests that require no special apparatus and training(3). Point-of-care testing is commercially accessible low-income countries for numerous infectious diseases including AIDS/HIV, malaria, syphilis, tuberculosis, human African trypanosomiasis, and Visceral leishmaniasis. In 2003 the term ASSURED test was coined by WHO/TDR (Special Programme for Research and Training in Tropical Diseases), to explain the ideal attributes of a diagnostic test (3).

Even when a diagnostic test with suitable results is available, there are many hindrances in initiating new test in the developing world. The introduction of new tests mainly depends upon the healthcare system and many other conditions such as supply chain management to prevent the stock out of diagnostic tests and drugs. Another major challenge is the alternation in the biology and pathological processes of infectious disease necessitate the direct identification of the infectious agent particularly during the early stage to minimize the further transmission of the disease (2).

In conclusion, prevention of infectious disease in low-income countries is challenged by the low standard provision of diagnostic facilities and a string action is required to remedy the condition. Diagnostic centers are often unreachable, under-resourced and the shortage of basic services and new tests are necessary that can be utilized for people living in remote areas. POC tests against infectious diseases can rescue many lives and enhance public health.

Infectious diseases form by pathogenic microorganisms for example microbes infections parasites or growths; the maladies can be spread straightforwardly or by implication starting with one individual then onto the next.

Effective treatment for irresistible infections involves finding the sort of germ set off the disease makes it simpler for a wellbeing expert to complete fitting treatment. in cases that these ailments are brought about by microbes, anti-infection agents are known to be the best technique for treatment as they murder the microscopic organisms all together closure the contamination.

A wide variety of infectious diseases consist of different side effects. Examinations of body liquids carry the ability to uncover proof of specific organisms which are causing the sickness. This helps health professionals tailor a patient’s treatment. Examples of common tests are; throat swabs. Taken from moist zones of the body, blood tests. Here an expert acquires an example of your blood by inserting a needle into a vein in the arm. Urine tests are another example, these are simple and painless, requiring patients to produce urination samples by peeing them into a container which then gets sent off to a laboratory for investigation.

Tuberculosis is another deadly infectious disease. This disease mainly affects the lungs. microbes inhaled into the lungs are encompassed by white platelets. In the event that the white platelets, called macrophages, contain the contamination, microbes remain walled off in territories called granulomas and dynamic disease doesn’t create. Tb is treated with the use of medication however the duration of prescription and number of drugs is longer and bigger than that of the more common and minor scale infectious diseases, for example, Lyme disease. This disease, on the other hand, takes 6 or more months to be treated as the usual course of treatment is for that long where 2 drugs are prescribed; Rifampicin and Isoniazid which are to be taken for the entire six-month course.

Cholera is an infectious disease that can cause serious problems in the bowels. There’s an extremely little danger of getting it while going in certain pieces of the world and you are most likely to get Cholera from exposing yourself to bacteria, drinking unclean water, eating sustenance (especially shellfish) that has been in unclean water, or eating nourishment that has been dealt with by someone who has been infected by the disease. This infectious disease requires prompt treatment as it can result in passing inside a couple of hours.

Lastly, there are many infectious diseases without treatments. An example of this is Polio which is another serious viral infection that used to be common in the UK and worldwide, rare nowadays because it can be prevented with vaccination. A difference here is that it’s an almost undetectable disease as most people with polio don’t have any symptoms and therefore won’t know they’re infected. Furthermore, there’s no cure, so it’s important to make sure that we’re fully vaccinated against it. It’s known to be the job of the immune system to fix the illness as done in 75% of cases and in this way treatment mostly centers around supporting substantial capacities and decreasing the danger of long haul issues while the body fends off the contamination

Before treatment is even needed, we should always look for ways to prevent disease. Staying away from disease and battle the spread of disease after is one of the best methods for control as antibodies are accessible to trigger the resistance to two or three pollutions for instance measles and chickenpox. These contaminations can be averted by immunizations as they work with the body’s characteristic resistances to result in immunity to those diseases.

Foodborne illnesses are to a great extent preventable. Great agrarian and assembling practices can diminish the spread of microorganisms among creatures and avert tainting of nourishments. Checking the whole nourishment creation procedure can pinpoint perils and control focuses where sullying can be anticipated, restricted, or dispensed with.

In terms of treatment for Cholera, rehydration is the main way to help the body as the objective is to supplant lost liquids and electrolytes utilizing a straightforward rehydration arrangement oral rehydration salts ors. Furthermore, some antibiotics may reduce both the amount and duration of cholera-related diarrhea for people who are severely ill. This is a rather simple and quick way to get rid of disease as it purely involves the intake of substances to fix the dehydration.

for treatment for helminthiasis, Anthelmintics are utilized to cure the individuals who are contaminated by helminths which are referred to as the condition helminthiasis. these meds are also used to treat corrupted animals. anthelmintic obstruction is said to exist in a populace of worms if over 5% of the worms endure treatment.

For a variety of infectious diseases like tb, finishing the full course of prescribed drugs is highly advised by specialists as counteracting the arrival of the contamination is extremely vital. discontinuing the prescription before the course has been completed builds the hazard that the microorganisms will return and end up resistant to future medications.

Topical antifungal meds can be utilized to treat the skin contaminations brought about by parasites. Some parasitic contaminations, for example, those influencing the lungs or the mucous films, an oral antifungal can be utilized as treatment. Increasingly extreme inner organ parasitic contaminations, particularly in individuals with debilitated insusceptible frameworks, may require intravenous antifungal drugs.

Evaluate why treatments may not always be accessible or appropriate, for particular individuals.

A downfall of Tuberculosis treatments is that they’ll only work efficiently on the basis that the medicines are taken exactly as required for the full-time period. As mentioned above, treatments are not fully accessible in some parts of the world. Only 2 percent of those who have Multidrug-Resistant Tuberculosis actually receive the right medication. Furthermore, Some of the drugs are known to have very severe side effects and therefore make it difficult for those affected or those simply unable to take them for such long amounts of time. Additionally, it has been discovered that many people have become resistant to medications, this occurs when patients don’t consume their medications appropriately or for the situation that the microbes that the sufferer is contaminated with has originated from an individual with a created resistance to the drugs for TB, there is known to have drug-resistant TB.

A major problem is that Life-saving medicine and vaccinations aren’t distributed equitably around the world. This means that people in the poorer parts of the world have no access to treatments that they may need in order to treat infectious diseases. It has been discovered that more than 50% of those suffering from HIV/AIDS, needing drug treatment, are not receiving it. And while those living in wealthy countries are routinely immunized with vaccines that ensure protection against youth pneumonia and looseness of the bowels, kids in poor nations are not; for every kid who kicks the bucket from pneumonia in an industrialized nation, more than 2,000 kids pass on from the disease in developing nations.

Medications may not generally befit for specific people due to Antimicrobial and anti-microbial medication obstruction. This is the capacity of a microorganism to withstand the impacts of an anti-toxin. It is a particular kind of medication resistance. As mentioned above, most infectious diseases are treated with the utilization of anti-infection agents and therefore resistance is becoming a major problem.

Numerous elements impact whether poor countries can get moderate medications of good quality. Most medical research work isn’t intended for the necessities of those individuals in the poorer nations since they are not a huge market. Subsequently, a huge level of the cash spent worldwide on human services research is devoted to issues influencing small percentages of the total actual populace. Endeavors are being made by pharmaceutical organizations, and different associations in order to defeat these difficulties, giving subsidizing, research, and gifts of meds. The deplorability of worldwide irresistible ailment isn’t just that such a large number of lives are lost or harmed, it’s that such a significant number of these diseases could be anticipated or treated adequately with ease drugs.

Even vaccinations come with a downside, they aren’t 100 percent reliable. Additionally, no known vaccine is without side effects. Constantly keeping up to date on all vaccines is key. Both staying away from those infected and staying at home if you notice any signs and symptoms of possible infection is another way to prevent spread.

Cholera is a disease characterized by extreme bouts of diarrhea (Somboonwit, Menezes, Holt, Sinnott, and Shapshak, 2017). In the 19th century, Cholera was believed to be a disease caused by breathing “bad air”, however researcher John Snow showed that cases of the disease were clustered around a public well (Symington, 2016). Upon inspecting the water from the well, John Snow discovered the presence of white particles floating giving weight to his theory that the disease was caused by waterborne bacterium (Symington, 2016). We now know the disease is caused by Vibrio cholerae, a gram-negative bacterium (Harris, LaRocque, Qadri, Ryan, and Calderwood, 2012). Under microscope the bacterium appears as a comma with a single flagellum for propulsion (Somboonwit et. al., 2017). Though there are hundreds of V. cholerae serogroups, only two, O1 and O139 serogroups, cause disease in humans (Harris et. al., 2012).

Prevalence

In the updated report by Ali, Nelson, Lopez, and Sack (2015), countries in Africa and southern Asia have the highest incidence rates of Cholera. Since Cholera is highly under reported due to a variety of factors such as social, economic and environmental circumstances, the exact numbers for incidence and case fatality rates are unknown (Ali et. al., 2015). However, current estimates put 1.4 billion people at risk of Cholera, and 2.9 million of those at-risk populations develop the disease (Ali, Nelson, Lopez, and Sack, 2015). Previously, the World Health Organization reported that the case fatality rates ranged from 0.0% to 15.8% in 2016 (Cholera case fatality rate, 2017). Since then, the World Health Organization (2017) reported that the case fatality rate is typically below 1% as reported by the most impacted countries. Children are the most vulnerable and comprise an estimated 50% of all Cholera cases and deaths (World Health Organization, 2017).

Chain of infection

V. cholerae’s natural reservoir is typically slightly salty waters (Almagro-Moreno and Taylor, 2013). V. cholerae is greatly affected by environmental factors like temperature, salt, pH and available nutrients (Almagro-Moreno and Taylor, 2013). In fact, V. cholerae experience optimal growth in waters with 0.2-3% salinity, 30-40ºC and with a pH of 8 (Vezzulli, Pruzzo, Huq, and Colwell, 2009). Within and around aquatic environments, fish, bivalves, lake flies and birds are some of the known hosts of Cholerae (Vezzulli et. al, 2009).

The route of transmission of Cholera is the faecal-oral route (World Health Organization, 2017). Humans are a natural host of V. cholerae and can contract the bacterium by consuming water or food that has been contaminated (Somboonwit et. al., 2017). Although the infectious dose needed to cause disease in humans is high (, it may be lowered if an individual’s stomach acid is altered (Hussain, Fazil, and Singh, 2011). If enough bacteria survive and pass from the stomach, they then begin to colonize the small intestine (Nelson, Harris, Morris, Calderwood and Camilli, 2009). Once in the small intestine, V. cholerae have two main virulence factors; 1) cholera toxin and 2) toxin-coregulated pilus (Nelson et. al., 2009). Cholera toxin is the substance responsible for the diseases staple characteristic secretory diarrhea (Wernick, Chinnapen, Cho, and Lencer, 2010). The toxin-coregulated pilus allow the V. cholerae cells to bind together and hold a position in the intestinal lumen (Nelson et. al., 2009). V. cholerae has an incubation period ranging between 2 hours to 5 days (Somboonwit et. al., 2017). According to Somboonwit et. al. (2017) most Cholera hosts are asymptomatic. However, asymptomatic hosts still shed high numbers of the bacteria through feces contributing further contamination (Nelson et. al., 2009).

As noted previously, the mainstay symptom of Cholera is secretory diarrhea (Somboonwit et. al., 2017). The diarrhea can be described as similar to that of rice water, with a pungent, fishy smell (Somboonwit et. al., 2017). If left untreated, symptomatic individuals may succumb to dehydration as fluid loss has been known to be as much as one litre every hour (Hussain et. al., 2011). Patients experiencing dehydration may be lethargic, have a fast but weak pulse and altered skin turgor as demonstrated by a pinch test (Somboonwit et. al., 2017). Further, symptoms resulting from loss of electrolytes may manifest as muscle weakness, fatigue, cramps and confusion (Somboonwit et. al., 2017).

Currently the test for cholera is to sample faecal contents of those suspected to be infected by the bacteria (World Health Organization, 2017). However, this method of testing is time-consuming and expensive, requiring the samples to be transported to laboratories with equipment necessary for testing as well as trained individuals to operate (World Health Organization, 2017). Polymerase chain reaction tests are also available providing a more accurate result, however they also require lab facilities and equipment (World Health Organization, 2017). Perhaps more preferably, rapid diagnostic tests can be performed in the field allowing for quick diagnosis and do not need to be performed by someone with extensive training (World Health Organization, 2017).

Rehydration therapy is the primary treatment of symptomatic cholera reducing the fatality rate significantly (Harris et. al., 2012). Antibiotic medications are available but are only an adjunct to rehydration therapy and to increase recovery rate (World Health Organization, 2017).

Community Context – Small Cities and Towns in Africa

Cholera is most prevalent in developing countries and effects the poorest of the population (World Health Organization, 2017). Many of the social determinants of health contribute to the persistence of the disease such as income and social status; social support networks, education, physical environment and personal health practices, just to name a few (Olago, Marshall, and Wandiga, 2007). The rest of this paper will focus on the impact of economic stability and environment as well as discuss methods of prevention.

The most effected by Cholera are the poorest in developing countries (Olago et. al., 2007). The majority of individuals effected are living on little income due to being self-employed, or being farmers who primarily eat what they grow (Olago et. al., 2007). In these areas government medical support can be scarce, and as such the private sector has become a large contributor of medical supplies, increasing the gap for low income individuals (Olago et. al., 2007). It is also difficult for individuals to protect themselves even through one of the simplest ways, boiling water; this is due to the price of wood being a common concern, as wood is required to start a fire to then boil the water (Olago et. al., 2007). Economics is not just an individual or community issue as Cholera outbreaks put a financial strain on governments as well (Olago et. al., 2007). However, Non-Government Organizations have been available to help communities set up methods of prevention like digging wells and building latrines (Olago et. al., 2007).

Cholera outbreaks have been tightly associated with climate, meaning that the environment one lives in is an important factor (Olago et. al., 2007); for example, Cholera outbreaks have been strongly associated with rainfall and temperature (Rebaudet, Sudre, Faucher, and Piarroux, 2013).

Disease Prevention and Management

Prevention of Cholera can be increased by improving access to clean water, building latrines in safe locations to eliminate the risk of further contamination, and educating the public on proper hygiene (World Health Organization, 2017; Rebaudet et. al., 2013; Somboonwit et. al., 2017). At the local level, increasing the access to clean water and creating ways to clean water is a simple prevention method that could be implemented; for example, the use of seri cloths to filter water has been shown to reduce Cholera infection (Almagro-Moreno and Taylor, 2013). However, more effective household water treatments are available, such as liquid chlorine and chlorine tablets, solar radiation, and boiling (Lantagne, and Yates, 2018). The Global Task Force on Cholera Control is also committing to prevent the disease by increasing surveillance and decreasing response time to implement support (Somboonwit et. al., 2017).

References

1. Ali, M., Nelson, A. R., Lopez, A. L., & Sack, D. A. (2015). Updated global burden of cholera in endemic countries. PLoS neglected tropical diseases, 9(6), e0003832. doi:10.1371/journal.pntd.0003832
2. Almagro-Moreno, S., & Taylor, R. K. (2013). Cholera: Environmental Reservoirs and Impact on Disease Transmission. Microbiology spectrum, 1(2), OH-0003-2012. doi:10.1128/microbiolspec.OH-0003-2012
3. Cholera case fatality rate (2017, September 18). Retrieved from https://www.who.int/gho/epidemic_diseases/cholera/case_fatality_rate_text/en/.
4. Harris, J. B., LaRocque, R. C., Qadri, F., Ryan, E. T., & Calderwood, S. B. (2012). Cholera. Lancet (London, England), 379(9835), 2466–2476. doi:10.1016/S0140-6736(12)60436-X
5. Hussain, M., Fazil, U. T., & Singh, D. V. (2011). Vibrio cholerae infection, novel drug targets and phage therapy. Future Microbiology, 6(10), doi.org.proxy1.lib.trentu.ca/10.2217/fmb.11.93
6. Lantagne, D., & Yates, T. (2018). Household water treatment and cholera control. The Journal of infectious diseases, 218(suppl_3), S147-S153.
7. Nelson, E. J., Harris, J. B., Morris, J. G., Jr, Calderwood, S. B., & Camilli, A. (2009). Cholera transmission: the host, pathogen and bacteriophage dynamic. Nature reviews. Microbiology, 7(10), 693–702. doi:10.1038/nrmicro2204
8. Olago, D., Marshall, M., & Wandiga, S. O. (2007). Climatic, Socio-Economic, and Health Factors Affecting Human Vulnerability to Cholera in the Lake Victoria Basin, East Africa. Ambio, 36(4), 350-358. Retrieved from http://www.jstor.org/stable/4315838
9. Rebaudet, S., Sudre, B., Faucher, B., & Piarroux, R. (2013). Environmental determinants of cholera outbreaks in inland Africa: a systematic review of main transmission foci and propagation routes. The Journal of infectious diseases, 208(suppl_1), S46-S54.
10. Somboonwit, C., Menezes, L. J., Holt, D. A., Sinnott, J. T., Shapshak, P. (2017). Current views and challenges on clinical cholera. Bioinformation, 13(12): 405-409
11. Symington, V. (2016). Cholera: Death by diarrhoea. Microbiology Society. Retrieved from https://microbiologyonline.org/file/e507d924d199de0ad42c1e59c7809547.pdf
12. Vezzulli, L., Pruzzo, C., Huq, A., & Colwell, R. R. (2009). Environmental reservoirs of Vibrio cholerae and their role in cholera. Environmental Microbiology Reports, 2(1), 27-33 doi:10.1111/j.1758-2229.2009.00128.x
13. Wernick, N. L., Chinnapen, D. J., Cho, J. A., & Lencer, W. I. (2010). Cholera toxin: an intracellular journey into the cytosol by way of the endoplasmic reticulum. Toxins, 2(3), 310–325. doi:10.3390/toxins2030310
14. World Health Organization (2017). Cholera vaccines: WHO position paper. Weekly Epidemiological Record, 92(34), 477-497

Freedom of movement, a term that has existed for many years is a civil right concept encompassing the right of individuals to travel from place to place. In this modern era, globalization and digitization connect people across great distances and bringing them together due to the growth of far recaching media convergence and broadened the horizon (UNESCO, 2016). People are witnessing the most conspicuous manifestations which is the unprecedented volume and speed of human mobility in this present era. From international tourists to war-displaced refugees, more people are on the move than ever before (Institute of Medicine,2006; UNESCO,2016). This can be illustrated by people travelling more frequently and visiting places that were once considered as remote parts of the world. More importantly, this movement has the potential to increase the transmission of infectious diseases (WHO,2012). As a result, increase cross border and cross-continental movement of people have manifested in the emergence and spread of infectious diseases. In contrast, research suggests that the advancement of biotechnology and vaccination coverage around the world have helped to reduce the transmission of disease (Greenwood, 2014). Biotechnology provides leveraging technology to allow rapid detection of various diseases whereas vaccination acts as an accelerated immunization that protects humans from the invasion of pathogens. Therefore, infectious diseases are preventable by using vaccines and biotech. Nonetheless, the disease can still be spread due to the concerning factor such as human contact. Hence, the main purpose of this writing is to focus on the increased freedom of movement that can lead to a higher rate of diseases around the globe.

These days, the emergence of new infectious diseases or the re-emergence of diseases are causing concern and travel have become a major contributor to the spreading of diseases. World Tourism Organization (2011) states international tourism in 2011 has hit 982 million which is an increase of 4.7% from 2010. According to Bauer (1999), travel is the main source of the epidemic and has an inseparable link with human existence. For example, travellers will be exposed to a variety of infectious diseases when travelling to developing countries due to the sudden change in environmental factors such as temperature. For instance, malaria is very common in tropical countries such as India and Nigeria (WHO,2013). Therefore, the risk of travellers being exposed to malaria will increase when travelling to tropical countries. Similarly, a serious health risk may arise in places where hygiene and sanitation are inadequate or medical services are lacking. Angelo, et al (2017) has conducted 4 different studies showing that 43%-79% of European travellers are reported to have developed a travel-related illness after travelling to India, Tanzania and Kenya. Another similar study has been conducted observing that 86.5% of U.S. residents have been infected with malaria when travelling back from Africa (Mace, Arguin and Tan, 2015). Therefore, as travel destinations diversify and international travel increases, this poses a health threat to travellers acquiring an infectious disease. Consequently, the increased freedom of movement around the world has led to a higher number of cases of diseases.

Technological advance has not only speed up the transmission diseases but also affected the aetiology of disease and open airways to the movement of infectious disease vector. As modern modes of transportation allow more people to travel around the world, this also functions as an efficient transport system for pathogens (Soto,2009). Research has suggested that transport systems accelerate the spread of infectious diseases such as influenza and coronavirus (Browne, Ahmad, Beck and Tam, 2015). For instance, the cases of SARS and MERS, a severe respiratory illness have illustrated how quickly infectious disease can spread around the globe through air travel (Kulczyriski, Tamaszewski, Tuniewski and Olender, 2017). For example, the in-flight transmission of SARS disease was reported to have spread from China to other distant countries such as France and Germany in 2002. To emphasise this issue, research has also shown that the air that passengers breathe consists of recirculated air from the cabin’s floor level and the air taken from the outside of the aircraft (Ibid,2017). In addition to that, it has frequently been stated that vectors have the ability to survive long flights at temperatures of -42°C (Browne, Ahmad, Beck, Tam,2015). Hence, the risk of being infected aboard an aircraft is high and inevitable due to improperly air circulation and inhalation of viruses in air droplets. As a result, the efficiency of modes of transport networks put people at risk from the emergence of diseases.

When analysing the effects of increased freedom of movement, it is significantly vital to examine the correlation between infectious diseases and the implementation of biotechnology and vaccination coverage globally. It is known that infectious disease poses a threat to the well-being of humans in a short period of time nevertheless this can be alleviated by ensuring that vaccines and biotechnology are accessible around the world. According to World Health Organization (2019), vaccinations and biotechnology has greatly reduced the burden of diseases. For instance, vaccination is available and provided for travellers who are going to endemic places such as Pakistan and India. As an illustration, Hepatitis A vaccination is recommended for European travellers when travelling to countries where sanitation and hygiene are poor such as Asia or Sub-Saharan Africa (NHS UK, 2016). Therefore, an increase in movement does not have necessarily related to the rapid rise of diseases. NHS UK (2016) stated that travel vaccines such as Polio, Hepatitis A and typhoid are free for everyone in the UK. In addition to that, vaccine coverage in European countries has been increasing over the years namely, Denmark and Italy (European Commission, 2018). More importantly, vaccination has already prevented approximately 10.5 million infectious diseases every year. The recent statistic also suggests that there is a decline in the incidence of measles as this resulted in an 80% reduction in global measles deaths (WHO,2018). Furthermore, vaccination is also available in developing countries. For instance, Albania has a 96% coverage for MCV1 whereas 62% for MCV1 in Afghanistan in 2017 (WHO, YEAR). Thus, vaccination is a key strategy in combating infectious diseases. As a result, the increased freedom in movement is not a contributing factor to the rise of communicable diseases around the world.

Vaccination is widely used to prevent getting infected by the disease. Yet the most prominent argument that arises from this is that the cost of vaccination and vaccines coverage in certain countries. World Health Organization (2017) concluded that vaccination coverage for certain diseases is still lacking in certain areas such as South-East Asia and Western Pacific. In particular, coverage for the rotavirus vaccine is only 1% in Western Pacific whereas 9% in South East Asia. Similarly, Angola only has 42% coverage for MCV1 and South Sudan with a coverage of 20% for measles virus (WHO, 2018). Thus, in countries that do not have high vaccination coverage for the certain virus, the infected people will be able to spread the local endemic disease to other places when travelling from one place to another. It is also important to emphasise that vaccines are expensive. NHS UK (2016) shows that not all vaccines are free such as vaccines for meningitis, tuberculosis and Japanese encephalitis. For instance, Japanese Encephalitis vaccination costs £112 per dose and it is a requirement to get 2 doses which will be £224 altogether; rabies vaccination costs £85 per dose and travellers are required to have 3 doses which will be £255 (Travel Vaccination, 2018). Therefore, vaccines are costly thus travellers will neglect the procedure of getting vaccinated before travelling to a different country. Hence this increases the cases of diseases as people who did not get vaccinated will be infected and thus bringing the virus to a new foreign place. In fact, vaccination might not be useful for long term travellers. Palvi et al (2014) conducted research to study the effect of vaccination for long term travellers from Greece. Results showed that yellow fever, typhoid fever and hepatitis A were administered to 1647 (74.7%), 741 (33.6%) and 652 (29.5%) long term travellers to Sub-Saharan Africa and the Indian subcontinent respectively (Ibid, 2014). These long-term travellers had sought pre-travel advice and receive vaccination however they are still infected with various diseases. Consequently, vaccination does not guarantee that getting vaccinated is able to prevent communicable diseases. Therefore, increase freedom of movement can increase the cases of disease as the virus is transferable and can be attached to a host to be carried to another area.

In conclusion, the arguments above show that increased freedom of movement around the world has led to a higher number of cases of diseases. As mentioned above, this is due to the increased demand for travelling and also a modern mode of transportation has opened up airways to the movement of infectious disease vectors. Therefore, when people travel from places to places, disease vector attaches themselves onto the human host or the vehicle transportation that enables them to travel across to another country. Consequently, the disease is able to spur and develop by infecting animals or humans. Even though biotechnology and vaccination have been introduced to society to detect, diagnose and combat disease, it does not provide an ultimate solution to stop or prevent the spreading of diseases. Conversely, this requires trained medical personnel to utilize the biotechnology and expensive facilities to develop vaccination thus affecting the price of the vaccines. As a result, even with the implementation of vaccines and biotech, infectious can still spread when humans move from one place to another.

According to Mayor Clinic, infectious diseases are ‘disorders caused by organisms, such as viruses, bacteria, fungi or parasites.’ It’s sometimes can break out in a large area, which has taken a heavy toll on human life. In a press release published in 1996, WHO stated that ‘infectious diseases kill over 17 million people a year, global crisis.’ The battle between humanity and infectious diseases has occurred for millennia. Although humans have made considerable progress in advancing the healthcare system, people have fallen victims to disease faster than ever before. This issue has myriad causes, including rapid globalization, modernizing transportation, and densely populated urban areas. Countless casualties caused by recent epidemic outbreaks pose a serious threat to international security as well as human existence. Therefore, this apparently requires that all member states involved and the international community join hands to solve.

The United Nations, since its inception, has been actively involved in promoting and protecting good health worldwide. Leading that effort within the UN system is the World Health Organization (WHO), whose constitution came into force in 1948. WHO staff, who include medical doctors, public health specialists, scientists and epidemiologists, and other experts are at work on the ground in 150 countries worldwide. They advise ministries of health on technical issues and provide assistance on prevention, treatment, and care services throughout the health sector. In 2005, WHO instituted the International Health Regulations (IHR), with the intent of having a consolidated system to track the evolution of diseases, share expertise on pathology, alert nearby countries of potential threats, and provide medical emergency responses. At the 71st World Health Assembly, held from 21-25 May 2018, delegates adopted a resolution on cholera prevention and control urging the Member States and the Director-General to act on cholera prevention and urging cholera-affected countries to implement a roadmap that aims to reduce deaths from the disease by 90% by 2030. In an attempt to deal with the Ebola epidemic, Dr. Matshidiso Moeti, WHO Regional Director for Africa said that WHO is investing a huge amount of resources into preventing Ebola from spreading outside DRC and assisting governments in their readiness to respond in case any country have a positive case of Ebola.’ Another example is the establishment of The Global Fund to fight AIDS, Tuberculosis (TB), and Malaria, a new partnership and funding mechanism initially hosted by WHO, which is created in collaboration with other UN agencies and major donors. It aims are to “attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, tuberculosis and malaria to support attainment of the Sustainable Development Goals established by the United Nations.”

Being situated in African, like other countries, South Sudan now has faced up to not only the extreme political situation but also unstable social conditions. In South Sudan, infectious diseases pose a major public health challenge and cause lots of loss of living. Frequent disease outbreaks are driven by multiple factors, including the conflict leading to the displacement of people, overcrowding, and a poor healthcare system. With nearly 3 million cases reported since 2015, malaria is one of the main causes of disease and death in South Sudan. Besides, the current ebola epidemic in DRC has been recorded is at risk of spreading to the surrounding areas. Facing with this situation, The Ministry of Health of South Sudan, with support from the World Health Organization (WHO), Gavi, the Vaccine Alliance, UNICEF and the US Centers for Disease Control and Prevention (CDC) and other partners, started vaccinating health workers and other front-line responders against Ebola as part of preparedness measures to fight the spread of the disease. At present, South Sudan is preparing for any potential case of Ebola spreading beyond the Democratic Republic of the Congo. As part of these preparedness activities, South Sudan received 2160 doses of the Ebola vaccine and handed it out to the people living near the Congo’s border.

South Sudan feels that it’s important for close coordination among South Sudan, WHO, and the Member States. South Sudan strives to ensure harnessing all stakeholder’s commitment and advocacy in sustained funding, collaboration, communication, and networking including community participation to enhance coordinated responses, as well as tracking and prompt case management. In addition, South Sudan will develop some tools and approaches related to diagnostics and novel therapies as well as three important public health systems- laboratory systems, networking, and coordination systems to detect and then respond to health threats. When a country has an outbreak of an infectious disease such as measles or cholera, a good health system that can detect it early is essential to help prevent further spread, and save lives and resources. Moreover, South Sudan demands more support from the UN to train more healthcare workers and to launch more vaccination campaigns. Besides, countries having infectious disease outbreaks, especially the Democratic Republic of the Congo should take measures to control the infectious areas and prevent infectious people from crossing the border.