kuliah kmpl mikro 2012-usb

8/14/2019 Kuliah Kmpl Mikro 2012-Usb

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S. Yumna Triyana

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MicrobesMicrobe = microorganism :

- prokaryotic : bacteria

- eukaryotic :fungi, protozoa, helminth

- intracellular parasites: viruses (do not havea cellular structure)

Prion : self-replicating proteins

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Where can we find microbes?

Everywhere : air, water, soil and rocks, plants, animalsand human body!

The number of microorganisms living on and in us isabout ten times higher than the number of cells thatmake up our entire body!

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Microbes in

healthy human

body 4

Human body is

an ecosystem


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BAD NEWS MICROBESDisease causing microbes

Pathogens, germs or bugs

Pathogenicity : ability to

cause infection

Virulence: the degree ofpathogenicity

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How do we become infected?

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Chain of infection components:

1. Adequate numberof

pathogens

2. Pathogens with sufficient

virulence

3. A susceptible host

4. An appropiate mode oftransmissionor transferal of

pathogens from source

(reservoir) to host

5. The correct portal of entry

into the host


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Microbes and humansVery few microbes are

always pathogenic

Many microbes arepotentially pathogenic

Most microbes arenever pathogenic


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Microbes and humansDisease can come about in several overlapping

ways

1. Some bacteria are entirely adapted to thepathogenic way of life in humans. They arenever part of the normal flora but may causesubclinical infection, e.g.M . tuberculosis

2. Some bacteria which are part of the normalflora acquire extra virulence factors makingthem pathogenic, e.g. E. coli


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3. Some bacteria from the normal flora can cause diseaseif they gain access to deep tissues by trauma, surgery,lines, especially if associated with a foreign body, e.g. S.epidermidis

4. In immunocompromised patients many free-livingbacteria and components of the normal f lora can causedisease, especially if introduced into deep tissues, e.g.

Acinetobacter

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How do microbes enter our body?

Travel through the air

Personal contact

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Touchingcontaminated surface


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Disease transmission Directhost to host transmission

Indirecthost to host transmission

- living agents are calledvectors

- non living agents are called fomites

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Disease transmission

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Reservoir and type of transmission

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When does infection occur?

Infection:- inflammation- organ dysfunction

Stages:1. entry into the host with evasion of host 1st

defenses2. adhesion to the host cells

3. propagation of the organism4. damage to host cells by toxins or inflammatoryresponse5. evasion of host 2nddefenses

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Terms

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Pathogens and disease they cause

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Changing nature ofinfectious disease

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Factors1. Demographic changes and human behaviour

Population growth

Poverty Population movement

2. Technological development

3. Environmental

4. Microbial adaptation and change

5. Climate change

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Environmental changes and infectious

disease

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Diseases associated with infectious

agents

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Microbial adaptation and change Lateral / horizontal gene transfer

- Transformation

- Transduction- Conjugation

Antigenic drift

Antigenic shift

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Transformation

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Transduction

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Conjugation

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F-plasmid (male)

Lacking plasmid

(female)

Mechanism?

- Channel in the

pillus

- Temporary fusion of

the mating cells


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Antigenic shift: intermediate

vessel/host

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Water and food-borne agents

connection to climate

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Environment the surroundings, conditions, influences that affect an

organism (Davis, 1989)

all the physical, chemical and biological factors

external to a person and all related behaviours excludes behaviour not related to environment, as well

as behaviour related to the social and culturalenvironment, and genetics.

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Environmental factors that threats to health

Environmental condition favouring disease vector (endemic)

Invasive biota (bacteria, viruses), their hosts and vectors

Environmental disruption: floodss, earthquakes, tsunami

Air quality: pollution

Water quality: biotic and abiotic contaminants

Monitoring and management of municipal, agricultural,industrial outflows to the environment (gases, liquid, solid

wastes)

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Waterborne infectioncommon source Potable water used for drinking and cooking : low

quality or improperly treated

Recreational water : swimming pools, lakes, spas

Sewage and wastewater

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Factsheet

No safe drinking-water: almost 1 billion people lackaccess to an improved supply

Diarrhoeal disease: 2 million annual deaths

attributable to unsafe water, sanitation and hygiene

Cholera: more than 50 countries still report cholera toWHO

Schistosomiasis: an estimated 260 million infected

Emerging challenges: increasing use of wastewater inagriculture is important for livelihood opportunities,

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Waterborne infection Microorganisms transmitted in water generally

grow in the intestine and leave the body in faeces

Water may then be polluted by faeces Numerous bacterial and protozoan pathogens can

be transmitted in primarily in drinking orrecreational water

Disease outbreaks from drinking or recreationalwater contamination relatively low in developedbut still high in developing countries

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Health hazard of excreta Excreta-related infections: diarrhoea

Pathogens:

- bacteria:cholera, typhoid, salmonella infection

-viruses: adenoviruses, enteroviruses, hepatitis Aviruses, rotaviruses

- protozoa: Giardia lamblia, Balantidium coliandEntamoeba histolytica(cysts)

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Helminths

- pass eggs or larval forms in the excreta

- intermediate hosts: soil, plant life, waterthe ones that pass eggs or larval forms in the

excreta are of importance in considering wastewateruse

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Persistence

the ability of an excreted organism to survive outside the

human bodySurvival times of excreted pathogens in freshwater and sewage at 20-30C

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Protozoal cysts are poor survivors in any environment,e.g. Entamoeba histolytica.

Helminth eggs vary from the very fragile to the verypersistent.

One of the most persistent is theAscarisegg whichmay survive for a year or more.

The soil is its intermediate hostprior to reinfectinghumans.

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Knowledge of the survival of pathogens in soil and onthe crop allows an initial assessment of the risk oftransmitting diseasevia produced foodstuff or through

worker exposure.

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Effectiveness to cause infection

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Factors determining infection Excreted load: concentration of pathogens

Latency : the time of excretionnew host

Persistence: viability in the environment

Multiplication: multiply outside the human

Infective dose: number of pathogens needed to causeinfection

Host response

Non-human host : intermediate host

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High probability of infection Long persistence in the environment

Low minimal infective dose

Short or no human immunity Minimal concurrent transmission through other

routes

Long latent period and or soil development stage is

required

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Environmental classification of excreted infections

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Ascariasis

An infection of the small intestine caused byAscaris lumbricoides, a large roundworm.

The eggs of the worm are found in soilcontaminated by human faeces or in uncookedfood contaminated by soil containing eggs of the

worm.

A person becomes infected after accidentallyswallowing the eggs. Eating uncooked food grown

in contaminated soil or irrigated with inadequatelytreated wastewater is another frequent avenue ofinfection.

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Ascariasis Eggs develop in the soil and become infective after 2-3

weeks, but can remain infective for several months or years.

Children are infected more often than adults, the mostcommon age group being 3-8 years.

The infection is likely to be more serious if nutrition ispoor. The first sign may be the passage of a live worm,usually in the faeces. In a severe infection, intestinalblockage may cause abdominal pain, particularly inchildren. People may also experience cough, wheezing anddifficulty in breathing, or fever.

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Ascariasis Up to 10% of the population of the developing world is

infected with intestinal worms a large percentage ofwhich is caused by Ascaris.

Worldwide, severe Ascaris infections causeapproximately 60,000 deaths per year, mainly inchildren.

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Ascariasis - intervention avoid contact with soil that may be contaminated with

human faeces;

wash hands with soap and water before handling food;

wash, peel or cook all raw vegetables and fruits;

protect food from soil and wash or reheat any food thatfalls on the floor.

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Ascariasis - intervention Proper disposal of human faecesWhere wastewater is used for irrigation waste

stabilization ponds and some other technologies are

effective in decreasing transmission due to food grownin contaminated soil. Treatment of infected individuals (and domestic

animals)Ascariasis can be effectively treated with mebendazole

or pyrantel pamoate.

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Campylobacteriosis Campylobacteriosis is an infection of the

gastrointestinal tract caused by Campylobacterjejuni orC. coli

Zoonosis. The bacteria are widely distributed andfound in most warm-blooded domestic and wildanimals. They are common in food animals such as

poultry, cattle, pigs, sheep, ostriches, and shellfishand in pets including cats and dogs. The animalsmay not have symptoms

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Campylobacteriosis Approximately 5%-14% of all diarrhoea worldwide is

thought to be caused by Campylobacter.

In both developed and developing countries, they cause

more cases of diarrhoea than Salmonella bacteria.

In developed countries, the disease is found mainly inchildren under 5 and in young adults.

In developing countries, children under 2 are mostaffected.

It is also a frequent cause of traveller's diarrhoea.

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Campylobacteriosisintervention and treatment Safe drinking-water supply including continuous

disinfection (chlorination) of drinking-water;

proper handling of production animals;

proper sewage-disposal systems and protection of thewater supply from contamination;

thorough cooking of potentially contaminated foods;

adequate personal hygiene (washing hands after toilet

use as well as after handling pets or farm animals); avoiding raw milk.

rehydration antibiotic therapy

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Cholera Caused by bacteria Vibrio cholerae

Cholera outbreaks can occur sporadically where watersupplies, sanitation, food safety and hygiene practices

are inadequate.

Overcrowded communities with poor sanitation andunsafe drinking-water supplies

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Giardiasis

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Cholera Cholera is an acute infection of the intestine, which begins

suddenly with painless watery diarrhoea, nausea andvomiting. Most people who become infected have very milddiarrhoea or symptom-free infection.

Malnourished people in particular experience more severesymptoms.

Severe cholera cases present with profuse diarrhoea andvomiting. Severe, untreated cholera can lead to rapid

dehydration and death. If untreated, 50% of people with severe cholera will die, but

prompt and adequate treatment reduces this to less than1% of cases.

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Cholera - intervention Provision of adequate safe drinking-water Proper personal hygiene Proper food hygiene Hygienic disposal of human excreta. Oral rehydration. Most people recover in 3 to 6

days. If the infected person becomes severely

dehydrated, intravenous fluids can be given.Antibiotics are not necessaryto successfully treat a

cholera patient.

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Hepatitis Hepatitis, a broad term for inflammation of the liver,

has a number of infectious and non-infectious causes.

Two of the viruses that cause hepatitis (hepatitis A and

E) can be transmitted through water and food

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Hepatitis A and E viruses, while unrelated to oneanother, are both transmitted via the faecal-oral route,most often through contaminated waterand from

person to person. Hepatitis A has also caused outbreaks transmitted

through injecting or non-injecting drug use.

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Hepatitis The illness starts with an abrupt onset of fever, body

weakness, loss of appetite, nausea and abdominaldiscomfort, followed by jaundice within a few days. Thedisease may range from mild (lasting 1-2 weeks) to severedisabling disease (lasting several months).

In areas highly endemic for hepatitis A, most infectionsoccur during early childhood. The majority of cases maynot show any symptoms; fatal cases due to fulminant acute

hepatitis are rare. Nearly all patients recover completely with no long-term

effects.

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Hepatitis The mortality rate is low (0.2% of icteric cases) Among patients with chronic hepatitis B or C or

underlying liver disease, who are superinfected withhepatitis A virus, the mortality rate increases considerably.

In countries with very low hepatitis A infection rates, thedisease may occur among specific risk groups such astravellers.

Hepatitis E is mainly found in young to middle-agedadults.

Women in the third trimester of pregnancyare especiallysusceptible to acute fulminant hepatitisarising fromhepatitis E infection.

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Hepatitis Countries with economies in transition and some

regions of industrialized countries where sanitaryconditions are sub-standard are also highly

affected, e.g.in southern and eastern Europe andsome parts of the Middle East.

Outbreaks of hepatitis E have occurred in Algeria,

Bangladesh, China, Ethiopia, Indonesia, Iran,Libyan Arab Jamahiriya, Mexico, Myanmar, Nepal,Pakistan, Somalia

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Hepatitis - intervention No specific antiviral drugs against hepatitis A and

E

Providing education on good sanitation andpersonal hygiene, especially hand-washing

Adequate and clean water supplies and properwaste disposal

Vaccination against hepatitis A for persons at risk,e.g. travellers visiting areas where the disease iscommon.

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Leptospirosis

Caused by bacteria Lepstospira spp that affects both humans andanimals. The early stages of the disease may include high fever, severe

headache, muscle pain, chills, redness in the eyes, abdominal pain,jaundice, haemorrhages in skin and mucous membranes (includingpulmonary bleeding), vomiting, diarrhoea and a rash.

Human infection occurs through direct contact with the urine ofinfected animalsor by contact with a urine-contaminated

environment,such as surface water, soil and plants.

The causative organisms have been found in a variety of both wild anddomestic animals, including rodents, insectivores, dogs, cattle, pigsand horses.

Leptospires can gain entry through cuts and abrasions in the skin andthrough mucous membranes of the eyes, nose and mouth. Human-to-human transmission occurs only rarely.

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LeptospirosisAn occupational hazard: for people who work

outdoors or with animals, such as rice and sugar-cane field workers, farmers, sewer workers,

veterinarians, dairy workers and militarypersonnel.

A recreational hazard : those who swim incontaminated waters.

In endemic areas :may peak during the rainyseason and even may reach epidemic proportionsin case of f looding.

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Leptospirosis - interventions control at the level of the infection source (e.g.

rodent control, animal vaccination); interrupt the transmission route (e.g. wearing

protective clothing, refrain from contact with

infected animals and from swimming incontaminated water, provide clean drinking-water); or prevent infection or disease in the human host

(e.g. vaccination, antibiotic prophylaxis,

information to doctors, veterinarians, risk groupsand the general population).

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Schistosomiasis caused by three main species of flatworm, namely

Schistosoma haematobium, S. japonicum, andS.mansoni.

Humans are infected when they enter larvae-infestedwater for domestic, occupational and recreationalpurposes.

Those who work in irrigation or fishing are atincreased risk for schistosomiasis.

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Schistosomiasis

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Schistosomiasis Schistosomiasis is endemic in 76 countries, most

of which are in Africa.

Other regions affected are: the Americas (Brazil,Suriname and Venezuela, as well as severalCaribbean islands); the Eastern Mediterranean(Islamic Republic of Iran, Iraq, Saudi Arabia,

Syrian Arab Republic and Yemen; and eastern Asia(Cambodia, China, Indonesia, Japan, Lao People'sDemocratic Republic and the Philippines

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Schistosomiasis - intervention Improved sanitation and potable water minimizes contamination of

and reduces contact with fresh water, thus limiting transmission.

Environmental modification preventing snail vectorsand limitinghuman water contact offers long-term control of schistosomiasis.

Health education is a fundamental component that ensurescommunity participation in control interventions.

In areas of high prevalence and intensity of infection, chemotherapywith praziquantel, targeted at school-age children and high-riskgroups, offers the most efficient way to achieve the recommendedstrategy for morbidity control.

Proper health impact assessment of new irrigation schemes and otherwater resources projects will provide a solid basis for the incorporationof health safeguards at design and construction plan

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Water-related infection Malaria

Dengue infection

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Malaria malaria occurs mostly in tropical and subtropical

countries, particularly in Africa south of the Sahara, South-East Asia, and the forest fringe zones in South America.

The ecology of the disease is closely associated with theavailability of water, as the larval stage of mosquitoesdevelops in different kinds of water bodies.

The mosquito species vary considerably in their water-ecological requirements, (sun-lit or shaded, with or

without aquatic vegetation, stagnant or slowly streaming,fresh or brackish) and this affects the disease ecology

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Malaria - intervention Reducing mortality, particularly among children, by early

case-detection and prompt treatment with effective anti-malarial drugs

Promoting the use of insecticide-treated bed nets,

especially by children and pregnant women Prevention of malaria in pregnancy by applying

intermittent preventive therapy Ensuring early detection and control of malaria epidemics,

especially in emergency situations. Where appropriate, countries and communities are being

encouraged to reduce mosquito breeding sites by filling inand draining water bodies and through otherenvironmental management schemes.

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Airborne infections Respiratory infections

From droplet or droplet nuclei

Droplet:

- cloud of infectious particle >5m in size

- 3 feet direct transmision

- influenza virus, adenovirus, rhinovirus and RSV

(respiratory syncytial virus).- through aerosolized oral and nasal secretionsfrom infected patients

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- Mycobacterium tuberculosis, VZV, measles virus(rubeola) and smallpox virus (variola major)

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Microorganisms associated with airborne

transmission

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Aspergillosis

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Tuberculosis

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10 Facts1. Tiap tahun jumlah manusia meninggal akibat

TB ternyata > daripada tahun sebelumnya

2. TB membunuh lebih banyak penduduk usiamuda & dewasa

3. Tiap tahun 2-3 juta penduduk meninggal karenaTB

4. Paling sedikit 1 orang akan terinfeksi baru olehTB tiap detik

5. Ada satu orang meninggal akibat TB tiap 10

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6. 1% dari populasi di dunia akan terinfeksi TB tiaptahun

7. 1/3 penduduk dunia telah terinfeksi dengan basilTB

8. Jika tidak diobati, seseorang dengan TB aktif dapatmenulari 10-15 orang dalam 1 tahun

9. TB menyebar melalui udara, saat orang terinfeksibatuk, meludah, berbicara atau bersin, seperti

influenza10. Kematian akibat TB biasanya terjadi secara

bertahap, sejalan dengan kerusakan kronik paru &akibat yang ditimbulkannya.

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SARS :severe acute respiratory syndrome SARS-associated coronavirus (SARS-CoV). SARS was

first reported in Asia in February 2003.

Over the next few months, the illness spread to more

than two dozen countries in North America, SouthAmerica, Europe, and Asia before the SARS globaloutbreak of 2003 was contained.

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SARS - symptoms SARS begins with a high fever (temperature greater

than 100.4F [>38.0C]). Other symptoms may include headache, an overall

feeling of discomfort, and body aches. Some people also have mild respiratory symptoms

at the outset.About 10 percent to 20 percent of patients have

diarrhea.After 2 to 7 days, SARS patients may develop a dry

cough. Most patients develop pneumonia.

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by close person-to-person contact.

by respiratory droplets (droplet spread) produced when an infectedperson coughs or sneezes.

Droplet spread can happen when droplets from the cough or sneeze ofan infected person are propelled a short distance (generally up to 3feet) through the air and deposited on the mucous membranes of themouth, nose, or eyes of persons who are nearby.

The virus also can spread when a person touches a surface or objectcontaminated with infectious droplets and then touches his or hermouth, nose, or eye(s).

In addition, it is possible that the SARS virus might spread morebroadly through the air (airborne spread) or by other ways that are notnow known.

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Influenza

Influenza viruses circulating in animals pose threats tohuman health.

Humans can become ill when infected with viruses fromanimal sources

avian influenza virus subtypes H5N1 and H9N2 and swineinfluenza virus subtypes H1N1 and H3N2.

The primary risk factor for human infection appears to bedirect or indirect exposure to infected live or dead animalsor contaminated environments

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LANGKAH PENCEGAHAN & PEMBERANTASAN

Peningkatan biosekuriti

Dekontaminasi / desinfeksi

Depopulasi / tindakan pemusnahan selektif / terbatas

Disposal

Vaksinasi

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Peningkatan biosekuriti

Desinfeksi alat & fasilitas peternakan

Dilarang mengeluarkan unggas sakit, kotoran &limbah peternakan

Membatasi keluar masuk orang ke dalam lokasipeternakan

Mencegah keluar masuknya tikus & hewan lain kedalam lokasi peternakan

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Dekontaminasi / desinfeksi

Pakan, tempat pakan / air minium semua peralatan

Pakaian pekerja kandang, alas kaki, kendaraan &bahan lain yang tercemar

Bangunan kandang yang kontak dengan unggas,kandang / tempat penampungan unggas

Permukaan jalan menuju peternakan / kandang /tempat penampungan unggas

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Depopulasi

Pemusnahan selektif dilakukan terhadap unggassehat yang sekandang dengan unggas yang sakitdi peternakan tertular. Sedangkan stamping outdilakukan di daerah tertular baru.

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disposal

Dilakukan dengan cara pembakaran & penguburandengan kedalaman minimal 1,5 meter, terhadap:

unggas mati (bangkai), karkas, telur terinfeksi

Kotoran (feses), bulu, alas kandang (sekam)

Pupuk & pakan ternak yang tercemar

Bahan peralatan lain yang terkontaminasi yang

tidak dapat disucihamakan secara efektif

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Climate change - response Surveillance

Epidemiological research

Public health infrastructure

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TERIMA KASIH

kuliah kmpl mikro 2012-usb

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