Epidemiology 529
Emerging Infections of International Health Importance

Course Introduction

Welcome to Epidemiology 529, Emerging Infections of International Health Importance!

This course applies a realistic appreciation of the importance of emerging infectious disease to the future of international public health. You will be introduced to some of the latest thinking in the field of emerging infections and will acquire the tools needed to examine the importance of new diseases. We will emphasize the concept of emergence and the mechanisms of emergence of pathogens, as outlined in the 1992 and 2003 Institute of Medicine Report; we'll also discuss specific diseases such as severe acute respiratory syndrome (SARS), bovine spongiform encephalopathy (BSE), HIV/AIDS, and human and avian influenza, and their implications for public health in the areas of prevention, surveillance, and control.

You can take this course as an elective in the Masters in Public Health degree programs in both the Departments of Health Services and Epidemiology at the University of Washington, or with the permission of the instructor.

Prerequisites

To succeed in this course, you will need to have some academic background in public health, epidemiology, and/or microbiology. The content of the course assumes basic knowledge of such core public-health principles epidemiologic terminology and the difference between case studies and randomized trials. The textbook provides some of the underlying principles of these disciplines, but not a complete overview

Learning Objectives

This course will enable you to identify and describe major emerging infectious diseases along with factors for emergence. In addition, at the completion of this course, you should be able to

• describe the interplay between the factors of emergence and the convergence model, using specific examples of contemporary infectious diseases; and
• explain the importance of a multi-disciplinary approach to surveillance and control of emerging infectious diseases.

About the Online Environment

Your online course offers several advantages to the traditional classroom, including the comprehensive Online Student Handbook, the ability to communicate electronically with students and with your instructor, and links to a rich array of online resources.

Online Student Handbook

This handbook answers questions about your online learning course, such as how to purchase your text, schedule an exam, obtain a transcript, and get technical help if you need it. The handbook also provides additional resources, such as how to order books or journals from the library and how to study for an online course.

Communicating with Your Instructors and Student Peers

• Online Discussion Forums, designed by the University of Washington award winning Catalyst team, allow you to communicate with other currently enrolled students and with your instructors. We encourage you to use the forums to exchange ideas, resources, and comments about your course work with other students in this course. This unstructured forum is monitored by your instructors.
• You can use e-mail to ask your instructors a question or preferably post your question on the forum. Your instructors will reply on the same forum.

Online Resources

As an online student, you have access to a wealth of Web resources compiled to provide fast, easy access to information that supports your online learning experience. Organized by subjects, Online Resources link you to sites with help for writing and research, study skills, language learning, and library reference materials. All links have been assessed for credibility and reliability, and they are regularly monitored to ensure their usability.

Course Topics

The course will cover the following topics:

• an introduction to the "factors of emergence/reemergence" for infectious disease;
• the evolution of and biological and physical requirements for the emergence/reemergence of microbes;
• the intersections of global trade and infectious diseases and the reciprocal relationship between them;
• methods for conducting an epidemiological investigation of an infectious-disease outbreak;
• laboratory diagnostic procedures used to identify and control infectious disease outbreaks;
• specific case studies of emerging or re-emerging infectious diseases including: cholera, malaria, bovine spongiform encephalophy (BSE), HIV/AIDS, avian and pandemic influenza, West Nile virus, and arboviruses such as yellow fever and dengue hemorrhagic fever;
• vaccine development and antibacterial resistance;
• challenges surrounding public healthcare delivery in limited-resource countries;
• disease modeling of infectious pathogens; and
• an overview of public-health prevention, response, and control systems, both within the United States and internationally.

Course Materials

The Textbook

The textbooks assigned for this course are

• Microbial Threats to Health: Emergence, Detection and Response, Institute of Medicine, Smolinski, Hamburg, Lederber, eds. 2003. The National Academy Press, Washington, DC. ISBN 0-30908-864-X; and
• Kimball, Ann Marie. Risky Trade: Infectious Disease in the Era of Global Trade. Hants, England: Ashgate Publishing, Ltd. 2006.
  ISBN: 0-7546-4296-8

Microbial Threats to Health: Emergence, Detection and Response is published by the Institute of Medicine. This text was chosen because it examines the principles and paradigms for emerging infections and discusses key factors underlying the increase of emerging infectious diseases.

Risky Trade:Infectious Disease in the Era of Global Trade goes into further detail about trade as it relates to the introduction and perpetuation of infectious disease. It was written by one of the course instructors.

Both texts will be available in the University of Washington book store as well as on reserve in the UW library.

Other Required Readings

Each lesson includes a set of required readings, which are predominantly journal articles and Web sites. The readings assigned for each lesson will focus on the subject matter within that lesson, and complement the material provided within the lesson. You will have access to these readings once you have enrolled in the course. Some are online, while others are available through the University of Washington Library's course reserve system.

Course Structure

This course is divided into three modules, each independent of the others.

Module One includes five lessons.

• In Lesson One, "Introduction to Emerging Infections," we will define "emerging infection," explain the paradigm of emergence and the factors of emergence as described in the 1992 IOM Report and modified in the 2003 Report. We will also describe how the factors of emergence operate globally and in globalizing disease threats.
• Lesson Two, "Ecology of Emergence," looks at the factors and selected pressures that contribute to antimicrobial/antibiotic resistance, describes the epidemiology of tuberculosis (TB) and the influence on TB of the HIV epidemic, explains the World Health Organization's "directly observed therapy" (DOT) strategy for TB control, and describes the factors of emergence that have led to the increase of TB.
• Lesson Three, "Trade-related Diseases," defines and gives examples of "trade-related infections," characterizes the impact of global trade on the emergence and transmission of new infections; and describes the outlines of the World Trade Organization's Sanitary and Phytosanitary Measures Agreement (SPS) and Technical Barriers to Trade Agreement (TBT) as these agreements relate to the emergence of new infections.
• Lesson Four, "Workup on the Unknown—Epidemiologic Investigations," looks at the process for investigating a disease outbreak, defines triggers and alerts in surveillance information, and describes the role of descriptive and analytic epidemiology in investigating unknown outbreaks.
• Lesson Five, "Workup on the Unknown—Laboratory Investigations," examines the structure of the U.S.'s Washington State Public Health Laboratories, distinguishes between traditional methods and molecular diagnostic methods, emphasizes the importance of cooperation and communication between agencies and laboratories in investigating unknown outbreaks, and describes why the laboratory sector is an increasingly important part of outbreak investigations and field epidemiology.

Module Two consist of six lessons.

• Lesson One, "Epidemics in Latin America," describes the infectious diseases that continue to be the major causes of illness and death worldwide and in the Americas; explains changes in patterns of infectious disease and the factors contributing to those changes; describes the history underlying Declaration of the Alma-Ata and the subsequent difficulties in implementing primary health care in developing countries; and considers whether new and emerging infectious disease threats are a short-term and decreasing problem or will continue to present challenges for the foreseeable future.
• In Lesson Two, "Arboviral and Vector-borne Infections," we will examine the importance of vector-borne diseases, such as plague, West Nile virus, dengue hemorrhagic fever, and yellow fever; explain how the re-emergence of vector-borne diseases play a prominent role in the global increase of infectious diseases; and look at ways increased global public-health measures can counteract this re-emergence of vector-borne diseases.
• Lesson Three, "Prions and Species-jumping" lists and describes the principal human and animal transmissible spongiform encephalopathies (TSEs), explains the theory of how prions cause TSEs, describes the factors that influence transmission of TSEs among and between species, explains the link between BSE and variant Creutzfeld Jacob disease, and describes methods for preventing and controlling BSE.
• In Lesson Four "Global Treatment Programs for HIV: Going for a Cure?," we'll describe the basics of HIV/AIDS epidemiology, identify the factors of emergence for HIV/AIDS, examine current HIV/AIDS treatment in resource-limited settings, explain the 3 x 5 initiative for HIV treatment, and describe continuing prevention and control strategies for HIV.
• Lesson Five, "Acute Respiratory Infections: Influenza Surveillance, Prospects for Treatment and Controls" describes and explains the epidemiology of influenza infection, explains why avian influenza is a serious public-health concern, describes the impact of influenza illness on various populations, describes how influenza vaccine can be used to alter the course of influenza in individuals and populations, and looks at such issues as cost-effectiveness and public safety of influenza vaccination programs.
• Lesson Six, "Global Diffusion Modeling Disease Transmission," explains the global significance of a possible pandemic of the influenza virus and why such a pandemic is of such grave concern, describes current preparations for an influenza pandemic within the United States, and explains how modeling programs can be used to visualize the diffusion of a pathogen across geographic space and how these programs are crucial to planning for a possible pandemic.

Module Three includes two lessons.

• In Lesson One, "Vaccines, Antivirals, and New Technologies,". you will gain an understanding of the history underlying vaccines and the interaction between the human immune system and vaccines, learn about contemporary vaccine research and development and the economic challenges surrounding the global vaccine market, study other, equally important challenges facing immunization coverage and vaccine delivery within the context of developing countries, and learn of several projects that international vaccine agencies are working on to increase safe and effective immunization coverage.
• Lesson Two, "World Health Organization:  International Organizations and Response to SARS and Emerging Infections," explains the international importance of emerging infectious diseases, describes the ways international public-health legislation can help in stopping the international spread of infectious diseases; and explains the importance of international collaboration on emerging public-health issues.

Assignments and Grading

Your work in this course will consist of

• three module problem sets; and
• optional, ungraded exercises imbedded in the lessons.

Assignment due dates are listed in the course schedule in your online syllabus.

Module Problem Sets

This course includes three sets of problems—one for each module. The problem sets for Modules 1 and 2 will each count as 30% of your final grade, while the problem set for Module 3 will count for 40% of your final grade. The problems for module 3 will also include questions that encompass some of the earlier material as well. In order to pass the course, you must score a minimum of 2.5 points (out of 4.0 points) or higher. If you successfully pass the course, you will receive three academic credits. There are no exams or papers for this course.

The problem sets require short to moderate-length narrative answers. These problems will test your knowledge of material from the online lessons as well as the assigned readings. The number of questions for each module problem set vary depending on the number of lessons associated with the module. Typically, you can expect one to two questions per lesson. Your instructors will assess the module problem sets. Short answers will be awarded points based on the answer provided. Partial credit for short answer questions is available and will be assessed by the course instructors.

Please see "About Your Instructors" in your online syllabus for instructions for submitting your responses to the problem sets.

Optional Exercises

Some lessons include "Your Turn" sidebars that contain questions about the material, often along with optional readings. These questions are intended to help you think about the implications of the information. They are optional, so you need not turn in your responses.

Note that we have set up discussion forums for each module. You'll find the links to the discussion forums in "Online Tools" in your online syllabus. We anticpate that you will use this tool to engage with other students and the instructor in dialog about the reading material and the topic per module. The discussion forums will be open at the beginning of the course. Once the module questions have been completed, the discussion forum for that module will close. You will receive more information on the discussion forums once the course begins.

Evaluation

At the end of each lesson, you'll find an evaluation form. We would appreciate your response to these evaluations. It is important for us to have timely feedback so we can improve the organization, content, usefulness, and expediency of this Web-based format. You may send the evaluations through e-mail.

There will also be two evaluations at the end of the course. One is the traditional evaluation from the University of Washington. The other is specifically designed to evaluate the online format for learning. Comments on the modules, lectures, or format are welcomed and can be sent to your instructor.

Study Tips

To succeed in this course, you should pay close attention to the key terms within the lesson. Although the module problem sets do not require that you memorize key term definitions, you should have a clear understanding of these terms and be able to identify how the key terms apply to emerging infections.

Read the assigned readings before you read the online lesson commentary. This will help you become familiar with the topic discussed in the lesson.

About the Course Developers

Dr. Carrie Horwitch, MD, MPH

Clinical Assistant Professor, Health Services; Associate Director, Medical Education, Virginia Mason Medical Center

Dr. Horwitch is a clinical assistant professor of Health Services in the School of Public Health and Community Medicine at the University of Washington. She is also co-investigator for the APEC Emerging Infections Network project and has been co-coordinator and instructor for the Emerging Infectious Diseases of International Public Health Importance course since its inception. She is an internal medicine specialist with experience in HIV/AIDS care and tropical medicine training. She is a consultant with I-TECH and ICAP for HIV/AIDS care in developing countries. She is an Associate Program Director for internal medicine residency and is the Director for the ambulatory and HIV clinic at the Virginia Mason Medical Center. She is a fellow of the American College of Physicians and is on the Washington State council of ACP.

Dr. Ann Marie Kimball, MD, MPH

Dr. Kimball is Professor of Epidemiology and Health Services at the University of Washington School of Public Health and Community Medicine. She is an adjunct professor in Biomedical and Health Informatics and Medicine with the School of Medicine. She is Director of the Asia Pacific Emerging Infections Network and is an attending physician at the STD Clinic at Harborview Medical Center. In 2001 she was named as a Fulbright New Century Scholar, and this year she received a Guggenheim scholar award. She has worked extensively in the areas of trade policy and disease control, and telecommunications and disease surveillance and alert systems. She serves on the Editorial Board of the Control of Communicable Diseases Manual (APHA 2000, 2005) and as a member of the Institute of Medicine Expert Committee to review the Global Emerging Infections Surveillance program. She is a fellow in the American College of Preventive Medicine. She is Chair of the University of Washington Hogness Symposium and a member of the International Faculty Council of the University.

---

©2003–2008, University of Washington. All rights reserved.
No part of this publication may be reproduced in any form or
by any means without permission in writing from the publisher.