If we want more evidence-based practice, we need more practice-based evidence.*
Table of Contents
Infectious and communicable disease control provided the model for public health. Unfortunately, even the communicable diseases today do not respond so easily to single interventions such as immunization or water purification. The modes of transmission and the multiplicity of factors influencing host and antimicrobial resistance make the viral diseases and the remaining bacterial diseases of our time less responsive to the environmental controls possible against some of the scourges of the past. New models of disease control are contrasted in this chapter with classical models. Our overall objective in this chapter is to develop an understanding of the principles of communicable disease control.
Basic concepts of infection, contamination and related processes of disease transmission are presented first. The epidemiology and classification of infectious diseases follows. The saga of smallpox eradication is a tale of victory, but with tuberculosis and some sexually transmitted diseases we seem to be losing ground. The concepts of host resistance and the agent-host-environment triad suggest specific strategies for control of communicable diseases.
Lethal Virus Overtaxes Hospitals in Toronto.
Mystery Illness Moves a Hospital to Quick Action.(The New York Times, March 23, 2003) - Severe Acute Respiratory Syndrome (SARS) is thought to be a new illness, which is found mostly in China and Hong Kong. However, the new scourge has possibly made its way to the United States. This possibility requires that hospital take necessary precautions when a suspected case is presented in order to prevent spread of the currently unknown infectious agent.
Crude Test Offers Hope for Tracking Mystery Virus. (The New York Times, March 22, 2003) - The World Health Organization has announced the development of a crude test to detect cases of Severe Acute Respiratory Syndrome (SARS).
Panel Urges Switch to Polio Shots.ATLANTA (AP, June 17, 1999) – A federal panel recommended Thursday that the oral polio vaccine that was first given to baby boomers on a sugar cube be abandoned in favor of the injected version to reduce the risk of contracting the paralyzing disease from the serum itself. The oral vaccine, developed by Dr. Albert Sabin, has been used for nearly four decades and played a major role in the elimination of polio. But because it is made with a live virus, it causes about eight people in the United States each year to become infected with polio. In contrast, the injectable vaccine developed by the medical pioneer Dr. Jonas Salk in the 1950s relies on a killed virus. Salk had long insisted his injectable vaccine was safer. However, other scientists said it was not as effective at providing lifelong immunity. [See below under "Other References" or go to the full report in MMWR at: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4808a1.htm.]
(AP, June 3, 1999) - Several people in Australia who caught a weakened form of HIV in the early 1980s are showing AIDS-like damage to their immune systems, a development with disappointing implications in the search for a vaccine. Between 1980 and 1984, 13 people in Australia received blood donated by an HIV-infected man, and eight of them caught the virus. When none got sick, researchers analyzed the virus and found that it was missing a working copy of a gene called nef,
which boosts HIV reproduction. Over the years, three of the infected people died
of other causes, and none has gotten AIDS. Some researchers had hoped that a
vaccine modeled on the weak virus could be an effective AIDS vaccine, protecting
people for life without making them sick. For New England Journal of Medicine abstract, see:
CHICAGO (AP, May 26, 1999) – Researchers have found that college students living on campus are about three times more likely to contract meningitis infections than classmates who live off campus. The analysis released Tuesday in The Journal of the American Medical Association was performed by researchers at Johns Hopkins University School of Public Health. The findings prompted the American College Health Association to renew its 1997 recommendation that all college students consider getting vaccinated against meningococcal disease, which can cause meningitis or an overwhelming and often fatal blood infection called meningococcemia. Meningococcal disease afflicts 125 to 175 college students annually and kills 15 to 20 of them, according to public health estimates.
ATLANTA (AP, May 14, 1999) – The U.S. flu season was apparently deadlier than usual this year, the government reported Thursday. The flu season runs from October through mid-May. The Centers for Disease Control and Prevention does not know yet how many people died this season from the flu. However, in an average flu season, there are about 20,000 deaths, and about 30,000 when the Type A-H3N2 virus hits – as it did this year, the CDC said. The deadliest flu season in the past decade was 1989-90, when about 44,000 people died. This year, the flu season got off to a slow start, with few cases until mid-January. By February, the flu was widespread in 40 states. The outbreaks had tapered off by mid-April. The strain most prevalent was Type A Sydney.
NEW DELHI, India (AP, Mar. 17, 1999) - With nearly half of its 980 million people infected with tuberculosis, India has obtained a $144 million loan from the World Bank to fight the disease. Using the loan, the government hopes to reach 271 million people using the directly observe treatment strategy (DOTS), G.R. Khatri, a deputy director general in the health ministry, said at a news conference Wednesday. Globally, tuberculosis is the biggest killer of young people and adults. A half million people die of it every year in India. The death rate has come down to five per 500,000 patients from 53 per 500,000 since India adopted the DOTS strategy 15 years ago, Khat ri said. At present, 13.9 million people are covered by DOTS.
. AMSTERDAM, Netherlands (AP, Mar. 16, 1999) - An outbreak of lethal Legionnaires' disease at a Dutch flower show killed another victim Tuesday, raising the death toll to 10, Dutch media reported. A government spokeswoman could not immediately confirm the reports of the latest death. The bacterial infection was traced to a flower show in Bovenkarpsel, 40 miles north of Amsterdam. On Monday, the government confirmed only that five deaths were due to Legionnaires' disease, although four others who had visited the show since have died. Just over 40 people were believed to have been infected with the pneumonia-like illness. Legionnaire's disease was named after an outbreak at a 1976 convention of the American Legion in Pennsylvania. The bacteria that are believed to cause the illness are found in soil and grow in air-conditioning ducts, storage tanks and rivers.
. WASHINGTON (AP, Feb. 26, 1999) - Black Americans are becoming infected with AIDS at record rates, receiving poorer care than whites and dying faster. Now, almost two decades into the AIDS epidemic, about 1,000 health care providers and activists gathered for the first medical conference on AIDS among black Americans - a frantic hunt for ways to fight the exploding racial divide. AIDS in the United States is evolving from a disease that once mostly affected white homosexuals into one largely of poor blacks, often infected from dirty drug needles or heterosexual encounters.
(The Nation, Feb. 25, 1999). At a workshop in Nairobi, the Kenya Medical Association (KMA)
announced the launch of a national public awareness campaign against typhoid.
One out of three Kenyans who gets infected with the disease eventually dies, a
consultant microbiologist said. The World Health organization (WHO) estimates
that 16 million people worldwide are afflicted by typhoid annually, resulting in
about 600,000 deaths (http://www.who.int/gpv-dvacco/disease/typhoid_fever.htm). Typhoid is difficult to diagnose, a problem made worse in Kenya by quacks running laboratory clinics. The first line of action recommended by WHO is to avoid faecal contamination of water sources. The meeting urged Rhone Poulenc to lower the price of their typhoid vaccine to make it affordable to a majority of Kenyans.
ATLANTA (AP, Feb. 18, 1999) - A U.S. federal health group wants 11 Western states with a high incidence of hepatitis A to require that children be vaccinated. Children are one of the highest risk groups for hepatitis A, the Atlanta-based Centers for Disease Control and Prevention's advisory committee on immunization said Wednesday. The committee recommended that states with at least 20 cases out of every 100,000 people - twice the national average for hepatitis. A cases between 1987 and 1997 - implement routine vaccinations. Those states currently are Arizona, Alaska, California, Idaho, Nevada, New Mexico, Oklahoma, Oregon, South Dakota, Utah and Washington.
The International WHO Network of Health Promoting Hospitals was set up in 1991 to support hospitals as the central institution of the health care sector to become a more health promoting setting. Health Promoting Hospitals focus on promoting health for patients, staff and the population in the community and they are trying to move towards a "healthy organization" (in a metaphorical sense). In the last years the experiences of several projects and activities brought about considerable expertise and knowledge. Recently the Ludwig Boltzmann-Institute for the Sociology of Health and Medicine as Co-ordinating Centre of the network set up a homepage:
(Arkia News Network, Feb. 5, 1999)- Cultural and religious beliefs are hampering the control of the cholera epidemic in Mozambique. Go to:
http://www.planetark.org/dailynewsstory.cfm/newsid/13706story.htm Isolation of cholera patients is not adhered to because relatives want to support them and end up getting infected as well. In northern Mozambique people don't use latrines, increasing the risk of the disease. In reaction to a series of violent incidents in Nampula, police detained 99 people accused of participating in a campaign of agitation against health workers involved in combating the cholera outbreak. The agitation was attributed partly to rumors deliberately spread by opposition political parties. Minister of Health, Aurelio Zilhao, said that cholera could be ended or reduced only with the improvement of the water supply systems and hygienic measures, especially in the rural areas.
(International Federation of Red Cross and Red Crescent Societies, Press Release, 4 February 1999)- The Red Cross is seeking UGS 50 million (EUR 32,200) for a cholera campaign in Uganda to avoid a repetition of last year's outbreak when 100-150 cases a day were registered in Kampala. As part of the National Cholera Task Force, the Red Cross has deployed 50 volunteers to provide community health education, chlorinate water sources, locate cholera cases and transport them to hospital. It also plans to improve environmental sanitation. Poor sanitation and drainage systems appear to be prime causes of the spread of cholera in Kampala. Poor domestic hygiene, inadequate latrine facilities and open defecation in and along city water courses are also contributing factors.
Uganda Red Cross Society, fax: +256-41-258184, mailto
Fiji: Health Threat in Wake of Floods.(Australian Broadcasting Corporation, 2 February 1999) Health authorities fear an outbreak of disease in Western Fiji as a result of drinking water pollution by overflowing sewage from pit latrines, dead cattle and poor drainage. Record floods were recorded in the wake of Tropical Cyclone Dani which hit the Pacific islands of Fiji and Vanuatu on 19 January 1999. Fijian authorities have mounted an intensive campaign in flood-affected areas and have used chemicals to destroy mosquito breeding sites. ReliefWeb, http://www.reliefweb.int
Vaccine Spells Hope for Humans Against Fatal Ebola Virus
Vaccine Spells Hope for Humans Against Fatal Ebola Virus (The Daily Telegraph January 19, 1998) Scientists have successfully immunized animals against the fatal Ebola virus. The researchers have developed a new method called genetic immunization.
CDC Starts New Efforts to Curb Surging Epidemic of Sexual Diseases. (Associated Press March 24,1998) An estimated 10-12 million new cases of sexually transmitted diseases are reported in the US each year.
Health Education: the Gateway to Malaria Prevention. (Times of Zambia March 24, 1998) Health education is essential in combating malaria. WHO and UNESCO has initiated a malaria-safe behaviors program for schools and parents. This disease is preventable and curable.
For related news stories, pleaseclick here.
Abraham, C., Clift, S., & Grabowski, P. Cognitive Predictors Of Adherence To Malaria Prophylaxis Regimens On Return From A Malarious Region: A Prospective Study. SOCIAL SCIENCE & MEDICINE 48 (11): 1641-1654.
Aral, S.O., Hughes, J.P., Stoner, B., Whittington, W., Handsfield, H.H., Anderson, R.M., & Holmes, K.K. (1999).
Sexual Mixing Patterns In The Spread Of Gonococcal And Chlamydial Infections. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 825-833.
Engel, J. P. (1998). Long-term Suppression of Genital Herpes. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (10): 928.
Gunn, R. A., Rolfs, R. T., Greenspan, J. R., et al. (1998). Role of Community-Based Organizations in Control of Sexually Transmitted Diseases. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (5): 419.
Gounder, C. (1998). The Progress Of The Polio Eradication Initiative: What Prospects For Eradicating Measles? HEALTH POLICY AND PLANNING 13(3):212-233.
Hinman, A. (1999). Eradication of Vaccine-Preventable Diseases. ANNUAL REVIEW OF PUBLIC HEALTH 20: 211-230.
Hutin, Y. J. F., Bell, B. P., Marshall, K. L. E., Schaben, C. P., Dart, M., Quinlisk, M. P., & Shapiro, C. N. (1999). Identifying Target Groups For A Potential Vaccination Program During A Hepatitis A Communitywide Outbreak. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (6): 918-921.
Kamb, M. L., Fishbein, M., Douglas Jr., J. M., et al. (1998). Efficacy of Risk-Reduction Counseling to Prevent Human Immunodeficiency Virus and Sexually Transmitted Diseases. JAMA - JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 280 (13): 1161.
St James, P.S., Shapiro, E., & Waisbren, S.E. (1999). The Resource Mothers Program For Maternal Phenylketonuria. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 762-764.
Thomas, M. P. (1998). Hepatitis A Vaccination. THE NEW ENGLAND JOURNAL OF MEDICINE 339 (10): 705.
Books and Reviews
Kalichman, Seth C. (2005). Positive Prevention: Reducing HIV Transmission among People Living with HIV/AIDS. New York: Springer.
Zacher M.W. (1999). Epidemiological Surveillance: International Cooperation To Monitor Infectious Diseases. In I. Kaul, M. Stern, & I. Grunberg, Eds. Global Public Goods. Oxford: Oxford University Press, pp. 268-285.
Malaria Surveillance --- United States, 2001.
Malaria Surveillance --- United States, 2001.
Morbidity and Mortality Weekly Report, 52(SS-5), July 18, 2003.
HIV Diagnoses Among Injection-Drug Users in States with HIV Surveillance --- 25
Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.
Multistate Outbreak of Monkeypox --- Illinois, Indiana, Kansas, Missouri, Ohio,
and Wisconsin, 2003. Morbidity and Mortality Weekly Report,
52(27), July 10, 2003.
West Nile Virus
Activity --- United States, July 3-9, 2003. Morbidity and
Mortality Weekly Report, 52(27), July 10, 2003.
Malaria Surveillance --- United States, 2001. Morbidity and Mortality Weekly Report, 52(SS-5), July 18, 2003.
HIV Diagnoses Among Injection-Drug Users in States with HIV Surveillance --- 25 State, 1994-2000. Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.
Update: Multistate Outbreak of Monkeypox --- Illinois, Indiana, Kansas, Missouri, Ohio, and Wisconsin, 2003. Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.
West Nile Virus Activity --- United States, July 3-9, 2003. Morbidity and Mortality Weekly Report, 52(27), July 10, 2003.
Rapid Increase in HIV Rates--Orel Oblast, Russian Federation, 1999--2001. Morbidity and Mortality Weekly Report, 52(28), July 18, 2003.
Severe Acute Respiratory Syndrome --- Singapore, 2003. Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.
Update: Adverse Events Following Civilian Smallpox Vaccination --- United States, 2003. Morbidity and Mortality Weekly Report, 52(18), May 9, 2003.
Severe Acute Respiratory Syndrome --- United States, 2003.
Morbidity and Mortality Weekly Report, 52(15), Apr 17,
Prevalence Among Working Coal Miners Examined in Federal Chest Radiograph
Surveillance Programs --- United States, 1996--2002.
Morbidity and Mortality Weekly Report, 52(15), Apr 17,
Events Following Civilian Smallpox Vaccination --- United States, 2003.
Morbidity and Mortality Weekly Report, 52(15), Apr 17, 2003.
Outbreak of Group A Streptococcal Pneumonia Among Marine Corps Recruits --- California, November 1--December 20, 2002. Morbidity and Mortality Weekly Reports 52 (6), February 14, 2003.
Increase in Coccidioidomycosis --- Arizona, 1998--2001. Morbidity and Mortality Weekly Report 52 (6), February 14, 2003.
Measles Control --- South-East Asia Region, 1990--1997.
Morbidity and Mortality Weekly Report 48 (25), July 2, 1999.
Vaccine-Preventable Diseases: Improving Vaccination Coverage in Children, Adolescents, and Adults. Morbidity and Mortality Weekly Report 48 (No. RR-8), June 18, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr4808a1.htm. http://www.cdc.gov/ncidod/diseases/flu/fluvirus.htm
Influenza Activity -- United States, 1998-1999 season. Morbidity and Mortality Weekly Report 48 (9), March 12, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00056627.htm
Progress Toward Poliomyelitis Eradication --- Pakistan, 1994--1998. Morbidity and Mortality Weekly Reports 48 (6), February 19, 1999.
Preventing Emerging Infectious Diseases: A Strategy for the 21st Century. This is CDC's strategic plan for reducing the health consequences of emerging and reemerging diseases. Electronically available from CDC, Georgia. You can request a copy of the plan by: 1) sending an email to email@example.com; 2) sending a fax to 404-639-4194; or 3) mailing a request to CDC, NCID, Office of Health Communication, 1600 Clifton Road NE, Mailstop C-14, Atlanta, GA 30333. Supplementary materials are available from the internet at http://www.cdc.gov/ncidod.
Adverse Effects Associated with 17D-Derived Yellow Fever Vaccination---United States, 2001-2002. Morbidity and Mortality Weekly Reports 51(44), November 8, 2002, pp. 989-993. http://www.cdc.gov/mmwr/preview/mmwrtml/mm5144a1.htm. In June 2001, seven cases of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) (previously called multiple organ system failure) in recipients of 17D-derived yellow fever vaccine (YEL) were reported to the Advisory Committee on Immunization Practices (ACIP). ACIP reviewed the cases, recommended enhanced surveillance for adverse events, and updated the ACIP statement on YEL. This report summarizes the preliminary surveillance findings, including two new suspected cases of YEL-AVD and four suspected cases of YEL-associated neurotropic disease (YEL-AND) (previously called postvaccinal encephalitis). Although YEL remains essential for travelers to area in which yellow fever (YF) is endemic, these findings underscore the need for continued enhanced surveillance and timely clinical assessment of YEL-associated disease.
1. Condoms and prevention. Condoms can be effective in the prevention of sexually transmitted diseases, if the are used. What predisposing, enabling, and reinforcing factors contribute to the behavior of condom use?
2. Surveillance and control systems. It is expected that public health departments will improve methods for monitoring and controlling the spread of newly recognized diseases, infections introduced from other nations, and unexpected epidemics. Recommend ways in which modern technology might be used towards this end.
3. Immunizations. Visit a passport office where immunization regulations are issued for travelers to foreign countries. Describe one of these diseases and the possible consequences of not being properly immunized against it.
4. Ethics and communicable diseases. Contact or visit a community clinic where sexually transmitted diseases are diagnosed and treated. What policies have been implemented to protect confidentiality and to notify others (parents, sexual partners, employers)? How is patient education conducted for prevention of infection reoccurrence?
5. Incidence and prevalence. Contact a local health officer in regard to communicable diseases that have occurred in the community during recent years. Using HIV/AIDs, tuberculosis, syphilis (as examples) plot the incidence and prevalence of these diseases over the last 30 years. Plot the differences between incidence and prevalence in the trend lines. Note the different trend line for these diseases. To what can these differences be attributed?
6. Milestones in disease eradication are presented as a boxed issues in this chapter. What role do you think private funding agencies should play in disease eradication? With new antibiotic resistant bacteria making their debut, what role should public health officials take in preventing the development of these new strains?