Category Archives: Infectious disease
Infographics, public health news and innovative efforts to improve community health were the topics of the most widely read posts on NewPublicHealth this year.
Take a look back at our most popular posts:
- The Robert Wood Johnson Foundation’s Commission to Build a Healthier America will release new recommendations on early childhood education and improving community health on Monday January 13. Earlier this year, new city maps to illustrate the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
- Three of the infographics created for the NewPublicHealth series on the National Prevention Strategy, a cross-federal agency emphasis on public health priorities, were among the most popular posts of 2013. Stable Jobs = Healthier Lives, the most widely viewed NPH infographic, tells a visual story about the role of employment in the health of our communities. One example: Laid-off workers are 54 percent more likely to have fair or poor health and 83 percent more likely to develop a stress-related health condition.
- Better Transportation =Healthier Lives, another 2013 infographic, tells a visual story about the role of transportation in the health of our communities. Consider this important piece of the infographic as we head into 2014: The risk of obesity increases 6 percent with every additional mile spent in the car, and decreases 5 percent with every kilometer walked.
- Top Five Things You Didn’t Know Could Spread Disease was the best read of the very well read stories on NewPublicHealth during Outbreak Week—an original series created by NPH to accompany the release in late December of Outbreaks: Protecting Americans from Infectious Disease, a pivotal report released by the Robert Wood Johnson Foundation and Trust for America’s Health.
- Better Education=Healthier Lives, another widely viewed—and shared—infographic on NewPublicHealth, shared the critical information that more education increases life span, decreases health risks such as heart disease and—for mothers who receive more years in school—increases the chance that her baby will die in infancy.
- How Healthy is Your County? In 2014 the Robert Wood Johnson Foundation will release the fifth County Health Rankings, a data set more and more communities rely on to see improvements—and room for change—in the health of their citizens. NewPublicHealth’s 2013 coverage of the County Health Rankings & Roadmaps included posts on the six communities that won the inaugural RWJF Roadmaps to Health Prize for their innovative strategies to create a culture of health by partnering across sectors in their communities.
- The Five Deadliest Outbreaks and Pandemics in History, was our seventh best read post of the year. Read it again and ask: Are we prepared as a nation for the next big outbreak?
- What does architecture have to do with public health? Visit the Apple Store in New York City’s SoHo neighborhood, Texas’ Red Swing project, or....view our post from earlier this year.
- Less than a month after the shootings in late 2012 at Sandy Hook elementary school in Connecticut, the Harvard School of Public Health held a live webcast town hall meeting on gun violence on the legal, political, and public health factors that could influence efforts to prevent gun massacres. And toward the end of 2013, NewPublicHealth sat down with former Surgeon General David Satcher, MD, MPH, to talk about the role of research in preventing gun violence.
- NewPublicHealth covered the release of a report by Trust for America’s Health that found that most states are not implementing enough proven strategies to prevent prescription drug abuse. But the year ended with some better news on the critical public health issue. An NPH news roundup post reported on a study funded by the National Institutes of Health which found that rates of prescription drug abuse by high school students have dropped slightly.
Close runners up included How Do You Transform a Community After a Century of Neglect?, which looked at how Bithlo, Fla. is working to bring much-needed services to its main street through the “Transformation Village” initiative, as well as ‘Unprecedented Destruction’: Ocean County Public Health Continues to Respond to Hurricane Sandy, which brought together a NewPublicHealth video and a Q&A to illustrate how public health officials and departments worked together to help their regions recover from the devastating superstorm. Also in the top 20 for year was an interview with New York State Health Commissioner Nirav R. Shah, MD, MPH, on the release of the 2013-17 Prevention Agenda: New York State’s Health Improvement Plan—a statewide, five-year plan to improve the health and quality of life for everyone who lives in New York State.
For “Outbreak Week” we’ve already covered the deadliest pandemics in human history. But which outbreaks could be around the corner? Outbreaks: Protecting Americans from Infectious Diseases, 2013, the new report from Trust for America’s Health and the Robert Wood Johnson Foundation, lays out a few possibilities on which infectious diseases may pose the more serious threats in the future. Here are the greatest threats to the United States, according to Tom Inglesby, MD, Chief Executive Officer and Director of the UPMC Center for Health Security.
Middle East Respiratory Syndrome (MERS)
Spread across 12 countries, the virus has killed almost 40 percent of the people it’s infected. And while it may currently be confined to one region of the world, the high level of air travel between the Middle East and the United States increase the chance that it could find its way into the country, according to Inglesby, who said “we still don’t have a good handle on how it spreads, and there is no treatment for it or vaccine against it.”
Novel influenza virus
A new flu strain that, like the seasonal flu, is far reaching, but which would have a “far higher mortality rate.” Recent examples of major flu pandemics include the 2009 H1N1 outbreak; recent studies indicate the swine flu may have killed more than 200,000 people. The new H7N9 is also notable because of its high mortality rate.
Accident involving a lethal engineered virus
With scientists experimenting on viruses — enhancing their lethality or ability to spread — the risk grows of an accident releasing an engineered virus into the population.
It’s the most common infectious disease in the world and drug-resistant strains are only making the matter worse. “The level of drug resistance is growing and coping with this needs to be a real priority,” said Inglesby.
Not a pathogen, but a reason why pathogens could become even more dangerous. The U.S. Food and Drug Administration is taking steps to combat this growing issue, including new regulations on antimicrobial use in food animals and new restrictions on antibacterial soaps.
Deliberate biological threats
A biological attack, whether from another nation or as a terrorist act, could cause not only severe illness and death, but also communication problems that would hinder the ability of public health departments to respond.
Climate change is making this already existing problem even greater—with the regional climate shifts, places that haven’t had to deal with mosquito-based threats are now seeing them swarm in because of the warmer weather. Notable examples include the West Nile Virus and Dengue Fever. “We need to reinvigorate our strategy for mosquito control and the infectious diseases that come with mosquitoes.
How does public health take care of the communities it serves during a foodborne illness or infectious disease outbreak? Through a series of sophisticated steps, most choreographed long before an emergency occurs. Every minute of every day, U.S. and global health experts monitor reports that could indicate a disease or foodborne illness outbreak, as well as review samples of food, water, soil and other resources to detect outbreaks. Some of the steps are well laid out and public; others, such as those monitored by the Department of Homeland Security—watchful for terror attacks on food and water supplies—are hidden from view, but supremely vigilant.
Other examples of outbreak preparedness activities:
- Each year the American Public Health Association updates its Control of Communicable Diseases manual, and adds updates as needed to the manual’s mobile platforms.
- Outbreak guidance for new public health officers, as well as refreshers for veterans, are provided by public health official member associations such as the National Association of County and City Health Officials and the Association of State and Territorial Health Officials.
- New public health officers are also invited to the U.S. Centers for Disease Control and Prevention (CDC) for an orientation that includes outbreak guidance.
No, health officials can’t know whether an outbreak might occur next week or next month—or never—and whether it’s going to be a new strain of flu, or tainted ground beef sold at multiple food outlets. But by having a set of continually reviewed steps for alerting the public—and keeping them up to date with real-time guidance—targeted advice for any outbreak can be quickly assessed and disseminated.
Health agencies typically share information and best practices with local and state health departments through conference calls and alerts throughout a crisis. And, with the explosion of social media, just about all health departments continually add communications channels for the people they serve. For example, health officials in Montgomery County, Texas, this week are keeping the public informed about an illness outbreak that may turn out to be a severe form of flu, through dedicated channels that include a telephone hotline and its Facebook page. Read the wealth of posts on preparedness on NewPublicHealth to see the many avenues health departments take to keep residents continually informed when an outbreak occurs.
We've declared this week "Outbreak Week" on NewPublicHealth, and we're using it as an opportunity to crystallize discussion among the public health community and beyond about whether we're prepared as a nation to handle the next big outbreak. Spread the word, not the germs.
Here are the highlights of our coverage this week:
- Top 5 Things You Didn't Know Spread Disease: We all know to be wary of mosquitos and ticks, but there are plenty of other ways diseases can spread that may not be top of mind. Are you prepared?
- The 5 Deadliest Outbreaks and Pandemics in History: A modern outbreak could be a virus that kills a couple hundred thousand, or simply an infected shipment of food that left dozens sick. However, a look back through history reveals outbreaks so expansive—so deadly—that they essentially changed the course of history.
- Outbreak Week Q&A on Vaccines with Litjen (L.J) Tan: 45,000 adults and 1,000 kids die each year from vaccine-preventable diseases. Where are the gaps and how can we close them?
- State Vaccine Exemptions' Impact on Vaccination Rates: A new study finds that non-medical exemption laws for vaccines required for school or daycare admission have significantly impacted the vaccination rates of at least one disease.
- INFOGRAPHIC: A Close Look at How Prepared We Are For the Next Outbreak: From antibiotic-resistant superbugs to the seasonal flu to Salmonella, infectious diseases are a serious health threat that also cost individuals and the health care industry billions.
- Outbreaks on the Big Screen: When outbreaks hit the big screen is it good for public health or does it make people panic?
- Where Polio Remains a Threat: Outbreak Week Q&A with Sona Bari: Bari of the World Health Organization discusses polio's resurgence as a critical global health issue and efforts to eradicate the disease globally.
- Throwback Thursday: Zombie Apocalypse: The CDC urged folks to prepare for the zombie apocalypse — with a goal of boosting overall preparedness for real health threats and disasters, back in 2011. Did it work?
- Outbreak Response Dream Team: Which pop culture characters would you want on your team with the diverse skills to respond to and cure a deadly, worldwide epidemic?
- Digital Outbreak Response: A roundup of how the digital world is working to improve emergency preparedness and outbreak response.
Outbreaks can spread faster than you think. But luckily the development of new digital tools and technologies to assist with documenting, tracking and alerting the public of the spread of infectious disease is progressing even more rapidly. There are new databases, maps and communications technologies that make tracking down an outbreak and getting it under control a much quicker and more efficient process. Digital developments focusing on emergency preparedness and response can help protect more of the population from the next pandemic.
We’ve brought together a few examples of how the digital world is working to improve emergency response:
- At the University of Pittsburgh School of Public Health, a new initiative called Project Tycho is working to convert 125 years worth of data from paper documents into an open-access database. Project Tycho will save researchers around the world the time of finding reliable historical data from different sources for infectious diseases, which is critical to understanding underlying epidemic dynamics, according to Dr. Willem van Panhuis, an assistant professor of epidemiology at University of Pittsburgh School of Public Health.
- The Advanced Molecular Detection Initiative proposed in the President’s 2014 Budget could help make huge strides in controlling infectious disease. The initiative would bring together experts in laboratory science, epidemiology and bioinformatics to join forces like never before. By using genetic sequencing to examine infectious pathogens, these technologies are on the verge of revolutionizing medical professionals’ abilities to diagnose infectious diseases; investigate and control outbreaks; understand transmission patterns; develop and target vaccines; and determine antimicrobial resistance—all with increased timeliness and accuracy and decreased costs.
- Social media and crowdsourcing technologies have helped medical professionals develop tools to track the spread of disease and where outbreaks are occurring and even make the data available to the general public. HealthMap is one of the original examples of using digital technologies to track outbreaks while keeping the public informed.
- In efforts to spread the skills needed to deal with public health issues such as outbreaks, the CDC has made learning more fun through games such and applications such as CDCology and Solve the Outbreak for the iPad. CDCology is a pilot program through the CDC and supported by HHSIgnite (beta). The pilot website uses CDC staff-created, student-solved, virtual microtasks to tackle public health challenges at CDC. As they complete the short microtasks, the students gain valuable educational experience, insight and exposure to the field of public health. Solve the Outbreak puts you in the shoes of a member of the Epidemic Intelligence Service. Playing the game presents the opportunities to use clues, analyze data, solve the scenario and save lives in this virtual world, but also helps teach the public more about the process behind handling a real outbreak.
CDC’s Top Accomplishments for 2013 Include Progress in Curtailing Outbreaks
A review by the U.S. Centers for Disease Control and Prevention (CDC) of progress in 2013 include improvements in preventing and curtailing infectious disease and foodborne illness outbreaks in the United States and globally:
- More than 12,000 facilities now track health care-associated infections using CDC’s National Healthcare Safety Network (NHSN), and bloodstream infections in patients with central lines have decreased by 44 percent and surgical-site infections have decreased by 20 percent since 2008.
- 2013 marks the 10th anniversary of the U.S. President’s Plan for Emergency AIDS Relief(PEPFAR). In 2013, PEPFAR prevented the one millionth baby from being infected with HIV and has 6.7 million people on treatment, with HIV incidence falling in nearly all PEPFAR countries.
- CDC published its first estimates of which foods were causing foodborne illnesses in the United States, referred to as Attribution Estimates. These estimates help regulators, industry and consumers more precisely target and implement effective measures to prevent food contamination, and allow people to use it to help guide their own food safety practices.
- CDC scientists traced the newly discovered Heartland virus that infected two men from northwestern Missouri to populations of lone star ticks in the region. This discovery helps CDC stay one step ahead of what could become another public health threat carried by ticks.
- In conjunction with public health officials in Eurasia’s Republic of Georgia, CDC helped identify a new poxvirus (related to smallpox) that sickened shepherds in Akhmeta, Georgia. The successful investigation shows that rapid detection saves precious time during response to emerging health threats.
- CDC researchers found that two new antibiotic regimens using existing drugs successfully treat gonorrhea infections. This is especially important given growing antibiotic resistance and dwindling treatment options for gonorrhea.
Read more on infectious disease.
‘Consumer Reports’ Study Finds Harmful Bacteria in Many Samples of Chicken Sold in the United States
A new investigation of the safety of chicken breasts sold in retail stores across the United States by Consumer Reports found potentially harmful bacteria on 97 percent of the samples tested. And about half of the chicken samples had at least one type of bacteria that was resistant to three or more classes of antibiotics. “We are looking to the government to ensure the safety and sustainability of the entire food supply,” said Urvashi Rangan, PHD, executive director of the Consumer Reports Food Safety and Sustainability Center. “We need to attack the root causes of the problems. Without a government focus on effective solutions, meat safety will continue to be compromised.” Consumer Reports has several recommendations for the U.S. government aimed at reducing bacterial contamination in the food supply:
- Congress should give the U.S. Department of Agriculture (USDA) the authority to mandate a recall of meat and poultry products.
- The FDA should prohibit antibiotic use in food animals except for the treatment of sick ones. (According to Consumer Reports, FDA’s action last week giving voluntary guidance to drug companies to end labeling of antibiotics for growth promotion uses is an important first step, but is far from what is needed overall.)
- The USDA should classify strains of salmonella bacteria that are resistant to multiple antibiotics and known to have caused disease as “adulterants,” so that inspectors look for those strains routinely and when found, the products cannot be sold.
- The USDA should move quickly to set strict levels for allowable salmonella and campylobacter in chicken parts.
- The USDA’s proposed rule to increase maximum line speeds and reduce the number of USDA inspectors at slaughter plants should be dropped.
Read more on bacteria.
Health Insurers Extend Deadline for Many 2013 Health Insurance Premium Payments
The trade association for many health insurance plans has announced that many plans will be extending the deadline for consumers to pay their first month’s premium. Consumers who select their plans by December 23 and pay their premiums by January 10 will be able to have coverage effective January 1. Under current rules and guidance, consumers who want to begin coverage on January 1 must select a plan by December 23 and pay the first month’s premium by December 31. The short time period in which to complete these steps, particularly around the holidays, combined with the ongoing technical issues with the Affordable Care Act insurance purchasing site healthcare.gov have raised concerns that some consumers’ coverage may not be able to begin on January 1. The association, America’s Health Insurance Plans, is urging consumers to check with the plan they have selected for more details about their specific coverage policy. Read more on the Affordable Care Act.
Picture this: The world just ended. Well, not completely. But things aren’t looking up. An influenza strain has cut a deadly swath through nearly every continent. Or maybe the Black Death is making a special encore appearance. Or your now-undead neighbor—Phil, normally a great guy, invited you to a dinner party just last week—is shuffling around the front yard, trying to gnaw on your brains.
The point is it’s time for action. And since we’re talking theoretical, we might as well be talking fictional, too. Below is NewPublicHealth’s “Outbreak Dream Team”—pop culture characters with the diverse skills we’d need to respond to and cure a deadly epidemic. And maybe a dose of what’s really needed in the way of a public health workforce to keep us ready for whatever could happen next.
- In a nationwide (or global) public health emergency such as a pandemic, the President has to step up and provide leadership among different sectors and divisions of the government to coordinate a response and assure the nation of a secure path forward.
Laura Roslin, “Battlestar Galactica”
As a former Secretary of Education she has experience working with large groups with disparate goals. (Plus, she gets that education impacts health in so many ways). And as president of the roughly 50,000 humans left alive after a Cylon invasion wiped nearly everyone out, she’s adept at balancing public policy needs, working with everyone from public advocates to top military leaders. Some of her decisions are more-than-a-bit iffy, but you try pleasing everyone all the time when the last vestiges of humanity are spread across a fleet of ships drifting through space.
National Public Health Lead
- Equivalent to the Director of the U.S. Centers for Disease Control and Prevention (CDC). The CDC safeguards the nation’s health by preparing for, detecting, rapidly responding to and preventing health threats 24/7 to save lives and protect communities. The director’s job is to make sure that happens.
Ann Perkins, “Parks & Recreation”
As a practicing public health nurse and the PR Director of Pawnee's Health Department, Ann Perkins has dealt with infectious disease control from a hospital, a government and even a girlfriend perspective. Smart and determined, this go-getter can not only treat the symptoms of infectious diseases, she can detect and track them, coordinate response, and educate the community—all while maintaining a confident, calm and collected public face. While Leslie Knope leads the town through the city council, Ann has the potential to lead diverse teams and bridge health and health care to coordinate a swift and decisive response. If she can take on Pawnee's obesity epidemic one candy company at a time and teach sex ed to senior citizens, she can certainly handle a national outbreak or two. Plus, she gets bonus points for being (probably) the only true public health character on television.
The pop culture craze of zombie apocalypse films, televisions shows and books penetrated deeper than many might have expected—even the U.S. Center for Disease Control and Prevention (CDC) weighed in on the cultural phenomenon, with a 2011 blog post on preparing for a real zombie apocalypse. The post covers everything from the history of zombie outbreaks to how to assemble an emergency supply kit should one of these possible apocalyptic zombie scenarios play out in your community.
At the time, NewPublicHealth spoke with the CDC’s Dave Daigle, who dreamed up the zombie post. The CDC campaign was crafted to help spread information on emergency preparedness for the upcoming hurricane season, while the zombie cover was designed both to attract a younger demographic and to offer an off-kilter slant that would make people pay attention. The post contains strong recommendations to help people prepare for many types of emergencies, from natural disasters to disease outbreaks—for example, your supply kit should include water, food, medications, important documents, and so on. The CDC was able to reach an even larger audience by packaging this valuable information in a playful nod to the fantastical fears that a zombie outbreak could actually happen.
Among the tips from the CDC’s Preparedness 101: Zombie Apocalypse: "Plan your evacuation route. When zombies are hungry they won’t stop until they get food (i.e., brains), which means you need to get out of town fast!"
Once the post went live, the staff sat back while it was tweeted, retweeted, Facebooked, commented on and reported on by a growing list of mainstream print and online publications. The result was an overwhelming success:
- The initial tweet received 70,426 clicks
- “CDC” and “Zombie Apocalypse” trended worldwide on Twitter
- The CDC Emergency Facebook page gained more than 7,000 fans within the first month of its launch
- There were more than 3,000 articles, broadcasts and other media coverage of the blog
- The messages received an estimated 3.6 billion impressions with a marketing worth of $3.4 million—and all for a campaign that cost $87.00
Severe Flu-Like Illness Under Investigation in Texas
Health officials in Montgomery County, Texas, are investigating an outbreak of an influenza-like illness that has so far resulted in eight hospitalizations, with four of those patients having since died. Recent tests on the other four show that one seems to have the 2009 H1N1 influenza virus, two were negative for all flu viruses and results are so far unknown on the fourth patient. Close to 2,000 cases of the illness have been reported. So far the investigation suggests that none of the patients who died had been vaccinated against flu, and county residents who have not yet had the flu shot are being urged to get one. According to the county’s health director, the hospitalized patients range in age from 41 to 65, which is not typical; severe flu symptoms more likely occur in very young or very old patients. The U.S. Centers for Disease Control and Prevention (CDC) is assisting the health department in investigating the outbreak, and the county has established a telephone hotline and Facebook page to respond to questions from the public. According to news reports, the current outbreak resembles a cluster of severe respiratory infections in Dothan, Ala., in May; however tests showed that those hospitalized patients had a variety of common respiratory viruses and bacteria, with no unusual pathogens. Read more on flu.
CDC Issues Travel Advisory in Caribbean
The U.S. Centers for Disease Control and Prevention (CDC) has issued a travel health notice because of recent cases of chikungunya on the Caribbean island of St. Martin, which have been confirmed by the World Health Organization. According to the CDC, chikungunya is a very serious illness caused by a virus that spreads through mosquito bites. The most common symptoms are fever and joint pain. Other symptoms may include headache, muscle pain, joint swelling, or rash. The mosquito that carries chikungunya virus can bite during the day and night, both indoors and outdoors, and often lives around buildings in urban areas. There is currently no vaccine or medicine to prevent chikungunya. Travelers can protect themselves by following CDC recommendations on preventing mosquito bites. "Microbes know no boundaries, and the appearance of chikungunya virus in the Western hemisphere represents another threat to health security," said CDC Director Tom Frieden, MD, MPH, in the release. "CDC experts have predicted and prepared for its arrival for several years and there are surveillance systems in place to help us track it." Read more on infectious disease.
Life Expectancy Increases among Treated HIV-Positive People in North America
A new study in the journal PLOS ONE finds that a 20-year-old HIV-positive adult on antiretroviral therapy (ART) in the U.S. or Canada may be expected to live into their early 70's, a life expectancy approaching that of the general population. Researchers calculated the life expectancies of nearly 23,000 individuals on ART based on mortality rates in the early to mid-2000s. Changes in life expectancy from 2000-2007 among HIV-positive individuals were then evaluated using sociodemographic and clinical characteristics, such as drug use history and immune cell counts. The researchers found that life expectancy at age 20 increased from 36.1 to 51.4 years from 2000-2002 to 2006-2007. Men and women had comparable life expectancies in all periods except the last (2006-2007). Life expectancy was lower for individuals with a history of injection drug use, those who were non-white, and those who initiated ART with low CD4 count (a count of cells that activate the immune response) compared to those who started at a higher count. Read more on HIV.
When it comes to movies, sometimes the most realistic scenarios are also the scariest. The dramatic, often global and always fatal spread of infectious disease is now a well-worn movie trope—but because it could happen it remains scary every time. The good news (in addition to them just being movies, so no need to grip the theater armrest so hard!) is these silver screen attempts at showing the story behind the spread and containment of infectious disease help to highlight the importance of public health. Without the many integrated public health systems that touch our lives daily and protect us in emergency situations, we’d be much more susceptible to all the many types of outbreaks that plague Hollywood characters.
Well, maybe not all of them...
As part of Outbreak Week, we’ve compiled a list of some of the scariest outbreaks to terrify movie watchers. What do you think they got right? (And spoilers below...)
The scariest part of this outbreak is realizing how quickly disease can spread—and through interactions you may not even realize. It also highlights the wide range of reactions people can have to a disease spreading through a population. Several days pass before doctors and administrators at the U.S. Centers for Disease Control and Prevention realize the extent or gravity of this new infection. First they need to identify virus, then they can start working toward a means of combating it, a process that will likely take several months. As the contagion spreads to millions of people worldwide, people panic and society breaks down.
World War Z
A mysterious infection turns entire human populations into rampaging, mindless zombies. After barely escaping the chaos, United Nations Investigator Gerry Lane is persuaded to go on a mission to investigate the disease. What follows is a perilous global trek where Lane must brave horrific dangers and long odds to find answers before civilization falls. What at least the book gets right is the vast number of organizations and government groups that must come together to respond to an outbreak.
28 Days Later
How scary would it be to wake up after being in a month-long coma only to find your city completely deserted, with cars left empty and seemingly nothing but silence? One look at the film’s barren London streets will show you. Then think about how you’d feel if you found out that this emptiness was caused by rage virus-infected animals released by group of animal rights activists in protest of animals being used for medical research. And the virus was still out there...
An unknown virus wiped out five billion people in 1996. By 2035, only 1 percent of the population was still surviving, forced to live underground. A convict reluctantly volunteers to be sent back in time to 1996 to gather information about the origin of the epidemic (which he's told was spread by a mysterious "Army of the Twelve Monkeys") and locate the virus before it mutates, so that scientists from his time can study—and hopefully cure—the disease.
As a toxin begins to turn the residents of Ogden Marsh, Iowa into violent psychopaths, Sheriff David Dutton tries to make sense of the situation while he his wife, and two other unaffected townspeople band together in a fight for survival. Eventually military support is brought in to attempt to contain the outbreak.
(Image source: WikiCommons, Sailko)