Category Archives: Infectious diseases
Tomorrow, March 25, the day after World Tuberculosis Day, the Public Broadcasting Program Frontline will present TB Silent Killer a new documentary that looks at tuberculosis in Swaziland, the country with the highest incidence of the disease.
While many people, especially in the United States, think tuberculosis has long since been eradicated, there are in fact more than 8 million new infections every year, many of them virulent new drug-resistant strains that are passed—throughout the world—through a cough or a sneeze. According to the World Health Organization, tuberculosis has become the second-leading cause of death from an infectious disease on the planet.
Jezza Neumann, the filmmaker who created TB Silent Killer, tells the story of several people in Swaziland suffering daily from the disease, including ten-year-old Nokubegha, whose mother recently died of a multidrug resistant strain of tuberculosis and whose 17-year-old brother cares for her.
“In Swaziland, a quarter of all adults are HIV-positive, which means their immune systems are compromised and especially susceptible to TB infection,” said Neumann, “But globalization and international travel mean that these infections have the potential to spread all over the world.”
NewPublicHealth spoke by phone with Jezza Neumann a few days before the documentary was scheduled to air on Frontline (Check local PBS schedules here.)
NewPublicHealth: Why did you choose tuberculosis as your topic?
Jezza Neumann: The idea being to make films that make a difference and give voice to the voiceless. In doing so, we’ve made and kept relationships with nonprofits and NGOs and other organizations and look to find the issue that’s hidden in the background that no one is hearing about, that’s not getting the platform that it needs.
One of the organizations we’d worked a lot with is MSF, Medecins Sans Frontieres, or Doctors Without Borders as it’s known over here. The press officer at the U.K. office knew that Doctors Without Borders had been struggling to get the issue of tuberculosis out on the mainstream. People had done small reports but she knew there was a big impact possible with a documentary because the reality is if you combine the facts, stats and figures in documents with a film that has a human face and a human cost of those facts, stats and figures, it becomes something so much bigger. The documentary becomes a platform that has a life far further reaching than just the transmission.
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.
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
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)
While it has been decades since polio was a critical threat for much of the developed world, the disease—a virus that can spread from person to person and affect the brain and spinal cord with the potential for paralysis—still causes disease and death in the developing world. Earlier this year cases were reported in Syria, while in Israel the polio virus was found in soil likely from human waste infected with the disease, prompting a revaccination campaign among children age 5 and under. Polio has continued to spread in Afghanistan, Nigeria and Pakistan, and has been reintroduced and continues to spread in Chad and in the Horn of Africa after the spread of the virus was previously stopped. Other countries have seen small numbers of cases recently after no cases for decades.
Because even a small spread of the disease could reach the United States if infected individuals carry the virus here, the U.S. Centers for Disease Control and Prevention (CDC) several years ago made polio one focus of their Emergency Operations Center. CDC staff work with the World Health Organization and foreign health departments on vaccination campaigns aimed at fully eradicating the disease.
>>Bonus Content: View the CDC's infographic, "The Time to Eradicate Polio is Now."
NewPublicHealth spoke recently with Sona Bari, senior communications officer at the World Health Organization about the efforts underway to eradicate polio globally.
NPH: How are you able to detect polio outbreaks?
Sona Bari: We have a global surveillance system for polio and know from it that since 1988 the reduction of the disease has been over 99 percent. Polio is now endemic, which means indigenous polio virus transmission has never been stopped in parts of three countries: Nigeria, Afghanistan and Pakistan. So the surveillance is important because you can get polio down to very low levels like you do now, but it can reemerge. To completely eradicate polio you have to have an effective intervention, which is largely by vaccination. And you can be bring polio under very tight control by massive vaccination, but the virus is very good at finding children who are unvaccinated or under-vaccinated, and in Nigeria, Afghanistan and Pakistan we still have large groups of unvaccinated children. So the reason that polio transmission has not been stopped in these areas is that not enough children are vaccinated.
NPH: Why is there insufficient vaccination in those countries?
Bari: The basic reason is the quality of vaccination activities. Do these countries have decent health systems—strong routine immunization systems where children are regularly taken to a medical facility for their immunizations? When there are mass vaccination campaigns, are we reaching all children? Then there are, on top of that, layers of political complexities. In one part of Pakistan, for example, there is a ban on polio vaccinations by the local warlords. So there are access and security issues, layered on top of the difficultly of reaching all who need vaccines in countries such as Nigeria or Pakistan. That said, we know that these circumstances are not unique. They may differ from country to country, and each country does have a unique combination of the obstacles, but polio has been eradicated in countries that are far poorer than Nigeria or Pakistan, that have had worse conflict and that have perhaps much worse health systems. So it can be done.
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. A new report from Trust for America’s Health and the Robert Wood Johnson Foundation, Outbreaks: Protecting Americans from Infectious Diseases, assesses gaps in our public health system that could severely limit our ability to effectively respond to an outbreak.
NewPublicHealth created an infographic that illustrates many of the key findings of the new report.