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What is the Burden of Disease Caused by Communicable Diseases? What Public Health Tools are Available to Address the Burden of Communicable Diseases?
Introduction
How Can Barriers Against Disease Address the Burden of Communicable Diseases? How Can Immunization Be Used to Address the Burden of Communicable Diseases? How Can Screening and Case Finding Address the Burden of Communicable Diseases? How Can Public Health Efforts Maximize Effectiveness of Treatment and Prevent Resistance? How Can Public Health Strategies Eliminate Specific Communicable Diseases?
Introduction
Your dorm mate went to bed not feeling well one night and early the next morning you had trouble arousing her. She was rushed to the hospital just in time to be effectively diagnosed and treated for meningococcal meningitis. The health department recommends immediate antibiotic treatment for everyone in close contact with your roommate. They set up a process to watch for additional cases to be sure an outbreak is not in progress. Fortunately no more cases occur. You ask yourself should your college require that all freshman to have the meningococcal vaccine before they can register for classes?
Many ppl today are carriers Genes, nutrition, reduced immunity produce activity P.H. movements such as Sanitariums, Vaccines, X-ray, Milk Pasteurization, worked to nearly eliminate incidence 1940s began medical treatment era of TB antibiotic treatments
Not so fast!
1980s saw resurgence in developed world Never ended pandemic in many underdeveloped regions Various reasonsHIV increases susceptibility, promotes spread Drug resistant TB on rise
How do we Eradicate?
Barrier, Protection Immunization Screening
Treatment
Maximize effectiveness and prevent resistance
Is Eradication Easy?
HIV/AIDS
Burden of Disease:
1.2 Million people living w/ HIV/AIDS Another 250,000 undiagnosed Half of 1.2 million people receive regular care 25% of 1.2 million are at undetectable viral load
Potential interventions
Sexual contact
Latex condom Circumcision Abstinence Serial monogamy reduces spread compared to two or more concurrent partners
Blood transfusion Blood and blood products, such as pooled blood products previously used in U.S. by hemophiliacs
Potential interventions
Mothertochild transmission
Cesarean delivery Drug treatment during pregnancy and at time of delivery for mother and child
Breast-feeding
Very low per exposure, Continuation of drug but up to 25% over year treatment reduces, but does or more of breast not eliminate transmission feeding
Less than 0.5% of Postexposure HIV treatment with positive drugs established as needlesticks effective result in prevention transmission
NoMay persist on contaminated needles long enough for transmission NoCarrier state is constant Effective long-term immunity does not usually occur
Easily-diagnosed disease?
Vaccination effective postexposure?
NoRequires testing
NoNone currently available
Is Eradication Easy?
HIV/AIDS
Barrier, protection Isolation? Sexual protection?
Immunization Treatment but no vaccine Treatment slows progression, does not prevent spread Screening Stigma associated w/ screening creates barrier What are end results? Maximize effectiveness, prevent spread Yes, but how!
HIV/AIDS
New efforts to Maximize effectiveness of treatment to reduce incidence Compliance to treatment reduces viral load to undetectable levels
Creates new level of prevention via UVL Reduces risk of infection by 98%*
http://www.aidsmap.com/page/1429357/
Polio
Yes
Measles
Yes
Yes
Yes
Yes
Yes
Polio
YesBut may not be sustained in Immune Compromised individuals
YesBut may not be sustained in Immune Compromised Individuals Virus used for production of the live vaccine can produce polio-like illness and has potential to revert back to "wild type infection"
Measles
YesBut may not be sustained in immune Compromised individuals YesBut may not be sustained in immune Compromised individuals
Yes
Polio
Yes
Measles
Yes
Yes
Yes/No Disease relatively easy to identify, but large number of Asymptomatic infections
No Disease may be confused with other diseases by those unfamiliar with measles
So you see
Eradication of communicable disease isnt simple Controlling infection can be a P.H. Objective Public Health efforts must be long term and consistent Evidence-Based practice must be up to date for P.H. efforts to continue to work