Reopening the Book on Infectious Diseases?

“It is time to close the book on infectious diseases, and declare the war against pestilence won,” Surgeon General William Stewart is rumored to have said when testifying before Congress in 1969 (though whether he actually said this is debatable).In the 1960s and 1970s, most of society believed that diseases were a thing of the past. Polio had been eradicated by vaccines and penicillin made bacteria relatively harmless. With many of the known diseases conquered, society had good reason to feel safe.

That security was short-lived. In 1976, Ebola was discovered after it appears to have mutated from bats. In the early 1980s, HIV/AIDS appeared, morphing from two similar diseases found in chimpanzees. Before these diseases were fully understood, fear was the new prevailing attitude returning society to the pre-60s outlooks. "'Emergence' is in fact regression, a return to the standard that prevailed universally in the previous century," Nobel Laureate and Columbia biologist Joshua Lederberg wrote in a special infectious disease issue of the Journal of the American Medical Association.

Now, not only do we have new diseases to handle, the old ones are making a comeback. The World Health Organization (WHO) has identified six diseases whose worldwide re-emergence should be monitored: diphtheria, cholera, dengue fever, yellow fever, and bubonic plague (That’s right, guys. The Black Death of the Dark Ages is on the list of re-emerging diseases).

Though the list might be helpful to focus health officials, it also limits what diseases they are watching and health officials are aware of it. "Scarlet fever was a problem for my mother's generation," says Stephen Morse of the epidemiology division in Columbia's School of Public Health. "It essentially disappeared, and for no good reason. We don't understand why [diseases] flare from time to time, and until we do I'm uncomfortable ignoring them.”

The Council of Foreign Relations recently released a map that shows the recent resurgence of measles (maroon), mumps (olive green), rubella (blue), polio (gold), whooping cough(light green), and others (yellow). The circles are localized outbreaks, while the size of the circle indicates the number of people infected.

If you look, measles have re-emerged in Europe and whooping cough in the United States. The Wakefield study in 1998, which I wrote about here, made many parents worry that the measles, mumps, and rubella vaccine was dangerous. Though this was later proven false and Wakefield found to have a conflict of interest, fears still resonate and immunization rates reflect this.

“Viruses and bacteria have taken full advantage of the immunization gaps. In 2011, France reported a massive measles outbreak with nearly 15,000 cases. Only the Democratic Republic of Congo, India, Indonesia, Nigeria and Somalia suffered larger measles outbreaks that year. In 2012, the U.K. reported more than 2,000 measles cases, the largest number since 1994. Here in the U.S., the prevalence of whooping cough shot up in 2012 to nearly 50,000 cases. Last year cases declined to about 24,000 — which is still more than tenfold the number reported back in the early '80s when the bacteria infected less than 2,000 people,” according to a newscast from the national public radio (NPR).

In addition, though you may not think much about it, the flu could be problematic in the future. Though relatively harmless now, influenza could evolve into an epidemic or pandemic level. The antigens it displays to our immune system change every year regardless, which is why nurses are required to renew their flu vaccine annually. The flu already kills 36,000 people a year in America alone. I, for one, am not tempted to wait and see what strain evolves into something worse.

While the WHO and other organizations such as the Center for Disease Control (CDC) and the department of Pandemic and Epidemic Diseases (PED) have been taking measures to counteract these issues, some factors remain out of their hands. The decision to vaccinate children is left to the parents. After the Wakefield scare, many parents decided to forgo vaccines instead of risk any side effects that vaccines were rumored to have. "In England, they did the experiment: They simply stopped vaccinating for pertussis. And they wound up with a lot of sick kids. In this country, we are now seeing the waning of immunity," says Dr. Glenda Garvey, Columbia clinical professor of medicine and interim chief of infectious disease at Columbia-Presbyterian Medical Center.

According to Steve Mirsky,

“The diphtheria situation in the former Soviet Union involves a more serious disease combined with a crumbling public health infrastructure; organized vaccination efforts are in shambles.”

But wait, it gets worse. According to IFLScience,

“Gary Baum of The Hollywood Reporter has investigated childhood illness and vaccination rates around Los Angeles County. He discovered that some schools in the most affluent L.A neighborhoods have vaccination rates lower than Southern Sudan. Let that sink in for a minute; one of the poorest regions in the world that is unable to supply clean drinking water for half of its inhabitants has a greater vaccination rate than schools that educate the offspring of Hollywood’s elite.”

                The lowered rates of vaccines increase the risk of epidemics which could lead to pandemics. A pandemic covers a much wider geographical area, often worldwide. A pandemic also infects many more people than an epidemic. An epidemic is specific to one city, region or country, while a pandemic goes much further than national borders.  In order to avoid any disease reaching these levels, it is essential that health organizations work together.

"First, you need surveillance," says Bob Howard of the CDC's National Center for Infectious Diseases. "You also have to have science that is up-to-date and capable of dealing with what you discover in the field. Once you do, you want to have appropriate prevention and control in place, and that includes communication to let people know what the threats are and how to control or prevent the spread of that disease threat. Finally, there's got to be that strong public health infrastructure in place. If you don't have a system in place, the three previous things will not work." Basically, in the words of Mad-Eye Moody, “Constant vigilance!”

  

Sources:
http://www.npr.org/blogs/health/2014/01/25/265750719/how-vaccine-fears-fueled-the-resurgence-of-preventable-diseases
http://www.columbia.edu/cu/21stC/issue-2.3/mirsky.html
http://cid.oxfordjournals.org/content/47/2/294.1.full
http://www.avert.org/origin-hiv-aids.htm
http://www.postandcourier.com/article/20141019/PC05/141019524/1177/understanding-risk-stop-worrying-about-ebola-and-go-get-a-flu-shot
http://www.iflscience.com/health-and-medicine/vaccination-rates-plummet-elite-los-angeles-schools