Public Health and Transit Systems: Challenges Posed by Infectious Diseases

1
Public Health and Transit Systems Challenges
Posed by Infectious Diseases

• Glen Nowak, Ph.D.
• Chief, Media Relations
• Centers for Disease Control and Prevention

DEPARTMENT OF HEALTH AND HUMAN SERVICES
2
For the second year in a row, CDCs Director,
Julie Gerberding, MD, MPH was voted among the top
100 most powerful women in the world by Forbes
Magazine.Voted number 32, Forbes says
Outbreaks, pandemics and bioterrorism Oh, my!
Gerberding has one of the creepiest jobs on the
planet. She runs the government agency that
strives to track and control microscopic threats
to the health of the US population. 
3
(No Transcript)
4
Traveler with Multidrug Resistant Tuberculosis
(MDR TB)

• May 18 Georgia Dept. of Health notifies CDCs
  Quarantine division that a patient with MDR TB
  has traveled internationally.
• May 22 CDC lab tests indicate patient may have
  extensively drug resistant TB (XDR TB)
• May 22/23 CDC Quarantine officer talks with
  patient, who is in Rome.
• May 25 Patient re-enters U.S., having flown
  from Prague to Montreal, and then getting rental
  car.

5
Communication Challenges

• 1.6 million people enter U.S. every day as
  travelers
• Every day, many people who are ill and/or
  infected with a transmissible disease travel via
  public or commercial carriers
• Some are actively transmitting disease
• Some who are actively transmitting disease dont
  feel ill or have noticeable symptoms
• Flu-like illness is a diagnosis that can be
  applied to a wide range of illnesses (making it
  difficult to accurately and meaningfully screen
  passengers)

6
Communication challenges continued. . .

• Many people who are ill want to be ill in their
  own homes (thus, they travel)
• Focus is often on air travel, but people travel
  on ships, trains and buses.
• Science is often scant thus
• Recommendations can vary
• Recommendations may be best more on medical
  practice
• No single (government) entity has jurisdiction
  over entire travel process.

7
Entities involved in travel

• Airline sells ticket, provides transportation
• Cruise line sells ticket, provides
  transportation, often has on-ship clinic
• Local health department has jurisdiction over
  local public health issues
• State health department has jurisdiction over
  state public health issues
• Airports major airports often have medical
  facilities
• CDC has quarantine stations at 20 U.S. airports
  and also provides inspections of cruise ships
• Health care providers provide advice to patients

8
Communication Factors that Come into Play

• Healthcare provider-patient communication
• Not Contagious doesnt equal Not Infectious
• Awareness of travel plans / travel
  recommendations
• Airline and cruise line manifests
• Quick access
• Accuracy and completeness
• Airport or Port involved
• Media
• Brings promise of increased public visibility
• Brings potential for inaccuracies,
  sensationalism, etc.

9
One typical scenario

• One (or some) passengers on a plane from a city
  in southeast Asia report that they are ill they
  have chills, feel feverish and have a bad
  headache
• Somewhere prior to scheduled landing in U.S.,
  pilot informs air traffic control they have sick
  passengers
• Plane lands passengers informed no one can
  leave until CDC official boards and does
  assessment
• Passenger on plane calls media
• Media arrive on scene and call CDC to find out
  whats going on

10
What typically happens

• CDC media relations person
• Thanks reporter and gives them overview of what
  CDC typically does in a situation like this
• Calls Quarantine Division and Directors
  Emergency Operations Center to find out more (or
  if they are even aware)
• Calls quarantine officer/office involved
• Calls HHS office of public affairs
• Calls airport public affairs office
• Calls airline public affairs office
• Calls local health department public affairs
  office
• Possibly calls state health department public
  affairs office
• Calls back reporter(s)

11
Typical case continued. . .

• Ill person(s) evaluated
• Usually allowed to continue travel
• If warranted, transported to medical facility
• Other passengers
• Names and contact information may be obtained
• Allowed to continue travel
• Media
• Most never aware or interested
• Usually quickly lose interest (because nothing
  exotic or out-of-the-ordinary is involved)

12
Another typical scenario

• Person diagnosed with a potentially contagious
  disease decides to travel (e.g., on an
  international flight)
• Local health department
• May be notified
• May not know
• May know and not be able to prevent
• If health department is aware, may contact CDC
  for assistance in preventing travel (e.g., no
  fly list)
• If person travels. . . .

13
Some Lessons Learned / Approaches Used

• Identify all the entities/organizations that can
  be affected
• Establish contact lists
• When possible, make contacts before emergencies
• Confirm, confirm, confirm claims and diagnoses
• Initial information often incomplete or
  inaccurate
• Health/science reporters usually arent the ones
  who call
• Be prepared to quickly make lots of phone calls
• Many organizations could be involved or called by
  media
• Fosters media and message coordination

14
Some Lessons Learned / Approaches Used (2)

• Media/public expectations and assumptions often
  dont match public health realities
• People with transmissible illnesses follow
  doctors orders
• Its possible to quickly, easily, cheaply,
  accurately screen for, or detect, travelers with
  problematic illnesses
• Theres little scientific or medical uncertainty
  or disagreement (e.g., XDR TB)
• Keep in mind that conflict, controversy,
  uncertainty are primary drivers of media interest
  (especially continued interest)

15
Thank You!