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History of Public Health

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Pertussis ('Whooping Cough') Monkeypox. SARS. West Nile Virus ... Pertussis 147,271 5,420 96.30. Polio (paralytic) 16,316 0 100.00. Rubella 47,745 20 99.95 ... – PowerPoint PPT presentation

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Title: History of Public Health


1
  • History of Public Health
  • and Its Role in Addressing
  • Emerging Disease Threats
  • MMI 554
  • September 8, 2009
  • Peter A. Shult, Ph.D.
  • Director, Communicable Disease Division
  • and Emergency Laboratory Response
  • Wisconsin State Laboratory of Hygiene
  • shult_at_slh.wisc.edu

2
History of Public Health and Its Role in
Addressing Emerging Disease Threats
  • The student should be able to
  • Discuss the history and reasons for the current
    emerging infectious diseases (EID) crisis
  • Understand what public health is and discuss the
    history of the public health response to
    infectious diseases
  • Discuss in broad terms the strategies employed by
    the CDC to counter the EID threat
  • Discuss continuing challenges to the public
    health response to the EID threat

3
Emerging Infectious Diseases
  • What Is Your Perception?
  • More infectious diseases affecting us?
  • Greater perception/detection of what
  • always was?
  • Are we hypersensitive to any threat?
  • All of the above?

4
Recent EID Threats and the list
continues to grow
  • Pandemic Influenza swine flu
  • E.coli O157H7/Salmonella
  • Norovirus
  • MDR, XDR tuberculosis
  • Community-acquired MRSA/ Epidemic C. difficile
  • Mumps, Measles, Rubella
  • Pertussis (Whooping Cough)
  • Monkeypox
  • SARS
  • West Nile Virus
  • Anthrax, ricin and other bioterrorism agents

5
Key Resources
www.cdc.gov
www.promedmail.org
6
Novel H1N1 Influenza Resources
  • www.cdc.gov/h1n1flu

www.pandemic.wisconsin.gov
7
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8
Key Factors in Infectious Disease Emergence
-Historical Perspective-
  • Population Growth
  • Urbanization
  • Travel/Trade
  • The importance of the Far East
  • Goods, people and rodents
  • Virgin populations
  • Wars
  • Changes in Land Use
  • Microbial Adaptation

9
WHAT IS PUBLIC HEALTH?
  • The art and science of preventing
  • disease and disability, prolonging life,
  • promoting health of populations, and
  • ensuring a healthful environment
  • through organized community effort

10
Public Health in Antiquity
  • Waste removal/ fresh water
  • Romans, 1st century B.C.
  • Variolation
  • China, 1000 A.D.
  • Quarantine/Isolation
  • Europe, 14th century
  • Vaccination
  • Late 18th - early 19th century

11
THE ROAD TO MODERN PUBLIC HEALTH
  • 1850s.The birth of Epidemiology as a science
  • 1850s-90s..Germ theory and cellular biology,
    etiology of many bacterial diseases
  • 1866-1919..Municipal and state boards of health
  • 1887-1919..State public health labs opened
  • 1890s-1900sArthropod-borne infections, sewage
    treatment, chlorination, pasteurization, garbage
    collection, refrigeration, pure food practices,
    pest control
  • 1930s-present..Discovery and development of
    antibiotics
  • 1950s-60sEtiology of viral diseases, viral
    vaccines, effective insecticides

12
Comparison of Maximum and Recent Reported
Morbidity, Vaccine-Preventable Diseases United
States
Disease Pre-vaccine
Era 2001
change
Smallpox                         
48,164                   
0        100Diphtheria 175,885 2
99.99 Measles 503,282
108 99.98 Mumps 152,209
226 99.80 Pertussis 147,271
5,420 96.30 Polio
(paralytic) 16,316 0
100.00 Rubella 47,745
20 99.95 Cong. Rubella Synd.
823
2 99.80 Tetanus 1,314 27
97.90 H.influenzae type b
20,000
290 98.60

13
FIGURE 1. Crude death rate for infectious
diseases - United States, 1900 - 1996.
14
U.S. Life Expectancy Change
  • 80 attributed to public health interventions
  • 20 attributed to medical advances

15
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16
What is going on here?http//books.nap.edu/catalo
g.php?record_id10636 (online readable/searchable
version)
17
EMERGING INFECTIOUS DISEASES SINCE 1970
  • 1973 - Rotavirus
  • 1975 - Parvovirus B-19
  • 1976 - Cryptosporidium
  • 1977 - Ebola
  • 1977 - L. pneumophilia
  • 1977- Hantaan virus
  • 1977 - C. jejuni
  • 1980 - HTLV-1
  • 1981 - S. aureus - Toxic Shock
  • 1982 - E. coli O157H7
  • 1982 - HTLV-2
  • 1982 - B. burgdorferi
  • 1983 - HIV
  • 1983 - H. pylori
  • 1986 - Cyclospora cayatanensis
  • 1988 - HHV-6
  • 1988 - Hepatitis E
  • 1989 - Erlichia chafeensis
  • 1989 - Hepatitis C
  • 1991 - Guanarito virus
  • 1991 - Babesia species
  • 1992 - Vibrio cholerae O139
  • 1992 - Bartonella henselae
  • 1993 - Sin nombre virus
  • 1993 - Encephalitozoon cuniculi
  • 1994 - Sabia virus
  • 1995 - HHV-8
  • 1995 - vCJD

18
Factors in Infectious Disease Emergence
- 1992 -
  • Ecological Changes
  • Human Demographics and Behavior
  • International Travel and Commerce
  • Technology and Industry
  • Microbial Adaptation and Change
  • Breakdown in Public Health Infrastructure

19
Factors in Infectious Disease EmergenceBreakdown
in Public Health Infrastructure
  • HISTORICALLY
  • Societal change or disruption
  • RECENTLY- circa. 1970 - 1992
  • Re-defining health risks
  • Complacency
  • Treatment vs. prevention mind set
  • Decrease in to public health
  • Lack of surveillance networks
  • Lack of trained personnel
  • Reduction in prevention programs

20
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21
Public Awareness of Disease Threats
22

Emerging Infectious Diseases The Public
Health Response
  • Targets
  • Surveillance and Response
  • Applied Research
  • Infrastructure and Training
  • Prevention and Control
  • The Outcomes
  • Raised awareness of public health deficiencies
  • We understood what needed to be done however,
    minimal funding to do it

http//www.cdc.gov/ncidod/diseases/eid/index.htm
23
A Defining Event
Anthrax 2001
24
Anthrax 2001 The Outcome
  • Mild contamination of other US postal facilities
  • 22 human cases in US
  • 11 inhalation
  • (5 deaths)
  • 11 cutaneous
  • 10,000 people prophylaxed
  • Nationwide Effects
  • Concerns/panic
  • 4-5 letters containing anthrax spores sent in
    mail
  • 4 regions initially affected in US
  • Florida
  • New York City / New Jersey
  • Washington Metro
  • Connecticut

25
CDC Program Announcement 99051Public Health
Preparedness Response to BioterrorismEMERGENCY
SUPPLEMENTAL 2002-2009
  • Preparedness Planning and Readiness Assessment
  • Surveillance Epidemiology Capacity
  • Laboratory Capacity - Biological Agents
  • Laboratory Capacity - Chemical Agents
  • Health Alert Network
  • Communication and
  • Health Info Dissemination
  • Education and Training

26
Another Defining Event
Avian Influenza
  • The Spread of Avian Flu
  • Status - Summer 2009

27
Pandemic Influenza Planning
http//www.pandemicflu.gov/
  • National Strategy
  • Stopping, slowing or limiting the spread of a
    pandemic to the U.S.
  • Limiting the domestic spread of a pandemic, and
    mitigating disease, suffering and death
  • Sustaining infrastructure and mitigating impact
    to the economy and the functioning of society

28
Enhancing Public Health Response
to Emerging Infectious Diseases
  • 2009HAVE WE ELIMINATED THE
    THREAT?

29
A Reason for Optimism?
Summer 2007
30
THE EID THREAT IS A GLOBAL ONE
31
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32
Enhancing Public Health Response
to Emerging Infectious Diseases
  • 2009WHY DOES THE THREAT
    STILL EXIST?

33
WHAT IS PUBLIC HEALTH?
  • The art and science of preventing
  • disease and disability, prolonging life,
  • promoting health of populations, and
  • ensuring a healthful environment
  • through organized community effort

34
Factors in Infectious Disease Emergence
  • Human demographics and behavior
  • International travel and commerce
  • Technology and industry
  • Human susceptibility to infection
  • War and famine
  • Lack of political will
  • Poverty and social inequality
  • Intent to harm
  • Breakdown in
  • public health
  • Microbial
  • adaptation
  • and change

Emergence
  • Ecological factors
  • Zoonotic diseases
  • Economic development and land use
  • Climate and weather

35
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36
ADDRESSING THE THREAT OF
EMERGING INFECTIOUS DISEASES
  • The Publics Role in Public Health
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