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Meanwhile, Kathleen A. Alexander and others identified different factors that contributed to the most recent Ebola outbreak, during their paper called “What Factors Might Have Led to the Emergence of Ebola in West Africa” (2015). Some of their identified factors were the potential infection due to the consumption of dead apes, meteorological factors could have help in the spread of the disease, seasonal influences of forage and wildlife as potentially increasing during the contacts between wildlife species, the used of traditional healers instead of doctors, poor sanitation, migration, and poor education (Alexander & others, 2015).
Taking in consideration all the information above I believe, the lack of education, traditional healers, poor sanitation, lack of safe food sources, and migration are the main factors that contributed to the most recent Ebola outbreak. These can be divided as sociological, socioeconomic and environmental factors. The continued reliance in traditional healers will continue as this event is a deeply rooted cultural belief. Something like this will be difficult to change in a society. Migration and education as socioeconomic factors tell us that people would continue to move in hopes to escape the disease and/or in hope to get a better job to provide for their families. Environmental factors such as poor safe food sources and sanitation would only continue to allow for a faster spread of diseases throughout the country.
Immediate public health challenges that I envisage as a result of the Ebola outbreak are the concise and direct definition of Ebola outbreak throughout the region and the correct method of communication to the countries adjacent to the source of the outbreak. By identifying, communicating, and controlling the information of resources, we can stop the spread of the outbreak. Another immediate public health challenges would be the identification of first responders to a future outbreak.
Delayed public health challenges that I envisage as a result of the Ebola outbreak are training and education of a designated first responder team throughout the local population, coordination between the health departments of the adjacent countries, ensure complete reporting was completed for the previous outbreak as it would provide accurate data of where your weak points or hotspots for a future outbreak. Eventually, surveillance training would have to be done with all the health departments which was involved in the previous outbreak and work their way outward to ensure we can prevent another outbreak. And finally, population education in methods of prevention, maybe educating them on the factors mention above such as migration during an outbreak, season of possible outbreak that coincide with the local wildlife and the reliance of the use of healer versus medicine.
Infectious diseases are becoming chronic, especially in developing countries due to their aging population and their malnutrition. Gaetan Gavazzi & others in their study of Aging and Infectious Diseases in the Developing World (2004), stated that developing countries are having difficulty with their adding population due to their medical advances and their malnutrition. Their concern is that with the population having a longer expectancy of life elderly population is more susceptible to infections. Some of these infectious diseases are respiratory tract infections, diarrheal diseases, tuberculosis, malaria, and AIDS. Malnutrition can also be a person since a person of low weight but, malnutrition is referred as a person who doesn’t eat the correct among of food and/or source of food. This could lead to the populations to develop chronic diseases which can lower or disrupt their immune system allowing for infectious diseases to take place (Gavazzi & others, 2004).
Immunity for malaria among the elderly population have being seen to be low compared to the younger population. A study has shown that P. falciparum is severe in the elderly population. In a publication called “Malaria in the returning older traveler,’ Allen and others (2016), reported that higher risk of adverse outcomes has been noted in the elderly population (Allen & others, 2016). Another example for infectious diseases that can be considered chronic in developing countries are the multiple sources which can cause an infectious diarrhea. Some of these sources of infection are vibrio cholerae, shigella, salmonella, and campylobacter, noroviruses, rotavirus, giardia, and cryptosporidium. Diarrhea has been a label as the second most important cause of death by the WHO (Gavazzi & others, 2004).
Strategies that I can recommend to developing countries to prevent these two infectious diseases of becoming are case definition, expedient communication, and education in food safety, vector control and water protection. Taking malaria into consideration first, vector control and water protection should be a national campaign plan to address all the population in order to prevent future outbreaks of malaria. Education should be targeted to ensured everyone can protect their water source causing an immediate reduction of the vector responsible for malaria.
Dealing with an infectious diarrhea would be a more undertaking as it can be caused by many sources. First, the developing country would need to prepare a plan to educate their national health department in order to be able to regulate their specific areas. Eventually, the population would need to be educated with food safety at the vendor level. By this, I mean the local shop who sales bread, meat, and milk. During my travels throughout Africa, I often responded to my Sailors having developed diarrhea for consuming food at those local shops. After I had visited the local shops and talk to them about food safety, they would often either like me or asked me to vacate their shops. For those that asked me to stay, after I explained the importance of food safety, I could see a grim in their faces as they could understand how dangerous it could be consuming infected food. At a national level, departments of health at developing countries need to adapt the WHO case definitions for infectious diseases as well as to their communication’s plans address at the International Health Regulations. It is at this level of government that education for food safety, vector control and water protection should be documented and track in order to prevent future outbreaks and reduce the infectious diseases that are becoming chronic diseases.
Yes, vaccines are an important tool in fighting infectious diseases that could help us to prevent, control and/or eradicate diseases like smallpox. Benefits to an individual include pre-exposure to diseases reducing the individual from ever acquiring the disease in the first place by developing antigens. Some of these infectious diseases include hepatitis A and B, measles, varicella, yellow fever, and rabies. For society, benefits include the prevention of deaths, a decrease in incident rates, and a decline in mortality rates. Some vaccines have been able to assist us in the prevention of stillbirths, cancers, and pneumococcal diseases (WHO, 2008). Vaccines are an important method of survivability, specially to those of us in the military that are involved in traveling the world and expose to numerous of infectious diseases.
Despite the advancement in the manufacture and supply of vaccines, why do you think that the immunization rates are so varied across the world and as a public health professional what strategies do you suggest improving the rates and access to vaccines?
In my opinion, immunization rates are varied across the world due to a few reasons; one is the vaccine supplies, and another is the cost of vaccines. According to Vanderslott & Roser, on their paper called Vaccination many countries, as much as one third have had vaccine supply issues. Some of the reasons for the shortage include engineering problems, inadequate stockpile, and/or companies leaving the market. Cost of vaccines had numerous reasons to be affected. Of these reasons one that have been documented is the development of new vaccines. This can cause that the manufacturing company leaves behind a less profitable vaccine for a more profitable vaccine, causing a high cost for the newly develop vaccine as well as a shortage of the old vaccine. As newly develop vaccines are becoming more available and are developed by more companies, supplies start to become more available and cost becomes lower as their patent protection is over (Vanderslott & Roser, 2013).
A strategy that I would suggest improving the rates and access to vaccines is to develop a comprehensive plan at a national level but manage at the very lowest level possible. An example of this is how the military provide immunizations to its service members and families. The guidance received from the top-level officials from the military is to provide immunizations regularly such as hepatitis A and B vaccines, as well as influenza in a yearly basis. Other immunizations are required to service members and their families depending to the region or country that they are stations. All that guidance is followed at the local level by the Public Health Directorate of Military Treatment Facilities (MTF). Each MTF’s is required to communicate to each Commanding Officer of the immunization’s status of his/her service member. My current job involves tracking over 10,000 service members’ immunization status, the coordination of a vaccine request and the planning to ensure vaccines are always available.
We accomplish all of these by ensuring each unit has a representative that track immunizations status of his/her specific unit. Then, vaccine requests are sent to me for review, and the MTFs provide the immunizations based on our monthly requests. The leadership of each command receives the information status each week and ensure service members are available to receive their immunizations.
In the Navy, each MTF follows the Chief of the Bureau of Medicine and Surgery, BUMEDINST 6220.12B, Medical Surveillance and Notifiable Event Reporting Instruction, which provides specific guidance for us to address and outbreak on infectious diseases. This surveillance program is tracked by using a computer program called Electronic Surveillance for the Early Notification of Community-based Epidemics (ESSENCE). ESSENCE is tracked on a workday basis, or during holidays and times of WHO/national alerts are issue. This computer program collects its information from laboratory results as well as from patient visits recorded in our electronic database, Armed Forces Health Longitudinal Technology Application (AHLTA).
If a positive laboratory result or probable case is identified, a medical event report is completed and reported to higher echelons for recording and notification to local or state health department notification. Some of the infectious diseases reported are amebiasis, anthrax, biological warfare agent, botulism, cholera, dengue fever, E. coli 0157:H7, encephalitis, hantavirus, hemorrhagic fever, legionellosis, malaria, measles, meningococcal, pertussis, Q fever, rabies, smallpox, tuberculosis, tularemia, typhoid fever, typhus fever, yellow fever, and any undiagnosed outbreak. Notification to any of these must be made within 24 hours (BUMEDINST 6220.12, 2009).
If an infectious diseases’ outbreak takes happens, the Operational Naval Instruction 3500.41 takes placed as a guidance to deal with the outbreak. Each MTF is required to have a Public Health Emergency Officer (PHEO), which he or she would be required to manage, report and advice installation Commanders on how to deal with the situation (OPNAVINST 3500.41, 2018). An example of the PHEO’s job is during the H1N1 Pandemic it was his job to coordinate the vaccine supply’s administration and distribution of the vaccine to everyone. Other responsibilities include the coordination between him, and the Public Affairs Officer so as to provide accurate information to our community.
A recommendation that I would give to my current base Commander would be to do base wide pandemic exercises, something that I was able to be a part of in my last command. It would involve the cooperation and work between all the base services such as military policy, emergency services, and emergency room and public health directorate staff. As I currently live in the desert of California, a base-wide event that could provide training to all his service members would be a contamination of our portable water source. Due to high temperatures everyone drinks more water than those station in a colder region or base.
Another training that I would recommend is something I also did in my last command, Immunization Shot Exercise. In a three-day event, we coordinated with all the units located in the same base, and with military police, and family members in order to vaccinate between 8,000 to 9,000 personnel and family members. Here with a population size of over 10,000 active service members and an estimated 20,000 family members, this would be a more time consuming but given the fact that it is always a hassle to track marines to report for their flu immunization, this could be a great benefit to our readiness.
References
- Alexander, K. A., Sanderson, C. E., Marathe, M., Lewis, B. L., Rivers, C. M., Shaman, J., . . . Eubank, S. (2015). What Factors Might Have Led to the Emergence of Ebola in West Africa? PLOS Neglected Tropical Diseases, 9(6). doi:10.1371/journal.pntd.0003652
- Allen, N., Bergin, C., & Kennelly, S. (2016). Malaria in the returning older traveler. Tropical Diseases, Travel Medicine and Vaccines, 2(1). doi:10.1186/s40794-016-0018-9
- Andre, F., Booy, R., Bock, H., Clemens, J., Datta, S., John, T., . . . Schmitt, H. (2008). Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World Health Organization, 86(2), 140-146. doi:10.2471/blt.07.040089
- BUMED INSTRUCTION 6220.12. (2009, February 12). Retrieved July 20, 2019, from https://www.med.navy.mil/sites/nmcphc/Documents/policy-and-instruction/bumed_inst_6220-12B.pdf
- Factors that contributed to undetected spread of the Ebola virus and impeded rapid containment. (2015, September 22). Retrieved July 20, 2019, from https://www.who.int/csr/disease/ebola/one-year-report/factors/en/
- Gavazzi, G., Herrmann, F., & Krause, K. (2004). Aging and Infectious Diseases in the Developing World. Clinical Infectious Diseases, 39(1), 83-91. doi:10.1086/421559
- Nyenswah, T., Engineer, C. Y., & Peters, D. H. (2016, June 2). Leadership in Times of Crisis: The Example of Ebola Virus Disease in Liberia. Retrieved July 20, 2019, from https://www.tandfonline.com/doi/full/10.1080/23288604.2016.1222793
- OPNAV INSTRUCTION 3500.41. (2018, November 19). Retrieved July 20, 2019, from https://www.secnav.navy.mil/doni/Directives/03000 Naval Operations and Readiness/03-500 Training and Readiness Services/3500.41A.pdf
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