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CHAPTER 9

The “Conquest” of Infectious Diseases

Infectious Diseases: Major Killers in the Past

Bubonic plague

“Black Death”

Tuberculosis

Smallpox

Cholera

Typhoid

Typhus

Yellow Fever

Diphtheria

Measles

Influenza

Infectious Diseases Were “Conquered” by the 1960s

Immunization

Antibiotics

Public health measures

Purification of water

Proper disposal of sewage

Pasteurization of milk

Improved nutrition and personal hygiene

Infectious Agents

Bacteria

Tuberculosis, cholera, typhoid, tetanus, diphtheria, dysentery, syphilis, streptococci, staphylococci

Viruses

Smallpox, poliomyelitis, hepatitis, measles, rabies, AIDS, yellow fever

Parasites

Malaria, cryptosporidiosis, giardiasis, roundworms, tapeworms, hookworms, pinworms

Means of Transmission

Directly from one person to another

Aerosol

Touching contaminated object and putting hands to mouth, nose, or eyes

Contaminated water or food

Fecal-oral route

Vectors

Sexual contact

Carriers

Chain of Infection

The transmission pattern is composed of links:

Pathogen (infectious agent)

Reservoir

Means of transmission

Susceptible host

Public health measures to control the spread of disease are aimed at interrupting the chain of infection at whichever links are most vulnerable.

Interrupting Chain of Infection

Kill pathogen with antibiotics.

Eliminate the reservoir.

Prevent transmission:

Hand washing

Quarantine

Condoms

Increase resistance of host by immunization.

Public Health Measures

Epidemiologic surveillance

Contact tracing

Immunization and treatment of identified patients to prevent further spread

Quarantine if necessary

Examples

SARS

Controlled by classic public health measures

Rabies

Surveillance of wildlife

Immunization of dogs

Post-exposure prophylaxis

Eradication

Eradication is possible if there is no nonhuman reservoir and if a vaccine exists.

Smallpox was eradicated in 1977.

Polio was eradicated from the Western Hemisphere.

Now it is only in a few countries.

There is religious opposition in some countries.

Measles is the next target.

Now it is no longer endemic in the U.S.

Fear of Vaccines

Rumors spread of vaccines causing autism and SIDS.

Side effects do exist for some vaccines.

Some parents refuse to accept risks.

Herd immunity is lost if many people do not get vaccinated.

Pharmaceutical companies are reluctant to develop vaccines.

Low profits

Risk of lawsuits

Discussion Question 1

Choose several infectious diseases and analyze how they are spread, using the chain of infection.

Examples are AIDS, rabies, cryptosporidiosis, cholera, malaria, smallpox, syphilis.

For each disease, how can the chain of infection be interrupted?

Discussion Question 2

Why is AIDS not on the list of diseases targeted for eradication?

Why is rabies not targeted?

Discussion Question 3

Visit the website of the Centers for Disease Control and Prevention, www.cdc.gov.

Where in the U.S. is rabies endemic in animals? Have there been any cases of human rabies in the last year or two?

Where in the U.S. have there been measles outbreaks in the last year or two? What was the source of the outbreak?

Where in the world have there been polio outbreaks in the last year?

Discussion Question 4

Visit the CDC website on vaccines and immunizations, www.cdc.gov/vaccines.

What evidence can you find about the safety of childhood vaccines?

Do you believe the benefits outweigh the risks of vaccination?