Week Three Discussion post
dream86
Chapter10PPT.pptxChapter 10
Public Policy and Infectious Disease Prevention and Control
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
1
LEARNING OBJECTIVES
Describe the importance and health impact of infectious diseases
Explain the main ways in which policy is used in prevention and control of infectious disease
Explain the importance of vaccines in prevention and control of Infectious disease
Describe the importance of policy in reducing Health Care Acquired Infections and HIV transmission.
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
2
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
Prevention of infectious diseases provided one of the most significant accomplishments of public health
Many of the approaches that the public health community uses now are based on major infectious-disease challenges and policies in the late 19th and early 20th century
In spite of advances, infectious diseases still account for about one quarter of annual deaths worldwide
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
3
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
The burden of these diseases varies greatly by geography, with seen in low-income countries
United States less affected by the infectious diseases of childhood like pneumonia, diarrhea, and malaria
Remains vulnerable to and affected by emerging infections and other infectious-disease problems such as COVID-19
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
4
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
5
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
In the United States chronic viral infections, such as HIV and Hepatitis B contribute to ongoing morbidity
Food-borne infections common with both health and economic consequences
Increasing global connectivity is a reason why antimicrobial resistance has now become a global public health crisis, whose solution will require multinational, transdisciplinary, and policy approaches
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
6
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
Increasing connectivity of the world with rapid and global transportation enhances the risk of localized infections becoming pandemic problems
Recent outbreak of Ebola virus infection in West Africa provides an lesson in global vulnerability
Spread of the epidemic was facilitated by the fact that the initial infection occurred in a part of the world where there has been significant breakdown of public governance (after many years of civil war) and where public health infrastructure was essentially nonexistent
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
7
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
Infectious disease prevention policy requires varied stakeholders to implement at local, state, and national levels:
Clinical
Research
Public health communities
Policy strategy can be planned for virtually every infectious disease
Goal is to disrupt transmission from an affected individual or source other vulnerable individuals (or communities)
Infectious disease prevention policy must include these components:
Tracking methods
Transmission and control protocols
Prevention strategies
Treatment regimens
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
8
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
Public policy is driven in part by public attitudes, which, in turn, affect policy makers readiness to take action
Public acceptance of approaches to prevent and control infectious diseases is generally high, even through these approaches generally involve some type invasion of privacy and personal rights
Area in which we have most control over is vaccination but this tactic has become an area of greater public skepticism
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
9
IDENTIFYING THE PROBLEM: INFECTIOUS DISEASES AND CONSEQUENCES
Control and prevention of infectious can include any or all of the following:
Mandatory reporting and identification of infected individuals to public authorities
Tracing of contacts
Attendant loss of privacy and occasional embarrassment
Mandatory vaccination
Compulsory quarantine
Mandatory treatment
Extreme cases include incarceration
In all of these scenarios, there has been little to no public debate as to the appropriateness of the public health measures
This may reflect a general accept of the reasoning for the measures
In many cases it also may reflect the general fear (whether reasonable/unfounded that the public has regarding contagious diseases
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
10
Importance of Tracking Infectious Diseases
Capacity to track infections and identify potential outbreaks is a critical public health need
Requires the appropriate epidemiologic infrastructure to:
Collects data on communicable diseases
Analyze data to identify outbreaks or potential sources of new infection
Capacity to intervene when appropriate
Infectious diseases in which data gathering is critical to prevention:
STI infections such as HIV)
Hospital associated infections
Tuberculosis
Foodborne illnesses
And now, most recently COVID-19
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
11
Importance of Tracking Infectious Diseases
Tracking and data gathering are vital to understanding emerging infectious diseases that might have pandemic potential
Box 10.1
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
12
Importance of Tracking Infectious Diseases
In ideal circumstances disease surveillance infrastructure should have a local focus
Surveillance and identification of possible infections that require mandatory reporting vary from state to state
Ultimately, should also be linked to both state and national public health agencies so emerging outbreaks that have epidemic or pandemic potential can be rapidly identified and effective prevention policy solutions
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
13
Importance of Tracking Infectious Diseases
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
14
Box 10.2
Reportable Infectious diseases to
Missouri PH Department of Health and Senior Services
Importance of Tracking Infectious Diseases
Quick Thoughts
What are your feelings about the public health response to COVID-19?
Why do you feel this way? Can you support your statement?
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
15
Prevention policies should address control measures that interrupt transmission
The type of intervention needed will depend on the mode of transmission of the infection
Preventing Transmission of Infectious Disease Vector-Borne Infections
Remains important in the United States due to increase in mosquito-borne infections have over the last 15 years
Vectors of focus:
West Nile Virus
Dengue Fever
Chikungunya Fever
Attempts to control vectors typically include:
Insecticides
Control of stagnant water
Physical barriers (bed netting)
Especially useful in resource-poor settings
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
16
Zoonotic infections are also of focus
Policy prevention approaches involve coordination with animal control regulations
Prevention of rabies transmission in human and domestic animals requires jurisdictions to implement laws or regulations to require rabies vaccination for dogs
Penalties for those who do not comply
In the U.K. or Ireland where rabies is not endemic in local animals, these regulations extend to require
Either evidence of immunity or quarantine for up to six months before dogs can be imported.
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
17
Preventing Transmission of Infectious Disease Vector-Borne Infections
Most food-borne outbreaks are local, therefore, local and state epidemiology critical in identifying such outbreaks
Epidemiologic investigation may identify a source and this requires i other regulators to determine whether breaches in existing laws and regulations occurred
Investigation involves agencies such as:
Center for Disease Control and Prevention (CDC)
State/local Health Department
Food and Drug Administration (FDA)
US. Department of Agriculture
Food-borne outbreaks have resulted in stricter regulations in the United States
FDA to regulate egg safety to better control Salmonella contamination
CDC to increase population-based surveillance of common food-borne pathogens
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
18
Preventing Transmission of Infectious Disease Food-Borne Infections
Preventing Transmission of Infectious Disease Human-to-Human Transmission
Require prevention policies based on the risk and timing of infection
Quarantine
Often requires the law to enforce and raises an emotive public response to emerging infections (especially those with lethal consequences)
But, often is the only effective public health strategy when individuals with infection can be identified before they become contagious, and, therefore, have the ability to infect others
The recent outbreak of Ebola virus infection provided an object lesson in the effectiveness of quarantine
Individuals with Ebola virus infection are only infectious after they exhibit symptoms
The likelihood of transmission increases with duration of symptoms and severity of illness
Quarantining symptomatic individuals is very effective way of interrupting transmission and halting an epidemic
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
19
Preventing Transmission of Infectious Disease Human-to-Human Transmission
Quarantine
Less effective strategy to adopt in cases where individuals, are highly infectious BEFORE they become symptomatic
Influenza
Measles
COVID-19
Selective isolation of symptomatic individuals until they are no longer infectious can be used for these viral illnesses
Policies within healthcare organizations require that healthcare workers who develop the flu do not return to work until symptoms resolve
Those infected (or thought to be infected) with COVID-19 self-isolate for 14 days after appearance of first symptoms
CDC’s COVID-19 quarantine guidelines: https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/quarantine.html
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
20
Contact Tracing
Identification and diagnosis of persons who may have come into contact with an infected individual is an important element of prevention strategies
Sexually transmitted diseases
Tuberculosis (TB)
COVID-19
TB Contact Tracing Strategy:
Begins with identifying infected individuals
Persons with active infection are identified and screened to determine if they have active or latent disease
Cases are then offered referred to treatment (for active disease) or chemoprophylaxis (for latent infection)
Active TB is very contagious, but the risk to others is eliminated with effective therapy
In some individuals with infectious TB refuse treatment
As a result of policy, public health departments have the ability to forcibly incarcerate individuals and mandate treatment
Draconian laws stem from an earlier era when effective control measures were not available but, are still valid
In such cases, the courts have accepted that protection of the public outweighs the rights of an individual
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
21
Preventing Transmission of Infectious Disease Human-to-Human Transmission
Vaccination as a public health measure has been the most successful infectious diseases intervention
Eradication of smallpox, decreases major childhood diseases such as Polio, Measles, Diphtheria
In the U.S. childhood immunization prevents-40,000 deaths and as many as 20 million infections
Vaccinations involve the administration of an antigen (a living weakened antigen; a killed pathogen, or a reactive component of a pathogen), which then stimulates an immune response in the human host
Immune response generated by the vaccine usually prevents infection
Some circumstances, vaccines do not prevent infection but do prevent disease
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
22
Vaccination as a Prevention Strategy
Enforcement of the use of vaccinations as a public health strategy usually involves demonstrating immune status at various points in an individual’s life
U.S. public health policy now recommends childhood vaccination against
Polio
Measles, Mumps, Rubella (MMR)
Pertussis
Rotavirus
Hemophilus influenza pneumococcus
Varicella
Most school districts require evidence of immunity to common childhood infections prior to admission
California Policy recently implemented was SB 276 (Pan): Mandatory Vaccination
Sparked major debate by opponents as an infringement on parental rights, personal liberties and safety
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
23
Vaccination as a Prevention Strategy
Certain occupations require vaccinations as mandatory employment stipulations
Most healthcare workers are required to demonstrate evidence of immunity to
Hepatitis B
Annual Influenza vaccine
Many jurisdictions require food handlers to-present evidence immunity to hepatitis A due to outbreaks of as a result of fecal contamination from in food from infected hosts
Extensive progress in development of new vaccines for old and new emerging pathogens
This progress has been paralleled with increasing loss of public confidence for vaccines in general
It is critically important that public health professionals understand and effectively address this public reaction
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
24
Vaccination as a Prevention Strategy
Skepticism for vaccination can be based on many factors
Herd immunity versus vaccine safety
Growing vaccine schedule and combination of several vaccines at once has potential to ignite adverse events in some children
“Social elitism”
Differences among countries and health authorities regarding administration of vaccines and schedules
Parents (and even grandparents) have no personal recollection of the potentially catastrophic effects of early childhood infections
Can sometimes lead to lack of “observable” importance which is often coupled with misplaced science
Some skeptical of the vaccine industry and question the financial motives of large corporations
Some skeptical of science in general and concerned that scientists minimize-risk because of conflicts of interest/scientific fraud
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
25
Vaccination as a Prevention Strategy
Reluctance to vaccinate has led to small pockets of reemergence of some diseases
Measles outbreak at Disneyland, CA
Transmission outbreaks introduce risks to children that cannot receive vaccines (those too young or immunocompromised)
Addition to the health consequences of such outbreaks, financial costs to the public health system
For example, two outbreaks of measles in Utah 2011 resulted in 13 cases but estimated to cost the public health system over $300,000 in additional resources
Policies are seen as a potential solution to address the issue of “rights.”
Schools in some areas have considered policies allowing refusal of attendance for unvaccinated children
In 2015, several states introduced legislation to limit or abolish religious exemptions to mandatory vaccination
SB 277 (Pan): Mandatory Vaccination: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160SB277
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
26
Vaccination as a Prevention Strategy
Case Study: Policies Related to Health Care-Associated Infections
In the United States, it is estimated that 100,000 people die of health care associated infections (HCAIs) in hospitals each year
Not include mortality in nonhospital settings (e.g., outpatient clinics, long-term care facilities, or dialysis that are increasingly a standard part of American health care
These infections estimated to add at least $30 billion in additional direct medical costs and probably have an even greater economic consequence
Traditional public health approaches to control infectious diseases in the community are also applicable in the healthcare setting
Surveillance has allowed for identification important preventable risk factors for infections and to investigate interventions that can decrease rates
Line-associated blood stream infection
Postoperative wound infection
Catheter-associated urinary tract infection
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
27
Identification, prevention, and mitigation of risk behaviors can take place via healthcare policy and significantly reduce transmission of HCAIs
Isolation of patients (form of quarantine) decreases transmission of antimicrobial resistant infection
Behavior changes among healthcare professionals
Adherence to handh-washing requirements
From a policy perspective, in the U.S. the most critical advancement has been federal and state measures such as HCAI prevention plans to enforce the necessary behavioral responses
States have mandatory reporting of certain HCAIs to increase accountability in hospital settings
Centers for Medicare and dicaid Services (CMS) have introduced financial incentives to increase adherence the CDC s infection control guidelines
CDC has developed a national system, the National Healthcare Safety Network (NHSN), which tracks data on:
Infection rates with antimicrobial resistant organisms
Use of antimicrobials
Adherence to infection control measures
Vaccination rates among healthcare workers
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
28
Case Study: Policies Related to Health Care-Associated Infections
Case Study: Policies Relating to Human Immunodeficiency Virus (HIV) Infection
HIV infection is one of the greatest global public health challenges of the last 30 years
Since 1981, there have been over 20 million deaths from HIV infection
Nearly 20 years after the development of effective treatment for there are 2.5 million new cases of HIV each year across the world and at least 1.5 million people die annually from HIV disease
As with other viral infections, the ideal prevention strategy would be an effective vaccine
But, with over 25 years of research vaccines for HIV have not been successful
Unlike some other viral infections, live attenuated virus is not a safe option HIV immunization
Current challenges include uncertainty as to what would constitute protective immunity, the genetic diversity of the virus, and difficulty in finding antigens that can provide sustained effective immune responses that might be effective
Therefore, prevention strategy other than an HIV vaccine should be considered
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
29
Prevention of mother-to-child transmission of HIV is an example of policy success
Early clinical trials demonstrated that treating mothers during pregnancy and labor, and treating infants for a short period after birth, could greatly reduce childhood infection
Rapid creation of policy to screen all mothers for HIV during pregnancy and offering treatment to infected pregnant women
First offered as an opt-out approach and could decline testing
Then refined to an opt-out approach in which mothers were assumed to consent unless they formally declined
Outcome of Screening Policy Approach
Neonatal and pediatric HIV infection decreased tremendously in the developed world, and usually only occurs in situations where mothers have had little or no care
Breastfeeding and prevention of mother-to-child transmission of HIV
Western world, it is recommended that HIV-infected women not breastfeed
In the developing world, formula feeding is associated with higher mortality and not recommended
Additionally, not breastfeeding may stigmatize the HIV-infected mother
Prevention policies in the developing world implement guidelines that, if available, mothers receive antiretroviral therapy throughout the period of breastfeeding
Evidence-based policy that results in best outcomes for mom and baby
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
30
Case Study: Policies Relating to Human Immunodeficiency Virus (HIV) Infection
Both behavioral and biomedical approaches have their place in prevention of HIV
Condom use has been known to be effective in reducing HIV
Advocacy of condom use as public policy and education approaches to increase both use and acceptability of condoms have often been hampered by political considerations that ignore science
Public policy guided by political and/or religious considerations rather than science can have detrimental effects
Between 2001 and 2008, the CDC was unable to fully advocate for condom use as a strategy in HIV prevention because public policy was focused on abstinence as a strategy although not it did not demonstrate clear effectiveness
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
31
Case Study: Policies Relating to Human Immunodeficiency Virus (HIV) Infection
Preventing Transmission of Vector-Borne Disease
Treatment of HIV as a Prevention Strategy
Treatment of infected individuals can decrease and possibly eliminate risk of transmission
Community Viral Load
The more HIV-infected individuals that are being treated there will be less HIV available to infect new patients
Given rise to public policy: Test & Treat
Increase HIV testing and then increase access to treatment for infected patients
Gave rise to treating uninfected high-risk individuals
Provision of antiretroviral drugs to prevent HIV acquisition in spite of continued high-risk behavior
Pre-Exposure Prophylaxis (PrEP)
In 2014, the U.S. Public Health Service issued guidelines suggesting that PrEP be considered as an option for individuals at substantial risk for HIV
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
32
SB 277 (Pan) Public health: Vaccinations
Background leading to SB 277:
The recent 2014–2015 measles outbreak in Disneyland, which led to the highest number of cases in the state in over 10 years
The outbreak also spread to other states, Mexico and Canada
The media cited low rates of vaccination in parts of California and scientific studies supported the claim
Institute for Health Policy & Research brief: https://ihpl.llu.edu/sites/ihpl.llu.edu/files/docs/Policy-At-A-Glance/SB-277-At-a-Glance_Final-10-09-15.pdf
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
33
SB 277 (Pan) Public health: Vaccinations: Bill Summary
Effective July 1, 2016, students who have a personal belief exemption on file before January 1, 2016 and who attend public or private school can no longer be exempted from vaccinations because of the beliefs of their parents when they hit a mandated checkpoint for ensuring immunizations: kindergarten and seventh grade
For example, a first grader who has a personal belief exemption on file before January 1, 2016, may remain in school without being vaccinated until he or she starts seventh grade
An eighth grader who has a personal belief exemption on file before January 1, 2016, may remain in a school without being vaccinated for the remainder of schooling
Unless otherwise exempt, all other students must have their vaccines up to date at the start of the 2016-17 school year
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
34
SB 277 (Pan) Public health: Vaccinations: Positions
Pro SB 277: Vaccinate California https://vaccinatecalifornia.org/about/
Against SB 277:
Parental Rights https://parentalrights.org/oppose-sb276-ca/
California Coalition for Vaccine Choice https://parentsrightscalifornia.weebly.com/?fbclid=IwAR3nbXLL_tMeC1a3LfLkbpE9mrnA6ZxhF71pJ6WwLgCH0JRJic7gAoVDUCs
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
35
SB 277 (Pan) Public health: Vaccinations.
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
36
Fox News Debate
SB 277 (Pan) Public health: Vaccinations.
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
37
Advocacy for Opposition
Vaccination as a Prevention Strategy - DEBATE
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
38
Vaccination for Prevention (pp 204-207)
Break into 2 types of groups: Support OR Opposition
Topic: SB 277 Mandatory Vaccination
Group 1: Opposition to Mandatory Vaccination
Group 2: Support for Mandatory Vaccination
Vaccination as a Prevention Strategy - DEBATE
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
39
Vaccination for Prevention (pp 204-207)
Break into 2 types of groups: Support OR Opposition for SB 277
Get into pairs. Then, review the summary of the general vaccine issue pp.205-207
Then, select your position FOR or AGAINST
Using your pc or phone to research your position on SB 277
Then, select one point to argue regarding the SB 277 policy that is being debated. Your point has to align with your position. Use one fact in your argument.
Each student has one minute to argue their position.
Let’s debate!
SB 277 (Pan) Public health: Vaccinations - Outcome
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
40
SB 277 (Pan) Public health: Vaccinations: Outcome
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
41
California Gov. Jerry Brown just approved one of the toughest mandatory vaccine laws in the country (Vox News, 2015)
https://www.vox.com/2015/4/9/8376449/california-vaccine-exemption
SB 277 (Pan) Public health: Vaccinations: Outcome
Eyler, Chriqui, Moreland-Russell & Brownson, 2016
42
Experiences With Medical Exemptions After a Change in Vaccine Exemption Policy in California
Salini Mohanty, Alison M. Buttenheim, Caroline M. Joyce, Amanda C. Howa, Daniel Salmon and Saad B. Omer
Pediatrics November 2018, 142 (5) e20181051; DOI: https://doi.org/10.1542/peds.2018-1051
OR
https://pediatrics.aappublications.org/content/142/5/e20181051
