Information is the basis for planning, organizing, manag-ing, and providing high-quality care. The process begins with basic vital statistics and the epidemiology of infec-tious and noninfecinfec-tious diseases in order to identify and
quantify the health needs of the population. It extends into health information systems in order to manage and monitor the functioning of the health care system. Surveillance of health events at national, regional, and community levels depends on building information systems and linking data to provide community health profiles. This is fundamental to monitoring and managing health systems. It requires clear policy to ensure that information systems do not exist to serve only those who process the data at national levels, but are returned to the community level and linked with other data sources in readily usable formats (Box 3.29).
Information is widely available in health statistics and published data of all kinds, today more than ever on the Internet. Health policy formulation requires seeking the appropriate information and making intelligent use of it.
Educating health workers in using information coordina-tion and streamlining of data helps them understand the relevance and impact of their actions. Information systems and the flow of properly organized and disseminated data are vital for management. They are as important to the functioning of the system as an intelligence service is to a military operation. The vast and expensive mechanism of a health service operates in the dark without a continu-ously monitoring information system and applied research methods of epidemiology.
Throughout the world, health care systems are under critical scrutiny because of concerns over costs, accessi-bility, appropriateness, quality, and outcomes of care.
Box 3.29 Evidence-Based Public Health and the Burden of Proof
The Hippocratic Oath specifies: do good and do no harm. This has found expression in the Precautionary Principle, a contem-porary redefinition of Bradford Hill’s case for action. According to this principle, when in doubt about the possible presence of a hazard, the burden of proof is shifted from showing presence of risk to showing total absence of risk.
This principle creates a dilemma in public health and in clinical medicine in that it suggests the normal evidence required for action is without validity, implying any possible risk of intervention outweighs the risk of nonintervention.
Great care is warranted when introducing new public health interventions, but the weight of evidence must include not only epidemiologic studies but policies derived from Delphi consul-tative procedures and successful use of the intervention in large population groups over long periods of time, without substantive evidence of harmful effect.
A balance between the Precautionary Principle, the experi-ence of “good pubic health practice” and epidemiologic evi-dence is often a delicate judgment, but is nonetheless essential for policy in this field. Last’s definition of evidence-based public health is wise, with “application of best available experi-ence in setting public health policies and priorities. The
evidence comes from official vital and health statistics and from peer reviewed publications in epidemiology, sociology, economics and other relevant disciplines.”
Failure to act on best practices and cumulative evidence can be an ethical and indeed a legal problem (see Chapter 15), where inordinate delay in implementing scientific and practical positive experience with public health interventions can allow serious morbidity and mortality to go unchecked when they are preventable.
The time lag between adequate scientific evidence and pos-itive experience with good public health practices can be very long and measures that can save or improve the quality of life for large numbers of people are delayed in implementation due to lack of political motivation, priorities, and active or passive resistance by professional or lobby groups with other agendas.
Delay in adoption of a two-dose policy for measles vaccina-tion and slow implementavaccina-tion in some developing countries cost millions of lives. Banning of DDT in the 1960s due to envi-ronmental concerns contributed to the resurgence of malaria, again costing millions of lives. The responsibility to keep up with scientific and best public health practices is an important responsibility of public health in balance with due precaution.
Source: Adapted from Last, J. M. 2007. A Dictionary of Public Health. New York: Oxford University Press.
The effectiveness of a health system is frequently on the political agenda. Quality assurance and accountability are critical in the operation of any health system. Health expenditures must be increasingly justified in terms of their need and cost-effectiveness, policy formulation, stra-tegies, and priorities, taking into account economic, socio-logical, and political factors.
Curbing the soaring costs of health care is a necessity and not a matter of choice for governments and indivi-duals if the WHO policy of Health for All is to be achieved. One means of reaching the goals and objectives of this policy is to develop an efficient health information system. Knowing the population, the epidemiologic pat-terns of its diseases, and its health care services and utili-zation, are all part of monitoring and feedback systems essential to allow the health system to evaluate health sta-tus, and keep pace with changes. They are therefore essen-tial elements of the New Public Health.
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Communicable Diseases
Introduction
Public Health and the Control of Communicable Disease The Nature of Communicable Disease
Host–Agent–Environment Triad
Classifications of Communicable Diseases Modes of Transmission of Disease Immunity
Surveillance
Health Care–Associated Infections Endemic and Epidemic Disease
Epidemic Investigation
Control of Communicable Diseases Treatment
Methods of Prevention Vaccine-Preventable Diseases
Immunization Coverage Vaccine-Preventable Diseases
Essentials of an Immunization Program Regulation of Vaccines
Vaccine Development
Control/Eradication of Infectious Diseases Smallpox
Eradication of Poliomyelitis Other Candidates for Eradication Future Candidates for Eradication Vector-Borne Diseases
Malaria
Rickettsial Infections
Arboviruses (Arthropod-Borne Viral Diseases) Lyme Disease
Parasitic Diseases Echinococcosis Tapeworm Onchocerciasis Dracunculiasis Schistosomiasis Leishmaniasis Trypanosomiasis Other Parasitic Diseases Legionnaire’s Disease Leprosy
Trachoma
Sexually Transmitted Infections Syphilis
Gonorrhea
Other Sexually Transmitted Infections Control of Sexually Transmitted Infections HIV/AIDS
Diarrheal Diseases Salmonella Shigella Escherichia coli Cholera
Viral Gastroenteritis Parasitic Gastroenteritis
A Program Approach to Diarrheal Disease Control Acute Respiratory Infections
Inequalities in Control of Communicable Diseases Communicable Disease Control in the New Public Health Summary
Electronic Resources Recommended Readings Bibliography
INTRODUCTION
Despite advances in medical sciences and public health, infectious diseases remain a central task of public health in the twenty-first century, especially HIV/AIDS, TB, malaria, SARS, avian flu, and others. Globalization has facilitated the spread of many infectious agents to all cor-ners of the globe. Mass travel, economic globalization, and climate changes along with accelerating urbanization of human populations are causing environmental disrup-tion, including global warming. There are and will be more consequences in international transmission of infectious diseases than are now known, in humans and wildlife.
This chapter describes communicable diseases and pro-grams for their prevention, control, elimination, and eradica-tion. Control of communicable disease requires a systems approach using available resources effectively, mobilizing environmental measures, immunization, and clinical and
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health systems. Rapid transportation and communication make a virus outbreak in any part of the world an interna-tional concern, both for professionals and the general public.
A basic understanding of infectious diseases is therefore an expectation of any student, just as a general knowledge of family health, chronic disease, nutrition, and economics are part of the modern public health culture.
The material presented in this chapter is intended to give an introduction for the student or review for the pub-lic health practitioner, with an emphasis on the applied aspects of communicable disease control. We have relied for the content of this chapter on several standard refer-ences, especially Heymann’s Control of Communicable Diseases Manual, 18th ed. WHO Vaccine Preventable Diseases Monitoring System: 2007 Global Summary;
Jawetz, Melnick and Adelberg’s Medical Microbiology, 21st ed., along with Morbidity and Mortality Weekly Report of the Centers for Disease Control and Prevention (CDC), and WHO’s Weekly Epidemiologic Record (WER). ProMed is a highly recommended Harvard University–based Web site, frequent update source of current infectious disease outbreaks around the world, available with free subscription at Web site listed in elec-tronic resources.We also have relied on elecelec-tronic sources such as PubMed, the American Academy of Pediatrics, World Health Organization (WHO), and United Nations Children’s Fund (UNICEF) Web sites, as well as library access journals. The references listed will augment the limited discussion possible in this text.