Thursday, July 14, 2011

Disease Burdens More Than Just the Patient

Often, when we talk about infectious diseases and outbreaks, the focus tends to be on those who got sick: the symptoms they experienced, how likely they might have been to infect others and so forth. We may talk about whether or not they were vaccinated, what complications they may have suffered and the costs that they bore through lost work/school days or how much treatment cost. Only occasionally do people think about the effects of an infection or outbreak on the government. After all, infections only have a direct impact on the person who has the disease and maybe those around them, right? How could a disease have any significant impact on a government. They're big, faceless things that just kind of exist in the background, except when there's a problem or it's election season.

The fact of the matter is, outbreaks of infectious disease actually have quite an impact on governments, particularly local ones. As just one example, I recently received the following from an anonymous reader:

From the onset of the outbreak on March 19, 2011 through July 13, Utah has had 15 confirmed cases of measles. Nine cases occurred in Salt Lake County, five cases occurred in Cache County, and one case occurred in Millard County.

After June 6, two additional Utah residents have been confirmed to have measles by CDC testing. One of these persons resided in Cache County, and the other resided in Millard County. Both of these affected persons were close contacts of a person with a previously identified case in Cache County. Both had unknown vaccination histories and had been vaccinated post-exposure on June 6. On June 16, both affected persons developed rash. The Cache County resident reported limited contact with anyone during the infectious period. The Millard County resident traveled from northern to central Utah, attended church, and worked in Millard County during the infectious period. Approximately 100 work contacts received a measles, mumps, and rubella (MMR) vaccine dose within three days of exposure. Any work contacts that could not provide documentation of two doses of MMR had titers drawn. Those without immunity were quarantined.

Two probable measles cases are also being investigated. One probable case occurred in a Cache County resident with no history of vaccination. This resident has a possible epidemiological link to the Millard County resident. Rash onset was June 22. Commercial IgM testing was positive; the sample will be run at CDC for confirmation. This resident had limited contact with others during infectious period.

The other probable case occurred in a California resident with a rash onset of July 4. On July 5, this person traveled by airplane to Utah. DGMQ was notified because the travel occurred during the infectious period. States with residents who were identified as contacts were also notified. Commercial IgM testing was positive; the sample will be run at CDC for confirmation. The affected person had one documented dose of MMR.

Take a moment to think about what you've just read. What kind of resources were required to deal with this outbreak? How much time is involved working on each case to try to prevent the spread of the disease?

It all starts with a case being reported: patient 1. Public health officials need to track down the person, interview them and, probably, their doctor(s) to find out as many details as possible about when they first showed any symptoms of infection, when new symptoms appeared, anything they can about the course of the patient's illness. They also need to find out where the patient has been during the days or weeks they were contagious and with whom they may have had contact. All this time, the patient needs treatment and may be forced into quarantine, along with any close contacts, like family members, who have potentially been infected.

When the officials get all this information, then they need to track down identifiable individuals (coworkers, classmates, family, etc.) to inform them and take measures to try to beat the infection before it has a chance to set up residence. Notices are sent to local businesses that the patient may have visited and press releases sent out to warn those the officials may not be able to track down and notify directly. If the patient traveled between states or to another country while infectious, then those regions also need to be notified.

Finally, they need to keep vigilant watch for any additional cases popping up. If someone else was infected by patient 1, it could be days to weeks before they surface. But what about the person that infected the patient 1 to begin with? Did they infect any others? There may be more patients cropping up earlier than might be expected.

Speaking of the person that infected the patient 1, the health officials also need to try to track down that individual and run the same investigation they did with patient 1. If the case was reported, then things are a bit easier, but if it went unreported? Then things get a bit trickier. By this time, weeks may have passed. Memories are likely hazy, but the officials must do their best to get as much information as possible. Who else might be incubating or spreading the disease?

A lot of time is spent on the ground, investigating, interviewing. But information alone won't stop a disease from spreading. Vaccines need to be distributed and administered to those suspected to be at risk of infection due to contact with the patient and incomplete or no immunization history at all. Placing people under quarantine can help, as long as the individuals comply with the quarantine, which, let's face it, doesn't always happen.

Everything I've described above is just for one case. A single person infected with a highly contagious disease like measles. Hundreds of man-hours and hundreds (if not thousands) of dollars will have been spent on just a single confirmed, or even suspected, case. Multiply that by every case in the outbreak and the strain on the local government becomes readily apparent. Every case eats up valuable time and your tax dollars as the local government does what it is meant to do: protect its citizens.

Bare bones.

And that is something that during sound economic times we may not think about a great deal. But what happens when finances are tight? What would happen in Utah if the state government ran out of money or, like Minnesota recently, shut down, leaving the department of health to run on bare bones? Would they be able to stop the spread of the disease? How many people would become ill?

The amount of time, money and other resources that go into the efforts to investigate and head off outbreaks before they can spread wildly is nothing to laugh at. The simple reality is that so much of that could be saved and used for other projects through the maintenance of herd immunity, and one of the safest, most reliable methods we have of achieving that is vaccination.

If you care about public health, vaccination should be a cause you support. If you care about how your taxes are used, vaccination should be a cause you support. If you have any thought or compassion for those around you, vaccination should be a cause you support, vocally.

Protect yourself, protect your family, protect your community. Get vaccinated.


  1. WAY TO GO TODDW!!! This made me want to jump up and punch the air. I was going to say something about the limited funds for autism research and point out that if people were vaccinating to prevent the spread of infectious diseases, we might have more funds to divert toward autism research in the end as we'd save so much just cleaning up the mess an outbreak can cause. Kind of ironic, no? The anti-vaccine people are the cause of the shortage of funding available for autism research... (maybe not directly, but indirectly I'm sure.) But I think you covered it very well yourself and I shared it too!

  2. Glad you liked it, Venna. And, yes, you make a good point about money that could be used to help parents with autistic kids being used, instead, to prevent the spread of an outbreak that could have been avoided.

  3. @LokaSamasta

    You are perfectly welcome to make on-topic comments, as I have told you before. Also as I told you, your off-topic rants will be marked as spam. If you cannot abide by that, then feel free to go to some other blog. Should I happen to write a post on your topic of interest, comment away to your heart's content.

    If you feel that my blog is boring or too narrowly focused, again, you are welcome to not read it and find a blog that is more interesting to you.

    The only thing I ask of my readers and commenters is to show a little bit of etiquette, common sense and respect. Just as I would not visit your blog and leave comments on every post about some specific topic that is totally unrelated, I expect you to grant me the same kindness and not spam my blog with perseverative off-topic comments.

  4. Hey Todd, much as my treatments work please bear in mind that I am still an asperger so to expect me to get it 'socially perfect' is perhaps asking a lot? Common sense only applies to NTs, not aspies!

    Nonetheless, I made a comment at AoA which is in moderation. How do I submit it to you? The people at RI sent me to AoA and you are the moderation proofing blog for AoA.

    How do I submit it to you?



    Knowing the genetics of autism is the same as knowing the blueprints of a building. It does not tell us why or how the building got there but it does make it a lot more easy to repair or treat the building

    Anyway, cause of autism can wait. I wanted to know what are AoA's thoughts and position of cannabis therapy for autism please?



    As you can see, there is reason in there for them to censor it if they want to.

    Regarding the on/off topic business. You guys never bring it up so it is never on-topic. How else is it to be brought up?

    Is the last time. It wasn't exactly 'science' was it?

    It seems like the rules are unfollowable (from an autistic point of view).

    Did you really visit my blog? I'm flattered.

  5. @LokaSamasta

    "Common sense only applies to NTs, not aspies!"

    Not really. I know aspies who show a good bit of common sense.

    "Nonetheless, I made a comment at AoA which is in moderation. How do I submit it to you?"

    You send me an e-mail and let me know which AoA post you commented on. I'll put up a new post in which you can copy your comment. The only thing I would ask is that you follow their commenting policy. If you do so and they still do not allow your comment to appear, then I'm more than happy to provide a place for it. A tip, don't spam the same comment over and over on various posts over there. Not only is it rude and a likely violation of their commenting policy, but I probably won't start a thread for you either, as they will be fully within their rights to moderate your comments.

    If I do start a new thread for a comment censored at AoA, then when you copy your comment, include the date and time you posted it there.

    "Regarding the on/off topic business. You guys never bring it up so it is never on-topic. How else is it to be brought up?"

    Then you either wait patiently or find someplace that is actively discussing it. I can't recommend any, as I do not personally know of any. Search for some on your own.

    There may be some reasons that people don't take up your topic when you ask them. For example, you ask way too frequently, making a nuisance of yourself. By behaving in a manner that greatly annoys people, you only hamper your own efforts. Another reason is that perhaps the forum you choose doesn't have anyone who is qualified to cover the topic. For example, I'm not personally familiar enough with it, so I am not comfortable writing about it and I frankly don't have enough time, currently, to become knowledgeable enough to discuss it. Likewise, researchers that you entreat to talk about it may not have expertise in that field and, thus, not be qualified to conduct research in it.

    "It seems like the rules are unfollowable (from an autistic point of view)."

    Not really:

    1) If asked to stay on-topic, then stay on-topic.
    2) If asked not to post under numerous different names, stop doing so.
    3) Don't spam.

    Try taking a break from commenting to learn from others.

    Barring finding a place to comment on the subject on-topic, you have a blog, so write about it there.

    "Did you really visit my blog?"

    No, but if I were to visit, I would not post off-topic, spamming comments.

  6. Cool, I put the text of my comment in my last response, I've taken a screenshot too.

    We will have to agree to disagree. The EU court of Human rights ruled that the phrase 'common sense' should not be used in the workplace because it discriminates against autistic people. 'Common Sense' is actually a xenophobic anti-predator adaptation.

    Which of my blogs did you not visit?

    And, assuming I am not deluded and cannabis is medicine for autism, can you understand my frustration? Do you recall how 'cannabis for autism' was received by Orac's commentariat when it was first presented?

  7. It's there.


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