Environmental and global health issues

Environmental and Global Health Issues

Environmental & Global Health Issues

Communicable disease outbreak: Measles

Until recently, it was thought that measles had been entirely eradicated in the United States, thanks to the success of the national vaccination program. According to the CDC, "measles was declared eliminated from the United States in 2000" (Measles outbreaks, 2012, CDC). However, that proud statement has been amended, as cases of measles have once again begun to reassert themselves slowly within our nation's borders. On average, every year 60 people in the United States contracts the measles. In 2011, that figure skyrocketed to 222. 40% of these cases originated outside the U.S. "They brought the disease to the United States and spread it to others. This caused 17 measles outbreaks in various U.S. communities" (Measles outbreaks, 2012, CDC). Of the countries implicated in the spread of the illness, France, Italy, Romania, Spain, and Germany were responsible for 90% of the transmissions. To be classified as a case of measles, the patient must exhibit the classic rash for three days or more, a temperature above 101F and a cough or have a laboratory confirmation of measles (McLean 2011).

Thus, there is an alarming trend as measles has reasserted itself as a communicable illness thanks to continued fears about childhood vaccinations. 86% of the patients that contracted the measles were unvaccinated or had unknown vaccination status. (A small percentage of vaccinated persons can still contract the disease). A "drop in MMR vaccination coverage in a community can increase the risk for large, sustained measles outbreaks, as experienced recently in Canada and France, or reestablishment of endemic transmission, as experienced in the United Kingdom," which means the illness no longer needs to be 'imported' from abroad to be transmitted from person to person (McLean 2011).

The 'imported' nature of the measles outbreak can be seen in the following graphic illustration, in which there are small, concentrated pockets of import-associated measles scattered throughout the United States, without a clear trail of transmission.

Source of graphic: McLean 2011, CDC website

Measles is an extremely contagious disease and spreads rapidly from person to person. It can also be deadly, a fact often forgotten because of the successful vaccination campaign that nearly eliminated the disease in the 20th century. Worldwide, the disease causes the death of up to 200,000 persons every year out of approximately 20 million cases. It can also cause miscarriages and premature births (Measles, 2012, CDC Overview). The disease can be especially dangerous for children, leading to ear infections, pneumonia, or encephalitis. One or two children of every thousand that contracts measles die (Measles, 2012, CDC Overview). While fears about vaccinations have been shown to be largely unsubstantiated, the risks of not vaccinating are very clear. Some parents have been hoping to rely upon 'herd immunity' for their unvaccinated children but recent epidemiological trends illustrate the unwise nature of their actions.

Q2. Protocol for reporting SARS for healthcare professionals

In the event of a suspected or confirmed outbreak of SARS, all healthcare professionals should report the cases to the state or local health department. Examples of 'red flags' include "all persons requiring hospitalization for radiographically confirmed pneumonia who report at least one of the three risk factors for exposure to SARS-CoV" (Reporting of cases of SARS-CoV disease, 2012, CDC). These include travel to areas where widespread SARS outbreaks have been known to have occurred, such as mainland China, Hong Kong or Taiwan or contact with a person who has traveled to that area; employment in occupations (such as healthcare) where exposure to persons who have contracted SARS may be likely, and people who are "part of a cluster of cases of atypical pneumonia without an alternative diagnosis" (Reporting of cases of SARS-CoV disease, 2012, CDC).

Any positive SARS test should be immediately reported "by telephone to the state or local health department for confirmation and implementation of urgent and appropriate isolation precautions, contact tracing, and follow-up" (Reporting of cases of SARS-CoV disease, 2012, CDC). The patient should be questioned to determine the paths of transmission for his or her illness: how he or she may have contracted it and who may have been unwittingly exposed.

Q3. Air quality

On days in which the air quality is poor, a high-ozone day can cause "inflammation and heightens sensitivity to outdoor allergens such as pollen or mold. This can increase the chance of an asthma attack" (Worth 2009). Patients with a high degree of sensitivity to ozone-related pollution are advised to stay inside on such days, particularly during the later hours of the day. In contrast, days in which the quality of the air is poor because of high concentrations of mold are considered not as alarming. "For someone with nasal allergies to pollen, treatment is good so we often don't recommend avoidance [of the outdoors]. But we don't have any shots to reduce people's sensitivity to ozone" unlike other outdoor triggers (Worth 2009).