Introduction to Health and Health Care in the U.S. Public Health, Part 2 Welcome to Component 1: Introduction to Health Care and Public Health in the U.S.: Public Health, Part 2. This is lecture a. The component, Introduction to Health Care and Public Health in the U.S., is a survey of how health care and public health are organized and services are delivered in the U.S. Lecture a This material (Comp 1 Unit 8) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. Health IT Workforce Curriculum Version 4.0

Public Health, Part 2 Learning Objectives - 1 Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health (Lecture a) Discuss the activities and achievements of public health in the realm of communicable disease (Lecture a) The learning objectives for Public Health, Part 2, are to: Give examples of and explain the general program categories of public health, including communicable disease, chronic disease, terrorism response, and environmental public health Discuss the activities and achievements of public health in the realm of communicable disease

Public Health, Part 2 Learning Objectives - 2 Compare and contrast the different types of terrorism and the different public health responses (Lecture b) Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards (Lecture c) Compare and contrast the different types of terrorism and the different public health responses, and Describe chronic disease activities and achievements of public health, and the work of public health in the realm of environmental health hazards.

Communicable Disease (CD) Communicable: those diseases that result from organisms such as bacteria, protozoans, fungi, and viruses To control infectious diseases: Clean water and better sanitation Antimicrobial therapy This lecture will cover public health and communicable diseases. Communicable diseases can also be termed infectious or transmittable diseases. They are caused by organisms such as bacteria, protozoans, fungi, or viruses entering the body. The control of infectious diseases can mostly be traced to two advances. First, better sanitation and clean water, which have brought many diseases, even typhoid and cholera, under control. Second, antimicrobial therapy – the arsenal of medical treatments against infectious diseases has expanded greatly through the discovery of agents such as penicillin.

Public Health Triumphs New infectious diseases will continue to emerge Two of the brightest triumphs of public health are encouraging: Smallpox Polio New communicable diseases continue to appear – the “emerging infectious diseases” – and probably always will. Other diseases continue to evade good control, such as tuberculosis, drug resistant infections, and so forth. But it is encouraging to consider some more details of two of public health’s brightest triumphs, and how these once fearsome diseases were brought under control: smallpox and polio.

Public Health Triumphs: Smallpox Contagious and often fatal; caused by a virus that has been around for thousands of years 1796 Edward Jenner Discovered milkmaids who had caught cowpox did not catch smallpox 1800 Smallpox vaccination began in the U.S. 1949 - Last case of smallpox in the U. S. Smallpox virus has been sickening populations for thousands of years. In 1796, Edward Jenner discovered that cowpox conferred immunity to smallpox upon milkmaids. In 1800, the technique of smallpox vaccination was introduced into the U.S., and a century and a half later, the U.S. was declared free of smallpox.

Smallpox, continued 1966 International Smallpox Eradication program established 1977 Last naturally occurring case in the world, Somalia 1977 Worldwide eradication of smallpox following global vaccination program The International Smallpox Eradication program was established in 1966, and by 1977 the global vaccination program had effectively eradicated the disease.

Smallpox: Current State Routine vaccination against smallpox was stopped after the disease’s eradication Other than laboratory stockpiles, the Variola virus has been eliminated from the world Routine general vaccination against smallpox was discontinued after eradication of the disease. The virus has been eliminated from the earth, with the exception of some laboratory stockpiles.

Smallpox: A Terrorism Concern? CDC plan to protect Americans against smallpox as a biological weapon Includes the creation and use of special teams of health care and public health workers Vaccination within 3 days of exposure will completely prevent or significantly modify smallpox for most U.S. has stockpiled vaccine – it is a live vaccine to a related virus Are these stockpiles a matter of concern for terrorism risk? The Centers for Disease Control and Prevention, or CDC, has detailed plans to protect the U.S. in the case of a smallpox weapon, the plans include deploying teams of medical and public health workers to stop the spread, using stockpiled, live vaccine to a related virus.

Public Health Triumphs: Polio History - evidence of polio in an Egyptian stone engraving over 3,000 years old Virus mainly affects children <5 years of age. Spread by contact or by ingestion of fecal contamination in food or water Polio is another disease that has been a threat for thousands of years – there is evidence of polio in an Egyptian stone engraving more than 3000 years old. The polio virus mainly affects children under 5 years of age, and is spread by fecal contamination of food or water.

Polio, continued Highly infectious, the virus invades the nervous system Up to 95% of people may not have symptoms, those who do can have severe effects including paralysis 1955: Salk polio vaccine licensed. Rapid eradication in industrialized countries The highly contagious virus invades the nervous system. The vast majority of those infected are not seriously affected, but for those who are, the symptoms are severe, including paralysis. In 1955, the Salk polio vaccine was licensed which led to the rapid decline of polio cases in industrialized nations.

Polio: Current State Polio has been effectively eliminated in industrialized countries, but still a risk in other countries World Health Organization (WHO) continues its efforts toward global eradication of polio Currently, polio has been effectively eliminated in industrialized countries; however, it still poses a risk in other countries. The World Health Organization or WHO, continues to strive for global eradication.

Public Health Communicable Disease Prevention Activities State and local health department activities include: Monitor incidence of CDs Investigate outbreaks Intervene/treat populations Report data to CDC Public health departments at the state and local level work to prevent communicable disease in the population through a combination of monitoring and surveillance, outbreak investigation, interventions and treatments, and reporting of data to CDC.

Federal Prevention Activities CDC activities include: Gathering national data on infectious diseases Managing national prevention and surveillance programs Distributing funding and other resources Collaborating with state and local public health during outbreak responses Federal-level activities by the CDC include gathering national data, managing national prevention and surveillance programs, distributing funding, and collaborating in outbreak responses.

Simplified Case Study: Food Poisoning Outbreak Investigation - 1 Public Health receives laboratory reports positive for foodborne pathogens Public Health Epidemiologists investigate Samples sent to Public Health Laboratory Fieldwork determines many of the patients ate at a company picnic Outbreak investigations can take many forms and be quite complex. This slide illustrates a fictional – and very simplified – outbreak investigation of a food poisoning incident. In our fictional example, public health first learns about the incident by receipt of laboratory reports positive for foodborne pathogens. Epidemiologists investigate the report, sending additional samples to the public health laboratory to be more closely identified. The epidemiologists trace the illness to a company picnic.

Simplified Case Study: Food Poisoning Outbreak Investigation - 2 Questionnaires and statistical analyses identify the culprit as contamination in a dairy product served at the picnic Further investigation reveals a sanitation issue at the dairy has led to contamination in their product A product recall is issued Questionnaires are sent to those who are ill and statistical analysis identifies the problem as a dairy product served at the picnic. Yet more investigation reveals the product was contaminated at the dairy due to a sanitation issue. A product recall is issued.

Simplified Case Study: Food Poisoning Outbreak Investigation - 3 The dairy fixes the sanitation problem, and further tests show the product is now free of contamination Public health reviews and evaluates the study and how to help prevent further such incidences Data reported to CDC become part of the national data set The dairy fixes the problem that led to the contamination. Public health utilizes the data gathered and lessons learned to help prevent future problems. The information is reported to the CDC and becomes part of the national data set.

Communicable Disease Topics Animal-Related Diseases Food-Related Diseases Sexually Transmitted Diseases Water-Related Diseases Health Care-Related Infections and Issues Bioterrorism Agents/ Diseases Childhood Diseases HIV/AIDS Insects and Arthropod-Related Diseases Emerging Infectious Diseases This listing of some communicable disease topics gives a good idea of the diversity involved. We’ll look at a few of these in more detail.

Sampling of Communicable Diseases: Animal Related Rabies A fatal viral infection, caused when the virus is introduced into breaks in skin (such as by an animal bite) Some public health responses: monitoring, managing treatment, education for responsible pet ownership Rabies is a good example of an animal-related disease. A fatal infection results when the virus is introduced into breaks in the skin, commonly by an animal bite. Public health responses include monitoring for incidents, managing treatment, and encouraging prevention by pet vaccinations.

Sampling of Communicable Diseases: Food Related E. coli O157:H7 Bacterial infection usually traced to food contaminated with cow feces. Can lead to very severe health outcomes, including death Public health responses: monitoring, interventions, outbreak investigation, education on prevention A serious food-related disease is caused by E. coli O157:H7. Incidents are usually traced to food contaminated with cow feces, and can be very severe. Public health responds by monitoring, assisting in interventions, investigating outbreaks, and providing education for prevention.

Sampling of Communicable Diseases: Sexually Transmitted Gonorrhea Bacterial infection transmitted by sexual contact or during birth. Can lead to permanent health problems. Public health responses: monitoring, interventions, outbreak investigation, education on prevention and treatment Gonorrhea is an example of a sexually-transmitted disease. This bacterial infection can lead to permanent health problems. The public health response includes monitoring, interventions, investigation of outbreaks, and education on prevention and treatment.

Sampling of Communicable Diseases: Water-Related Cryptosporidiosis Microscopic parasite, ingested by drinking water contaminated with animal or human feces Some public health responses: monitoring, outbreak investigation, education on water treatment The parasite Cryptosporidiosis causes one example of a water-related disease. The parasite is ingested by drinking contaminated water. Public health responses include monitoring, investigation of outbreaks, and education on water treatment.

Sampling of Communicable Diseases: Health Care-Related Methicillin-resistant Staphylococcus Aureus (MRSA) Bacteria resistant to certain antibiotics, in health care settings may be introduced by visitors or by health care providers Some public health responses: monitoring, outbreak investigation, education on prevention for both patients and health care providers Methicillin-resistant Staphylococcus Aureus, or MRSA, can cause a health care-related disease, if it is introduced in a health care setting by visitors or providers. Public health responses include monitoring, investigation of outbreaks, and education for both patients and providers.

Sampling of Communicable Diseases: Childhood Diseases Chickenpox Viral infection causing fever and itchy rash, highly contagious, spread by coughing, sneezing, contact Some public health responses: monitoring of disease and vaccinations, outbreak investigation, education on prevention through vaccination Chickenpox is an example of childhood disease; this highly contagious viral infection is spread by coughing, sneezing, or contact. Public health response includes monitoring, intervention by vaccination, outbreak investigation, and education on vaccination.

Sampling of Communicable Diseases: HIV/AIDS Human Immunodeficiency Virus (HIV), which can lead to Acquired Immune Deficiency Syndrome (AIDS) Viral infection transmitted by sexual or other body fluid contact Some public health responses: monitoring of disease and treatments, outbreak investigation, education on prevention and testing The human immunodeficiency virus, or HIV can lead to acquired immune deficiency syndrome, or AIDS. The public health response includes monitoring of disease and treatments, outbreak investigation, and education on prevention and testing.

Sampling of Communicable Diseases: Emerging Dengue infection Viral infection, transmitted by mosquito. Endemic to Puerto Rico and many popular tourist destinations in Latin America and Asia. No vaccine or specific medication Some public health responses: monitoring of disease, outbreak investigation, education on avoidance and mosquito control Emerging infectious diseases, mentioned earlier in this unit, continue to appear. One example is Dengue infection, native to many popular tourist destinations in Latin America, Asia, and Puerto Rico. This mosquito-transmitted disease is appearing more often in the United States. Public health response includes monitoring, outbreak investigations, and education on avoidance and on mosquito control.

Public Health, Part 2 Summary – Lecture a Communicable diseases Public health outbreak investigations This concludes lecture a of Public Health, Part 2. In summary, the topic of communicable diseases is discussed in detail, using notable examples including smallpox and polio. Public health disease outbreak investigations are discussed using a simplified food poisoning incident.

Public Health, Part 2 References – Lecture a Nationally Notifiable Infectious Conditions - United States 2010. (2010). Retrieved January 31, 2017, from Centers for Disease Control and Prevention - Office of Surveillance, Epidemiology, and Laboratory Services website: https://wwwn.cdc.gov/nndss/ No Audio

Introduction to Health Care and Public Health in the U. S Introduction to Health Care and Public Health in the U.S. Public Health, Part 2 Lecture a This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0001. No Audio Health IT Workforce Curriculum Version 4.0