Unfortunately, news channels across the nation have been busy reporting the latest negative news; between the unforgettable events in Ferguson, Missouri to the landslides and floods in California. I’m sure news of our recent Ebola virus outbreak continues to lurk in conversations among friends and with family around the dinner table. However, are we well informed about this outbreak? Do we know all the facts needed to protect ourselves? Are we aware of the other threats; other diseases? In order to protect ourselves from these fatal diseases we must educate ourselves.
Disease Epidemics within the Last Decade
According to World Health Organization (WHO), an epidemic is a widespread occurrence of an infectious disease in a community at a particular time. Over the past decade, many disease epidemics have taken place such as Dengue Fever, Cholera, Middle East Respiratory Syndrome Coronavirus or MERS-CoV, the Plague and now Ebola. These diseases have crept up multiple times within the past ten years and have spread from country to country.
Dengue Fever
Dengue Fever originally emerged in Pakistan in 2006 and again in 2011 as Pakistan continues the struggle to retain it with a death toll of approximately 400. The disease has also made its way to Indonesia, Singapore, India, Philippines, Puerto Rico, Dominican Republic, Mexico, Bolivia, Brazil and Cambodia. Dengue Fever is characterized by fevers, headaches, muscle, bone and joint pain, pain behind the eyes, minor bleeding of the gums and nose, a widespread rash and nausea and vomiting. The disease is mosquito-borne. When a mosquito feeds on an infected person or animal, it will later feed on an uninfected person or animal causing the infection to spread. Because of this, the disease is very difficult to manage and centers itself in the tropical and subtropical areas. Although there is no vaccine against Dengue Fever, prevention techniques are recommended such as environmental management of mosquito habitats and household protection against mosquito and other insect bites.
Cholera
Another widespread epidemic is Cholera. Since its first pandemic in 1816, there have been approximately five million cases with a death toll of over a hundred and twenty thousand. Most recently, it has affected countries such as Bangladesh, Angola, Ethiopia, Iraq, Somalia, Vietnam, Chad, Zimbabwe, and Hispaniola. Cholera is characterized by a rapid heart rate, loss of skin elasticity, low blood pressure, muscle cramps, watery diarrhea and vomiting and dry mucus membranes from inside the mouth, throat, nose and eyelids. Cholera is caused by bacteria found in food and water. Once consumed, the bacterium releases a toxin in the intestines that produces severe diarrhea. Often it is the diarrhea that causes death by extreme dehydration within hours. Vaccines are available for Cholera and should be used in conjunction with additional illness prevention precautions.
MERS-CoV
Primarily affecting the respiratory system such as the lungs and breathing tubes, Middle East Respiratory Syndrome Coronavirus, or MERS-CoV was first reported in Saudi Arabia in 2012. Since then, it has emerged in United Arab Emirates (UAE), Qatar, Oman, Jordan (2012), Kuwait, Yemen, Lebanon and Iran. There are also countries with cases caused by travel such as United Kingdom (UK), France, Tunisia, Italy, Malaysia, Philippines, Greece, Egypt, United States of America (USA), Netherlands, Algeria, Austria and Turkey. MERS-CoV is characterized by severe acute respiratory illness accompanied by a fever, cough and a shortness of breath. MERS-CoV also seems to contribute to other more severe illnesses such as pneumonia and kidney failure. Thirty percent of patients who were already symptomatic prior to the MERS-CoV infection have died. Such symptoms included diabetes, cancer, or chronic lung, heart or kidney disease. However those who were not symptomatic with these chronic conditions have recovered from the disease. Since its very recent outbreak, there is still some ambiguity among the origins of the virus and its means of transmission. Although it is assumed to have come from an animal source of some kind, it has yet to be determined. According to the Centers for Disease Control and Prevention, or the CDC, transmission is caused by close contact with infected individuals accompanied with poor preventative practices such as washing your hands. There is no vaccine available for MERS-CoV since the new virus is still under study. However, since its symptoms are often challenging to identify, it is recommended to follow standard illness prevention protocol in day to day activities.
The Plague
Most noticeable for the deaths of 70% of the total population in medieval Europe, the Plague still infects lives today. It infects animals and humans through an infected flea bite carrying the infectious bacteria, handling an infected animal or inhaling infectious droplets from an infected animal or human. Just recently in 2013, seven hundred and eighty cases were reported worldwide with a death toll of a hundred and twenty six. However, since its pre-antibiotic era from 1900-1941, the American death cases have dropped significantly from 66% to 11%. But let’s not forget the other countries also affected such as Madagascar (2014), Congo (2006) and many more over the past centuries. The Plague is characterized by fever, headache, chills, weakness, abdominal pain, blackened skin and other tissues, rapidly developing pneumonia, shortness of breath, chest pain, and watery or blood mucus depending on the strain of Plague. There are three different strains for Plague, each characterized by the means of transmission. Although vaccines are engineered against the disease, they show little to no value in its prevention. Proper prevention protocol for the Plague is to avoid the handling of animal carcasses, take necessary health precautions with flea bites that look peculiar or cause additional symptoms and avoid direct contact with any infected tissues or infected individuals. See a doctor right away if any of the Plague symptoms are identified.
Ebola
Since its original outbreak in 1976 in the Democratic Republic of Congo, Ebola has claimed the lives of over 7,500 worldwide. Numerous countries have been infected in the last ten years such as Sudan, Congo, and Uganda. It is transmitted through close contact with blood, secretions, organs and other bodily fluids of infected animals or humans, as well as surfaces and materials. This can be something as simple as an infected patient who sweats on his bedding which is then picked up, bear-handedly by the staff member. This simple act can easily infect the staff member. Gloves and masks must be worn to prevention transmission. This acute illness is often fatal if not treated promptly. It is characterized by two waves of symptoms. The first includes a sudden onset of fever, fatigue, muscle pain, headache and sore throat. The second wave includes vomiting, diarrhea, rash, symptoms of impaired kidney and liver function, and in some cases, both internal and external bleeding. With Ebola vaccines still under way and the infection currently at a 50% fatality rate. Protect yourself from the Ebola virus by following standard sickness prevention protocol such as washing your hands and avoiding the handing of infected individuals or their bedding or clothing without the proper protection.
What Do These Diseases Have in Common?
Predominately originating in under developed countries, these diseases commonly thrive in poor, unkempt environments where irrigation is poor and hygiene education is deficient. As stated before, Dengue Fever is a mosquito-borne illness. In poor tropical and subtropical areas where rain is frequent, the water tends to build up in unnatural areas surrounding poorly insulated homes. This is a breeding ground for mosquitoes and a feeding frenzy when humans are readily available through split screens and cracked, deteriorating walls.
On the other hand, Cholera is a bacteria driven infectious disease. Such bacterium is derived by the fecal matter of those who have been infected regardless if they are systematic. Because of the nature of this disease, it is often spread through municipal water supplies, or water products made from or grown with municipal water, foods or drinks sold by street vendors or raw or undercooked fish and seafood caught in contaminated waters. Needless to say, the Cholera disease thrives in areas in which personal hygiene is inadequate.
Other diseases are prominent in countries that lack medical staff, supplies and education. With diseases such as MERS-CoV, Plague and Ebola, the transmission closely resembles the common cold and therefore begins almost a domino effect. For example, imagine a small hospital in a village of an under developed country. A large amount of infected individuals come to the hospital for treatment. With scarce supplies and a small staff, these infected individuals seemingly take over and exhaust the small hospital’s supplies and cause the staff to become overworked. Then imagine this same small hospital with a worn out staff and limited to no supplies, and all of the other citizens of the village who were infected by the first wave come in for treatment. The small hospital is depleted of supplies while the staff works under fatigue, hectic and disorganized conditions; desperately attempting to treat all of their patients. This causes the staff to skip prevention protocol in order to accommodate all patients. In turn, the staff is infected and the infected keep on infecting causing an outbreak epidemic!
We Are Not Immune!
Although the United States has been considered a developed country for over a century, we too have had our share of epidemics. In 1918, two historical calamities took place in the United States, WWI and the Influenza epidemic. The tragic war of WWI lasted approximately three and a half years and claimed the lives of about sixteen million. It is truly a sad time in our nation’s history. However, as the war came to an end, the tragedy in our country did not stop. The country lost control of the Influenza outbreak as it claimed fifty million American lives and in just one year, decreased the country’s life expectancy rate by twelve years. This epidemic was not bias. It inflected the old, the young and health-strong young adults. It affected both rural and urban areas as it nearly wiped out the nation’s population by twenty five percent.
The United States has affective healthcare. We even had large hospitals with ample amounts of staff. We were equipped and educated staff with disease control precautions. However, this is when Influenza was a “new disease” and we did not know where it came from or how to treat it. We continued to lose the lives of Americans until we were able to study the disease, learn its symptoms and means of transmission and, later, build a vaccine against it. Simply put, Ebola can very well be our country’s Influenza if we do not educate ourselves on how to prevent it from happening. Although Ebola is still very mysterious in the world of health and disease, we know have educated ourselves on how the disease is transmitted.
Approximately twenty cases have been treated for Ebola in the United States and Europe. Of those cases, most of them were in the health industry who worked in West Africa as a part of the treatment staff against Ebola. These included doctors, nurses, missionaries, journalists and aid workers. Of these cases, ten were Americans who were infected while treating those in West Africa and were sent back and quarantined and treated. Unfortunately, of these ten cases, one was fatal. Similar cases and professions were reported in countries such as Spain, Britain, France, Germany, Norway, Switzerland, and Italy.
Although these individuals were promptly quarantined and an outbreak was prevented, the incubation period for Ebola is two to twenty-one days. Because of this wide range, it is possible for an infected individual to come to the United States, later become ill and infects others before getting treated or even being diagnosed. Certain states have even mandated a quarantine period of twenty one days for individuals returning from West Africa regardless of any onset symptoms. These states include New York, New Jersey and Illinois. Five airports in the U.S. are screening travelers from West Africa. These include Kennedy International, Washington Dulles International, O’Hare International, Hartsfield-Jackson International and Newark Liberty International.
Other measures have been taken for additional protection against other epidemic diseases for those in richer, more developed countries. For example, when leaving to an under developed country, the CDC and WHO provide information and locations for disease vaccinations prone to the country to which they are traveling to. The CDC website lists news updates on recent disease outbreaks in each country and tips to prevent infection and illness. Some travel tips provided by both WHO and the CDC are food and water safety such as what to eat and not eat. For an example, most would think that a salad is perfectly healthy or ice in your water on a hot tropical day is harmless. Little do we know both of these are high risk for bacteria-causing infection.
Resources
Imagine being ill in an under developed country for just one day! That alone may take you from a light case to a severe illness in just hours without adequate medical attention. For example, here in the U.S. if you fall ill to a stomach flu or food poisoning and become dehydrated due to severe vomiting or diarrhea, your physician will recommend Pedialyte to hydrate yourself with a condensed amount of electrolytes. If this were to happen in an under developed country, this may not be an option. In fact, not only will they not even know what Pedialyte is, you may be attempting to hydrate yourself with more bacteria filled water, causing your symptoms to become more severe with each sip. However, in the case that you do become ill in such a situation, the CDC website also provides helpful and detailed information on health care abroad.
On the Traveler’s Health CDC webpage, resources are also available for vaccines needed per country of destination, health tips for traveling with children or pregnant woman, as well as countries in which unnecessary travel is recommended against. On the vaccination tab, local clinics that provide needed vaccines are listed per state while tips for self medicating expecting mothers and children is listed under the Special Groups tab. The CDC holds an array of invaluable information that, even if you are not a traveler, can be viable to your everyday health. The World Health Organization website lists helpful and practical information on the general precautions of traveling in any country. This includes medical examination references for before and after travel, travel-related risks, medical kit and toiletry items to pack, etc.
Both of these websites are highly beneficial to both domestic and foreign health. Just as you come to a foreign county and are unaware of risks that lie before you, we are also unaware of risks that stand beside us in the grocery line. Every day, millions of travelers enter the United States, whether they are returning Americans or visiting foreigners. We never know what risks we face when we leave our home each day. Infectious disease outbreaks can happen anywhere! An unknown traveler from an infected area can travel to the next town, country or even continent and infect another person causing the beginning of an outbreak. It is up to us to educate ourselves on the recent outbreaks that we are possibly exposing ourselves to. We must be able to identify such illnesses and prevent them from transmitting. This may save our own life as well as the lives of others!