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I. Introduction A. Past
EIDs A. In the
New World III. Center for Disease Control (CDC) A. Mission
statement IV. Issues V. Conclusion |
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Emerging infectious diseases (EIDs) are the third leading cause of death in the United States and the first leading cause of death worldwide (3). Thus, should EID's be considered an oncoming threat to human existence or is it God's response to our unbiblical stewardship of the Earth or is it nature's practical solution to overpopulation. Since the beginning of time, human existence has been overwhelmed by threatening diseases. To begin with, leprosy and other highly contagious skin diseases affected humanity as early as in the days of the Old Testament. Due to its rapidly infectious manner and its degrading and dehumanizing results, skin-diseased victims were often ostracized and permanently confined to live in isolated caves. During the Medieval and Renaissance historical periods of Europe, one-third of its population or 25 million people were unmercifully obliterated in a mere two years by the Bubonic plague (10.a). However, the wrath of the Bubonic plague did not end in those two years, as it continued to invade the European expanse for the next two hundred years (1348-1530) as an epidemic commonly known as the "Black Death" (10.d). The next Bubonic plague outbreak occurred in south-central, southwestern, and northern India accompanied also by the Pneumonic plague in 1994 (10.c). An outbreak of Marburg disease, a type of hemorrhagic fever, was observed in laboratory workers in Marburg, Germany and Belgrade, Yugoslavia. These workers were accidentally exposed and infected with the virus resulting in 31 cases, in which 7 people died. In 1976, the Ebola virus, another type of hemorrhagic fever, imploded in Central Africa claiming some 500 victims. Until this very day, the Ebola virus is still continuously reappearing throughout the African continent (10.f). Presently, humanity is still being threatened by new emerging and reemerging infectious diseases. In 1994, Gloucestershire, England was assailed by the infamous and unstoppable "flesh-eating bacteria" or Necrotizing Fasciitis, which virtually devoured its victims to death (2). In March of 1996, 2.6 million cows were slaughtered in the United Kingdom in an effort to rid themselves of the invasion of the Mad Cow disease. Another term for Mad Cow disease is Bovine Spongiform Encephalopathy (BSE), which is a disease observed solely in cattle. Mad Cow disease or BSE is transmitted to humans via the consumption of infected beef resulting in a fatal human brain disorder known as Creutzfeldt-Jacob (CJD). As a result of this "British beef scare" 32 people died of CJD, of whose deaths were linked to Mad Cow disease (10.e). Similarly, 1 million chickens were gassed to death in Hong Kong in 1997 in order to prevent the already undertaking spread of Influenza A (H5N1) or "Bird Flu". The worst Influenza A epidemic occurred in the United States killing 20 million people in 1918 (10.b). In New York last month, five people died of a rare encephalitis disease caused by a West Nile-like virus, which is believed to have been transmitted from birds, who researchers found to have died from the West Nile virus (8). Finally, and probably the most menacing disease ever in human history would have to be HIV and AIDS, which is still infecting the human population worldwide in gross amounts. There are several points of view and standpoints to take when considering and responding to the emerging infectious diseases affecting our world. For example, from a scientific point of view one might consider EIDs to be an oncoming threat to the existence of the human population. Therefore, in response to this belief it might become one's duty as a scientist to work towards a solution to this problem. One plausible response would be to eradicate or prevent the spread of such diseases by way of new scientific and medical technology. However, the use of scientific and medical technology always tends to bring up ethical issues that must be taken into consideration and resolved. Perhaps, better worded, "We are now embarking on our most daring explorations, unraveling the mysteries of our inner world and charting new routes to the conquest of diseaseÖ But as we consider how to use the fruits of discovery, we must also never retreat from our commitment to human values, the good of society, our basic sense of right and wrongÖit is up to us to determine whether it [technology] will be used as a force for good or evil" (4). Thus, a scientific point of view might consider EIDs to be a threat to humanity and must be dealt with by means of new technology before it is too late. Another way to look at EIDs would be through the eyes of an animist. An animist is one who believes that God communicates to us through nature (6). Thus an animist would consider natural disasters and EIDs as bad omens and warnings from God and His response to our human baseness. For example, animists took the outbreak of the Ebola virus as a retort to the Earth's overpopulation and deforestation; therefore, humanity is to blame for releasing the virus from its confinements by being unbiblical caretakers of their land. Furthermore, an animist might not seek the solution to EIDs in medical technology, but they might find a solution in a reflection and reassessment of their life styles in order to prevent further "signs" from God. Finally, one other standpoint could be one of a futurist. Beginning with our prehistory and until this present day, the human race has observed, recorded and explored the outer and larger world found beyond our atmospheric boundaries, but not until the nineteenth century did humanity even begin to wonder about the unknown, inner and miniscule world found within our own terrestrial limits and bodies-the small yet infinite world of molecules, atoms, protonsÖ, and DNA, chromosomes, genesÖ Taking it even one step further, maybe it is time to focus on science through different dimensions. We might discover that humanity is yet the minute world for other and more larger living beings or we might discover that our roles could be switched. Maybe it is time to hear the point of view of an outsider looking in, "I'd like to share a revelation that I've had during my time here [Earth]. It came to me when I tried to classify your species [humans]. I realized you are not actually mammals. Every mammal on this planet instinctively develops a natural equilibrium with the surrounding environment, but you humans do not. You move to an area, and multiply, and multiply until every natural resource is consumed. The only way you can survive is to spread to another area. There is another organism on this planet that follows the same pattern. Do you know what it is? A virus. Human beings are a disease, a cancer of this planet, you are a plague and we [EIDs] are the cure" (9). Perhaps we are a cancer to the Earth and EIDs are her antigens! For the moment, a futuristic point of view might seem to be extremely farfetched, but without believers in new realities and without dramatic curiosities humanity would have never have made it this far. According to an informational and educative resource from 1997, the EIDs affecting the world currently are the following. In North America the prevailing EIDs are Streptococcus A, E.coli 0157:H7, Influenza A, AIDS, Lyme disease, drug-resistant pneumococcus and cryptosporidiosis (1). Streptococcus A is an airborne species of bacteria, which inhabits the human respiratory tract causing diseases like strep. throat plus most upper and lower respiratory tract infections. E.coli 0157:H7 is a foodborne pathogen associated with contaminated meat. Influenza A is a viral pulmonary disease. AIDS (Aquired Immunodefficiency Syndrome) is a sexually transmitted disease, which weakens its victim's immune system. Lyme disease is an inflammatory disorder caused by spirochete and is transmitted via deer ticks, ixodes. It usually results in arthritis and neurological symptoms. Drug-resistant pneumococcus is a type of bacterial pneumonia in adults. Finally, cryptosporidiosis is a waterborne disease caused by the protozoan, Cryptosporidium parvum, found in animal fecal matter. Cryptosporidiosis is common in many AIDS victims (1). EIDs that are common in Central and South America are the Hanta virus, vancomycin-resistant enterococcus, Dengue, Pandemic cholera, and Venezuelan hemorrhagic fever (1). The Hanta virus causes severe respiratory failure by filling the lungs with blood plasma and is transmitted through the urine and saliva of its host (1). Vancomycin-resistant enterococcus is a type of bacteria, which inhabits the human intestinal tract and this particular strain is resistant to the vancomycin antibiotic (7). Dengue fever is a virus, which is transmitted to humans via mosquitoes (1). Pandemic Cholera is caused by Vibrio cholerae and is transmitted through human fecal matter. It grows in the human gastrointestinal tract causing severe diarrhea (1). EIDS that are predominant in Africa are the Rift Valley fever, Lassa fever, AIDS, Yellow fever, E.coli 0157:H7 and multi drug-resistant Shigella dysenteriae (1). Rift Valley fever is a viral type of hepatitis most common in animals, but present in humans as well (7). Lassa fever is a viral hemorrhagic fever. Yellow fever is caused by a small RNA virus and transmitted through mosquitoes. Shigella dysenteriae is a bacterial form of dysentery with acute inflammation of the intestinal tract, which leads to bleeding ulceration (1). The EIDs in Asia Minor are Cholera, Pneumonic plague, Japanese encephalitis and the EID current in Europe is Diptheria and in Australia it is Dengue fever (1). Japanese encephalitis is an inflammation of the brain (7). Diptheria is an inflammation of the pharynx caused by Corynebacterium diptheriae (1). Center for Disease Control (CDC) The Center for Disease Control and Prevention (CDC) is a U.S.-based agency of the Department of Health and Human Services. CDC's mission is to promote health and quality of life by preventing and controlling disease, injury, and disability. The key to preventing and controlling EIDs is their early detection. Through the CDC and its sister organization, Agency for Toxic Substances and Disease Registry (ATSDR), early detection of threatening EIDs is possible (11). Such organizations are comprised of laboratories that usually take care of identifying new diseases and they are usually the first to identify which new diseases will be problematic (3). Procedures for Detection & Prevention According to the Science article written by Binder, who is a member of the National Center for Infectious Diseases (NCID) and the CDC, some of the factors, which contribute to the propagation of EIDs are four. First of all, the factor that contributes to the proliferation of EIDs to a great extent is the environmental factor, which includes global warming, inadequate sanitation, and urbanization of rural areas. Another factor is the social issue, which includes inadequate health care and an increase in international travel. Also demographic problems such as an increase in the aging population, industrial development and overpopulation prove to be significant donors to the augmentation of EIDs. Last but not least, microbial evolution, due to misuse and abuse of antibiotics is another relative and vital problematic factor. In order to manage these factors, CDC and other pertinent organizations have set out to organize campaigns of control and prevention. In efforts to control EIDs, CDC has organized "networks of medical specialists in emergency medicine, infectious diseases, and travel medicine" in preparation for potential outbreaks (3). Along with these networks there are also laboratory facilities around the country prepared to participate and assist in controlling unsuspected outbreaks with adequate staff, equipment, and level 4 biosafety levels (11). Perhaps it would be more effective to control EIDs by preventing any occurrences in the first place. Binder, in her article, proposes a few techniques for prevention. On method would be to screen and treat all blood and blood by-products to prevent the transmission of hepatitis B and HIV. Another method would be to apply "intrapartum antibiotics to women who have a high risk of passing group B streptococcus to their newborns" (3). Finally, she also proposes to form an antimicrobial campaign in efforts to reduce the overuse of antibiotics thus preventing disease-causing microorganism from becoming immune to our antibiotics. Probably the most essential component for controlling and preventing EIDs would be a worldwide network for interactive and rapid communication. Ideally, this network would also contain a systematic collection of information from global outbreaks and the procedures followed to control these infestations. For example, PulseNet or the National Molecular Subtyping Network for Foodborne Disease Surveillance has greatly contributed to the prevention and most importantly the control of foodborne illnesses by making use of a speedy communication system (3). In addition, due to an increase in international travel and global commerce, EIDs are very likely to travel across borders making the spread of EIDs a global concern. Thus, Binder suggests preventative methods such as consuming only safe food and water, immunizations, improvement of personal hygiene, and reduction of the inappropiate use of antibiotics. Furthermore, she also suggest the production of new vaccines such as DNA vaccines and edible vaccines, which would be safer, more effective and easier to produce, store, and to transport to remote parts of the world. However, some of these preventative and control methods do tend to bring up certain ethical issues. First of all, if we were to employ a worldwide communication network and screen individuals for HIV, would we be invading their right for privacy? Would vaccines for the elderly, the fastest growing minority, be a wise way to spend funds reserved for fighting EIDs? Secondly, with an increase in international travel and business commerce, how are we to stop the transport and spread of diseases across borders? What about the lack of resources and inadequate health care facilities and equipment in third world countries? Is the incorporation of newer scientific and medical technology the right answer to this dilemma? Finally, how are we supposed to prevent and control EIDs? The answer to this question might lie in our personal answer to the following question. What are we, are we scientists, naturalists, futurists or a combination of two or all? I believe that a response to this question will enable us to arrive to a practical solution to a global problem. 1. Atlas, R. (2nd ed.). (1997). Principles of Microbiology. Kentucky: University of Louisville, McGraw-Hill. 2. Bardorff, D., & Roemmele, J. (1999, Feb. 2). "National Necrotizing FasciitisFoundation". http://www.unff.org/graphic.html 3. Binder, S., Levitt, A., Sacks, J. J., & Hughes, J. M. (1999, May 21). Emerging Infectious Diseases: PublicHealth Issues for the 21st Century. Science, 284, 1311- 1312. 4. Clinton, B. (1997, June 2). Science in the 21st Century. Science, 284, 1951. 5. Discovery Channel Online. (1999). "Epidemic! On the Trail of Killer Diseases". http://www.discovery.com/exp/epidemic/dengue/micromonsters.html 6. Nida, E. A., & Smalley, W.A. (1959). Introducing Animism. New York: Friendship Press. 7. Stedman, T. L. (24th ed.). (1982). Stedman's Medical Dictionary. Baltimore/London: Williams and Wilkins Inc. 8. Steffen, S. (1999, Oct. 22). "CDC Confirms West Nile Virus Caused New York Deaths". http://www.cnn.com/HEALTH/9910/22/west.nile.01/ 9. The Matrix, videotape, dir. Andy & Larry Wachowski. With Keanu Reeves, Laurence Fishburne, Carrie-Anne Moss, Hugo Weaving, Gloria Foster, Joe Pantoliano. Warner Bros., 1999 (136 mins.). 10. The Wonderful World of Diseases. (1999, Oct. 23). http://www.diseaseworld.com/disease.htm a. Janis, E. (1999). http://ponderosa-pine.uoregon.edu/students/Janis/impact.html b. Larson, E. (1998, Feb. 28). http://www.pathfinder.com/time/magazine/1998/dom/980223/cover1.html c. Medical College of Wisconsin. (1994, Sept. 30). http://www.intmed.mcw.edu/ITC/Plague.html d. Oshiem. (1999, Oct. 28). http://jefferson.village.virginia.edu/osheim/plaguein.html e . University of Wisconsin. (1999, July 14). http://whyfiles.news.wisc.edu/012mad_cow/mad_cow_main.html f. Webster, R., & Granoff, A. (1995). http://www.bocklabs.wisc.edu/eov-ebola.html 11. United States Department of Health and Human Services. (1999, Oct.13). "Centers for Disease Control and Prevention". http://www.cdc.gov/aboutcdc.htm |