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Infectious Diseases Are Back In Unusual Places By Farouk Martins, Omo Aresa
It could be exciting to watch the chase of one man with a case of (MultiDrugResistant) tuberculosis all over by the richest Country but it does not hurt to say: we told you so. Epidemiologists have been warning about the resurgence of infectious diseases for two decades. In places where almost full immunization program have been so successful, few parents had taken exception to its implementation for religious and philosophical reasons. Others fear immunization more than the disease itself but autism fear has been disproved.
We had a similar reservation in Nigeria in 2003 but ours was based on sincere suspicion of infertility agent in the polio vaccine. By the time the opposition to polio vaccine was solved, thanks to cooler heads between our experts who demanded new “clean” vaccines suitable for local standard and our religious leaders, cases went from 355 in 19 States to 682 in 31 States. Note, before antibiotics and the development of vaccines for infectious diseases, patients were isolated within family compounds or in government sanatoriums.
Nevertheless, the chase of this individual with a resistant form of TB had appropriately caused more than a stir while those in the developing countries who have to deal with so many cases in endemic areas wonder what type of epidemic broke out in the USA. The lesson learned about three decades ago by my cohorts became useful from time to time. In an environment free of infectious diseases, one case is as much an epidemic because of its tendency to spread, as many cases in an endemic area. Say what?
Epidemiologists do not fold their hands while infections, no matter the number of cases, increase by one more person. So in a village, a man went to see a doctor for gonorrhea infection. Fortunately he met a public health doctor who wanted to see his girl friend or wife. Hiding in macho custom, he said that it was forbidden. It was explained to him that if he was treated alone, he would come back again and again for the same treatment. But if he would bring his partner, all of them would be treated without reoccurrence.
It is the same attitude in the developed countries where HIV disproportionately grows in minority populations especially amongst women of color because men would never admit they had it. As they go and infect multiple partners, they play macho men in the neck of the hoods and play sissy outside. It is made worse by the use of drugs and dirty needles.
Some resistant forms of tuberculosis were found amongst a subpopulation with HIV virus in South Africa. Only one of those 25 cases survived. The chances are that they are also present in other populations with HIV virus in other parts of the world. It is a double yoke for people carrying the cross of these diseases. As many sick people spend a considerable amount of their time and greater amount of meager earning on food to sustain the family, additional burden of resistant TB, incurable AIDS and malaria; it’s enough to succumb to
Therefore a cautious relief awaits the final results of the new TB vaccine tested in Gambia and being tested in South Africa that is supposed to boost the immune system T cells with the tuberculosis BCG vaccine administration. This may overcome the genetic mutations detected in the laboratory vaccines that lower the effectiveness of the new strains over the years compared to the old strains.
Out of the estimated 8.8 million people that develop normal form of tuberculosis; it still kills more than two million people a year including some cases that do not even respond to treatment called Extensively Drug-Resistant TB. While both Multi Drug-Resistant and XDR (ExtensivelyDrug-Resstant) TB are slightly different, XDR is resistant to the most effective first and secondary line of drugs. The best effort is to provide comfort.
In the case of Polio, there is no cure, but it is easier to eradicate than HIV or Malaria because it is hosted in our guts (intestine). Since we have moved away from monolithic community health workers to those who can counsel on malaria, tuberculosis, AIDS and polio at the same time, the amount of time spent on polio eradication enhances the others’ prevention. Moreover, polio vaccine must be provided about four times before the age of five so while counseling on other diseases, booster shots of polio vaccine can be given.
The advantage of the Oral Polio vaccine over the Inactive vaccine is the ability to induce both intestinal and local immunity interrupting wild polio virus transmission in the environment. Inactive polio vaccine also protects an individual who gets it but it can not prevent unhygienic fecal-oral spread from the intestine. So in many developed countries where most of the children are immunized, inactive polio vaccine is recommended as in cases of weakened immune system and in developing countries where it is essential to deal with environmental transmission, oral polio vaccine is recommended.
But for the AID virus that gained attention in the gay community of the USA, infectious diseases had become tropical diseases studied in the schools of Public Health. Schools of Hygiene were short of resources to undertake major researches. For a while, the gays in US community were condemned as if it was a curse from the gods for their promiscuous behavior. May be if Epidemiologists and other researchers got as much cooperation when HIV first gained notoriety in gay sub-population as when the whole world chased the man with resistant TB, AIDS problem could have been contained then and solved now.
The irony was that if it was in Asia or Africa that such an infectious disease broke out in a sub-population, World Health Organization, researchers from School of Hygiene in England and Center for Disease Control in Atlanta would have swoop the area to contain its spread. It is more difficult in the USA to temper with individual rights and quarantine a local area. It is even difficult to curtail the movement of an individual as demonstrated by the chase of the man with multi drug resistant tuberculosis. He was “advised” not to travel. He did and eluded many safety nets in different countries.
Fortunately, the world has become more understanding of how these infectious diseases can travel from one continent to another regardless of where they originated from. Avian flu virus or Severe Acute Respiratory Syndrome (SARS) amongst many diseases has no geographical boundary.
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