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On duty with the disease detectives

The recent confirmation that Zika virus is spreading in the southern states of the United States has been met with considerable public anxiety. Infectious diseases strike a particular primal fear in populations, not least because they are perceived to be unfamiliar, strike suddenly and unpredictably, and have strong cultural associations with filth, contagion, or nuisance vectors such as mosquitoes. In our technology-driven society, words like “infection”, “outbreak”, “epidemic”, and “plague” seem to hark back to a time when humans were at the mercy of the natural world. Surely by now modern medicine should have sorted this out?

Health protection doctors and nurses are familiar faces on the frontline of the response to the Zika epidemic, and have had high profile roles in other recent outbreaks such as Ebola, measles, and pandemic flu. Less widely known however is their day-to-day role in detecting and responding to local infections and outbreaks. For example, timely action to provide antibiotics and vaccination to university students who have been in contact with a case of meningitis infection may prevent further tragic cases. Identification of the source of contaminated food at a wedding vomiting outbreak could prevent other couples having their special day ruined.

Health protection professionals are often called “disease detectives”. The comparison is apt: they have to be highly skilled in gathering and appraising rapidly-emerging evidence, making high-pressure decisions with imperfect information, and in coordinating action from multiple different agencies and individuals. The real world is messy: information is often incomplete, especially in the first few cases of an outbreak, and quick action is needed.

1200px-mutirao_de_combate_ao_mosquito_aedes_aegypti_no_grupamento_de_fuzileiros_navais_de_brasilia_24063648524
Mutirão de combate ao mosquito Aedes Aegypti no Grupamento de Fuzileiros Navais de Brasília (Efforts to combat the Aedes Aegypti mosquito in the Brazilian Marine Corp) by Ministério da Defesa. CC BY 2.0 via Wikimedia Commons.

Disease detective work is not limited to infections. The same skills that help public health professionals to detect and respond to infections can be used with other threats to health. Such threats include fires or floods and pollution of air or land, indeed, almost any environmental threat that affects a community in some way.

Most family and hospital doctors will only very rarely see an infection that requires urgent public health action. For example, in the United Kingdom, it would be unusual for a general practitioner to see more than one individual with the feared meningococcal disease during their whole career. When the unusual does strike however, they need to be able to quickly investigate and identify, then act rapidly and effectively. If action is delayed, public health officials will always be swimming upstream trying to catch-up with rapidly escalating numbers of exposed and unwell people.

The importance of easy and timely access to relevant information continues to be demonstrated time and again with national and international infectious disease incidents, such as the outbreaks of Ebola in West Africa and the spread of Zika in South America. Detailed infectious diseases plans and guidelines are invaluable for front-line healthcare professionals and alike, but in a time constrained environment with competing pressures, simpler tools which provide clear and succinct information come into their own. Practically focused, topic specific checklists with essential actions for clinicians and public health workers (including those without a medical background) make it much easier to ensure a timely and appropriate response. Access to user-friendly information is key to demystifying health protection work – ensuring that everyone is empowered to play his or her role in protecting the public from threats to their health and inspiring others to enter the exciting and fascinating world of the disease detectives.

Featured image credit: Pictured are two researchers looking at slides of cultures of cells that make monoclonal antibodies. These are grown in a lab and the researchers are analyzing the products to select the most promising of them. Image by Linda Bartlett, The National Cancer Institute’s (NCI) Visuals Online. Public domain via Wikimedia Commons

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