So you see

Eradication of communicable disease isnt simple Controlling infection can be a P.H. Objective Public Health efforts must be long term and consistent Evidence-Based practice must be up to date for P.H. efforts to continue to work

Eradication
No Animal Reservoir
Does not affect any other species that can then infect additional humans. SO, if the disease is eliminated in humans, it cannot hide in other reservoirs and later reinfect.

Short Persistence in Environment

Cannot persist more than a brief amount of time in environment w/o host

Absence of long-term carrier state

Person cannot transmit disease post recovery.

Disease produces long-term immunity

After recovery, immunity is established preventing second infection

Eradication
Vaccination establishes long-term immunity
Presence of vaccine in host continues to provide protection, no additional strains can infect

Herd Immunity provides protection for others

80% of population can be vaccinated to protect remaining ppl

Easily Identified Disease

Exposed persons are easily observed and diagnosed

Effective Post Exposure Vaccination

Vaccine is effective after exposure to disease has occurred.

The more these criteria can be met, the better the odds of eradication. Analysis of disease epidemiology must be extensive to conclude that a disease has potential for eradication.

Control
Because eradication is not often viable, we must look to control of infectious diseases Spanish Flu killed 50 million ppl Pandemic Influenza is a real threat: Seasonal flu kills 30,000/year Annual Impact of seasonal flu in U.S.
3.1million hospitalized days 31.4 mil outpatient visits $10.4billion direct medical costs $16.3billion lost earnings from illness and death Total economic burden of $87.1billion.

Low effectiveness of screening for new strains New anti-virals can slow transmission but create resistance

Control
Seasonal Influenza control effort:
Increase research on vaccines and administration Encourage isolation/quarantine Drug use in pandemic events Staying healthy (MRFR)

Potential for Eradication

Influenza
Disease is limited to humans, i.e., no animal reservoir? Limited persistence in the environment? Absence of long-term carrier state? Long-term immunity results from infection? NOAnimal reservoirs exist YES YES-but transmission occurs rapidly/easily NO mutations in strains make immunity difficult to achieve

Vaccination confers long-term immunity? Herd immunity prevents perpetuation of an epidemic? Easily-diagnosed disease? Vaccination effective postexposure?

NOmutations make vaccinations inconsistent NO-mutations make vaccinations inconsistent NORequires testing, testing often late for treatment NO

Control v. Eradication
Rabies 20-60 day incubation period post infection
Attacks central nervous system eventually causing encephalitis Acute symptomology: violent movement, uncontrolled excitement, hydrophobia, mania, encephalitis 1-2 weeks from acute symptoms to death 55,00 deaths annually 2 in the United States!

Control
Rabies
Very first vaccine was for rabies, but it was diabolical 1887-1970 vast improvements in science of vaccinations led to safe vaccines that are now administered 30,000x annually

How did rabies get reigned in??? multiple levels of intervention Pre-exposure mandatory vaccination for dogs/cats, oral vaccines administered to wild animals en masse
Post-exposure-vaccine works after exposure! Immediately following bite of wild animal Quarantine of domestic animals and then vaccine

Successful control is possible, but also requires multi-level prevention techniques and coordinated efforts.

Potential for Eradication

RABIES
Disease is limited to humans, i.e., no animal reservoir? Limited persistence in the environment? Absence of long-term carrier state? Long-term immunity results from infection? NOAnimal reservoirs exist NO-can survive in saliva/blood for months NO-carriers can be asymptomatic long periods NO

Vaccination confers long-term immunity? Herd immunity prevents perpetuation of an epidemic? Easily-diagnosed disease? Vaccination effective postexposure?

NOreadministration is required YES-in multiple species, at multiple stages NO-at time of infection, assumptions must be made YES-prior to entering chronic phase

Friday Fun Facts

Deduplicated Discharges * & Rate*, Infectious and Parasitic Diseases, Race: All Races, Ages: All Lifestages, Payor: All Payors SELECTED YEARS TOTAL DEDUPLICATE DEDUPLICATED DISCHARGE D DISCHARGES RATE Georgia Clarke 276,392 2,595 276.8 217.1 FLU 10.4 14.8

Deaths & Age-Adjusted Death Rate, Infectious and Parasitic Diseases, Race: All Races, Ages: All Lifestages 2000-2010 DEATHS AGE-ADJUSTED DEATH RATE FLU 0.3 Georgia 24,041 30.6 0.8 Clarke 161 20.3

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