Outbreak

Protocols and Containment

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Where there is life, there is disease, and where there is disease, there are men and women dedicated to studying, and hopefully preventing, further outbreaks. For thousands of years, certain conditions served as breeding grounds for disease, and dedicated epidemiologists researched the incidence, distribution, and the conditions that were enabling these diseases to spread and grow.
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The first known significant epidemiological investigation took place during the outbreak of cholera in London in 1849. At the time, knowledge of germs and bacteria – such as Vibrio cholerae, the bacterium responsible for cholera – was minimal. Physician John Snow suspected that those sickened by cholera and exhibiting telltale signs of the disease including vomiting, muscle cramps and diarrhoea severe enough to lead to death, had something in common. Upon further investigation, in 1854, Doctor Snow traced the outbreak back to, of all things, a water pump near Broad Street in London’s Soho district. His discovery was remarkable for a number of reasons, primarily that it was water contaminated with faeces from cesspools and not air, as had previously been believed, that was responsible for the outbreak.

Sanitation in London, as in many major urban centres at the time, was atrocious. Many people were packed into one area, had poor hygiene, and shared dirty water from the same pump. The disease saw outbreaks in several parts of London. During the first three days of September 1854, 127 lay dead. Just one week later, the death toll had risen to 500 and over 600 by the time it ended.

The outbreak of cholera in London is only one example of how quickly and viciously illness can spread when conditions are right. Poor sanitation, a lack of potable water, insufficient hygiene, and sick persons crammed into living spaces with healthy people still see contagious illnesses spread like wildfire to this day. In rooming houses, hostels, and senior care facilities, where many residents are in a weakened condition, bacteria transmitted by coughing, sneezing, or even talking can make an entire facility sick in a very short time.

Fortunately, there are institutions around the world dedicated to studying the spread of diseases and investigating ways of stopping them. In the United States, there are the Centers for Disease Control and Prevention (CDC). With its headquarters and main laboratories in Atlanta, Georgia, the CDC researchers track disease origins and occurrences and devise methods for their control and prevention.

Over the centuries, untold millions have died worldwide from of breaks of the plague, cholera, smallpox, and a host of other diseases. In recent decades, mankind has had to face other illnesses including human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS) in the late 1970s, Ebola virus disease (EVD, formerly known as Ebola haemorrhagic fever), and Legionnaires’ disease (a form of pneumonia caused due to Legionella bacteria in air-conditioners, hot water tanks, and cooling towers).

In 2002, the world experienced severe acute respiratory syndrome, better known as SARS, and outbreaks of avian flu. And following the terrorist attacks on American soil on September 11, 2001, there was a widespread fear of the spread of disease through biological warfare, with deadly anthrax spores being mailed to news agencies and two Democratic United States senators.

In Australia, there are organizations dedicated to monitoring and sharing knowledge about the spread of diseases. These groups include The Australasian Epidemiological Association, which develops and promotes the discipline of epidemiology in Australasia; the Australian National University’s National Centre for Epidemiology & Population Health; the Australian Government’s Department of Health; and others. Some, such as the Centre for Chronic Disease Prevention (CCDP), are focused on communities in Far North Queensland to improve the lives of residents and address the spread of modern-day health issues, including diabetes, heart, and renal disease.

Historically, Australia has experienced devastating diseases. Prior to the arrival of Europeans, indigenous persons suffered very little from communicable disease. However, with settlement came illnesses including measles, scarlet fever, tuberculosis, syphilis, and ‘colonial fever’ (typhoid) in the 1870s, much of it spread through crowded conditions and the intermingling of human and animal waste.

As shipping routes grew, the dreaded plague reached Australia in 1900, which many at the time still believed was spread via human contact and not through epizootic infection among rats. Soon after the first infection, many others continued between 1900 and 1925, killing hundreds, particularly in Sydney and all the way to North Queensland.

In recent years, Australia has not been immune from diseases affecting other nations. There were outbreaks of SARS in 2003, along with other illnesses. As of mid-December, 2009, Australia had documented 37,537 confirmed cases of swine flu (H1N1 influenza). And in mid-2015, newspapers cautioned that it was only a matter of time until chikungunya – a viral disease that is transmitted to humans by infected mosquitoes and causes nausea, rashes, debilitating muscle and joint pain, and fatigue – would hit Australian shores, years after it emerged from Africa and rapidly spread through India, Papua New Guinea, and the Pacific Islands.

Curiously, in late 2015, syphilis, an infectious disease spread through sexual contact or kissing, made a dramatic recurrence across northern Australia. The recent spike in the disease – the worst outbreak in thirty years – triggered concerns about the sexually transmitted infection (STI), prompting the distribution of condom wallets with a cartoon and the wording “saddle up for safe sex” to be distributed at Kimberly rodeos. The goal was to encourage young Aboriginals to take precautions to prevent the spread of the disease. Tragically, syphilis is potentially disastrous to pregnant women, often resulting in stillbirths or severely disabled newborns. If left untreated in adults, syphilis can result in permanent damage to the brain, heart, and cause blindness and even dementia.

Today, groups of individuals can be exposed to diseases which rapidly spread due to international travel. Likewise, modern food processing methods have created breeding grounds for infectious diseases, particularly as our consumption of animals containing potential pathogens, such as pigs, chickens, and cows, continues to grow and diseases mutate into infectious strains affecting humans.

And although not communicable, today’s sedentary lifestyle has seen numbers spike worldwide for cancer, diabetes, and heart disease from the consumption of high-sugar and high-salt processed foods.

The ever-changing weather of late November saw outbreaks of “thunderstorm asthma” causing widespread breathing problems in Melbourne. A rare condition occurring when high levels of rain-soaked pollen break down into easily-inhaled microscopic fragments, this condition following rainstorms sent hundreds to hospital and killed at least four. Even if they are not well-known as smallpox or influenza, it is vital for all outbreaks to be continually monitored in the hopes of preventing widespread illnesses and death in the future.

Worldwide, communicable diseases remain a constant threat. In Australia, the Office of Health Protection (OHP) remains involved in many activities to reduce the incidence of infectious diseases and the devastating impact they have on human health, along with their social and economic effects. According to the OHP, “communicable diseases remain a significant public health priority both in Australia and internationally. The problems facing Australia today are diverse: foodborne diseases; emergence of antimicrobial resistant bacteria; sexually transmitted diseases; vector-borne diseases; vaccine-preventable diseases.”

As it holds a key role as a coordinator of the national response to communicable disease outbreaks, the OHP is a leader in developing practice guidelines and national public health policy. Across Australia, agencies such as the Communicable Diseases Network Australia (CDNA) strive to achieve a national perspective. One of the keys to the containment of communicable diseases is surveillance and vigilance.

Groups conduct extensive research and coordinate with other agencies to collect data, such as the Kirby Institute for infection and immunity in society and the National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases (NCIRS). Data is distributed through Communicable Diseases Intelligence (CDI), a peer-reviewed scientific quarterly journal published by the Office of Health Protection, Department of Health, which disseminates knowledge about communicable diseases relevant to Australia.

Stem Cells

The scientific study of stem cells has existed for a long time and has already contributed greatly to modern medicine. As scientific inquiry continues to advance and as discoveries gain more traction and acceptance in the scientific and medical communities, the true breadth and potential of this area of study can start to be realized.

October 17, 2017, 9:10 AM AEDT

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