By: Melanie Thompson
During the Ebola outbreak in West Africa in 2014, the world tuned in to watch as an epidemic with dire consequences unfolded in three nations. With the world having become a global community—not only is the information feed instantaneous from around the globe, but you can jump on a plane and be in a new country in just a few hours—it has become increasingly important to pay attention to the health status of nations that aren’t your next door neighbors. Ebola came to America when Thomas Duncan walked into a Dallas, Texas hospital on September 25, 2014. All of a sudden, we became increasingly alarmed as to how we were going to keep this disease at bay in our own country.
During this timeframe, David McCandless from Information is Beautiful (www.informationisbeautiful.net) created a great graphical representation of which diseases are most contagious and which diseases are most deadly. It can be found here: https://bit.ly/2pZo35b. On his graph, the diseases are strewn on the X-axis (left to right) based upon how contagious they are. On the extreme right side of the graph are diseases like measles, malaria, whooping cough and mumps—they are easily spread from one person to another. These fall into Mr. McCandless’ category of “Vaccinate Now!” However, as you move from the bottom of the graph to the top of the graph, you go from not being very deadly to being very deadly. Untreated rabies falls into the spectrum here as being 100% fatal. But you can also see from this graph that it is not very contagious. More of a concern would be diseases like tuberculosis, polio, smallpox, diphtheria and dengue fever. These are more infectious than rabies, but they aren’t as deadly. However, with tuberculosis having a case fatality rate near 70%, this disease is of concern, particularly since it is more contagious than rabies.
Vaccinations have made it possible to survive on this planet even when infectious diseases occur in the natural environment. Smallpox was eradicated thanks to vaccines; polio is next on the list to, hopefully, be eradicated. These are horrifying diseases, but because we don’t have a current memory of just how horrible they can be, I thought I would resurrect these diseases briefly so that you can decide for yourself if you are glad they are no longer circulating in our North American population.
Prior to 1960, there were three diseases that were at the forefront of deaths caused by infectious diseases and smallpox was in that mix. In the 1950’s there were about 50 million new cases of smallpox each year. The global death toll from smallpox in the 20th century is estimated to be around 300 million people. As a comparison, the New York Times estimated that in the 20th century, 100 million people died as a direct or indirect result of armed conflict. In other words, three times as many people died from smallpox vs. war in the 20th century. Thirty percent of the people who contracted smallpox died from it, and often, those who survived were left with permanent scarring over their bodies and some were even left blind. To see pictures of what smallpox looked like, click this link: https://www.cdc.gov/smallpox/about/index.html
Polio is not seen very often in the United States, but there are pockets of this disease in other countries. The poliovirus is spread through the oral-fecal route—that means you had feces (poop) from an infected person on your hands, and you touched your mouth, or an object that was contaminated with the feces of an infected person came into contact with your mouth if you ended up with polio. (Just one more reason we preach, “Wash Your Hands!”) Occasionally, the disease is transferred by coughing or sneezing, too.
Some people who are infected with the poliovirus have flu-like symptoms; others may develop more serious symptoms like having the feeling of pins and needles in their legs, contracting meningitis (4% of those who get polio have this symptom) or serious paralysis occurring in the arms, legs and other muscles throughout the body (including the diaphragm, which can then affect a person’s ability to breathe). To see a picture of an iron lung, a device for people who could not breathe on their own, please visit the Public Health Image Library https://phil.cdc.gov/Details.aspx?pid=19382. Fortunately, we now have an effective vaccine for this disease, and workers from across the globe are working diligently to stop the spread of polio in those areas where the disease still occurs.
The final disease I wanted to talk about is measles. Many people think measles is no big deal. The disease starts out with a high fever, cough, runny nose and watery eyes; eventually, the infected person will develop white spots in their mouth and will then get small, red dots that appear as a rash that covers the body.
However, some people will get severe complications: 1 out of every 20 children with measles will get pneumonia—this is the most common cause of death from measles that occurs in young children. One child out of every 1,000 will develop encephalitis which can lead to convulsions or will leave the child with an intellectual disability. And worst of all, for every 1,000 children who get the measles, two of them will die from the disease. Ask yourself this, then: In a room full of 500 babies with measles, one of them gets to die; is this acceptable? In 2016, there were 89,780 measles deaths globally. The four counties our health district covers (Madison, Stanton, Cuming and Burt in Nebraska) have a total of around 57,000 and the four counties in Northeast Nebraska Public Health Department’s district (Wayne, Cedar, Dixon and Thurston counties) has a population of 32,000, for reference. Now image all of those people dead; that’s how many people died, globally, in 2016 from the measles. This is also unacceptable because we have an extremely effective vaccine that could prevent this disease from spreading. More information can be found at the World Health Organization website http://www.who.int/mediacentre/factsheets/fs286/en/ and the Centers for Disease Control website https://www.cdc.gov/measles/
There has been a growing sense that infectious diseases have gone away. In a way, they have. Vaccines have been an important tool in reducing and even eradicating infectious diseases and allowing our children to grow to old age. However, we have slowly ‘forgotten’ what those infectious diseases were like when they no longer occur in our population on a regular basis. It is important to remember just how bad those diseases can be so that we don’t let down our guard and find ourselves facing these diseases on a more frequent basis again.