Lecture 18

Role: London physician during the Industrial Revolution.
Contextual Statistics:
- Average life span: 37 years.
- Conditions: Smog, fecal contamination, overcrowding, malnutrition.
Major Outbreaks: Influenza, measles, cholera, typhus, smallpox, typhoid.
Contributions:
- Authored articles on hygiene and public health.
- Developed the concept of surveillance.
- Established the first national system of vital statistics recording causes of death and mortality by occupation.
Significance: Recognized as one of the founding fathers of epidemiology.

Role: Recognized as one of the fathers of epidemiology through cholera studies in London.
Key Insights:
- Waterborne transmission opposed the prevailing airborne disease theory (miasma).
- Published a pivotal paper in 1849 on cholera’s waterborne nature relating to the Thames River contamination.
Soho Cholera Outbreak (1854):
- For 7 days, approximately 10% of Soho’s population died.
- Specific incident: 616 deaths linked to a contaminated well due to cesspool leakage.
- Response: 1866 public advice to boil water.
- Later: 1883, Robert Koch isolated Vibrio cholerae, confirming cholera’s association with contaminated water.
Methodology:
- Proposed and tested hypotheses systematically by comparing various community groups.
- Established evidence linking cholera cases to the Broad Street pump water source leading to public health interventions (removal of the pump handle).

Definition (CDC):
- Epidemiology is "the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems."
Epidemiology Triangle Components:
- Agent: What causes the disease?
- Host: Who is affected?
- Environment: Where does the disease exist?
Epidemiologists' Mission:
- Break at least one side of the Epidemiology Triangle to disrupt the connection between agent, host, and environment and halt disease continuation.

Definition (Institute of Medicine):
- Public health is “organized community efforts aimed at the prevention of disease and the promotion of health.”
Four Pillars of Public Health:
1. Assessment: Identify and monitor health problems.
2. Policy Development: Formulate public policies based on scientific evidence.
3. Assurance: Ensure that services are provided to population to improve health.
4. Research: Support the ongoing search for new knowledge in health.
Quotation: "Public health is the disease that never developed, the epidemic that never occurred and the disaster that never happened." – Wayne LaMorte, M.D., Ph.D., MPH

Detect and respond to new and emerging health threats.
Tackle major health problems leading to disability and death in the U.S.
Implement advances in science and technology to prevent disease.
Promote healthy behaviors and safe environments.
Develop leaders and train the public health workforce, including disease detectives.
Monitor the health status of the nation.

Description:
- A 24/7/365 real-time monitoring tool that integrates various data such as online news, eyewitness reports, and official statistics.
- Purpose: Provides a comprehensive view of global infectious disease status and their impacts on health.
Origin:
- Created in 2006 by Boston Children’s Hospital researchers, epidemiologists, and software developers.
- Includes a mobile app called "Outbreaks Near Me".

Discovery: First identified in 1976 near the Ebola River, Africa.
Species: Four species of Ebola virus infect humans.
Transmission: Requires direct contact; potential sexual transmission from survivors.
Incubation: 2-21 days; patients become infectious once symptoms appear, which include
- Severe fever.
- Vomiting.
- Diarrhea.
- Muscle pain.
- General weakness.
- Symptoms often mimic other diseases at the onset.
Treatment:
- Fluid replacement and maintaining blood pressure.
- Antivirals if available.
Fatality Rate: Approximately 50%.

Key Statistics:
- WHO reported 28,637 probable cases.
- Over 17,000 children became orphans.
- Economic Impact:
- GDP loss of $2.2 billion in 2015.
- Spending over $3.6 billion during the outbreak, $2.4 billion contributed by the U.S.
- Education disruption: Schools closed for over 6 months, many children took on work responsibilities.
Timeline Highlights:
- Initial outbreak began in 1976.
- In March 2014, multiple countries confirmed cases and began containment measures.
- Liberia declared EVD-free on January 13, 2016.

Cultural Issues: Traditional burial practices may hide deceased from public health efforts.
Distrust: Communities might avoid treatment centers, leading to more cases being kept at home.
Fear: Movement from affected areas can increase disease spread.
Stability Issues: Armed conflicts and instability impede public health response efforts.

Treatments explored include two systems:
- Selective investigational therapies like ReGN-EB3 and mAb114 show promise.
- Results indicate that early treatment improves survival rates.
In a study, mortality rates varied significantly based on the drug used.
The response also includes ring vaccination strategies to contain outbreaks quickly.

1st Outbreak: April – June 2018.
- 38 confirmed cases; 28 deaths.
Method: Utilized ring vaccination strategies, engaging contacts and their contacts in immunization efforts.
Containment Success: Demonstrated rapid containment methods in extensive geographical challenges.
Preparedness: Evaluated ongoing methodologies and increased readiness for subsequent outbreaks.

Public health efforts require constant adaptability to emerging challenges, leveraging history through learning, and emphasizing community trust for successful interventions.
Evolving strategies in disease control highlight the importance of international cooperation and innovative health solutions.