Communicable Disease in the United States, Essay Example

Communicable disease is defined as an illness due to an infectious agent or the toxic products that occur through the transmission of the agent or its products from an infected person, animal or other source, such as food or contaminated water to a susceptible host. In order to reduce mortality rates among all immigrants and travelers and to prevent the introduction and spread of communicable diseases, regulations, science, and research are continually conducted and in the United States, are regulated through the government. Regulations for communicable diseases in the United States have been underway for over 100 years.  The United States Congress authorized the Public Health Service to begin collecting morbidity data on smallpox, plague, cholera, and yellow fever in 1878. As of 2012, all the states within the United States undergo disease surveillance under specified procedures given from the Centers for Disease Control and Prevention (CDC) and the Council for State and Territorial Epidemiologists. (Sickbert-Bennett et al., 2011) There has also been a list of national communicable diseases that are mandatory to be reported.  The list has increased to greater than 60 diseases.  These diseases include the diseases that have vaccinations to prevent illness (e.g. pertussis, diphtheria, Haemophilus Influenzae Type B (HIB), Hepatitis A, Hepatitis B, Influenza, Measles, Mumps, Rubella, Tetanus, Pneumococcal Disease), infectious diseases (e.g. West Nile virus), foodborne illnesses (e.g. Salmonella, E.coli), sexually transmitted diseases (e.g. HIV), and aerosol and droplet acquired diseases (e.g. tuberculosis, meningitis). With the emergence and continuance of these diseases, surveillance and reporting of these diseases has been a required regulation for the United States. In fact, the CDC has developed specific programs in order for surveillance to work properly, such as the Active Bacteria Core surveillance, influenza-related hospitalization surveillance and FoodNet.  The purpose of these programs is for the CDC to be able to determine the number of communicable disease occurrences or incidences in communicates, as well as disease outbreaks, in order to assess, prevent and control the disease.

The CDC works with the Secretary of the Department of Health and Human Services and has implemented regulations for preventing the spread of communicable diseases in the United States.  In order to help prevent the spread of transmission of communicable diseases, the Secretary of the Department of Health and Human Services has a division called the Global Migration and Quarantine which operates Quarantine stations at ports of entry, provides medical examinations of individuals entering the United States, and has an administration for foreign quarantine regulations in order to govern the transfer of animals and cargo.  In addition, the CDC has a quarantine and isolation division.   Under Federal government law, the CDC has been given the authority to follow the Federal regulations in order to prevent and control the spread of communicable diseases. (CDC (a))  The following paper describes the government laws and regulations, as well as the steps that the CDC takes in order to implement and follow the regulations.  In addition, the paper analyzes recent research and data that have been reported on communicable diseases in the United States, as well as internationally.  Furthermore, the paper provides recommendations for awareness of communicable diseases in the United States.

Federal Laws and Regulations

The United States has enforced a United States Code in the Public Health and Welfare Section, Chapter 6A of the general and permanent laws of the United States. The laws are within Title 42, Public Health Service, and Subchapter II.  Within this section, the law states that the Surgeon General is authorized to enforce regulations in order to prevent the introduction, transmission, or spread of communicable disease from foreign countries into the United States.  The law governs that there can be inspection, fumigation, disinfection, sanitation, pest extermination, and destruction of animals or objects found to be contaminated or a source of infection to humans.  In addition, there are specific communicable diseases that provide for the apprehension, detention or conditional release of individuals in order to prevent the spread or transmission.  These disease are specified under the section 361 (b) of the Public Health Service Act and are as follows: Cholera, Diphtheria, infection Tuberculosis, Plague, Smallpox, Yellow Fever, Viral Hemorrhagic Fevers and (Lass, Marburg, Ebola, Crimean-Congo, South American, and other not  yet determined).  In addition, Severe Acute Respiratory Syndrome (SARS) and Influenza also have the potential for severe public health consequences and are therefore determined communicable per the Secretary’s discretion.  In addition to the laws for communicable diseases of individuals, animals or objects entering the United States, medical examiners are required, under the Title 42 Code of Regulation to issue medical notification of their medical findings.  (CDC (a))

The CDC, under 42 Code of Federal Regulations parts 70 and 71, has been granted the authority to detain, examine and release individuals coming into the United States, as well as traveling between states, which are suspected of carrying the specified communicable diseases.  (CDC (a))  This is part of the isolation and quarantine section of the act where an ill person suspected of carrying a communicable disease is isolated and separated from healthy individuals.  This helps prevent the spread of the communicable disease.

The United States government has also implemented a Model State Health Emergency Power Act after the September 11, 2001 terrorist attack and the possibility of emerging infectious diseases and bioterrorism.  The Act grants specific emergency authority state governors and public health authorities. The act states that during a public emergency, state and local officials are able to use the necessary and appropriate property for care and treatment for patients, as well as destroy contaminated property.  In addition, they are authorized to perform vaccinations and separate individuals from the population who are exposed to the illness. (CDC (b), 6)

The National Center for Emerging and Zoonotic Infectious Diseases is another Division of the CDC that focuses on preventing diseases, disability and death caused by infectious diseases. The main focus is through a holistic point of view by establishing the connection between microorganisms and the environment. (CDC(c)

Reported Data and Statistics

The CDC continually reports infectious disease outbreaks that occur in the United States and lists these outbreaks on their website.  For instance, on November 12, 2012, the CDC posted information regarding an outbreak from a strain of Shiga toxin-producing Escherichia coli O157:H7 (STEC O157:H7).  As seen in Figure 1, there were five states, mostly in New York, with a total of 28 individuals infected and 42% requiring hospitalizations.  The site also indicates the investigation efforts of state, local and federal public health agencies.  The site also indicates the source for the outbreak and the recall efforts.

The CDC also compiles a Summary of Notifiable Diseases on a yearly basis which contains statistics for the reported notifiable infectious diseases that occurred in the United States.  The statistics are analyzed from data submitted by the state health departments through the Surveillance System.  (CDC MMWR, 2)  The data for the notifiable infectious diseases is published on a weekly basis and then finalized into an annual report.  (CDC MMWR, 4)  Each notifiable disease is formatted into a table by month, sex, ethnicity and state.  In addition, each communicable disease is graphed individually to illustrate the number of cases that were reported in the United States for that year.  An example of the reported diseases for the 2010 year is illustrated in Table 1.  As seen in Figure 2, Cholera reported cases are illustrated for the year 2010.  The report also indicates that all cholera infections were acquired during travel outside of the United States.  (CDC MMWR, 55)

Immunizations in the United States are an important part of preventing the transmission and spread of communicable diseases.  The U.S. Department of Health and Human Services, therefore, conducts studies to evaluate the success of immunizations between State and National statistics.  One study, conducted by Kruszon-Moran, et al. (2012), evaluated the antibody prevalence estimates for infection with T. gondii, HAV, CMV, HSV-1 or HSV-2 or vaccination to measles, mumps, rubella, or varicella.  The Los Angeles County (LAC) was selected for the study over a six year span.  The purpose was to evaluate the presence of antibodies to the infectious diseases in which vaccinations are offered.  LAC was chosen since the County contains more Mexican Americans than other U.S. populations.  The study found that there was no significant difference between the Mexican-American populations in LAC compared with the United States for presence of the antibodies for the infectious diseases. (Kruszon-Moran et al., 2012)

In addition to the Federal and National Organizations that provide data and statistics, statistics are developed within each of the State themselves, from their own State Department of Health and Human Services.  For instance, the Pennsylvania Department of Health not only reports the information directly to the CDC, but compiles information for State statistics and compares to National statistics.  As an example, Pennsylvania Department of Health provided information on HIV, STDs and Tuberculosis.  In fact, it was reported that in 2010, there were more than 11,000 cases of Tuberculosis reported, with over 200 cases in Pennsylvania. (Pennsylvania Department of Health) North Carolina Department of Health also indicated the number of Tuberculosis cases to be 296 in the year 2010.  The State also illustrates the decrease in amount of cases since 1980.  (North Carolina Department of Health and Human Services, 2)

Recommendations

The Federal government has helped facilitate the prevention of the transmission and spread of communicable disease through the Surveillance System.  The system must run not only at the National level, but at the local level as well.  Reporting of communicable diseases at the local level will help protect the public health.  The reporting helps ensure that the diseases are being monitored at the Federal level through the CDC.  This allows the CDC to measure any type of trend, institute control and prevention measures, identify the population at risk, identify the source, and remove source as needed.  This also helps the CDC update the notifiable infectious disease list at the National Level.  In addition, reporting cases at the local level will help with proper identification of the disease, as well as follow-up of cases or emerging new cases.  Furthermore, this will help ensure that individuals receive the proper treatment, as well as vaccinations, quarantine individuals and close areas where an outbreak has occurred.  One of the most important parts of the surveillance is for the health officials to be able to predict or identify a sudden change in the disease, as well as its distribution among the population.

The education for the public on communicable diseases is somewhat lacking.  The public should be made more aware of the type of outbreaks and the number of individuals affected per year.  Perhaps educating at the grade school and high school level, as well as mandatory health reviews in the workplace, whether, private, state, or federal operations would increase awareness, especially in regard to vaccinations.  The statistics are available for public use; however, only individuals seeking the information find these statistics.

Conclusion

The United States Congress has instituted Federal regulations in regard to reporting communicable diseases at the local, State and National level.  The authority for these regulations is provided through the Center for Disease Control and Prevention (CDC).  The CDC works with multiple agencies in order to help prevent the transmission and spread of communicable diseases in the United States through isolation and quarantine of incoming individuals, animals or products to the United States.  In addition, the CDC monitors the number of cases reported by Health Care officials, as well as creates weekly and annual reports with statistics illustrating the types of cases found, the origin, the place, the sex of individuals, age, etc.  In addition, the list of communicable diseases is continually updated based on the gathered information.

In order to continue monitoring and preventing the spread of communicable diseases, it is important for the local and State levels to follow the Federal regulations and report all incidents.  In addition, it is important for the public to be continually educated on communicable diseases and their prevention, especially in regard to vaccinations.

Figure 1.  Illustration of the number of individuals infected with the illness by state. (CDC(d))

Figure 2.  Illustration of the cholera infections reported in the United States.

Works Cited

CDC(a).  Legal Authorities for Isolation and Quarantine. 2012 Jan. [November 25, 2012].http://www.cdc.gov/quarantine/AboutLawsRegulationsQuarantineIsolation.html

CDC (b).  The Model State Emergency Health Powers Act As of December 21, 2001.  A Draft for Discussion Prepared by: The Center for Law and the Public’s Health at Georgetown and John Hopkins Univeristies.  For the Centers for Disease Control and Prevention [CDC].

CDC (c).  About the National Center for Emerging and Zoonotic Infectious Diseases.  2012. [November 26, 2012]. http://www.cdc.gov/ncezid/about-ncezid.html

CDC(d).  Multistate Outbreak of Shiga Toxin-producing Escherichia coli O157:H7 Infections Linked to Organic Spinach and Spring Mix Blend.  2012.  [November 26, 2012]. http://www.cdc.gov/ecoli/2012/O157H7-11-12/map.html

CDC MMWR.  2011.  Summary of Notifiable Diseases — United States, 2010.  Morbidity and Mortality Weekly Report. 59(53):1-111.

Kruszon-Moran, D., Porter, K.S., McQuillan, G., Goud Billioux, V., Kim-Farley, Hirsch, R.  Infectious Disease Prevalence in Los Angeles County- A Comparison to National Estimates, 1999-2004.  April 2012.  NCHS Data Brief 90:1-

North Carolina Department of Health and Human Services.  2010 Tuberculosis Statistics for North Carolina.  Department of Health and Human Services.  2011.  [November 26, 2012].  http://epi.publichealth.nc.gov/cd/tb/figures.html

Pennsylvania Department of Health.  Communicable Diseases.  2012.  [November 26, 2012]. http://www.portal.state.pa.us/portal/server.pt?open=514&objID=590074&mode=2

Sickbert-Bennett EE, Weber DJ, Poole C, MacDonald PDM, Maillard J-M. Completeness of communicable disease reporting, North Carolina, USA, 1995–1997 and 2000–2006. Emerg Infect Dis [serial on the Internet]. 2011 Jan [November 25, 2012]. http://dx.doi.org/10.3201/eid1701.100660