DR.S.I.SHELLEY, MANAGING MEMBER (CEO), LABORATORY.NY.USA, NEWGENE RESEARCH : In 1918, as the First World War was winding to a close, a mysterious disease that left victims blue in the face and gasping for air tore through the trenches crisscrossing Europe and traversed the oceans, stowed away on war ships. By the time the so-called Spanish flu had run its course in 1920, the pandemic had infected more than a quarter of the world’s population and resulted in some 30 million to 100 million deaths (1, 2). In comparison, the two World Wars are estimated to have killed roughly 77 million combined (3). By any measure, the 1918 flu pandemic was one of the worst catastrophes of the twentieth century.
In the 100 years that have passed since the Spanish flu first besieged the world, no pandemic has approached its magnitude of fatality over such a short period. Humanity’s relative good fortune with respect to infectious disease can be attributed, in part, to the elaborate global health system the world has gradually developed as a bulwark against infectious disease threats, both known and unknown. This system consists of various formal and informal networks of organizations that serve different stakeholders; have varying goals, modalities, resources, and accountability; operate at different territorial levels (i.e., local, national, regional, or global); and cut across the public, private-for-profit, and private-not-for-profit sectors.
Despite its track record, whether the global health system as currently constituted can provide effective protection against an expanding and evolving array of infectious disease threats has been called into question by recent outbreaks of Ebola, Zika, dengue, Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and influenza, as well as the looming specter of rising antimicrobial resistance (AMR). Taken together, these diseases—along with a slew of other known and unknown pathogens—jeopardize not only human health, but also various forms of social and economic well-being. Of particular concern is the lack of a single entity that has a sufficiently high-level and comprehensive view of the full range of potential threats—whether naturally occurring, accidental, or due to intentional biological attack—and of the network of organizations tasked with their surveillance, prevention, and mitigation.
To address emerging global challenges with regard to infectious disease and associated social and economic risks, we propose the formation of a multidisciplinary Global Technical Council on Infectious Disease Threats. The Council, which may be self-standing or housed within an existing organization, would strengthen the global health system by doing the following: (1) improving collaboration and coordination across relevant organizations; (2) filling in knowledge gaps with respect to (for example) infectious disease surveillance, research and development (R&D) needs, financing models, supply chain logistics, and the social and economic impacts of potential threats; and (3) making high-level, evidence-based recommendations for managing global risks associated with infectious disease.
Increased longevity is among the most remarkable aspects of human progress. Global life expectancy has increased by 24 years since 1950 (4). Large numbers of people are now living into their eighth and ninth decades (4), and life expectancy is projected to exceed 85 in several countries (and 80 in many more) in the second half of this century (5). These advances reflect precipitous declines in infectious disease mortality, for which we can thank improvements in sanitation, hygiene, the availability of clean water, nutrition, vaccination, antibiotics, medical practices, and health systems, as well as income growth.The coronavirus disease 2019 (COVID-19) pandemic is often described as an ‘unprecedented’ event, as the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) took many by surprise. However, from a scientific and historical standpoint, the novel coronavirus pandemic was entirely predictable.
In fact, scientists and experts had previously written about a possible pandemic, warning that the world was not prepared. A 2017 article published in Time by Bryan Walsh, entitled “The World Is Not Ready for the Next Pandemic,” is an example of how data was already warning of the world’s vulnerability to hyper infectious diseases.
Deadly Diseases:Epidemics throughout history
Experts warn a global pandemic will halt humanity as we know it in the next 20 to 30 years. Past epidemics may offer some insight into what the future holds. Here’s a look back at some of them.
disease may be an unavoidable fact of life, but there are many strategies available to help us protect ourselves from infection and to treat a disease once it has developed.
Some are simple steps that individuals can take; others are national or global methods of detection, prevention, and treatment. All are critical to keeping communities, nations, and global populations healthy and secure.
Vaccines and Medicines
Medicines have existed in human society probably as long as sickness itself. However, with the advent of the modern pharmaceutical industry, biochemical approaches to preventing and treating disease have acquired a new level of prominence in the evolving relationship between microbes and their human hosts.
A vaccine is a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe or its toxins. The agent stimulates the body’s immune system to recognize it as foreign, destroy it, and ”remember” it, so that the immune system can more easily identify and destroy any of these microorganisms that it encounters later. The body’s immune system responds to vaccines as if they contain an actual pathogen, even though the vaccine itself is not capable of causing disease. Because vaccines are widely used in the United States, many once-common diseases—polio, measles, diphtheria, whooping cough, mumps, tetanus, and certain forms of meningitis—are now rare or well controlled.
Vaccinated people produce antibodies that neutralize a disease-causing virus or bacterium. They are much less likely to become infected and transmit those germs to others. Even people who have not been vaccinated may be protected by the immunity of the “herd,” because the vaccinated people around them are not getting sick or transmitting the infection. The higher the proportion of vaccinated people in a community, the lower the likelihood that a susceptible person will come into contact with an infectious individual—leading to greater herd immunity.
In the past, thimerosal, a preservative that contains mercury, was used in some vaccines and other products. Use of this product became the subject of controversy, with some arguing that the substance caused autism in children. Extensive, independent research has presented no convincing evidence of harm associated with the low levels of thimerosal present in vaccines. Since 2001, thimerosal has not been routinely used as a preservative in recommended childhood vaccines.
Antibiotics and Antivirals
Antibiotics are powerful medicines that fight bacterial infections. They either kill bacteria or stop them from reproducing, allowing the body’s natural defenses to eliminate the pathogens. Used properly, antibiotics can save lives. But growing antibiotic resistance is curbing the effectiveness of these drugs. Taking an antibiotic as directed, even after symptoms disappear, is key to curing an infection and preventing the development of resistant bacteria.
Antibiotics don’t work against viral infections such as colds or the flu. In those cases, antiviral drugs, which fight infection either by inhibiting a virus’s ability to reproduce or by strengthening the body’s immune response to the infection, are used. There are several different classes of drugs in the antiviral family, and each is used for specific kinds of viral infections. (Unlike antibacterial drugs, which may cover a wide spectrum of pathogens, antiviral medications are used to treat a narrower range of organisms.) Antiviral drugs are now available to treat a number of viruses, including influenza, HIV, herpes, and hepatitis B. Like bacteria, viruses mutate over time and develop resistance to antiviral drugs.
Modern medicine needs new kinds of antibiotics and antivirals to treat drug-resistant infections. But the pipeline of new drugs is drying up. For example, nearly 40 years elapsed between introduction of the two newest molecular classes of antibiotics: fluoroquinolones (such as Cipro) in 1962 and the oxazolidinones (such as Zyvox) in 2000.
Major pharmaceutical companies have limited interest in dedicating resources to the antibiotics market because these short-course drugs are not as profitable as drugs that treat chronic conditions and lifestyle-related ailments, such as high blood pressure or high cholesterol. Antibiotic research and development is also expensive, risky, and time consuming. Return on that investment can be unpredictable, considering that resistance to antibiotics develops over time, eventually making them less effective.
New antiviral drugs are also in short supply. These medicines have been much more difficult to develop than antibacterial drugs because antivirals can damage host cells where the viruses reside. Today, there are more antiviral drugs for HIV than for any other viral disease, transforming an infection that was once considered a death sentence into a manageable chronic condition. But novel drugs are needed to combat other epidemic viral infections, such as influenza and hepatitis B and C.
Several programs have been developed to stimulate research and development of new vaccines and medicines. The U.S. Department of Health and Human Services recently formed the Biomedical Advanced Research and Development Authority, which provides an integrated, systematic approach to the development and purchase of the vaccines, drugs, therapies, and diagnostic tools necessary for public health medical emergencies. The Cures Acceleration Network provision of the Patient Protection and Affordable Care Act, signed into law by President Obama in March 2010, is designed to move research discoveries through to safe and effective therapies by awarding grants through the National Institutes of Health to biotech companies, universities, and patient advocacy groups. And nonprofit organizations dedicated to accelerating the discovery and clinical development of new therapies to treat infectious diseases are bringing together philanthropists, medical research foundations, industry leaders, and other key stakeholders to forge effective collaborations.
Daily habits provide some of the strongest defenses against infectious diseases. Among the sensible actions you can take:
• Keep immunizations up to date.
• Wash your hands often. Washing with regular soap and rinsing with running water, followed by thorough drying, is considered the most important way to prevent disease transmission. Routine consumer use of residue-producing antibacterial products, such as those containing the chemical triclosan, have not been proven to confer health benefits and may actually contribute to antibiotic resistance.
• Prepare and handle food carefully. (See “How to Protect Yourself” in the Foodborne Pathogens section on page 16.)
• Use antibiotics only for infections caused by bacteria. Viral infections cannot be treated with antibiotics. Your doctor may prescribe an antiviral medication if your condition warrants it.
• Report to your doctor any rapidly worsening infection or any infection that does not get better after taking a course of antibiotics, if prescribed.
• Be careful around all wild animals and unfamiliar domestic animals. After any animal bite, cleanse the wound with soap and water and consult a clinician for further evaluation. Enjoy wild animals with your eyes, not by touching them.
• Avoid insect bites whenever possible by using insect repellent and wearing long-sleeved shirts, long pants, and a hat outdoors.
• Protect yourself by using safe sex practices. You and your partner should be tested for sexually transmitted diseases, including HIV, if there has been any risk of exposure. Consistently and correctly use condoms when having sex with a partner of unknown status. Avoid sex with an injecting drug user.
• Stay alert to disease threats when traveling or visiting underdeveloped countries. Seek advice from a reliable source, such as the WHO or the CDC, if you are going to areas of moderate-to-high disease risk.
• Acquire healthy habits such as eating well, getting enough sleep, exercising, and avoiding tobacco and illegal drug use.
Keeping our nation safe from disease outbreaks depends on effective and well-coordinated programs that monitor public health. What are some of the key efforts at work in the United States?
Public Health Capacity
The mission of public health is to safeguard and improve the health of the community as a whole. Effectively responding to infectious disease threats therefore requires a robust public health system. In the United States, public health surveillance for infectious diseases is conducted through a variety of agencies. Health care providers and others report cases of notifiable infectious diseases (as defined by local and state health codes) to state health departments. State health department officials, in turn, verify disease reports, monitor disease incidence, identify possible outbreaks, and forward their findings to the CDC. The CDC and other federal agencies, including the Food and Drug Administration, the U.S. Department of Agriculture, and the U.S. Department of Defense, independently gather and analyze information for disease surveillance.
Public health advocates have called for improved surveillance to better monitor infectious diseases across the country. Among their recommendations: a national electronic infectious diseases reporting system; innovative methods of disease surveillance (such as automated laboratory reporting of infectious disease or systematic gathering of informal reports of disease from the Internet); and fortifying the entire public health system, which historically has been underfunded compared to biomedical research.
Syndromic surveillance—the near- or real-time monitoring of nonspecific pre-diagnostic signs of disease outbreaks—is an innovative surveillance method that is being explored by some cities and states with assistance from the federal government as a means of providing early warning of infectious disease outbreaks. Syndromic surveillance rests on the idea that, following large-scale exposure to infectious disease in an epidemic or bioterrorist attack, people will first develop symptoms, stay away from work or school, and attempt to treat themselves before seeing a doctor. These systems therefore monitor school and work absenteeism, sales of over-the-counter medications, illness-related 9-1-1 calls, and other patterns that suggest an outbreak. However, most surveillance still focuses on tracking reported infections.
Foodborne diseases are largely preventable—but the goal requires vigilance in every step from the farm to the table. Good agricultural and manufacturing practices can reduce the spread of microbes among animals and prevent contamination of foods. Monitoring the entire food production process can pinpoint hazards and control points where contamination can be prevented, limited, or eliminated. A formal method for evaluating risk control is called the Hazard Analysis Critical Control Point, or HACCP (pronounced “has-sip”) system. First developed by NASA to ensure that the food eaten by astronauts was safe, HACCP safety principles are now being applied to a widening range of foods, including meat, poultry, seafood, fruit juices, and other products.
In recent years the U.S. Government Accountability Office, food safety advocates, and legislators have documented problems resulting from the fragmented nature of the nation’s food safety system. At least a dozen federal agencies, implementing at least 30 different laws, have roles in overseeing the safety of the nation’s food supply. Advocates have recommended that all food safety activities be consolidated into a single federal agency with a unified mission.
National borders offer trivial impediment to infectious disease threats. In the highly interconnected and readily traversed global village of our time, one nation’s problem soon becomes every nation’s problem. Therefore, many of the strategies described above must be implemented worldwide, not just nationally, in order to have a true impact.
Just as national surveillance is critical to controlling outbreaks within a nation, global surveillance is a critical component to responding to infectious disease worldwide. Among the strongest measures promoting worldwide infectious disease surveillance are the WHO’s revised International Health Regulations, which entered into force in 2007. These require WHO member states to report certain diseases and outbreaks that may represent public health emergencies of international concern to the WHO and to strengthen their capacities for public health surveillance, diagnosis, and response. In addition, the CDC’s Division of Global Migration and Quarantine, an integrated and comprehensive partnership of local, national, and global health authorities, works to prevent, detect, and contain infectious diseases in countries of origin and at U.S. ports of entry.
Technological advances in disease surveillance and detection such as regional syndromic surveillance, bioinformatics, and rapid diagnostic methods, have strengthened infectious disease control and prevention efforts. The global response to SARS, for example, was triggered by a report posted to the Program for Monitoring Emerging Diseases—or ProMED Mail—a global electronic reporting system for outbreaks of emerging infectious diseases and toxins.
Other networks are beginning to listen in on what scientists call “viral chatter”—the seemingly commonplace transmission of animal viruses to humans in parts of the world where the two populations overlap, such as live-animal markets or urban areas carved out of tropical rainforests. By identifying viruses, bacteria, and parasites in animals where they naturally live, and monitoring those organisms as they move from animals into people, it may be possible to prevent deadly new infections of animal origin from entering and racing through human populations. The One Health Initiative, a worldwide movement to forge collaborations among physicians, veterinarians, and other related disciplines, is an example of efforts to improve communication about human and animal diseases.
Public Health in Developing Nations
The gaps in life expectancy between the richest and poorest countries now exceed 40 years—in large measure owing to the toll of infectious diseases. Safe water supplies, sewage treatment and disposal, improved food safety, and vaccination programs are urgently needed in developing nations. A major barrier to achieving these improvements is the underlying weakness of public health systems in resource-poor countries, including a shortage of health care workers, which hinders efforts to immunize, treat, and monitor the status of patients. Poor nations also lack disease surveillance programs and up-to-date laboratories, which are essential in the mission to find, diagnose, and contain infectious diseases.
Distribution of Medicines
Life-saving vaccines and medications are not distributed equitably around the world. More than half of those suffering from HIV/AIDS who need drug treatment are not receiving it. Only 2 percent of people with multidrug-resistant TB receive the right medications. And while children in wealthy countries are routinely immunized with vaccines that protect against childhood pneumonia and diarrhea, children in poor countries are not; for each child who dies from pneumonia in an industrialized country, more than 2,000 children die from the infection in developing countries.
Many factors influence whether poor nations can obtain affordable drugs of good quality. Most drug research and development is not geared toward the needs of people in poor countries because they are not a large market. As a result, a large percentage of the money spent worldwide on health care research is dedicated to problems affecting a small percentage of the world’s population. Social and political challenges to the distribution of medicines are factors as well. Efforts are being made by foundations, pharmaceutical companies, and other organizations to overcome these challenges, providing funding, research, and donations of medications. The tragedy of global infectious disease is not only that so many lives are lost or damaged, it’s that so many of these infections could be prevented or treated effectively with low-cost drugs.
Following the emergence of antibiotics and vaccination, many scientists and physicians believed that infectious diseases would cease to be major public health problems, and non-infectious chronic diseases would become more important in terms of public health, a phenomenon known as “epidemiological transition”. However, as a result of the emergence of new human pathogens, the re-emergence of many infections, and problems in controlling endemic diseases, infectious diseases remain major public health problems, along with non-infectious chronic diseases
Considering disability-adjusted life years (DALYs) or number of infected individuals, the major infectious diseases on global scale are tuberculosis and other respiratory infections, HIV/AIDS and other sexually transmitted diseases, yellow fever, malaria, dengue and other mosquito-borne diseases, viral hepatitis, rabies, cholera, African trypanosomiasis, Chagas disease, leishmaniasis, cysticercosis/taeniasis, dracunculiasis, echinococcosis, cystic echinococcosis, trachoma, foodborne trematodiasis, lymphatic filariasis, onchocerciasis, schistosomiasis, ascariasis, trichuriasis, hookworm disease, Buruli ulcer, leprosy, and yaws – Although the impacts of these diseases are global, they affect countries disproportionately, being particularly important on populations living in tropical regions. Most of such diseases can be considered as neglected by governments, research institutions and the pharmaceutical industry, which aggravates the problem of infected individuals and countries where the diseases are endemic.
Urbanization, high population density, deforestation, climate changes, the growing interaction of humans with livestock and wild animals, the increase in the number and frequency of international travels, migratory flows, health system failures, social inequalities, and geopolitical conflicts are factors that contribute to the emergence and spread of new pathogens in human populations. As a consequence of the intensity of these factors in different parts of the world, outbreaks of emerging and re-emerging diseases are increasingly common worldwide, being considered “the new normal” in the field of infectious diseases; In this context, Zika virus infection in the Americas (Faria et al., 2017; Metsky et al., 2017) and Ebola virus infection in Africa (became important in terms of public health in the last years. The ongoing Coronavirus Disease 2019 (COVID-19) pandemic (caused by Severe Acute Respiratory Syndrome Coronavirus 2 – SARS-CoV-2) exemplifies how a new human disease can emerge and spread globally in just a few months (Wu F et al., 2020). Also, the COVID-19 pandemic showed that the capacity of countries to manage public health emergencies is quite heterogeneous, pointing out the need for coordinate
1878 the Marine Hospital Service had begun to lose its identity as a relief organization solely for sick seamen. The prevalence of major epidemic diseases such as smallpox, yellow fever, and cholera spurred Congress to enact a national law in 1878 to prevent the introduction of contagious and infectious diseases into the United States, later extending it to prevent the spread of disease among the states. The task of controlling epidemic diseases through quarantine and disinfection measures as well as immunization programs fell to the Marine Hospital Service and hastened its evolution into the Public Health Service which served the whole nation.
As a result of new laws the functions of the Service expanded greatly to include the supervision of national quarantine, the medical inspection of immigrants. the prevention of interstate spread of disease, and general investigations in the field of public health, such as that of yellow fever epidemics. To help the Service meet these increased tasks the Congress in 1889 established the Commissioned Corps along military lines, with titles and pay corresponding to Army and Navy grades. In 1930 and 1944 the Corps was expanded to include, besides physicians, engineers, dentists, research scientists, nurses, and other health care specialists.
As epidemic diseases were brought under control the Public Health Service began to shift its attention to other areas such as cancer, heart disease, health in the workplace, and the impact of environmental problems, such as toxic waste disposal, on health. But the Public Health Service is still called upon to investigate outbreaks of disease such as Legionnaire’s, toxic shock syndrome, and now the deadliest epidemic of our age — AIDS. Much of the work of the early plague fighters and sanitarians is now carried out by the scientists at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.
1.Public Health Service officers in uniform at the Montauk Point, New York, Quarantine Station. An Act of Congress in 1870 formally organized the Marine Hospital Service as a national agency with centralized administration under a medical officer, the Supervising Surgeon, who was later given the title of Surgeon General. The Service was reorganized along military lines, with uniforms, entrance examinations, and tenure and promotion on the basis of merit, free from politics. Gradually, local physicians were replaced with medical officers, who were admitted only after examination and were subject to assignment wherever required.
2.Public Health Service officers in front of the quarantine hospital in the Dry Tortugas, Florida. Ravaging epidemics, which were taking their toll on the United States population, and the continued failure of the Federal Government to exert its proper authority in quarantine matters stimulated John M. Woodworth, the first Surgeon General of the Marine Hospital Service, to press for action in developing an effective national quarantine system. Largely through his efforts the national quarantine act “to prevent the introduction of contagious or infectious diseases into the United States” was passed in 1878. This legislation also gave authority for the very important Public Health Service publication now known as Public Health Reports.
North end of the disinfecting wharves at the quarantine station on Blackbeard Island, Georgia. This station for the detention and treatment of infected ship crews and cargoes, together with another quarantine station on Sapelo Sound in Georgia, were established in 1883 as part of a national quarantine system. They constituted part of the South Atlantic Quarantine region.
The Public Health Service quarantine boarding launch “Walter Wyman” in New York City harbor. Walter Wyman was Surgeon General of the Public Health Service from 1891 to 1911 and among his many accomplishments was the development of the national maritime quarantine system.
Fumigation of a ship in New York City harbor by spraying of hydrocyanic acid gas. The introduction of hydrocyanic acid gas by the Public Health Service in 1913 to replace sulphur dioxide the chief fumigant relied upon for centuries was a very important contribution to quarantine procedure.
Camp E. A. Perry, yellow fever detention camp, on the south bank of St. Mary’s River in Florida near the Georgia border, established by the Marine Hospital Service in 1888. During the spring and summer of that year there were numerous outbreaks of yellow fever in the gulf states. The Service assisted state and local health authorities in controlling its spread by setting up camps such as this. Persons traveling from yellow fever areas were required to remain in the camp for the incubation period (6-10 days) before proceeding elsewhere. This camp which was up for several weeks, was named in honor of Governor E. A. Perry of Florida, who cooperated in establishing and maintaining it. Camps near infected cities were not new, but an inland quarantine, where suspects were detained only long enough to demonstrate that they were not infected and then allowed to proceed, were new at the time.
United States troops in the Spanish-American War suffered from yellow fever. Fear of its spread to the mainland after the end of hostilities in 1899 invoked large-scale efforts by the Marine Hospital Service to ensure adequate quarantine inspection of troops being returned from Cuba and Puerto Rico. Here troops are undergoing inspection and disinfection of baggage at the quarantine detention camp on Daufuskie Island South Carolina
4. fumigating and disinfecting team getting ready to work in New Orleans.Quarantine inspection in Baltimore harbor. Unless specifically exempted by regulation, every ship, aircraft, or other carrier entering a United States port is examined for purposes of quarantine.The immigration law of 1891 made it mandatory that all immigrants coming into the United States be given a health inspection by the Public Health Service physicians. The law stipulated the exclusion of “all idiots, insane persons, paupers or persons likely to become public charges, persons suffering from a loathsome or dangerous contagious disease,” and criminals. The largest inspection center was on Ellis Island in New York Harbor. Here the physicians are looking at the eyes for signs of trachoma
5.Quarantine detention at Immigration Station on Ellis Island, New York. Those suspected of having a communicable disease were segregated at once and, after confirmation of the diagnosis, admitted to the communicable disease hospital for care and treatment.Asian immigrants arriving at the Immigration Station on Angel Island near San Francisco, California. Angel Island was one of about 50 American ports designated as ports of entry for immigrants by the immigration law of 1891.Disinfecting clothing of immigrants at the Immigration Station on Angel Island, San Francisco, California.Testing an Asian immigrant at the Immigration Station on Angel Island, San Francisco, CaliforniaThe foreman of a ratproofing crew in New Orleans, Louisiana, pointing out the progress of the work to Public Health Service officer Dr. Charles V. Aiken. Bubonic plague broke out in New Orleans in June 1914. Full plague control operations such as this continued until 1916 when the city was declared free of infection.
6.Two sisters suffering from trachoma, a contagious chlamydial disease of the eye which, if untreated, could lead to blindness. Because of its prevalence Congress and President Woodrow Wilson authorized the Public Health Service in 1913 to use money from its annual “epidemic” fund for the prevention and control of trachoma.
8Sanitary engineer Ralph E. Tarbett oversees malaria control work during World War I. A drip can containing oil and kerosene is used to eliminate a mosquito-breeding area. Starting in 1912 and 1913 malaria studies and malaria control efforts were led by Public Health Service officer Henry R. Carter and Rudolph H. von Ezdorf. From 1912 to 1917 the main effort was directed toward determining where malaria was prevalent in the United States and measuring its economic impact.Typhoid fever attributable to poor sanitary conditions, was a major cause of illness in the United States during the 19th and early 20th centuries, especially in the rural areas. Here an entire family receives inoculations against typhoid fever.The working environment and its effect on worker’s health became a major area of study for the Public Health Service starting in 1910. Investigations in the garment making industry, as illustrated by these women making flowers, revealed unsanitary conditions and an excessive rate of tuberculosis. Other studies were done of silicosis among miners, sanitation and working conditions in the steel industry, lead poisoning in the pottery industry, and radiation hazards in the radium dial painting industry. These studies and surveys were coordinated by the Division of Industrial Hygiene and led by such officers as Joseph W. Schereschewsky. They eventually helped to better health conditions and provided safer work environments for many workers.
9.Rural sanitary surveys conducted by the Public Health Service under the leadership of such officers as Leslie L. Lumsden (1875-1946) and Charles W. Stiles (1867-1941) tried to ascertain the health conditions in rural areas of the United States through house-to-house canvasses. Working in close cooperation with local officials, the public health survey teams also provided 7.advice to these households concerning the safe disposal of human wastes by building sanitary privies, the protection of water supplies by safeguarding wells to prevent surface drainage, and the screening of homes to prevent the entrance of disease-bearing insects, particularly flies and mosquitos. The construction of sanitary privies for each household, such as these shown here in an agricultural migrant village, played an important part in the development of rural sanitation. This work was greatly advanced during the 1930s through the federal privy-building programs of the Civil Works Administration and the Work Projects Administration.The Public Health Service rural sanitary surveys during the first two decades of the 20th century led to the establishment of many local county health boards and departments who continued the work of rural sanitation on a daily basis. Health education was one of their primary tools. The poster for privies printed for one of Dr. Lumsden’s county health campaigns is an example of the methods used. The results were quite dramatic as the incidence of typhoid fever and hookworm markedly diminished in areas where active sanitary measures were taken.Smallpox has been one of the most devastating diseases in American history especially among Native Americans. Sporadic cases of smallpox were still being reported in the United States during the 1930s and early 1940s. The Public Health Service primarily through the work of the Hygienic Laboratory, played an important role in controlling and finally eradicating this disease. Important contributions included the inspection of vaccine being produced to ensure purity. especially from contamination with tetanus; recommending the abandonment of dressings at the vaccination site to avoid post vaccination tetanus; and the development of the multiple pressure method of vaccination.Pneumonia was a serious concern of the Public Health Service in the early decades of the 20th century. Together with influenza it was the leading cause of death in the United States in 1900.This World War II advertisement informs the soldiers and other citizens about a new wonder drug that can cure venereal disease. The introduction of penicillin, first in limited amounts in 1943 for clinical trials and then in massive quantities by 1944 as a result of the war effort, brought about revolutionary changes in the control of infections and venereal disease. The Public Health Service together with other government agencies carried out an extensive study of the effect of penicillin in treating syphilis and gonorrhea.The Malaria Control Unit of the Philippines Public Health Rehabilitation Program in front of their headquarters. Following the reoccupation of the Philippines by the United States Armed Forces in 1945 and until 1950 the Public Health Service aided the Philippine government in surveying the general public health conditions on the Islands and reestablishing public health programs and quarantine facilities. The prevention and control of malaria with four to five million cases annually was a major objective of the program.
10.Medical discoveries and public health campaigns have almost eliminated deaths from the common diseases of childhood such as measles, diphtheria, scarlet fever, and whooping cough. As a result of these successes nearly 20 years were added to the average life expectancy at birth between 1900 and 1950-from 47 to 67 years.A collage of well known personages who gave publicity and support to a chest X-ray campaign in Los Angeles. During 1950 more than 2 million X-ray examinations were made by the Public Health Service, more than 1.8 million of them in community-wide chest X-ray surveys in Denver, Boston, Salt Lake City, San Diego, and Los Angeles.
11.The iron lung was used to sustain the lives of polio victims. Dr. James P. Leake and other Public Health Service scientists were instrumental in field investigations of poliomyelitis.Accurate health statistics are very important for formulating national health policies and funding health programs. This specially designed and equipped mobile examination center is the site of testing for the third National Health and Nutrition Examination Survey (NHANES III). NHANES III is designed to assess the health and nutritional status of adults and children in the United States and is being conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention. Approximately 40,000 individuals in 88 communities across the country will be asked to participate in this six-year survey which began in September 1988. The first two national surveys were done in l971-75 and l976-80.Persons who participate in the third National Health and Nutrition Examination Survey receive a physical examination and several other tests from a physician and a highly trained medical staff. These other tests will include a dental examination, hearing test, allergy skin test, lung capacity test, body measurement, electrocardiogram (ECG), and measurement of bone density.Public Health Service officer Gail Schmidt checking the level of contamination on the exterior of a building used by radium source manufacturer and importer in New York. Health hazards associated with radioactive materials have been a concern for the Service throughout most of this century. Since 1979 the Centers for Disease Control and Prevention in Atlanta, Georgia have had the primary responsibility of responding to environmental emergencies involving radiation and chemicals such as those caused by spills during transport fires, and other incidents. They assisted in the environmental epidemiologic investigation following the Three Mile Island nuclear reactor accident in 1979.Not only did the Centers for Disease Control and Prevention take over the foreign quarantine functions in 1967 they also extended quarantine into space. The Centers for Disease Control and Prevention provided quarantine equipment and procedures for the United States space program, including the Apollo moon landings.Wearing high-level protective gear Public Health Service response teams collect samples for toxic substance identification. Since 1979 the Centers for Disease Control and Prevention (CDC) have coordinated activities to protect the public’s health against exposure to toxic chemicals in the environment. The Center for Environmental Health and the National Institute for Occupational Safety and Health (NIOSH) are the two organizational units within the CDC responsible for these activities. They include studies of indoor air quality, lead-based paint poisoning, and occupational exposure to asbestos and hundreds of other toxic and carcinogenic substances. Health studies of residents of Love Canal, an abandoned chemical waste dump in Niagara Falls, New York, in 1980 was one of their most well-known efforts. Health education is an important tool in the fight against the spread of AIDS. Surgeon General C. Everett Koop’s Report on AIDS and other brochures produced by the Public Health Service help to disseminate important information about AIDS.
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