Saturday, November 15, 2014

Epidemiology at Home: On Keeping Our Infectious Diseases in Perspective

'Tis the season for medical sensationalism in the American news media. First there was the Enterovirus, or EV-D68. Soon thereafter, we witnessed the arrival of Ebola on American soil. Thanks to Ebola's notoriously high mortality rate and the devastation the virus has wrought in Africa, well-meaning public officials here in the U.S. took up a call to arms for their own citizens... and panicked. Despite the facts - first, that Ebola is very difficult to catch, requiring direct and intimate contact with the blood or body fluids of an infected an outwardly symptomatic person; and second, that medical infrastructure in an industrialized nation such as ours make it easier to successfully treat and heal an individual who does catch the virus - the general public here in America is still on edge. And, I will argue, understandably so. Ebola is a serious disease, as is EV-D68 in children with respiratory problems. But "fair and balanced" or not, mainstream news outlets are typically very good at only two things: getting clicks and generating panic.

The problem is not widespread fear over deadly infectious diseases. Instead, the problem is public perception of relative risk. Big names like Ebola and EV-D68 get a lot of press, while more low-profile, everyday diseases like Influenza end up with considerably less screen time. Meanwhile, every year our old friend Flu is responsible for millions of severe illnesses and hundreds of thousands of deaths across the globe - orders of magnitude more than Ebola and Enterovirus combined. And here's the kicker: Flu is preventable.

Flu differs from Ebola in a variety of ways, including its ease of transmission and its capacity to mutate quickly from season to season. Infected persons can transmit the disease to others up to a day or so before they begin showing symptoms. The Flu is transmitted by droplets of moisture that are expelled into the air when an infected person talks, laughs, coughs, or sneezes. Others can also pick up the disease by touching surfaces where these droplets have landed and then failing to wash their hands before wiping their nose, rubbing their eyes, or otherwise touching their face. Once inside the body, the Flu virus spreads to the respiratory tract and causes widespread inflammation, leading to the characteristic signs and symptoms within a matter of days. Usually, healthy individuals begin to feel better within a week or two; however, as with most infectious diseases, the very young, the very old, and the chronically sick or immunocompromised are the most at risk for complications from the illness. At its worst, Flu can cause exacerbation of underlying heart or lung conditions, severe pneumonia, or respiratory failure. In children, a high fever often accompanies infection with Flu and, if unchecked, can cause brief febrile seizures. Even those with an uncomplicated case of Flu can expect to feel chilly, fatigued, congested, achey, and feverish for a few days. Unfortunately, recovering from the virus once offers little protection against future Flu seasons.

Given the severity of this year's outbreak of both EV-D68 in the United States and Ebola in Africa, many concerned citizens are clamoring for the creation of protective vaccines against these diseases. Yet many of these same concerned citizens decline the Flu shot for themselves and their children, usually with one of the following explanations: "It will make me sick," "I got that one year and then I got the Flu anyway," or "Nah, it's just the Flu. I'll take my chances." Each of these statements is misguided. The Flu shot is made up of an inactivated virus, so it is incapable of making anyone sick. Even the Flu spray, which is a nasal mist version of the immunization that contains a drastically weakened version of the virus, is specifically designed to convey immunity without being strong enough to cause infection. While it is possible to contract a rare strain of the Flu even after getting the Flu shot or spray, this is uncommon. It is much more likely for an individual to catch a severe cold and mistake it for the Flu or catch the Flu itself during the vaccine's two-week immunity-building period. Lastly, the Flu is a severe illness, especially for those who are already at risk for getting sick.

So, if you are feeling troubled about the state of public health in the world today, I have one recommendation: Get your Flu shot. Although it may not completely allay your fears, checking this box off your to-do list will categorically decrease your chances of catching a potentially deadly infectious disease within the next few months. Not everyone in the world has access to that kind of protection, so use it to your advantage! Then, stay away from the blood of people who are infected with Ebola, and you will (probably) be 2 for 2.

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