Infectious disease is an emerging field

ALBANY — Technological advances, including the airplane, have caused the world to get smaller and people to become more connected. From a public health standpoint, that can mean diseases not typically seen in a country can easily make their presence known — allowing infectious disease to become an emerging field.

Community-acquired infections including influenza, stomach flu and certain waterborne illnesses are among the bugs seen in Southwest Georgia, but there are others in the region that have a significant impact.

One example, Dr. Carlos Franco with Phoebe Infectious Diseases and Travel Medicine said, is HIV/AIDS — which is most often impacting African American males ages 15-25 and heterosexual women who thought they were in monogamous relationship.

“One thing that is very striking, a lot of those patients are (for a long time) undiagnosed,” he said. “It is growing. The more we test, the more we find.”

Lack of access and a late diagnosis leads to the higher prevalence of AIDS, along with drug use — the latter of which has become a growing concern on its own.

“The use of drugs affects the ability of patients to comply with medications,” Franco said.

As with other diseases, HIV/AIDS cases that come in late do not have ideal outcomes. Physicians in Southwest Georgia continue to see opportunistic infections associated with HIV/AIDS such as pneumocystis pneumonia, Franco said.

It is a priority for the Southwest Public Health District as well. While seeking out the vulnerable, there is also a push to get those who test positive into treatment immediately to not only improve their outcomes, but to reduce transmission.

“We are trying to come up with a task force and see how we can do testing on the go,” said Jacqueline Jenkins, epidemiologist with the Public Health district. “We have a huge, vulnerable population. It you don’t get tested, you don’t know.

“(We look out for) not just those that show up (for testing), but those who are vulnerable.”

Once on treatment, the focus is to keep people honest. Many patients tend to be non-compliant, so that can be a challenge.

“Even if you get them into care (some people) don’t stay,” Jenkins said. “Part of the Public Health mission is to make sure they stay in care.

Tuberculosis (TB), not often associated with the western world by the general public, had 9,421 cases reported in the United States in 2014, the Centers for Disease Control and Prevention said. Dougherty County, Franco said, is a county with among the highest rates of TB in Georgia.

“Overall, the rates are low (in the United States), but there are a few states with a higher rate and Georgia is one of them,” Franco said.

Franco said social factors often drive TB, including crowding, poor sanitation, HIV/AIDS and poor education.

Jenkins said there are TB nurses in the Public Health district responsible for making outbreak contacts.

“It’s a disease we follow in Southwest Georgia,” she said.

Franco said there have been cases in Southwest Georgia in recent years of Cryptococcus gattii, a fungus that the CDC says lives in the environment in many tropical and sub-tropical areas of the world. Often affecting those who are otherwise healthy, it causes brain damage.

It likely came to south Georgia by trees brought in from Australia, Franco said.

Vector borne illnesses from mosquitoes and ticks such as Rocky Mountain Spotted Fever and West Nile are still concerns. There was an outbreak of West Nile in 2012 that impacted Southwest Georgia.

“If you are young and exposed (to West Nile), there is usually a fever and a rash if you get symptoms,” Franco said. “In ages 60 or older, you see more invasive disease. Unfortunately, we had a number of those. Since 2012, we haven’t seen any.”

Zika, dengue and chikungunya are among the more emerging vector borne diseases, which Franco said have a low chance of impacting Southwest Georgia due to an environment less conducive to a spread. Zika, for example, is spread through the Aedes mosquito — which, while present in the Southeastern U.S, have a lower population density in the U.S. compared to other parts of the world.

Plus, Franco noted, that Brazil — one of the central countries for the recent Zika outbreak — has citizens who have containers of standing water they are trying to preserve. Standing water is an ideal breeding ground for most mosquitoes.

“We may see some (of Zika), but it is probably going to be limited,” he said.

Even with a vaccine for some of these diseases, infrastructure plays a big role, Franco said.

“With a degree of sanitation, the chance of major outbreaks are much lower, I think,” the infectious disease specialist said.

Carolyn Maschke, public information officer for the Public Health district, does a significant amount of global monitoring to make sure those working within the district stay up to speed on potential threats. Public Health officials in Southwest Georgia say anything emerging often comes into the U.S. through the south Georgia neighborhood first, one example being the H1N1 outbreak.

“When H1N1 was hitting, it was in Mexico first. It hit hard, and we were pretty much ready to go (when it came to Southwest Georgia),” Maschke said. “The first school closing was in Early County, and the first wave was in our district. By the time it hit Atlanta, we were already (experienced) with it.

“We try to be proactive, and I make sure we are prepped and ready to go.”

Meanwhile, teams in Public Health make sure the proper methods are used to get messages out to the public, whether through school letters or town hall meetings. Training is ongoing, and information is passed along.

“We look at the best way to push information out,” Maschke said. “It is very interactive … and it should be.”

While Ebola has become a distant memory in some people’s minds, it is something Public Health is still has on its radar to ensure preparedness measures are in place. It can be fatal, and there is a particular clinical protocol necessary to slow its spread.

“When it hit, hospitals weren’t prepared for that kind of an illness,” said Jenkins.

Jenkins, like many others working in Public Health, operate on the mentality of diseases being a plane ride away. If someone who recently came back from South America gets ill, for example, Zika is considered as a possibility.

“We always ask travel questions with everything we see,” she said.

These days, infectious disease is becoming an active — and a constantly emerging — field, because there is always something to battle.

“Something comes up sooner or later that takes the place of another (illness) … In a larger ecosystem, there is always something emerging. There is always a battle. We are just part of one big world, and everything is connected,” Franco said.

Public Health officials have discovered the same thing. It takes much time and energy to wrap the mind around it, and keeping people up to date is a full-time investment on its own.

“It’s evolving,” Jenkins said. “What they (the CDC) knows we are getting out as fast as we can.”