Infection Surveillance

Public agencies take credit for the control of infectious diseases,  achieved by reducing the microbial contamination of food, and drinking water. Improved sanitation and personal hygiene improved infection control. Infections such as typhoid and cholera transmitted by contaminated water were major causes death prior to the 20th century and were reduced dramatically by improved sanitation. Smallpox was eliminated by vaccination and some the most common endemic diseases continue to be controlled by vaccination.

Sad to say, the successes of the 20th century are not secure. Old infections reappear in more virulent forms and new infections emerge to challenge systems of control. Sustained attempts to develop vaccines against major threats such as influenza, AIDS dengue and malaria have limited or no success. 

Biologists in the 21^st century witness the processes of evolution which are most rapid in bacteria and yeast cells. These single-celled organisms are favored by geneticists since they replicate in a matter of hours and evolving genetic changes occur quickly. Bacteria acquire antibiotic resistance after repeated exposure to antibiotics that kill susceptible bacteria, leaving the resistant ones who eventually dominate the gene pool. Viruses evolve most rapidly. New and more virulent mutations continue to be a threat to human survival. Influenza viruses evolve so rapidly that new vaccines have to be developed every year to immunize human populations against infection with new variants of the virus.

My interest in infection surveillance and the lack thereof peaked after I developed an airborne fungal infection. I used simple microscopic techniques to diagnose my infection and invented a low tech culture method that allowed me to monitor the infection. Most of the physicians I encountered when I sought help to identify and treat this infection were not helpful. Indeed some were remarkably stubborn in their ignorance and  denial. I encountered, for example, the spurious argument that the infection has not been reported in BC before, therefore you can't have it. 

There are several facts to acknowledge.

1. Infectious agents constantly evolve.

2 The distribution of infectious agents is always changing. Planet wide events such as global warming,  travel and the shipment of goods and foods long distances connect all regions of the planet. The idea of localized disease is obsolete.  For example, climate changes allow the migration and proliferation of vectors such as mosquitoes that carry dengue, west nile virus, malaria, and yellow fever.  Other major diseases likely to spread with global warming are cholera, filariasis and sleeping sickness.

3. In Canada, medical awareness of diseases caused by fungi is limited and prompt, accurate diagnosis is unlikely. Diseases that are little known and are hard to diagnose become diseases that "never occur 'round here."

4. Infection Surveillance systems are inadequate  everywhere on the planet. In Canada,  surveillance systems either don't exist or if they do exist they are passive and disease-specific. Communications among local physicians and public health services are poor to non-existent. Canada lacks information-sharing. "New" diseases will not be recognized quickly or treated effectively.

5. There are many different infections at work in every community on any given day. The difficult task of identifying even common infections is seldom undertaken by community physicians. Local information about infections currently afflicting a community is not available.

Morse reported that concerns about the spread of infectious diseases such as pandemic influenza or severe acute respiratory syndrome (SARS), revealed the need for global early warnings and rapid responses that did not exist. He stated: ”Although progress has been made, many gaps remain. A number of the gaps can be addressed through increased political will, improved resources for reporting, improved coordination and sharing of information, raising local doctors awareness, and more efficient triggers for action. The increasing availability of communications and information technologies worldwide offers new opportunities for reporting. “ [Health Affairs 26, no. 4 (2007): 1069–1077]

Influenza surveillance has improved in recent years. In Canada, FluWatch, a national influenza surveillance system, is coordinated through the Centre for Infectious Disease Prevention and Control at the Public Health Agency of Canada. Sentinel physicians collect blood samples for influenza detection; participating labs can accurately identify serotypes of the viruses which are always changing. Online reports are current.

The limitation is that physicians and patients remain ignorant of the infections prevalent in their own communities. Testing for viral infections is minimal or nonexistent. The appearance of new sources of infection in the community will not be recognized nor remedied.

Also see

Reflections on an Illness
My Blastomycosis Story
Dr G's 2 slide culture