The Intersection of Public Health Preparation, Policy, and Practice

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Recently I have had the opportunity to fill positions at the University of Minnesota School of Public Health that have allowed me to gain new insights into the future of public health preparation, policy, and practice. In the midst of a paradigm shift from acute to chronic disease prevention, the future of public health has arguably never been more in question. Addressing the social determinants of health to prevent chronic diseases has rapidly evolved into the greatest public health challenge in human history. Local health departments, largely still reeling from the economic recession that began in 2007, are reporting budget decreases and staff layoffs. The stakeholders for the field of public health have never been more diverse- by addressing the social determinants of health  (education, poverty, geography, etc.) the scope of practice for public health agencies is largely unclear and potentially too wide-ranging for optimal resource allocation and workflows. Emerging (Zika virus) and reemerging (Ebola, vaccine-preventable diseases like measles) infectious diseases bring additional challenges and raise questions as to how much the field of public health can afford to shift away from traditional services like mosquito control and immunization programs. By 2020, an additional 250,000 public health workers will be needed to keep the world we live in healthy- according to a 2008 report by the Association of School of Public Health. Nationally, local health departments are striving towards becoming accredited- and in some states, like Ohio, this accreditation will be required for grant funding on which many small health departments survive on. The best solutions to these challenges will be born at the intersection of public health preparation (education), policy, and practice.

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BITTEN: ZIKA VIRUS 101

With the latest virus outbreak being the Zika virus, it’s important for people to know more about it so that they may take measures to protect themselves. The Zika virus was first discovered in primates in 1947. By 1952 the first human infections occur, recorded in Uganda and the United Republic of Tanzania, which is when it was discovered that mosquitoes are a carrier. In 2007 there are 14 documented cases of the Zika virus, however in 2013 there is an outbreak in French Polynesia. In 2015 an outbreak in Brazil occurs and it’s found that the Zika virus can cause neurological and autoimmune complications along with its common symptoms. Now, in 2016, the World Health Organization has declared Zika a public health emergency concern. Read more for a Zika virus infographic.

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Zika Virus Updates & Local Response

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The Food and Drug Administration has granted an Emergency Use Authorization (EUA) to Focus Diagnostics for the use of a a real-time polymerase chain reaction (RT-PCR) test to detect Zika virus in blood. As shared by the University of Minnesota’s Center for Infectious Disease Research and Policy, this new test will be available for physician use in the U.S. including Puerto Rico which just reported the first U.S. death due to Zika virus.

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Local Zika virus Outbreaks ‘Likely’ in U.S.

According to the Director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, the U.S. is likely to see outbreaks of the Zika virus, with perhaps dozens or scores of people affected. In a conversation with Fox News (article here), Dr. Fauci warns that local transmission of Zika virus is likely in the United States.

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Zika Research Underway

An article recently published by Nell Greenfieldboyce of NPR titled “Scientists Report in Real Time on Challenging Zika Research” highlights an ongoing research study led by the University of Wisconsin-Madison. Researchers are injecting Zika virus into pregnant rhesus macaque monkeys to see how the virus interacts with both the mother and fetus.

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Zika Virus: The Facts, Newest Reports

Zika virus has taken over headlines recently, although the arbovirus has been on the radar of disease sleuths, including me, for quite some time now. Just today, the first reported locally transmitted case of Zika virus in the United States occurred in Dallas County, Texas. In this case, the virus was spread via sexual contact and not a mosquito. The Zika virus is spread to people through mosquito bites, not unlike West Nile Virus, Yellow Fever, Dengue Fever, or the variants of vector-borne Encephalitis. According to the Centers for Disease Control and Prevention, the most common symptoms are fever, rash, joint pain, and conjunctivitis (red eyes). There have been reports that the virus causes a serious birth defect of the brain know as microcephaly (a condition in which a baby’s head is smaller than expected). Additionally, research is underway to determine whether the Zika virus is linked to an increase incidence of Guillain-Barre Syndrome in Brazil, where local transmission of Zika virus has become endemic.

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Antibiotic Resistance: The Hidden Consequences

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The Centers for Disease Control and Prevention (CDC) estimates that in the United States, more than two million people are sickened every year with antibiotic-resistant infections, with at least 23,000 dying as a result. The CDC recognizes that these numbers are probably much higher given the limitations and lack of precision of estimating the burden of morbidity and mortality associated with antibiotic-resistant bacteria.

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