key: cord-0008506-rksdfc7m authors: nan title: SELECTED EPIDEMICS & EMERGING PATHOGENS – CONCLUSION date: 2017-09-12 journal: Dis Mon DOI: 10.1016/j.disamonth.2017.03.023 sha: c13747c07d7c11454651af132a64013e769ef84a doc_id: 8506 cord_uid: rksdfc7m nan As health care professionals, we are tasked with remaining vigilant about the threats our patients may face. These include emerging and reemerging threats, nosocomial infections, travel-related illness, even bioweapons. By being attuned to the situations where our patients can become involved which may predispose them to increased risk of infections, we can provide invaluable support and guidance. This includes proper preventive measureswhether vector control, or places to avoid, how to dine in areas where food hygiene may be limited, medication prophylaxis, even obtaining appropriate travel health insurance, and where to obtain medical care, are all useful. Moreover being knowledgeable where to obtain information and updated treatment strategies is valuable. While the mainstay of containing emerging threats often rests upon public health expertisethat is the big picture. Science can provide timely antimicrobials, even vaccines to help thwart the spread of infections. But disease and health care live at the street level where person to person transmission occurs. Hospital and emergency department(ED) overcrowding remains a significant problem in containing the spread of infections. While some health care facilities (HCF) have improved access to masks and hand sanitizers, as well as placed cough/sneeze etiquette posters, these can have limited value if manpower shortages, cultural imperatives, for example going to a health care facility with many members of the family, language and education barriers all work against social distancing, personal hygiene and other containment strategies. Some practices and health care facilities have implemented old pediatric strategies of placing potentially contagious patients into separate areas. Clearly this is a space, manpower and resource intensive strategy, but one that may reduce transmission of illness from those who are injured. On the regional and national level, a serious discussion on best practices in terms of how to cohort and isolate potentially contagious people, as well as strategies to alleviate overcrowding, much of which stems from the misuse of ED and HCF for primary care problems is vitally necessary. It is important to recognize vaccine preventable illness from old but reemerging pathogens, such as whooping cough (pertussis), can be overlooked when patients present with upper respiratory illness. With some vaccines offering protection that wanes over time, and declining vaccine rates across populations, not to mention a growing number of visitors and immigrants from regions that do not have the same immunization capacity, greater awareness of illnesses endemic to such persons can aid in making a more rapid diagnosis. The prudent clinician should consider a broader range of pathogens based upon endemic infections from a more diverse population, especially the ones trending in your region. Moreover we can better familiarize ourselves with our infection control and public health response colleagues. We as health care professionals have a responsibility, and play an important role in limiting the spread of disease, if for no other reason than our own protection, given health care providers (HCP) are often at greater risk than patients for infection. HCP can also be spreaders of disease. We can assist in local preparedness efforts, provide appropriate educational information and medical care to patients, promote the use of vaccines and other preventive measures, including social distancing and hygiene practices, and set the stage for rapid recovery. Another lesson learned during the SARS CoV outbreak was the inconsistent study and shared experiences of live time treatments, thus limiting best practices in treatment options. Clearly our options in terms of countermeasures against viruses remains limited compared to bacterial pathogens. That notwithstanding, one has to wonder if a clinical research infrastructure in the early phases of that outbreak might have enhanced the public health and clinical response. Few prospective controlled studies were undertaken to define the best treatment options for SARS CoV in 2003, which limits our ability to apply these to MERS CoV [1] . As members of a health care community, often with staff privileges in medical centers and hospitals, nursing homes and rehabilitation facilities, we can influence the actions of our work place and referral locations. Consider walking around the facility looking at it through the eyes of an educator and lay personwhat message comes through? Do you get a sense that it is a culture of infection control, or one that has abandoned responsibility to limit disease? The United States, which means our communities and urban centers, are the crossroads of global travel, international finance, and trade. Growing visitations of students, business people, along with immigration of persons from impoverished nations where citizens therein are often sick with a variety of communicable diseases, and bringing with them illnesses we may not be familiar with, it is incumbent upon us to work within our regions to address such vulnerabilities of capacity. This can be especially problematic with an overburdened public health system. But if we don't address these challenges now, while there aren't aggressive outbreaks emerging in our community, when one does occur, and that will happen, we will be much more prepared. That means lives saved. Together we can limit the risk of emerging pathogens and the impact of outbreaks in our community. World Tourism Organization Travel-associated illness Trends and Clusters Health problems after travel to developing countries Spectrum of disease and relation to place of exposure among ill returned travelers The role of the traveler in emerging infections and magnitude of travel Knowledge, attitudes and practices in travel-related infectious diseases: the European airport survey Epidemiology of travel -related hospitalization Hon KL Severe respiratory syndromes: Travel history matters Infectious diseases of potential risk for travelers. International travel and health Avian Influenza: The Next Pandemic? Disease a Month Health disparities among travelers visiting friends and relatives abroad Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network Human Coronavirus EMC is not the same as severe acute respiratory syndrome Coronavirus mBio Gulf War Servicemen and Servicewomen: The long road home and the role of health care professionals to enhance the troop's health and healing Dengue Fever, CDC Traveler's Information on Dengue Fever