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Saskia v. Popescu, MPH, MA, CIC, is a hospital epidemiologist and infection preventionist with Phoenix Children's Hospital. During her work as an infection preventionist she performed surveillance for infectious diseases, preparedness, and Ebola-response practices. She is currently a PhD candidate in Biodefense at George Mason University where her research focuses on the role of infection prevention in facilitating global health security efforts. She is certified in Infection Control.

Preventing an "Outbreak Anywhere" from Becoming an "Outbreak Everywhere"

DEC 20, 2017 | SASKIA V. POPESCU
The age-old saying that “an outbreak anywhere is an outbreak everywhere” rings especially true in the modern age of globalization and rapid air travel. The concept of global health security seeks to tackle infectious disease threats through public health and a critical understanding of the fact that all outbreaks, regardless of origin, can devastate lives and economies. For example, the 2002 to 2003 severe acute respiratory syndrome (SARS) outbreak alone is estimated to have cost $40 billion USD. Because of the devastating potential of outbreaks on global health security, the latest issue of the Centers for Disease Control and Prevention’s (CDC) Emerging Infectious Disease (EID) Journal focused solely on the topic and included articles on prevention, detection, and response.  

Prevention is the first component to health security, but in many ways, it is also the most difficult. Biological threats can come from anywhere: a naturally occurring outbreak, a laboratory accident, or even an act of biological terrorism. How do we prevent biothreats when they come from so many directions? Zoonotic diseases are one place to start as more than 60% of known diseases spread from animals and roughly 75% of new or emerging diseases in humans spread from animals. The concept of One Health (ie, that the health of humans is connected to that of animals and the environment) plays an increasingly important role in health security as rapid global travel and human expansion into ecosystems become more common. To this end, several of the articles within the prevention section of this issue of the EID focused on zoonotic diseases and their role in health security.

For example, Belay et al. looked at zoonotic disease programs that can enhance global health security. How can health care practitioners make coordination and collaboration more effective in these areas?

Firstly, One Health requires partnerships across many sectors: agriculture, medicine, environment, etc. “Such multisectoral partnerships should begin by identifying priority zoonotic diseases for national engagement with equal input from the different sectors,” the authors write. It is critical to assess the burden of zoonotic diseases, which requires strong surveillance and data collection (and sharing!) in animals and humans. Laboratory systems also play a vital role in such efforts, as timely, accurate, and reliable tests can make the difference between a small outbreak and a large pandemic.

Establishing proper response mechanisms is also a large part of prevention efforts. We need to have protocols in place to hit the ground running when cases start to bubble up. We need to have the ability to detect an outbreak using an established and reliable surveillance system, adequate laboratory capabilities, a trained workforce to utilize epidemiology, implementation of infection and prevention measures, and an outbreak management system. These are critical and must be accounted for in prevention efforts.

As international efforts to strengthen national capacity to respond to biological threats are underway, it’s important zoonotic diseases are prioritized and that prevention efforts work to include them.

While we are talking internationally, an increase in global travel has aided in the spread of communicable diseases. Outbreaks like the 2014–2015 Ebola outbreak and 2002–2003 SARS outbreak, highlighted the ability for accessible international travel to contribute and hasten the spread of infectious diseases. In their article, Vonnahme et al discussed US federal travel restrictions for persons with higher-risk exposures (HRE) to communicable diseases of public health concern (PHTRs).

For example, following the 2014–2015 Ebola outbreak, the role of travel was brought to the forefront of disease transmission and prevention efforts. As such, guidelines and travel restrictions were revised during the outbreak. Currently, “federal PHTR can be considered for any persons with a suspected or confirmed disease of public health interest or an HRE to a communicable disease that poses a public health threat should the person become symptomatic during travel,” the authors write.

During the increased implementation and enforcement of the guidelines from 2014–2016, 160 individuals were placed on PHTRs, 89% of which involved exposure to Ebola. Most of the HREs were related to an ongoing epidemic, and thankfully, no one on the list attempted to travel. All eventually had their PHTRs lifted following the disease incubation period.

These 2 focal points from the EID journal highlight the complexities of not only global health security but how diverse the prevention efforts must be. Prevention is a cornerstone of public health, and such efforts must be as diverse and resilient as the diseases they seek to defend against. 
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