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“Disease Warriors” and Epidemiology

1.      Summarize the documentary “Disease Warriors.” Give full description of the coverage of the documentary, and state briefly the ‘take-away’ message it gives.

“Disease Warriors” is a documentary that follows various developments in the field of health care, specifically the breakthroughs or discoveries in medical science that led to the creation of vaccines that either cured or prevented dangerous diseases over the years. The impact of medical research is highlighted in the film due to the contribution of those discoveries to the increase of life expectancy rates. The documentary also tackles problems in the field of health care brought about by various factors such as limited access to health care services, especially of vulnerable populations or populations who are in desperate need of medical attention. “Disease Warriors” may highlight the importance of prevention in dealing with diseases and the successes in the field of health care, but the documentary also emphasizes that despite these developments, there are still delicate problems and challenges that must be addressed in order to fully realize the goals of health care and increasing its reach globally.

2.      Recall and review the specific researchers profiled and describe their work and contributions.

-         1864, Paris: Louis Pasteur discovered that germs cause diseases. Pasteur was also responsible for the chicken cholera and rabies vaccines.

-         1796 England: Edward Jenner’s observations and experiments allowed him to discover the science underlying vaccines – that by exposing individuals to a particular strain and amount of bacteria makes them immune to others. Jenner’s smallpox vaccine was among the first successful vaccines during that time.

-         Jonas Salk made polio vaccine injectable.

-         Albert Sabin made a polio vaccine type that could be taken orally.

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-         Despite the absence of HIV vaccines, researchers, including Dr. Charles Wachihi, are continuing their current studies. Their discovery of 200 sex workers who are immune to AIDS is promising. British researchers are currently experimenting on a protein-based HIV vaccine based on the studies conducted on the DNA of the 200 sex workers.

3.      Based on the movie and your own further research

a.      List the diseases that were once major challenges that have been controlled (or nearly so). Make sure your list is complete and accurate. For each one list the time period when it was at its peak, how many people were known to have died from it, the geographic regions it affected, the mode of transmission, what made it an epidemic? And what brought it to an end?

- The polio virus was at its peak in 1952 afflicting 37.2 percent per 100,000 people (Wilson, 2007). Ten years ago, 175,000 polio cases were reported annually in India. Some countries Africa had the highest number of polio cases. The polio virus could be transmitted through contaminated water. The number of people who contracted the disease escalated due initially to the absence of the vaccine and then the limited number of vaccines. Polio cases decreased when vaccines were made available orally and as injectables.

- The rabies virus was at its peak during the 1950s. Rabies is dangerous because during severe stages, the virus reaches the brain. The virus is transmittable through animal bites and human contact. European countries like Romania and Bulgaria were most afflicted with the disease. The number of people with the disease increased due to the lack of vaccine and the cases decreased due to the discovery of the vaccine and its availability (Jackson & Wunner, 2007).

- Smallpox was at its peak during the seventeenth century. Neighboring European, Asian, and African countries were most afflicted by the disease. India and Nigeria had the highest number of smallpox victims. In 1975, India was declared smallpox free. Smallpox is transmitted through human contact and the consumption of fluids or objects touched by an individual with the virus. Smallpox became an epidemic due to the difficulties of administering vaccines to a large population. Smallpox decreased due to thorough vaccinations.

b.      List the disease that have arisen or become widespread in the past 25 years, such as SARS, the avian flu, and the West Nile virus. For each one describe when it surfaced, what it originates from/how it is contracted/transmitted or spread, its symptoms and how deadly it is, and what makes it dangerous as a public health problem.

- AIDS: Scientists are unsure about the exact origin of HIV because some people from America and other places in the world had already exhibited similar symptoms even before the virus spread in Africa. However, the virus is generally known to have originated from Africa during the 1980s. The virus killed 20 million in Africa alone, whie 42 million were infected. HIV is transmittable through sexual intercourse and exposure to infected blood. HIV is a killer disease because until now, there are no existing vaccines that work against the virus and the virus works to weaken an individual’ s immune system, which is supposed to be the human body’s primary defense against virus and bacteria (Cantwell, 1986).

- H1N1 Pandemic: spring 2009 (first wave) and fall 2009 (second wave). H1N1 is caused by “a novel strain of influenza virus (Steinhardt, 2010, p. 4). The virus spread before flu season in the South Hemisphere, therefore the onset f the virus was not immediately prevented (Choffness, 2010). The virus is dangerous because it spread before flu season, before people received flu jabs. The pandemic resulted to 17,700 deaths.

-Avian Flu: The Avian Flu pandemic began in 2005 in SouthEast Asia. The virus, H5N1 infects livestock, and thus, transmits through human beings through consumption and exposure to infected species. Avian Flu is dangerous because there are no vaccines available (Lind & Tamas, 2007).

-SARS: Severe Acute Respiratory Syndrome: The breakout started in Guangdong China in March 2003. The virus is spread through personal contact and respiratory secretions. The symptoms are similar to pneumonia. The virus spread because China was unable to contain the disease (Lee, 2006).

-Meningococcemia: The disease is caused by the Neisseria meningitides virus and spread or transmitted through respiratory secretions that could be ingested for the air. The disease is dangerous because the progress of the disease is fast. Early detection is advisable to prevent serious onset of the disease (Kim et al., 2007).  

-West Nile Virus: The West Nile Virus breakout started in the fall of 1999, although the disease first appeared during the 1970s. The disease is spread through mosquitoes. Like HIV, the virus is dangerous because it weakens the immune system and prevents a speedy recovery (Heinrich,

4.      In the documentary the practices of herd immunity versus ring vaccination was introduced. Give a detailed discussion of the pros and cons of each, which one is best suited to eradicating a disease, such as polio or measles? Give an example of a case when a population had natural immunity, how did this effect the spread of certain diseases?

-         Herd immunity: Vaccinating a majority of the population in a community but vaccinating majority, as shown by the event in Nigeria is impossible due to the lack of vaccine. This is ideal for diseases that are contained in one area, but not advisable when there are outbreaks on a massive scale. In the video, there are 200 sex workers immune to HIV but it did not change the spread of certain diseases. Being sex workers, their immunity may even have contributed to the spread of the virus because they did not experience symptoms and so they continued to engage in sexual intercourse, which may have lead to the infection of other people.

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-         Ring vaccination: Vaccinating people who are in the immediate vicinity of the victim called vaccination rings. The disadvantage of ring vaccination is that it is possible to miss cases outside those rings. Consequently, epidemic can still occur. Thus, the challenge is to detect cases early on in each location. Another challenge is traveling from one place to another, which is a difficult job, and the time it takes to travel may be enough for the disease to spread. Ring vaccination is ideal for outbreaks in different locations but it is not advisable for diseases that are contained in one single location/ community.

Vaccines and Obstacles to Eradication

1.      Tremendous amounts of money are invested worldwide in research and development of vaccines. If suitable vaccinations are available, why do the diseases still persist around the world? Answer the questions “What issues hamper getting vaccines to those who need it?” Give examples from the documentary.

Culture and religion are two primary barriers to combating diseases. In India, for instance, people used to refuse polio vaccinations because they believe it causes impotence. Others also In Nigeria, their religious practices prevent people from getting vaccines. The vaccine is banned in the country. Polio is still rampant in the country and then people from neighboring countries (Chad, Central African Republic, Sudan, also contracted the disease, which led to the spread of polio virus.

Vashon Island in West Seattle, concerned that their children’s immune system may not be able to handle bacteria in their body all at once and they believe that their natural immune system could work. Parents in the region are not willing to take risks considering vaccines have side effects.

People are discouraged to be immunized due to the high cost of vaccines.

Providing vaccination to a large population is a tedious job and even if many people are immunized, those who they missed may still be able to spread the virus.

Vaccines are administered much later, after the virus spread.  

In the video, there are workers who are not well trained about the proper storage and administraation of the vaccines.

2.      Research the controversy surrounding vaccinations. What, if any, risks are associated with vaccinations? What ethical reasons might deter people from being vaccinated? Why do certain people recommend that everyone should be vaccinated? What might happen to a child whose parents do not want their to be children vaccinated?

Vaccinations have adverse side effects such as the onset of genetic disease. Some parents claim that vaccines cause autism in children. Aside from fear of these side effects, people tend to avoid vaccinations because of their religious beliefs. However, considering the advantages of vaccinations, it is more advisable if everyone were vaccinated. Those who do not get immunization are at risk for various diseases, and they may become the vessel for the transmission and spread of the disease. Children are at high risk for being infected with various diseases and since they have weaker immune systems than adults do, there is a possibility that they may not be able to withstand the symptoms of the disease like adults (Kaufmann, 2006 ; Habakus, 2011).

3.      In the United States, vaccinations protect most people from many serious disease. For example, the Centers for Disease Control’s list of recommend childhood vaccination includes: hepatitis A and B, diphtheria, tetanus, pertussis (whooping cough), influenza (flu), polio, measles, mumps, rubella (German measles), varicella (chicken pox), and pneumonia. Most pediatricians advocate vaccination to all their patients. Have you been vaccinated for any of them (which ones)? Given our sociopolitical approach to vaccination and the fact that almost no one contracts these diseases because they have been vaccinated against them, how can living here in the U.S. affect how we think about the amount of disease around the world and its impact?

Yes, I was immunized for DPT, Influenza (yearly shot), MMR, and Varicella. Most people in the United States are not attuned to the situation in third world countries where vaccinations are either expensive or limited. Awareness about the situation of individuals in other countries will help people understand the gravity of the situation, that vaccination must not be taken for granted, and that they must contribute to help those in other countries get immunization. Moreover, sensitivity to these issues practically keeps them safe especially when they travel to other countries and return home. The video is also a cautionary story for Americans who travel to other places.

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1.      Unfortunately, a vaccine against HIV/AIDS has remained elusive. This is because the virus attacks cells of the immune system, compromising a person’s ability to rid his or her body of the virus. Before people understood what caused disease, public health workers could only fight epidemics through careful surveillance and quarantine. What factors have prevented the creation of a vaccine for HIV/AIDS?

The unclear source of the virus prevents developments in the creation of a vaccine, including the availability of resources for further research. Another reason is that AIDS is a pervasive disease (Stine, 2003).

2.      Where is HIV/AIDS still a deadly disease and why? What are the global health disparities in the treatment of HIV/AIDS and why do they exist? Compare and contrast 2 countries, say the U.S. and a country on the continent of Africa, use this contrast to illustrate the health disparities. You may use information from the documentary as well.

HIV/AIDS is significantly more deadly in Africa than in other regions. People in the Western Hemisphere can afford anti-retroviral vaccines, which combats HIV. On the other hand, people in Africa, like Kenya, cannot afford the vaccine. Therefore, they easily contract the disease. The primary issue is related to poverty. Take a country in the third world where they have been born poor and consequently, due to poverty and desperation, they resort to dangerous jobs like prostitution and drug dealing and because of these, HIV/AIDS were easily spread in the country. And still, people in these countries are suffering because they cannot afford even basic health services. People in these countries do not even have enough money to eat three times a day. Consequently, their immune systems weaken and they easily get infected with AIDS.

3.      After viewing this documentary, what do you see as the greatest challenge we still face in public health campaigns to eradicate disease around the globe?

The greatest challenges include: the lack of financial resources to fund further research so scientists can come up with vaccines to pervasive diseases, especially HIV/AIDS. If a large funding is provided for research, then maybe the vaccines could also be offered for free or at a lower cost and everyone, even people in third world countries, could afford to get immunized. Another challenge is the lack and resistance to learning and awareness. Culture causes people prevent people from learning about various diseases and the importance of vaccination, how these diseases could be prevented, and the ways through which they could protect themselves. 

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