Overview and Summary: Infectious Diseases: Challenges and Solutions

"Every three seconds a young child dies - in most cases from an infectious disease. In some countries, one in five children die before their fifth birthday. Every day 3, 000 people die from malaria - three out of four of them children. Every year 1.5 million people die from tuberculosis and another eight million are newly infected" (World Health Organization, 1999, para 3). Diarrheal diseases, HIV/AIDS, malaria, measles, pneumonia and tuberculosis cause 90% of infectious disease deaths. Much of the burden is borne by developing countries especially those areas with poor sanitation and unsafe drinking water. Table 1 shows this burden as a percentage borne by developing countries for three selected diseases (WHO, 2002a).

Around the globe, international health organizations, individual countries, private enterprises, non-governmental organizations, and many others are actively engaged in addressing these public health issues (WHO, 2002b). Additionally, other steps to address factors impacting health and the spread of infectious diseases, such as poverty, literacy, environmental status and hunger, are being taken under the framework of the United Nations Millennium Development Goals (United Nations, 2005). This topic’s articles move us forward in assisting with these efforts through expansion of our knowledge and provision of useful tools for our work.

This OJIN topic’s five initial articles cover a broad range of infectious disease topics. The first two articles discuss broad challenges in infectious disease management by providing a history of emerging infectious diseases and presenting several active public health surveillance management systems. The next three articles consider specific diseases that: have a long history but have re-emerged as a threat (TB), have evolved into a chronic infectious threat (HIV), and have recently emerged (SARS). These articles include discussion on diagnosis and treatment of tuberculosis in a low-resource country, challenges related to long-term medication adherence for HIV+ women, and innovative infection control practices developed during the 2003 SARS epidemic.

"Emerging Infectious Diseases at the Beginning of the 21^st Century," by Felissa R. Lashley, provides a historical perspective of emerging and re-emerging infectious diseases during the past 40 years. Factors contributing to the emergence of new infectious diseases are categorized into 13 distinct but related areas. The author summarizes several emerging infectious diseases including hemorrhagic fevers, monkey pox, transmissible spongiform encephalopathy, severe acute respiratory syndrome, West Nile virus, and avian influenza. Lashley underscores the need, before the next pandemic strikes, for health professionals to become educated about potential diseases, their diagnosis and treatment, and infection control procedures for preventing the spread of infection. Multi-sector collaboration—finance, behavioral health, media, rapid exchange of scientific information—will be essential in dealing with pandemics. Two broad areas cited for further development are ethical and social issues.

Tener Goodwin Veenema and Joanna Toke’s article, "Early Detection and Surveillance for Biopreparedness and Emerging Infectious Diseases, " provides an overview of epidemiology and disease surveillance with a focus on biological agents that can spread unintentionally or intentionally. Early detection is important to begin treatment and possible prophylaxis of others who may have been exposed and it lessens the opportunity for disease spread. Definitions, routes of transmission, personal protection, and an overview of surveillance systems are highlighted. Veenema and Toke describe interactive clinical support programs to assist health professionals in the early diagnosis and treatment of infectious diseases. They also emphasize the important role of nurses in the surveillance, detection, treatment, and prevention of the spread of infectious diseases.

Dorothy Chanda and Davina J. Gosnell describe the impact of tuberculosis in Zambia, Africa, with a special focus on nursing and nurses with TB, in their article, "The Impact of Tuberculosis on Zambia and the Zambian Nursing Workforce." The historical perspective includes the evolution of the African government’s plan for addressing TB and the current prioritization of TB as one of 6 public health target areas. One study conducted by Chanda and colleagues (Chanda, 2002) examined factors that affect TB rates in nurses at a major teaching hospital. The study found the nurse’s age, length of employment, and the shift they worked to be associated with higher TB rates. A discussion of collaborative efforts between governmental and non-governmental agencies highlights interventions to train community-based workers and family members. The authors conclude with recommendations to improve TB prevention, detection, and treatment of health professionals.

Managing complicated medication regimens is difficult under the best of circumstances. In the context of low education levels, poverty, illegal substance use, alcohol use, and family responsibilities it becomes even more of a challenge, especially for women. In "Motivating HIV Positive Women to Adhere to Antiretroviral Therapy and Risk Reduction Behavior: The KHARMA Project, " Marcia McDonnell Holstad, Colleen DiIorio, and Mabel Magowe review current data related to women infected with HIV, with an emphasis on medication adherence and risk reduction behavior. As part of a federally funded research study, an intervention, the Keeping Health and Active Risk reduction and Medication Adherence (KHARMA) project, was developed to address these issues using a motivational group process led by a nurse. Nurses caring for HIV positive women need to understand the complex social, psychological, economic factors that challenge their ability to take antiretroviral therapy and use risk reduction behaviors on a consistent basis. Nurse led motivational groups are one tool to help HIV positive women develop the necessary skills to manage their disease.

In "The 2003 SARS Outbreak: Global Challenges and Innovative Infection Control Measures," Cathryn Murphy, an Australian epidemiologist and infection control consultant, describes novel infection control practices she observed in several countries in response to the SARS outbreak. The author worked during the outbreak as a short term consultant for the WHO to assist in assessment of infection control practices in clinical and isolation facilities in three Southeast Asian countries. Creative examples of practice that emerged during the outbreak include triage outside of the emergency department, separating patients by use of colored umbrellas, use of pocket mirrors to check facemask fit, and use of a buddy system to ensure health care worker compliance with isolation precautions. Murphy includes pictures from her personal collection that demonstrate several of these practices for the reader. She recommends a minimum global level of infection control practice and using lessons learned to improve infection control practices.

Collectively these articles demonstrate that whether dealing with established or newly emerging infectious diseases, systems to detect and monitor them, or programs to improve treatment regimens and adherence, nurses are a critical part of the process. As nurses we have an obligation, according to the American Nurses Association Code of Ethics for Nurses with Interpretive Statements, " ...to promoting the health, welfare and safety of all people..." and "...to be knowledgeable about the health status of the community and existing threats to health and safety" (2001, Provision 8). The practical information and resources provided in these articles will help us to meet these obligations through becoming better educated about potential risks and providing us with innovative ways to improve our practice. Armed with current information and creative ways to help our patients, we move one step closer to improved health for peoples around the globe.

You are invited to express your response to this Online Journal Issues in Nursing (OJIN) Infectious Diseases topic in the form of either a Letter to the Editor or through the development of an article. Through participation in either form of response, you will take advantage of a unique aspect of the Internet to actively participate in timely dialogue about a current nursing issue.

Author

Mary Pat Couig, MPH, RN, FAAN
Email: mpcouig@comcast.net

RADM Mary Pat Couig (ret.) recently retired from active duty in the U.S. Public Health Service (USPHS) Commissioned Corps. From December 2000 to October 2005 she served as Chief Nurse Officer for the USPHS. As Chief Nurse Officer, she was the Senior Advisor for Nursing to VADM Richard Carmona, United States Surgeon General. She earned her Masters in Public Health from Johns Hopkins School of Hygiene and Public Health.