The state public health and clinical collaboratives that rapidly identified a national outbreak of meningitis with an unusual fungal etiology remain at the mercy of a foe that may prove equally unforgiving: the bean counter.
It can be frustratingly hard to prove the power of prevention, but there is no doubt in the meningitis outbreak that the rapid coordinated response saved many lives and probably millions of dollars. In attempt to quantify this, Tennessee epidemiologists estimate that in their state alone an additional 59 meningitis infections were prevented and at least five patient lives saved due to rapid identification and recall of the contaminated product.
“Despite the strength of the response, the outbreak also exposed vulnerabilities in the nation’s public health systems,” the CDC warned in a recent report on the outbreak. “Since 2008, state and local health departments have lost more than 45,000 jobs and eliminated many important programs and services. These reductions have resulted in even greater reliance on CDC‘s funding to state and local health departments to support core infectious disease program functions. The country could lose its frontline defense of highly trained, flexible epidemiology and laboratory experts capable of effectively detecting and responding to infectious threats.”
In other words, the next outbreak due to some contaminated product, a new emerging infection or even a bioterrorist attack could spread rapidly and cause more infections if such programs see eroding infrastructure and declining staff due to funding cuts. However, the meningitis outbreak showed the inherent value of such programs — wherein clinicians, infection preventionists and public health epidemiologists form partnerships and frequently communicate. In that regard, they could be even better if adequately funded and provided with the latest medical technology.
“There is a need to modernize public health systems at all levels with the best available technologies,” the authors note. “Public health has yet to benefit adequately from advances in information technology and molecular technologies, from electronic health records to rapid genetic sequencing of pathogens and enhanced bioinformatics capacities. As the use of culture-independent diagnostic tests expands in the clinical sector, laboratory-based surveillance systems that rely on cultures must be transformed to ensure their continued ability to detect and prevent clusters of illness. Further, public health needs to reach more broadly in its efforts to reduce infectious diseases and protect health—building and strengthening relationships with partners such as clinical networks, insurance companies and other payers, the media, industry, and consumer groups.”