Wednesday, July 3, 2019

Investigative public health: The scope of public health detectives

Dr KK Aggarwal

Resurgence of infectious diseases is a reflection of the existing public health system in the country. Infectious diseases occur every year in India with monotonous regularity and we are unable to control the frequency of their occurrence and their subsequent spread.

A public health approach to health care may be the answer. Unlike clinical medicine, which focuses on individuals and diagnosis and treatment, public health deals with the whole community and is preventive.

Every preventable death should be audited, and every index case of any communicable disease should be traced for the source.

The time has come for investigative public health department with appointment of public health detectives, who will help establish the cause of the outbreak and how can its spread be limited. Here lies the importance of contact tracing and their monitoring. Contacts can be the immediate family and/or those who have been in close proximity to the index case, including the health care workers who have looked after the patient.

·         Monsoons are not off, and every first reported case of dengue should be traced for its origin.
·         Typhoid is continuing (summer to monsoon) and every case in the community should be investigated for the common source of food. Recently in the US, typhoid outbreak was traced to patients who ate fresh papayas imported from Mexico and sold in a common food store. The CDC issued a safety alert advising consumers to not eat fruit imported from Mexico.
·         Last week Delhi reported its first death due to diphtheria. Source of the first case should be traced and surrounding areas.
·         Every case of GeneXpert positive TB should be traced back to the source including contact tracing.
·         Every unexplained death should have post-mortem X ray, CT, MRI or mini tissue biopsies to know the cause of death.
·         The index (first) case should be traced in diseases like diphtheria, flu, acute food poisoning etc.
·         Any new symptoms should be reported to the public health department.
·         The department should provide free investigations for the illnesses.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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