Dr. Raoult Ratard, the state epidemiologist with
the Louisiana Department of Public Health, discusses exotic diseases and how they
are handled.
Q: We're seeing some
rather exotic, virulent new diseases that we don't have a real handle on, such
as the West Nile Virux, SARS and now monkeypox. What's the explanation?
A:
The media are more interested, for one thing. In the past, when things like
[cases of West Nile, SARS and monkeypox] would happen, they wouldn't get reported.
Also, people are traveling faster, and sick people are going to be faster in
coming into a country. In the past, sick people would take a long time on a
ship to get here and would sometimes be cured by the time they crossed the Atlantic.
Q: Is it the natural
course of epidemiology that new diseases pop up, or is there another explanation?
A:
People are traveling more, and we are importing more goods. Some years ago,
we would only be eating fruits and vegetables from here. Now, you are going
to eat fruits and vegetables and animals from far away. They've shrunk the world.
Q: Is the problem in the
actual foods we import or the act of commerce?
A:
More or less, we've always had this problem; it's not really new. West Nile
probably was imported in some birds that came from the Middle East. SARS probably
came from some kind of wild cat in China, but the reason it came here is that
people (and goods) are traveling more and faster.
Q: Is the big difference
in the way the diseases are spread, i.e. through the air, blood, etc.?
A:
No. There's nothing new in the way they are transmitted.
Q: What are the steps epidemiologists
take to bring diseases under control?
A:
First, you need to recognize that there is a new disease around. Then, the Department
of Health has a department that will track track it and try to overcome obstacles
to getting it reported. Once it's being reported, you can start investigating
to understand why these people are getting this unusual disease. Once you know
where it's coming from, you can get on a course to overcome it.
Q: Is the human genome
mapping any help?
A:
For infectious diseases, they have found the genome for many bacterias. Not
the human genome, but the genome for the bacterias, makes a big difference.
After a few weeks, we knew what bacteria was causing SARS and had a diagnostic
test.
Q: What's the hardest
part of conquering a disease: finding out how it works or finding a way to stop
it?
A:
It depends on the disease. Sometimes we can stop it without knowing how it works.
Q: Of West Nile, SARS and
monkeypox, which is the most potentially dangerous to us here?
A: So
far West Nile because we have had so many cases and we don't have a very good
treatment for West Nile. The best thing we can do is have people take measures
to prevent themselves from getting it.
Q: Has there been
a reduction in the number of new cases of West Nile in humans? We know it has
been found in mosquitos and birds.
A:
So far, we have had no new cases.
Q: Are there new diseases
of concern popping up that the public just hasn't heard about yet?
A:
No. Any time there is a new disease, you hear about it. We (public health officials)
don't keep anything from the media. We tell you what we know when we know it.
What I do in public health is track the disease. Then we make sure that when
there is a preventative program, that the preventative program works well.
Q: So a lot of the
answer lies in education?
A:
It is education in letting the people know what's going on. With West Nile,
we track the disease, we know what's going on and tell people what they need
to do to protect themselves.
Q: Any general advice for
people?
A:
You have to take common sense precautions, but then you also don't want to forget
that you have to die someday of something and you don't want to make your life
too boring. Just crossing the street can be dangerous; more people die every
year from crossing the street than from the West Nile Virus. The solution is
not to be afraid of the street but to understand the risk and take reasonable
precautions. We look at infectious diseases the same way. They are not as dangerous
as crossing the street, but you want to take reasonable precautions against
them (such as wearing insect repellant and cleaning up potential breeding places
for mosquitos).
