Diseases know no borders.

With ebola in Texas, the return of whooping cough, and some new paralyzing virus making the rounds of children’s hospitals, public health is back on the agenda in a major way. The questions are how do we deal with contagious diseases when they brew in less developed nations and how do we deal with contagious diseases when a group of people refuse to comply with public health guidelines.

The United States has an adequate way of dealing with contagious diseases that don’t have the complications of a resistant minority and international issues. When Ian was diagnosed with whooping cough a few years ago, I was flabbergasted at the speedy response by officials. After the seven minute drive home from the doctor’s office, I walked into the house with my sick, flushed kid. My phone was ringing. The local public health nurse was on the phone.

For 30 minutes, she had me trace back everybody that we had been in contact with over the past two weeks, and where they were. Whooping cough is tough, because you are contagious before you come down with symptoms. This was incredibly complicated, because we had just finished with the Christmas holidays and we had been to a ton of parties. My in-laws stayed with us and then travelled to Cleveland, where they saw a ton of people, including an aunt who was on dialysis.

The entire family was immediately put on antibiotics. Ian missed a couple weeks of school. I think I had to keep Jonah home from school, too.  The nurse alerted our guests’ and friends’ the public health officials. She alerted the school districts. Ian’s school sent home a notice to every child in his school. (Luckily, Steve and Ian didn’t get anybody else sick.)

The public health machine worked well. The disease ended on our doorstep. Sure, there were some errors. Steve was misdiagnosed by the family doctor. Steve must have gotten the disease from work, where there were a large number of workers who travelled internationally or who had lived in countries without our vaccination requirements. Still, the local response to our ill kid was impressive.

But these tried and true methods of dealing with infectious diseases can’t handle the two new challenges of a resistant minority (those who refuse to vaccinate their children) and the poor public health systems in developing nations. Public health policy needs some new ideas.

UPDATE: Uh, I guess I wrote a blog post about this right after it happened. The public health officials responded a day later, as soon as the doctor got the results.