Balancing Clinical and Environmental Responses to Infectious Diseases

• Type of Material: Article
• Authors: Justin V Remais, Emory University; Joseph N.S. Eisenberg, University of Michigan
• Language: English
• Date: 2012-04-14
• Publisher: Elsevier: Lancet
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2012, Elsevier
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1016/S0140-6736(11)61227-0
• Title of Journal or Parent Work: Lancet
• ISSN: 0140-6736
• Volume: 379
• Issue: 9824
• Start Page: 1457
• End Page: 1459
• Grant/Funding Information: This work was partly supported by the National Institute of Allergy and Infectious Diseases (grants K01AI091864 and RO1AI050038), by the joint Ecology of Infectious Disease Program funded by the Fogarty International Center of the National Institutes of Health and the National Science Foundation (grants 0622743 and 0811934), and by the Global Health Institute at Emory University.
• Research Categories: Health Sciences, Public Health

Abstract

A child enters a village clinic in China presenting with symptoms of lead poisoning. She is treated, and the area around her house is investigated for the source of exposure, an environmental response designed to prevent re-exposure. A child enters the same clinic presenting with symptoms of acute schistosomiasis infection. He is treated and sent home only to be reinfected in his still-contaminated community. This contrasting response to chemical and infectious environmental hazards is not an isolated example; rather it is a reflection of the largely clinical orientation of many global infectious disease control efforts, despite the potential for environmental interventions to sustainably and cost-effectively limit re-exposure to environmental pathogens. We argue that the management of environmental pathogens— currently dominated by clinical intervention—could benefit from an improved balance between clinical response and environmental action. Interestingly, physicians themselves have argued for just such a balanced response to chemical environmental hazards—an important historical example is the chemical hazard lead (Pb).