Infectious Diseases, Misc

Tuberculosis is a globally widespread disease, with approximately a quarter of the world’s population currently infected. Some risk factors, such as HIV status, nutrition and body mass index, have already been thoroughly investigated. However, little attention has been given to behavioural and/or psychological risk factors such as stress and education level. This study investigated the risk factors for TB diagnosis by statistical analyses of publicly available data from the most recent wave of the Indonesian Family Life survey conducted in 2015. (...) Out of 34,249 respondents there were 328 who reported having TB. For comparison and completeness, variables were divided into levels: individual-, household- and community-level variables. The most prominent and interesting variables found to influence TB diagnosis status were investigated, and a logistic regression was subsequently developed to understand the extent to which each risk factor acts as a predictor for being diagnosed with TB. Age, health benefit or insurance, stress at work and living in a rural area all showed significant association with TB diagnosis status. This study’s findings suggest that suitable control measures, such as schemes for improving mental health/stress reduction and improved access to health care in rural areas should be implemented in Indonesia to address each of the key factors identified. (shrink)

Each year, over 200 million people are infected with the malaria parasite, nearly half a million of whom succumb to the disease. Emerging genetic technologies could, in theory, eliminate the burden of malaria throughout the world by intentionally eradicating the mosquitoes that transmit the disease. In this paper, we offer an ethical examination of the intentional eradication of Anopheles gambiae, the main malaria vector of sub-Saharan Africa. In our evaluation, we focus on two main considerations: the benefit of alleviating the (...) malaria burden, and the loss of value that would accompany the eradication of the species. We outline a typology of the different ways in which species are valued or could be valuable, then use that typology to appraise the value of the species in question. We argue that Anopheles gambiae has minor instrumental value, little final subjective value and no objective final value. (shrink)

The COVID-19 pandemic has shown that zoonotic diseases are a great threat for humanity. During the course of such a pandemic, public health authorities often apply the precautionary principle to justify disease control measures. However, evoking this principle is not without ethical implications. Especially within a One Health strategy, that requires us to balance public health benefits against the health interests of animals and the environment, unrestricted use of the precautionary principle can lead to moral dilemmas. In this article, we (...) analyze the ethical dimensions of the use of the precautionary principle in zoonotic disease control and formulate criteria to protect animals and the environment against one-sided interpretations. Furthermore, we distinguish two possible conceptions of the precautionary principle. First, we notice that because of the unpredictable nature of zoonotic diseases, public health authorities in general focus on the idea of precaution as preparedness. This reactive response often leads to difficult trade-offs between human and animal health. We therefore argue that this policy should always be accompanied by a second policy, that we refer to as precaution as prevention. Although zoonotic diseases are part of our natural world, we have to acknowledge that their origin and global impact are often a consequence of our disturbed relation with animals and the environment. (shrink)

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food consumption and noncommunicable disease, the argument in (...) this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption. (shrink)

Background: Infectious disease outbreaks such as COVID-19 and MERS pose a major threat to healthcare workers' physical and mental health. Studies exploring the positive changes gained from adapting to traumatic events, known as post-traumatic growth, have attracted much attention. However, it is unclear which factors or experiences lead to PTG among HCWs. The purpose of this mixed-method study was to investigate factors associated with PTG among HCWs who experienced the MERS outbreak in South Korea, and fully describe their experience of (...) developing PTG.Methods: Quantitative data from 78 participants were collected using psychometric tools for Psychological distress, Resilience, and Support for coping, and Post-traumatic growth. Qualitative interviews were conducted with seven nurses. Data were analyzed using the qualitative content analysis method according to the sub-themes of resilience, which was the main factor associated with PTG.Results: We found resilience to have a significant impact on PTG. Thus the qualitative interviews were analyzed using the core concepts of resilience. Qualitative interviews with nurses illustrated how participants experienced the development of resilience in terms of its sub-factors: hardiness, persistence, optimism, and support.Conclusion: HCWs who endured the MERS outbreak showed high levels of PTG, and the analysis of the interview data provided a fuller understanding on the experience of remaining resilient and developing PTG. These results provide practical and pragmatic information helpful for developing intervention strategies and protocols that can help HCWs transform adversity into growth and development. (shrink)

This article considers what can be learned regarding the ethical acceptability of intrusive interventions intended to halt the spread of infectious disease from existing ethical discussion of intrusive interventions used to prevent criminal conduct. The main body of the article identifies and briefly describes six objections that have been advanced against Crime Control, and considers how these might apply to Infection Control. The final section then draws out some more general lessons from the foregoing analysis for the ethical acceptability of (...) different kinds of Infection Control. (shrink)

Anthropogenic climate change is causing temperature rise in temperate zones resulting in climate conditions more similar to subtropical zones. As a result, rising temperatures increase the range of disease-carrying insects to new areas outside of subtropical zones, and increased precipitation causes flooding that is more hospitable for vector breeding. State governments, the federal government, and governmental agencies, like the Animal and Plant Health Inspection Service of USDA and the National Notifiable Disease Surveillance System of the U.S. Centers for Disease Control (...) and Prevention, lack a coordinated plan for vector-borne disease accompanying climate change. APHIS focuses its surveillance primarily on the effect of illness on agricultural production, while NNDSS focuses on the emergence of pathogens affecting human health. This article provides an analysis of the current framework of surveillance of, and response to, vector-borne infectious diseases, the impacts of climate change on the spread of vector-borne infectious diseases, and recommends changes to federal law to address these threats. (shrink)

This is an introduction to the topical collection Microbes, Networks, Knowledge: Disease Ecology in the twentieth Century, based on a workshop held at Queen Mary, University London on July 6–7 2016. More than twenty years ago, historian of science and medicine Andrew Mendelsohn asked, “Where did the modern, ecological understanding of epidemic disease come from?” Moving beyond Mendelsohn’s answer, this collection of new essays considers the global history of disease ecology in the past century and shows how epidemics and pandemics (...) have made “microbes complex”. (shrink)

This paper explains how discrimination and COVID-19 related stigmas are intertwined. When people stigmatize COVID-19 victims, they act in ways for which the victims suffer status loss and discrimination. As a result, they do not enjoy participatory parity in various aspects of their life making COVID-19 related stigmatization a deplorable instance of discrimination. But a society already fraught with discrimination is a breeding ground of stigmatization often because of people’s fear and anxiety about their life once they become a patient (...) of a disease like COVID-19. (shrink)

Controlled human infection (CHI) studies involve the deliberate exposure of healthy research participants to infectious agents to study early disease processes and evaluate interventions under controlled conditions with high efficiency. Although CHI studies expose participants to the risk of infection, they are designed to offer investigators unique advantages for studying the pathogenesis of infectious diseases and testing potential vaccines or treatments in humans. One of the central challenges facing investigators involves the fair selection of research subjects to participate in CHI (...) studies. While there is widespread agreement that investigators have a duty to select research participants fairly, this principle also yields conflicting ethical imperatives, for example requiring investigators to both exclude potential participants with co‐morbidities since they face increased risks, but also to include them in order to ensure generalizability. In this paper we defend an account of fair subject selection that is tailored to the context of CHI studies. We identify the considerations of fairness that bear directly on selecting participants for CHI studies and provide investigators and members of IRBs and RECs with a principled way to navigate the conflicting imperatives to which these considerations give rise. (shrink)

Fear, anger and hopelessness were the most frequent traumatic emotional responses in the general public during the first stage of outbreak of the COVID-19 epidemic in the Czech Republic (N = 1,000). The four most frequent categories of fear were determined: (a) fear of the negative impact on household finances, (b) fear of the negative impact on the household finances of significant others, (c) fear of the unavailability of health care, and (d) fear of an insufficient food supply. The pessimistic (...) communications used by the Czech mass media contributed to intensifying traumatic feelings, fears and psychological distress in the general public during the outbreak of the COVID-19 epidemic. The anxious emotional tone of the messages and the presentation of selectively chosen “bad ending stories” contributed to the psychological traumatization of the Czech population. This form of communication was motivated by an effort to reach the broadest audience possible. Older adults were the most affected part of the population because of their isolation and their very limited opportunity to share their worries and emotions with others. The communication used by the Czech mass media during the outbreak of the COVID-19 epidemic is a representative example of a traumatizing form of media communication during an epidemic. (shrink)

Recently, as a highly infectious disease of novel coronavirus has swept the globe, more and more patients need to be isolated in the rooms of the hospitals, so how to deliver the meals or drugs to these infectious patients is the urgent work. It is a reliable and effective method to transport medical supplies or meals to patients using robots, but how to teach the robot to the destination and to enter the door like a human is an exciting task. (...) In this paper, a novel human-like control framework for the mobile medical service robot is considered, where a Kinect sensor is used to manage human activity recognition to generate a designed teaching trajectory. Meanwhile, the learning technique of dynamic movement primitives with the Gaussian mixture model is applied to transfer the skill from humans to robots. A neural-based model predictive tracking controller is implemented to follow the teaching trajectory. Finally, some demonstrations are carried out in a hospital room to illustrate the superiority and effectiveness of the developed framework. (shrink)

Diphtheria is an acute toxin-mediated superficial infection of the respiratory tract or skin caused by the aerobic gram-positive bacillus Corynebacterium diphtheriae. The epidemiology of infection and clinical manifestations of the disease vary in different parts of the world. Historical accounts of diphtheria epidemics have been described in many parts of the world since antiquity. Developed in the late 19th century, the diphtheria antitoxin played a pivotal role in the history of public health and vaccinology prior to the advent of the (...) diphtheria-tetanus toxoids and acellular pertussis vaccine. One of the most significant demonstrations of the importance of DAT was its use in the 1925 diphtheria epidemic of Nome, Alaska. Coordinated emergency delivery of this life-saving antitoxin by dog-sled relay in the harshest of conditions has left a profound legacy in the annals of vaccinology and public health. Lead dogs Balto and Togo, and the dog-led antitoxin run of 1925 represent a dynamic illustration of the contribution made by non-human species towards mass immunization in the history of vaccinology. This unique example of cooperative interspecies fellowship and collaboration highlights the importance of the human-animal bond in the one-health initiative. (shrink)

Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética Tuberculose na América Latina e no Caribe: reflexões da bioética The objective of this article is to analyze the conditions of access to health services by people with tuberculosis in Latin America and the Caribbean, reflecting on the public health aspects involved from a bioethical perspective. A literature review of the context of tuberculosis in LAC based on epidemiological data was performed. The results were analyzed from its relationship with (...) the social determinants of health and the ethical principles that guide medical practice. Tuberculosis is a pressing public health problem in the region because of its family, social, economic and health impact. It mainly affects vulnerable individuals and populations. Health services violate ethical principles. Tuberculosis is a serious ethics and public health problem in the region that causes death, disability and increased poverty. It is imperative to ensure the right to health services and to understand the individual and public health consequences of non-adherence to treatment. It is important that national tuberculosis control strategies include principles of dignity and non-discrimination of the sick, changes in the social determinants of the disease, and respect for the ethnicity, language culture and identity of patients. Para citar este artículo / To reference this article / Para citar este artigo Muñoz del Carpio-Toia A, Sánchez-Pérez HJ, Verges de López C, López-Dávila LM, Sotomayor-Saavedra MA, Sorokin P. Tuberculosis en América Latina y el Caribe: reflexiones desde la bioética. pers. bioét. 2018; 22: 331-357. DOI: 10.5294/pebi.2018.22.2.10. (shrink)

Eh!woza is a public engagement initiative that explores the biomedical and social aspects of tuberculosis in South Africa. The project is a collaboration between scientists based in an infectious disease research institute, a local conceptual/visual artist, a youth-based educational non-governmental organization and young learners from a high-burden TB community. The learners participate in a series of interactive science and media production workshops: initially presented with biomedical knowledge about TB and, in later sessions, are trained in creating documentary films and engage (...) with ideas around visual representation. The participants are encouraged to make use of this newly acquired knowledge to tell stories from their chosen communities in Khayelitsha, a township in Cape Town. Through its engagement with the complex manner in which TB is experienced, framed and understood by biomedical scientists, young people, and those who have been affected by the disease, Eh!woza presents alternative ways of exploring the complexities of human illness. The integration and interrogation of biomedical understandings, lay narratives and the young participants’ framing of the disease poses questions about ’knowing', and the meanings people attribute to ways of ’knowing' and the actions they impel. The project also presents contrasting reflections on cure—from a biomedical perspective, and care—from the perspective of TB-affected young people and community members. In this article, we describe the Eh!woza project, present thoughts from the participating students on the science and media workshops, and detail the narratives of ill-health and disease from people within their neighbourhoods. We conclude with a critical analysis of the complexities of knowledge communication, notions of cure versus care, and a consideration of the potential contribution of this project to the growth of medical humanities in Africa. (shrink)

This article addresses an important, overlooked regulatory challenge during global health emergencies. It provides novel insights into how, and why, best practice can support decision makers in interpreting and implementing key guidance on conducting research during GHEs. The ability to conduct research before, during and after such events is crucial. The recent West-African Ebola outbreaks and the Zika virus have highlighted considerable room for improvement in meeting the imperative to research and rapidly develop effective therapies. A means of effectively capturing (...) these experiences and folding them into future decision-making is lacking; the need for effective practical translational measures remains. The challenge for the research community lies in extracting meaningful action-guiding content from pre-existing guidelines—which draw upon practical examples of guidelines ‘in action’—that assist in determining how to act in a particular situation. Insights are provided into the role of best practice as a means to do so; such examples can provide invaluable support to decision makers in interpreting high-level guidance; overarching guidelines retain their necessary level of generality and flexibility, whilst corresponding best practice examples—which incorporate important lessons learned—illustrate how such guidelines can be interpreted at a practical level. (shrink)

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly-recognised Congenital Zika Syndrome. This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in (...) the future. This so-called ‘non-identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non-identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non-identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non-identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person-affecting intervention over an impersonal intervention. However, their responses did not appear to be strongly influenced by the non-identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non-identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS. (shrink)

As a woman who believes whole-heartedly in the human right to safe and legal access to abortion regardless of circumstance, it is rare I find myself balking at a movement to extend legal access to abortion. However, in the case of Brazil’s Zika epidemic, I am struck by an ethical dilemma. Brazil, a historically pro-life country, is currently considering reforming their anti-abortion laws exclusively in cases of fetal defects caused by Zika infection.[1] I strongly believe reproductive rights are human rights, (...) however, if the only exceptions made in allowing safe and legal access to abortion are in cases of a disabled fetus, we as ethicists must pause. The fact that in Brazil, a country with a strong moral and legal belief in fetal personhood, lawmakers are willing to abandon this belief solely in cases of the physically and intellectually disabled presents dangerous infringements on disabled individuals’ rights. Furthermore, advocating for legal abortion solely in the case of fetal disability is ethically wrong and has historically eugenic undertones. As a pro-choice individual, it is essential to consider the ethical concerns that exist even in movements advocating for anti-abortion law reform. Brazil, a predominately Roman Catholic country, has maintained historically restrictive abortion laws. It is a foundational belief of the Catholic Church that life begins at conception and therefore the termination of pregnancy is akin to murder.[2] Thus, obtaining an illegal abortion is a crime punishable by up to three years imprisonment.[3] Up until 2012, abortion was prohibited unless the pregnancy posed a significant risk to the woman’s life, or the pregnancy in question resulted from rape. However, in 2012 the Supreme Federal Court of Brazil ruled to legalize abortion in the case of fetal anencephaly.[4] Notably, the Brazilian Supreme Court was able to make this decision by intentionally skirting the Catholic belief in fetal personhood. Since anencephaly leads to death immediately following birth, the court argued that in cases of anencephalic fetuses, abortion did not violate Catholic beliefs since anencephalic infants were not living persons.[5] In the current era of the Zika epidemic, which has affected Brazil significantly, Brazilian lawmakers and advocates are fighting to amend these restrictive abortion laws. This is due to the fact that Zika viral infection in pregnant women has been linked to fetal microcephaly and other significant birth defects characterized as Congenital Zika Syndrome.[6] As a result of these findings, advocates have argued to extend legal abortion status to pregnant women infected with Zika as a legal way to terminate fetuses that will likely result in permanently disabled infants. It is important to note the differences between microcephaly -- Congenital Zika Syndrome -- and the current exception to Brazilian abortion law, anencephaly. Infants born with anencephaly typically die within the first hours or day of birth, whereas in the case of microcephaly, diagnosed individuals can live up to 35 years and longer depending on the severity of the disease.[7] Therefore, the issue of personhood is not so easily skirted legally and morally in Brazil. Advocates for legal abortion in cases of Zika infection argue that women should have the right to terminate a pregnancy that will likely result in an infant with severe birth deformities and disabilities. However, in a country that strongly adheres to the Catholic belief that life begins at conception, it is imperative to consider what the ethical implications are on the rights of disabled individuals by making selective abortion law exceptions in cases of microcephaly. I recognize that raising any infant, but specifically a disabled infant is costly, both for the parents and for the state. Additionally, reproductive freedoms are particularly limited to women of low socioeconomic standing. Therefore, I do not mean to convey that abortion should not be allowed in cases of disability, or that abortion in cases of disability are always eugenic in nature. On the contrary, pregnant women should be able to weigh the pros and cons, economically and emotionally, before deciding to give birth to an infant. I also believe women should be allowed to abort a fetus under any circumstances without judgment. However, when the state makes exceptions exclusively in cases of disability, it poses numerous ethical concerns. There is a long and complicated global history between the movement for reproductive freedoms and disability rights movements. For example, in the United States, Margaret Sanger founded Planned Parenthood, an organization essential to providing safe and affordable reproductive healthcare, including abortions, on the principles of the eugenics movement.[8] Although it is likely Sanger aligned herself with the mainstream eugenics movement of her time as a strategic way to broaden her message of a woman’s right to reproductive freedom, the unfortunate association remains historically documented. Sanger is famously quoted as saying in 1921 that “the most urgent problem today is how to limit and discourage the over-fertility of the mentally and physically defective.”[9] Even feminists and strong reproductive rights supporters must recognize the eugenic potential of extending these rights only in specific circumstances. In a country like Brazil, where life is believed to begin at conception and abortion is criminalized with little exception, it should raise ethical questions when exceptions are being made for disabled fetuses. Additionally, these laws surrounding abortion present larger ethical issues that extend beyond reproductive rights. For example, if disabled fetuses are deemed specifically disposable simply for their disability, what does this potentially suggest for the disabled community of Brazil at large? This ethical framework could provide a precedent that works to justify the limitations of the rights of the disabled. All this being said, I do not believe reproductive rights and the rights of disabled individuals are inherently at odds with one another. On the contrary, I believe there are important connections between the limitation of women’s reproductive freedom and the oppression of disabled individuals, including intersecting class and race oppressions. Perhaps the most famous example of this in the United States is the case of Buck v. Bell of 1927. Under the mainstream eugenics movement, the U.S. Supreme Court ruled in favor of allowing forced sterilization of women who were deemed intellectually or physically unfit. In this case, disabled women’s bodies were forcibly sterilized without their consent by the state to promote a eugenic and able-ist agenda.[10] Similarly, there is a long history in Brazil of sterilizing women with HIV often under dubious consent.[11] Although sterilization is a common form of birth control for Brazilian women due to stringent anti-abortion laws, there are considerably higher rates of sterilization in populations of indigenous and Brazilians of afro-descent, strongly suggesting racial prejudice in these practices.[12] Reproductive rights and disability rights are not inherently in conflict. However, when access to abortion is morally and legally restricted, as in Brazil, making exceptions only in the case of disabled fetuses is ethically wrong. In a country where life is believed to begin at conception, abortion law exceptions in the case of Zika strongly suggests and justifies the idea that disabled individuals are valued less by society. Furthermore, it also perpetuates historical eugenic beliefs that have advocated for genocide. This is not to say I believe Brazil should not work towards wide-ranging abortion law reform. On the contrary, I believe it is imperative that women in Brazil and across the world are granted holistic and unrestricted reproductive freedoms to make their own choices regarding childbirth regardless of their circumstances. There is an ethical responsibility that women should be allowed safe, legal, and affordable abortions whenever needed and/or wanted including in cases of fetal disability if the pregnant woman so chooses. However, I do not believe that legal abortion should be exclusively granted solely in cases of fetal disability. Granting legal abortion specifically in cases of fetal disability but not in other circumstances presents dangerous ethical implications that disabled populations are worth less than their fellow able-bodied citizens. Works Cited [1] Boseley, Sarah. "Zika Emergency Pushes Women to Challenge Brazil's Abortion Law." The Guardian. Guardian News and Media, 19 July 2016. Web. 03 July 2017. [2] Catechism of the Catholic Church - IntraText. N.p., n.d. Web. 03 July 2017. [3] Human Rights Watch: Women's Human Rights: Abortion. N.p., n.d. Web. 03 July 2017. [4] Ray, Audacia. "Brazil: Supreme Court Makes Abortion Legal in Cases of Anencephaly." International Women's Health Coalition. N.p., 21 Nov. 2013. Web. 03 July 2017. [5] Luna, Naara. "Anencephalic Fetuses and Research Embryos: Subjects of Rights?" Estudos Feministas. Revista Estudos Feministas, n.d. Web. 03 July 2017. [6] "Zika Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 26 Apr. 2017. Web. 03 July 2017. [7] "Microcephaly – Life Expectancy, Pictures, Definition, Treatment." Medical Treasure. N.p., n.d. Web. 03 July 2017 [8] "Margaret Sanger, Race and Eugenics: A Complicated History." Time. Time, n.d. Web. 03 July 2017. [9] "The Eugenic Value of Birth Control Propaganda." The Public Papers of Margaret Sanger: Web Edition. N.p., n.d. Web. 03 July 2017. [10] Buck v. Bell, 274 U.S. 200 [11] "HIV-positive Women in Northeast Brazil: Tubal Sterilization, Medical Recommendation and Reproductive Rights." Taylor & Francis. N.p., n.d. Web. 03 July 2017 [12] Sterilization in Brazil. N.p., n.d. Web. 03 July 2017. (shrink)

Tuberculosis, caused by bacteria, usually affects the lung. Being airborne, TB has been one of the world’s deadliest communicable diseases. In spite of being curable and preventable, the disease has always been a continuous threat to human population. Moreover, there are cases of multidrug resistant, extremely drug resistant as well as HIV associated forms. Recognizing this grave threat, the World Health Organization urged every country to have a national program for tuberculosis prevention and control. After incidences of involuntary detentions of (...) people with suspected TB in some places, WHO also recommended that national TB prevention programs should incorporate ethical considerations in them. Specifically, it prescribed that human rights and social justice issues should be given due considerations. Studies suggest that India, following the international recommendations, has rolled down a national program to prevent and control TB cases in the country. However, neither is there much consideration of ethics in it, nor there is any pronounced effort to include social justice issues. The present paper investigates how the inclusion of elements from social justice theory can actually help India’s TB program to address the issue of equitable protection. Specifically, it shows how insights from JP Ruger’s ‘Health Capability Paradigm’ can help India’s TB strategies to render equitable protection by addressing health inequities. (shrink)

Herbert, Dilinie The Zika virus has dominated the news media and captured the attention of the international community. Epidemic disease has become the mainstay of public health emergencies in our recent past with Ebola virus in West Africa and now Zika virus in Latin America. An unexpected and troubling feature of this current outbreak is the high incidence of birth defects and neurological health complications. As scientists investigate a possible causal link, health authorities as well as Catholic Church leaders are (...) involved in communicating how women and the wider community should make decisions about their health, reproduction and pregnancy. A morally appropriate, culturally sensitive and socially inclusive approach to managing the immanent risk should be the priority. (shrink)

Se realizó una revisión bibliográfica con el objetivo de profundizar los conocimientos sobre el cólera y su historia. Se tratan aspectos relacionados con la etiología de la enfermedad, patogenia, cuadro clínico, tratamiento, epidemiología y prevención. El cólera es una enfermedad de origen multicausal donde intervienen factores biológicos, ambientales, sociales, políticos y culturales, la cual está resurgiendo como un problema sanitario de primera magnitud en muchos países. Para su erradicación es necesario desarrollar una fuerte promoción de salud en el seno de (...) la sociedad, garantizar atención rápida a enfermos y contactos e impedir la desorganización de la estructura social y económica en pro de la calidad de vida del ser humano. A bibliographical revision with the objective of deepening in the knowledge on cholera and its history was carried out. Some aspects related with its aetiology, pathology, clinical picture, treatment, epidemiology and prevention are considered. Cholera is an illness of multicausal origin where biological, environmental, social, political and cultural factors intervene. This disease is resurging as a sanitary problem of first magnitude in many countries. It is necessary to develop a strong promotion of health in the society to eradicate it, to guarantee a quick attention to sick and contacts and to impede the disorganization of the social and economic structure in favour of the quality of the human being life. (shrink)

In the contemporary biomedical literature, every disease is considered genetic. This extension of the concept of genetic disease is usually interpreted either in a trivial or genocentrist sense, but it is never taken seriously as the expression of a genetic theory of disease. However, a group of French researchers defend the idea of a genetic theory of infectious diseases. By identifying four common genetic mechanisms (Mendelian predisposition to multiple infections, Mendelian predisposition to one infection, and major gene and polygenic predispositions), (...) they attempt to unify infectious diseases from a genetic point of view. In this article, I analyze this explicit example of a genetic theory, which relies on mechanisms and is applied only to a specific category of diseases, what we call “a regional genetic theory.” I have three aims: to prove that a genetic theory of disease can be devoid of genocentrism, to consider the possibility of a genetic theory applied to every disease, and to introduce two hypotheses about the form that such a genetic theory could take by distinguishing between a genetic theory of diseases and a genetic theory of Disease. Finally, I suggest that network medicine could be an interesting framework for a genetic theory of Disease. (shrink)

Throughout the 19th century and early decades of the 20th century, milk was a dangerous food that required state intervention to make it safe. Throughout this period, the germ theory of contagious disease came to prominence, but could not explicitly determine the causal relationships linking germs, milk, and human illness. Using the notion of an ideational regime, I examine how (1) knowledge claims move from uncertainty to certainty and become privileged claims within ideational regimes that (2) result in an unintended, (...) but necessary deployment of a biopolitical strategy for governance. The argument here is that theoretical uncertainty meant managing populations as a uniform undifferentiated reality using pasteurization technologies. I use two historical moments as evidence of these processes. The first is the 1901 British Congress on Tuberculosis when I argue germ theory came to a theoretical standstill and the second is Ontario’s 1938 amendment to the province’s Public Health Act that permanently institutionalised province-wide compulsory pasteurisation laws organised around the notion of nutritional equivalency. This genealogical exploration should provide some insight into how bacteria became the singular cause of illness and into the conditions that led to targeting milk as the main site of intervention instead of treating individual bodies. (shrink)

In the mid-1800s, there was much debate about the origin or 'exciting cause' of cholera. Despite much confusion surrounding the disease, the so-called miasma theory emerged as the prevalent account about cholera's cause. Going against this mainstream view, the British physician John Snow inferred several things about cholera's origin and pathology that no one else inferred. Without observing the vibrio cholerae, however,-data unavailable to Snow and his colleagues-, there was no way of settling the question of what exactly was causing (...) cholera and how, or if, it was passed on. The question then arises as to how Snow arrived at conclusions so systematically different from those of his opponents. In this paper, I want to look at Snow's reasoning in some detail, and show that there were certain principles, explanatory power in particular, that were epistemologically important to Snow in their own right. I will show that Snow himself takes explanatory power to be an epistemic property, and makes explicit links between explanatory power and confirmation. Systematically juxtaposing Snow's claims and his opponents', I will show that Snow was right to tout the explanatory power of his theory, and that his conclusions about the epistemic superiority of his theory over that of the miasmatists' were justified. (shrink)

This paper reassesses Robert Koch’s work on tropical infections of humans and cattle as being inspired by an underlying interest in epidemiology. Such an interest was developed from the early 1890s when it became clear that an exclusive focus on pathogens was insufficient as an approach to explain the genesis and dynamics of epidemics. Koch, who had failed to do so before, now highlighted differences between infection and disease and described the role of various sub-clinical states of disease in the (...) propagation and—consequently—in the control of epidemics. Studying pathologies of men and cattle in tropical countries eventually facilitated the application of such measures in Europe through the screening of healthy carriers of typhoid, which was carried out in 1902. The concept of the carrier state can be understood as a spin-off from tropical medicine into the study and control of infectious disease in Europe. With it travelled assumptions that were typical for colonial and veterinary medicine where the health of indigenous individuals or cattle would be a secondary objective compared to the control of diseases in populations. (shrink)

The aim of this study was to analyze nurses' experiences of role strain when taking care of patients with severe acute respiratory syndrome (SARS). We adopted an interpretive/constructivist paradigm. Twenty-one nurses who had taken care of SARS patients were interviewed in focus groups. The data were analyzed using thematic analysis. The self-state of nurses during the SARS outbreak evolved into that of professional self as: (1) self-preservation; (2) self-mirroring; and (3) self-transcendence. The relationship between self-state and reflective practice is discussed.

Dramatic events involving dangerous microbes often focus attention on isolation and quarantine as policy instruments. The incident in May-June 2007 involving Andrew Speaker and drug-resistant tuberculosis joins other communicable disease crises that have forced contemplation or actual application of quarantine powers. Implementation of quarantine powers, which encompasses authority for both isolation and quarantine actions, is important not only for the handling of a specific event but also because the use of such authority provides a window on broader issues of public (...) health and the legal rules, ethical principles, and governance systems that support it. Debates about quarantine powers reflect political and social attitudes about public health that often tell us more about this policy endeavor than acts of isolation and quarantine themselves. (shrink)

Taiwan was affected by an outbreak of severe acute respiratory syndrome (SARS) in early 2003. A questionnaire survey was conducted to determine (1) the perceptions of risk of SARS infection in nurses; (2) the proportion of nurses considering leaving their job; and (3) work as well as non-work factors related to nurses' consideration of leaving their job because of the SARS outbreak. Nearly three quarters (71.9%) of the participants believed they were 'at great risk of exposure to SARS', 49.9% felt'an (...) increase in workload', and 32.4% thought that people avoided them because of their job; 7.6% of the nurses not only considered that they should not care for SARS patients but were looking for another job or considering resignation. The main predictors of nurses' consideration of leaving their job were shorter tenure, increased work stress, perceived risk of fatality from SARS, and affected social relationships. The findings are important in view of potential impending threats of pandemics such as avian influenza. (shrink)

Responses to public health emergencies can entail difficult decisions about restricting individual liberties to prevent the spread of disease. The quintessential example is quarantine. While isolating sick patients tends not to provoke much concern, quarantine of healthy people who only might be infected often is controversial. In fact, as the experience with severe acute respiratory syndrome (SARS) shows, the vast majority of those placed under quarantine typically don't become ill. Efforts to enforce involuntary quarantine through military or police powers also (...) can backfire, stoking both panic and disease spread. Yet quarantine is part of a limited arsenal of options when effective treatment or prophylaxis is not available, and some evidence suggests it can be effective, especially when it is voluntary, home-based and accompanied by extensive outreach, communication and education efforts. Even assuming that quarantine is medically effective, however, it still must be ethically justified because it creates harms for many of those affected. Moreover, ethical principles of reciprocity, transparency, non-discrimination and accountability should guide any implementation of quarantine. (shrink)

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

This study investigated the relationship between hospital nurses’ professional care obligation, their attitudes towards SARS infection control measures, whether they had ever cared for SARS patients, their current health status, selected demographic characteristics, and the time frame of the data collection (from May 6 to May 12 2003 during the SARS epidemic, and from June 17 to June 24 2003 after the SARS epidemic). The study defines 172 nurses’ willingness to provide care for SARS patients as a professional obligation regardless (...) of the nature of the disease. A conceptual model was developed and tested using ordinal logistic regression modelling. The findings showed that nurses’ levels of agreement with general SARS infection control measures and the lack of necessity for quarantining health care workers who provided care for SARS patients were statistically significant predicators of the nurses’ fulfilling of their professional care obligation. Suggestions and study limitations are discussed. (shrink)

SARS and monkeypox have given the public health community a unique opportunity to examine the use of quarantine measures. Until recently, the word “quarantine”was not used in polite conversation, and evoked unsavory images. The recent SARS epidemic illustrated the important role of quarantine and isolation as a public health response to communicable disease.As public health officials in Toronto began to take control of the SARS epidemic, a second wave of the disease emerged. In the first SARS epidemic, approximately 8,200 individuals (...) were isolated. There were approximately 82 probable cases, 66 suspect cases, and 24 deaths. On May 22, 2003, SARS II emerged. In total, approximately 13,000 people were quarantined. SARS II saw the onset of difficult questions being asked about the control and spread of SARS.The province of Ontario establishes the public health policies and legislative framework for the entire province. (shrink)

SARS and monkeypox have given the public health community a unique opportunity to examine the use of quarantine measures. Until recently, the word “quarantine”was not used in polite conversation, and evoked unsavory images. The recent SARS epidemic illustrated the important role of quarantine and isolation as a public health response to communicable disease.As public health officials in Toronto began to take control of the SARS epidemic, a second wave of the disease emerged. In the first SARS epidemic, approximately 8,200 individuals (...) were isolated. There were approximately 82 probable cases, 66 suspect cases, and 24 deaths. On May 22, 2003, SARS II emerged. In total, approximately 13,000 people were quarantined. SARS II saw the onset of difficult questions being asked about the control and spread of SARS.The province of Ontario establishes the public health policies and legislative framework for the entire province. (shrink)

The germ theory of disease famously brought a new notion of specificity into concepts of disease. At the same time, the work of Pasteur, Koch and their colleagues was developed during the same decades as Charles Darwin's theories of evolutionary biology challenged traditional notions of the essentialism of biological species. This essay examines some of the ways in which Darwin's work was invoked by British doctors seeking to explain clinical or epidemiological anomalies, in which infectious diseases did not appear to (...) breed true. (shrink)

This essay is concerned with popular and biomedical accounts of the appearance of pellagra at the turn of the last century. Many of these accounts portrayed the disease as communicable despite early evidence to the contrary, which suggested it was attributable to nutritional factors. The nonspecific nature of its symptom profile, along with the enormous range of cure-alls offered to the public, made the etiology of pellagra open to a variety of interpretations. However, as the author shows, the infection paradigm (...) and genetic determinism hindered efforts to understand and treat pellagra. (shrink)

Robert Koch based his claim that specific microorganisms cause particular diseases on laboratory studies. This paper examines how Koch set up a plausible line of argument by using special methods of representing bacteria. One kind of representation consisted in making the bacteria visible; the other mode of representation was based on disease phenomena. Using a range of techniques of isolating and controlling microorganisms, Koch combined these different modes of representation in a way that made his claims convincing. Thus, the microorganism (...) as a specific cause of disease emerged through a chain of repeated processes of selection and representation in the laboratory. (shrink)

The outbreak of syphilis in Europe elicited a variety of responses concerning the disease's origins and cure. In this essay, I examine the theory of the origins of syphilis advanced by the 16th-century Italian surgeon Leonardo Fioravanti. According to Fioravanti, syphilis was not new but had always existed, although it was unknown to the ancients. The syphilis epidemic, he argued, was caused by cannibalism among the French and Italian armies during the siege of Naples in 1494. Fioravanti's strange and novel (...) theory is connected with his view of disease as corruption of the body caused by eating improper foods. His theory of bodily pollution, a metaphor for the corruption of society, coincided with Counter-Reformation concepts about sin and the social order. (shrink)

This paper attempts to show how leading contemporary disciplines influenced the discovery of Chagas' disease and the formation of the early disease concept. Chagas was among the first generation of Brazilian trained scientists who incorporated modern principles of tropical medicine in its research. Thus, Chagas was familiar with characteristics of vector borne tropical diseases such as malaria and yellow fever. The detection of a hitherto unknown trypanosome in the gut of a reduviid bug prompted him to search for a related (...) vector borne disease. Among the disciplines that were influential on Chagas' discovery and early disease description were pathology, entomology and parasitology. Parasitology as a new discipline was of crucial importance to tropical medicine and had a political dimension in the context of colonial medicine. Hence, leading scientists in tropical medicine were located in European countries and in the United States of America. One of these was the German Schaudinn School of Protozoology. The early description of American Trypanosomiasis can also be seen as a reflection of the Schaudinn School of Protozoology which dominated Chagas' scientific orientation towards parasitology with regard to the interpretation of the observed phenomena of the life cycle and the morphology and biology of T. cruzi. The first Chagas' disease concept was based on research of the biology and entomology of the trypanosome and its vector as well as on pathological studies of fatal cases. This concept was characterized by a confusion of some of the chronic forms of the disease, as iodine deficiency and goitre were endemic in some rural regions in Brazil. Therefore, early concepts of the disease faced strong opposition and even raised doubts about its existence. (shrink)

During the mid-nineteenth century the annual tuberculosis mortality in the penitentiaries at Auburn, N.Y., Boston, and Philadelphia exceeded 10 percent of the inmate population. At the beginning of the sanatorium era, 80 percent of the prison deaths were attributed to TB. As the mountain air was “commonly known” to be healthful, the first prison sanatorium was opened in the mountains near Dannemora, N.Y. in 1904. It served to isolate contagious prison inmates until the advent of effective chemotherapy for the disease (...) in the 1950’s. Early antibiotic therapy for TB was such a great success that the public health aspects of TB in prisons remained dormant for the next 40 years.In 1991, a correctional officer from Auburn Correctional Facility in Auburn, New York died as a result of multidrug-resistant TB. He had been posted to care for hospitalized patients, from whom he acquired his disease. This death, and the transmission of TB infection to health care workers in the same hospital, brought the nature and extent of modern inmate medical care into finer focus. (shrink)