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).