Commentary
TB, Emerging Diseases and the Role of Personal Responsibility
Chris J. Wiant, M.P.H. Ph.D.

The recently reported story of a man with multi-drug resistant tuberculosis should sensitize us to the fact that what many think is an eradicated disease is really quite prevalent in certain countries of the world and remains potentially deadly. More importantly, this case demonstrates how easily diseases more contagious than TB could be spread around the world in a very short time. What are the lessons that should be learned from this incident to reduce the chance of a more deadly outbreak of disease?

The most important way to prevent the spread of many diseases is for each of us to assume personal responsibility. For example, the major source of disease outbreaks associated with food products is contamination resulting from failure to wash hands or improperly cleaning and sanitizing food contact surfaces. Drug resistant strains of many diseases evolve as a result of the failure to complete the prescribed course of treatment. Colds and influenza are transmitted as a result of failure to practice good personal hygiene (e.g. washing hands or covering a cough). Good personal hygiene is the first line of defense against transmitting disease to others.

If we are faced with an outbreak of avian flu in humans that reaches the U.S., as many fear is inevitable, there will not be adequate vaccine available for timely use in preventing the disease from spreading. A government ordered quarantine of the general public to prevent person-to-person contact is unlikely to be effective or enforceable. Neither the medical community nor the government will be able to intervene effectively to stop the spread of the disease without cooperation from the public.

We as individuals possess the most potent weapons against becoming victims of a pandemic flu outbreak. Public health officials and others will provide the public with strategies that can be very effective in limiting exposure to the disease and, therefore, reducing the magnitude of the outbreak. Those recommendations, such as hand washing, disinfection of contaminated surfaces and objects and other personal hygiene measures can all be easily implemented by individuals.

However, it will require voluntary action by all of us to make these non-pharmaceutical remedies effective. One individual who decides to ignore the recommendations, board a plane and fly to another city or country will potentially infect people who will not know they are at risk. How many of your friends, neighbors and coworkers would demonstrate this behavior? They can then become carriers of the virus and begin a new generation of the disease by exposing others. This multiplying effect can quickly create an unmanageable outbreak.

As the recent TB case demonstrates, even with proper medication and sound medical advice, the most important factor in disease management is the willingness of patients to heed the advice and take personal responsibility for protecting themselves and others.

Chris Wiant is President and CEO of Caring for Colorado Foundation in Denver Colorado and chairman of the Water Quality & Health Council.