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2 December, 2019 00:00 00 AM

The AIDS epidemic: Public health importance of case reports - an example

The AIDS epidemic: Public health importance of case reports - an example

December 1, is observed as World AIDS Day every year from 1988 to raise awareness and bring people together in the fight against HIV/AIDS. AIDS is the abbreviation of Acquired Immunodeficiency Syndrome and the disease is caused by HIV (Human Immunodeficiency Virus). The disease was first heard in the decades of 1980s globally. In Bangladesh National Committee on AIDS was formed in 1985.

The first detected case of HIV in Bangladesh was in 1989. Since then HIV continued to exist. In 2018, number of new cases detected was 869 among which 148 succumbed to this fatal virus. Cumulative detected HIV/AIDS cases from 1989 to 2018 was 6,455. Total number of deaths in this period was reported to be 1,022.

Case reports are usually drafted by clinicians. Case reports are also relevant in public health. Working with information from case reports or a series of cases is often the first step in a field or community investigation.     For an epidemiologist concerned with the clinical details of an illness, the causal agent, the environmental facilitators and other risk factors, additional information will be needed. Demographic, social and other behavioral characteristics and possible exposure to biological, physical or chemical agents are also essential.

In mid-1981, an epidemiologist at the Los Angeles County Health Department realized that the five reports he had received of a rare kind of pneumonia caused by Pneumocystitis carinii might be an epidemic. The disease reports came from three different hospitals and had involved men between 29 and 36 years of age.

Typically, this kind of pneumonia occurs among people who have depression of their immune system, which can occur, for example, when people receive cancer chemotherapy. At one hospital, a large university medical center, the clinician caring for these patients had already recognized this unusual occurrence. A month later, a report from another part of the United States documented the occurrence of this same kind of pneumonia.

In addition, some patients had the unusual infections and a rare form of cancer, Kaposi’s sarcoma. This group of 26 individuals ranged in age from 26 to 51 years. Twenty of them lived in New York City, six in California; eight had died within 24 months after diagnosis of Kaposi’s sarcoma; all were male homosexuals. Within the next year, CDC received 355 additional case reports. Five states- California, Florida, New Jersey, New York and Texas –accounted for 86% of the reported cases. This was the beginning of the AIDS epidemic.

A cluster of people with an unusual infection that affected previously well individuals was picked up by an astute clinician and an observant epidemiologist. The epidemiologist knew that even five cases of this kind represented an unusual occurrence, perhaps even an epidemic.

He took the following four key actions:

1. He confirmed each case.

2. Next, he provided a clear, brief description to a central public agency (CDC).

3. Third, he identified the common characteristics of the individuals.

4. Finally, he ensured that the reports stimulated others to search for additional clusters of cases by distributing them to health professionals, including colleagues in epidemiology.

The original group of five reports published in June 1981 and augmented a month later by 26 more cases increased more than 10-fold by June 1982, to 355 cases and by August 1983, to 1972 cases. As of December 1988, almost 83,000 cases of AIDS have been reported in the United States, and more than 46,000 people had died of AIDS.

World Health Organization has reported the occurrence of AIDS from all over the world. It not only involves homosexuals, it also involves heterosexuals, sex workers, IV drug users, blood transfusion receivers, accidental needle prick injury among health professionals (nurses, doctors) and also innocent fetus receives it through placenta if the mother is HIV positive, innocent infant and young child receives it through breast feeding and the poor garbage collectors (tokai) get it by left out syringes, needles in dust bins and waste disposal sites.

Under privileged poor child who uses condom as playing balloon may also get it. 1 million Rohingya Community pushed inside our country in 2018 and that posed a threat of AIDS epidemic. Due to our harsh poverty rural poor woman are obliged to seek work in Middle East countries as home assistant and about 5% of them are being reported to be used as sex slave. This is again another threat for our country.        

 

In 21st century, the epidemic is on decreasing trend globally (fewer than 1 million people dying each year from AIDS related illnesses and 21.7 million people were on treatment (UNAIDS data 2018). While it is on decreasing trend globally, in Bangladesh it is on increasing trend. The most important cause of this epidemic in Bangladesh is IV drug use.

 

Government Strategy: 90-90-90 i.e. 90 percent of HIV cases have to be detected, 90 percent have to come under treatment and 90 percent of patients has to remain under control. Government wants to eradicate HIV/AIDS by 2030. Assistance from all walks of life is needed. We have to fight against drug addiction, prostitution, promiscuity, pornography and adultery. We have to lead life as guided by religion and moral teaching.        

Dr. Md. Tufael Hossain, Associate Professor,

Community Medicine, Community Based

Medical College Bangladesh

 

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Editor : M. Shamsur Rahman

Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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