10 January 2005

--- Is This a Case of Finding The "Less-Frightening" Term?

The increase in the number of meningococcemia cases during the past few weeks in the northern Luzon area, mainly Baguio City, has once more raised fears among many Filipinos about the possibility of a meningococcemia epidemic in other parts of the country.

A new term has even been coined for the current frenzy: "praningococcemia," which gives you a glimpse on how the problematic Filipino handles his difficulties. The word comes from two words: "praning", which is street lingo for paranoid or paranoia, and of course, "meningococcemia," the infectious bacterial infection basking in the limelights lately.

Since news of increased number of meningococcemia cases in Baguio City spread during the Christmas holidays until today, there have been reports of enterprising pharmacies hiking the prices of antibiotics and surgical masks, Baguio City trips and hotel cancellations, Baguio City vegetables and strawberries rotting because no one would dare touch or buy them anymore, and Baguio City folk avoiding their public market like the plague because reports have it that it was there where the first cases were seen.

Last November, there were also news of meningococcemia cases. At that time, people here also feared of meningococcemia outbreaks and epidemics, and that made me write a post saying that technically speaking, based on an authoritative reference used by both the CDC and WHO, there was no meningococcemia outbreak.

And now, we are back again to the same scenario, this time with a slightly higher number of cases than last November, but still wondering whether there's an outbreak, an epidemic, or pure, unfounded rumor-mongering. Vital questions need to be answered:
  • In cases like this, when do we call an increase in the number of cases an outbreak, an epidemic, or a pandemic?

  • Is there really a difference between an OUTBREAK and an EPIDEMIC? Is the difference in terms of quantity of cases involved, and if so, how many is too many?

  • What are the benefits, if any, of declaring the present case an outbreak or an epidemic?
The REAL PROBLEM, I think, is the INCONSISTENCY in the announcements of concerned health officials. If you were the ordinary Juan or Joe walking the street, you will be at a loss on what the CORRECT TERM to use in the current situation.

Health Execs Conflict on 'Outbreak' Tag for Baguio
Published on page A15 of the January 9, 2005 issue of the Philippine Daily Inquirer

BAGUIO CITY , Benguet, Philippines -- World Health Organization officials said there was no outbreak of meningococcemia in Baguio City, contradicting a statement made by Health Secretary Manuel Dayrit on Friday.

Dr. Luningning Villa, program manager of the Emerging and Re-emerging infectious unit of the National Center for Disease Prevention and Control of the Department of Health, said Baguio is officially on the meningococcemia alert based on WHO standards.

But she said calling the situation an outbreak is still debatable although Dayrit was interviewed on TV Friday describing the cases of meningococcemia in the city as "technically an outbreak."

"We are still assessing the situation. We need more information so it is difficult to say," said Dr. Hitoshi Oshitani, WHO regional adviser for communicable disease surveillance and response.

The WHO team assessed the 39 cases in Baguio and Benguet province from March 21, 2004 to Jan. 7 this year and said 34 cases met their criteria for suspected meningococcal infection. The WHO team said four cases from December 2004 to Jan. 7 this year were confirmed to be meningococcemia.


In cases like this, it might be good if health officials from the Department of Health (DOH) to the World Health Organization (WHO) to at least show some CONSISTENCY. Health professionals like us need not confuse an already fearing public.

My proposal is to go back to the academe. How about a half-day review class on Epidemiology, courtesy of my highly-esteemed professors in the only university which has undoubtably the best public health school in the country? That can surely help. Besides, I know that my good professors wouldn't mind reminding our local health officials the basics in epidemiologic terms as long as it will help in removing the prevailing fear and confusion.

More questions on meningococcemia? Click here and here for a comprehensive discussion. If you want to see how meningococcal rashes look like depending on severity, click here.

While net-surfing, it is sometimes amusing to find some answers to the questions I posted above in places I would most unlikely find them. From MSN's Slate comes this interesting insight:

For diseases that cause a statistically insignificant number of deaths each week, the CDC often uses incidence data in lieu of fatality percentages. The rule of thumb for meningococcal disease, for example, is that AN ATTACK RATE in excess of 15 cases per 100,000 people for two consecutive weeks constitutes a SIZEABLE EPIDEMIC.

In countries with more centralized health-care systems, such as the United Kingdom, the measurement is usually done by surveying the number of complaints made to general practitioners. In the United Kingdom, if 1,000 out of every 100,000 GP consultations are flu-related, then it's an epidemic.

The CDC doesn't have epidemic thresholds for every disease and actually tends to frown on some of the media hair-splitting over the outbreak-epidemic line. The center's online glossary states that "outbreak" can actually be used interchangeably with "epidemic" and that the former is often preferable merely because it's a less frightening term.

Few epidemiological words stir up more panic than "pandemic," and for good reason. A pandemic is an epidemic that occurs across several countries and affects a sizable portion of the population in each, although there's no formal definition of what constitutes "sizable." According to the CDC, the last influenza pandemic took place in 1968-69, when the Hong Kong flu killed 33,800 Americans between September and March.

[MSN's Slate]

I think ordinary people will appreciate it more if health officials can educate them on what the proper terms are and what the corresponding plan of actions are per identified disease condition. Conflicting statements and inconsistencies will only fuel more fear and confusion.

NOTE: To medical resident doctors and interns writing me emails requesting for meningococcemia statistical figures and other details, I strongly advice you to go to the Department of Health (DOH) library. Do your own research, guys. When I was like you, I also did it the old-fashioned way. You learn more by going to the library. Good luck on your research presentations.

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