Recently, public health nurses have been the subject of intense scrutiny in the Maine Department of Human Services, and they are the focus of a heavily lobbied bill in the Legislature to restore their ranks. I have worked side by side with these professionals, and I know their value and their skills.
I have been an infectious disease specialist for the last 29 years in Maine, including four years as the state epidemiologist. In that role, I worked with a team of dedicated professionals to identify highly infectious diseases and develop strategies to protect Maine residents. To perform my job successfully, I relied on public health nurses to help respond to outbreaks and epidemics. They were the glue in public health interventions, and I could not function effectively without them.
Infectious diseases are a leading cause of illness and death worldwide. In the last two decades, we have seen diseases such as Ebola, Zika, SARS, H1N1 and many more emerge. When outbreaks occur, the need to respond is immediate. The Maine Center for Disease Control and Prevention helps identify these diseases, but we need the public health nurses at our sides to provide vaccines and medications to stop the contagion. They provide just-in-time response when no one else is able to respond.
Tracking infectious diseases and mobilizing to prevent and treat outbreaks is one of the oldest functions of governments. This role dates back hundreds of years, even to the Middle Ages, when epidemics of plague, syphilis and smallpox broke out. Maine residents today expect their public health department to protect them from contagious diseases, and public health nurses are vital for managing outbreaks when they occur. During my time as state epidemiologist, I can recall several outbreaks when public health nurses were needed to minimize morbidity and mortality.
A few years ago in Penobscot County, the middle and high schools had a four-fold increase in cases of pertussis, or whooping cough. Whooping cough is a serious illness in children and can cause death in infants. The Maine Center for Disease Control and Prevention worked closely with the schools to provide vaccines to interrupt the outbreak. Who gave these shots? Public health nurses did, allowing a rapid and effective response to a public health emergency.
Another example occurred in Aroostook County, where an elderly resident in a long-term care facility developed tuberculosis. Tuberculosis case rates for the elderly are higher than for any other age group. Once a case of tuberculosis occurs in a nursing home, the risk to other residents increases dramatically. Public health nurses went to the facility, helped treat those infected and helped identify others who either might have active tuberculosis or had become infected. There were three more cases of active tuberculosis, all identified and treated. Without the public health nurses, this outbreak likely would have been far worse.
In Cumberland County, three family members were diagnosed with hepatitis A, a highly contagious liver infection caused by a virus. Hepatitis A is transmitted person to person or by eating food handled by someone with the virus. One of them helped prepare food for a church supper before she knew she was ill, and more than 100 people attending the supper were likely exposed to the virus. Within 48 hours, the Maine Center for Disease Control and Prevention and its public health nurses organized a clinic to provide hepatitis A vaccines to all exposed church members. This required timely coordination, cooperation and logistics to provide this protection to the public. And this outbreak was stopped in its tracks.
And the list of outbreaks goes on — measles in summer camps, H1N1 throughout the state and an increase in gonorrhea in Androscoggin County. In all these cases, it was public health nurses to the rescue.
Infectious disease control has two major goals: avoid transmission of illness and interrupt transmission once it occurs. For a state public health program to be effective, there needs to be a fully-functioning surveillance program and a proactive system to prevent disease outbreaks — that is public health nurses.
Today it may be Ebola, whooping cough, hepatitis A or tuberculosis, but tomorrow it will be new plague. Our residents want to feel confident that public health is there to protect them. I am confident public health nurses will act to protect us all.
Stephen Sears is infectious disease specialist, and he spent four years as the Maine state epidemiologist. He lives in Belgrade.