Epidemiological Report

Epidemiological Report: Miami-Dade County

            Emerging and re-emerging infectious diseases remain a significant health threat in the U.S. A significant number of Americans continue to contract various infectious diseases most of which are vaccine preventable. These diseases put considerable strain on the healthcare system and impeded the efforts to improve public health. The Center for Disease Control and Prevention (CDC) has developed a comprehensive list of infectious diseases that must be reported by healthcare providers. This list is updated annually to capture the changing trends of infectious diseases in the country. It contains airborne, foodborne, waterborne, vectorborne, zoonotic, vaccine-preventable, sexually transmitted, and CNS diseases. Some of the commonly reported infectious diseases in Miami-Dade County include Tuberculosis (TB), HIV/Aids and Lyme disease. An analysis of the three diseases with a focus on their morbidity, mortality, impact on the community and identification and containment is crucial.

The Communicable Diseases

TB

            The incidences of TB in Miami-Dade have declined considerably in the last 10 years. In 2007, the county’s TB incidence rate was 7.6 cases per 100,000 persons. This rate declined to 3.6 cases per 100,000 persons in 2017 (Florida Department of Health, 2017c). However, the county has a higher TB incidence rate in comparison to Florida and the nation. Currently, the TB incidence rate for Florida and U.S are 2.7 and 2.9 cases per 100,000 respectively (Florida Department of Health, 2016d). The age-adjusted TB mortality rate for Miami-Dade and Florida are the same. The current rate is 0.1 deaths per 100,000.

HIV/AIDS

            Miami-Dade has witnessed a decline in the HIV/Aids incidence rate in the last decade. The HIV/AIDS incidence rate for the county was 40 cases per 100,000 in 2006. This rate declined to 17.1 cases per 100,000 in 2016 (Florida Department of Health, 2016b). Despite the sustained decline in the HIV/AIDS cases in Miami-Dade, the county’s HIV/AIDS incidence rate remains considerably high in comparison to the Florida and national averages. Currently, the HIV/AIDS incidence rates for Florida and the nation are 10.5 and 12.3 cases per 100,000. The age-adjusted HIV/AIDS mortality rate for Miami-Dade has declined consistently between 2006 and 2016. The 2006 rate was 18 cases per 1000,000 while the 2016 rate was 6.1 cases per 100,000 (Florida Department of Health, 2016a). However, Miami-Dade’s age-adjusted HIV/AIDS mortality rate is higher than the Florida and national averages. The current rates for Florida and the nation are 3.9 and 2.0 cases per 100,000 respectively.

Lyme disease

            The incidences of Lyme disease in Miami-Dade increased between 2011 and 2014 but declined in 2015 and 2016. Currently, the county’s Lyme disease incidence rate is 0.3 cases per 100,000 (Florida Department of Health, 2016c). This rate is considerably low in comparison to the Florida and national averages. The incidence rate for Florida and the nation are 1.0 and 8.0 cases per 100,000.

Analysis

TB

            TB caused considerable socioeconomic burden on patients and their families. Most people develop feelings of helplessness, hopelessness and fear when diagnosed with TB. The victim’s social live changes drastically. His relatives and friends may start avoiding him and terminate all communication. Furthermore, TB has significant economic effects on the patient due to decreased productivity and the high cost of treatment (Morris et al., 2013). Therefore, the household income declines considerably and one may be forced to seek financial assistance from relatives. The negative experiences associated with TB may cause the patient to develop stress, frustration, depression and suicidal tendencies. Miami-Dade Department of Health lists TB as one of the reportable infectious diseases. It provides comprehensive data regarding the incidences and mortality of the disease from 1997. The county has a comprehensive TB program that comprises of clinical, field/outreach, surveillance and administrative support services (Florida Department of Health, 2017b). These services are designed to enable Miami-Dade to attain three key TB objectives by HealthyPeople2020. The first objective is to reduce the TB incidence rate to 1.0 case per 100,000 persons from the current 3.6 cases per 100,000 by 2020. The second objective is to raise the TB treatment completion rate above 90 percent for all patients (HealthyPeople2020, 2018b). The county’s TB program focuses on the diagnosis and treatment of active and latent TB through specialized TB clinics, TB education and targeted testing and liaison with healthcare facilities and providers to ensure the compliance with the standards for TB treatment.

HIV/AIDS

            The main socioeconomic effects of HIV/AIDS include strained relationships with spouses and relatives, family and community-induced stigma, increase healthcare expenditure and declined household income due to decreased productivity. According to Haldar et al. (2011), more than 80 percent of the persons diagnosed with HIV/AIDS lose their jobs due to illnesses. More than 40 percent of the patients are constantly blamed by the relatives for the spouse’s illness. HIV/AIDS is a reportable infectious disease in Miami-Dade. The county has created several HIV/AIDS prevention programs in accordance with the HealthyPeopl2020 HIV goals.

These programs include mobile HIV testing and counseling sites, AIDS drug assistance, HIV surveillance, linkage to treatment, HIV-related education and condom distribution (Florida Department of Health, 2017a). The programs are focused on reducing new HIV infections, increasing HIV testing and increasing access to care for persons diagnosed with HIV. These activities are expected to reduce Miami-Dade’s HIV/AIDS incidence and mortality rates to below 12 cases per 100,000 and 3 cases per 100,000 respectively (HealthyPeople2020, 2018a).

Lyme disease

            The early Lyme disease can be treated effectively using a combination of commonly available antibiotics such as amoxicillin. However, the advanced disease is difficult to treat due to its adverse effects on the patient’s neurological and cardiac systems. According to Lymedisease.org (2013), the total cost of treating the late stage Lyme disease can exceed $10,000. The neurological and cardiac effects of the disease can alter the individual’s social life, productivity and household income. Miami-Dade has listed Lyme disease as a reportable infectious disease under the vectorborne and zoonotic diseases. The county’s Lyme disease prevention initiatives focus on preventive education and disease surveillance. However, the HealthyPeople2020 has not developed any objectives regarding the prevention and or treatment of Lyme disease. The county’s initiatives are based on CDC recommendations for Lyme disease prevention with the outcome scores benchmarked against the state and national averages.

 Conclusion

            The analysis of the TB, HIV/AIDS and Lyme disease morbidity and mortality in Miami-Dade County highlights the need for multidimensional and evidence-based strategies for preventing and treating infectious diseases. These strategies should be aligned with the HealthyPeople2020 objectives so that the health outcomes for the affected populations concur with the targeted national scores. Chronic diseases in Miami-Dade have overtaken infectious diseases as the leading causes of death. However, the county cannot ignore the adverse socioeconomic effects of diseases such as TB and HIV/Aids. The ongoing surveillance and response to the identified cases of the infectious diseases are crucial to the county’s public health promotion goals.