Comments on the Communicable Disease Issue by the Guest Editors 
Neal D. Goldstein, PhD, MBI1; Deborah Kahal, MD, MPH, FACP2 

1. Drexel University Dornsife School of Public Health, Department of Epidemiology and 
Biostatistics, Philadelphia, PA; William J. Holloway Community Program, Christiana Care 
Health System, Newark, DE 
2. William J. Holloway Community Program, Christiana Care Health System, Newark, DE 

The focus on infectious diseases in public health ebbs and flows. Students of the field are taught 
that developed countries have undergone an epidemiological transition whereby morbidity and 
mortality from non-infectious diseases has eclipsed that of infectious causes.1 Nevertheless, 
infectious etiologies of disease remain a substantial threat to the public’s health. The last decade 
has seen a re-emergence of vaccine preventable diseases,2 including pertussis and measles; an 
increase in sexually transmitted infections (STIs) most notably syphilis among gay, bisexual, and 
other men who have sex with men3; a worsening Hepatitis C infection (HCV) crisis in the setting 
of the opioid epidemic4; and the ongoing struggle to control the HIV epidemic well into its fourth 
decade.5 To that end, we have solicited a wide range of experts in infectious disease 
epidemiology, public health practice, and clinical medicine to contribute insightful, and at times, 
provocative discussions of important infectious diseases within Delaware. Globally, nationally, 
and locally, healthcare systems face many challenges related to infectious diseases, from creating 
the infrastructure and microenvironments to support responsible antibiotic prescribing practices 
to immunization advocacy (and rapid response to complications stemming from a lack of 
adequate vaccination coverage) to ongoing efforts to test and treat for STIs. This issue of the 
Delaware Journal of Public Health tackles these broad issues. 
Certainly, we are all cognizant of the on-going debate surrounding vaccinations in our country. 
With the recent measles outbreak in Washington and elsewhere,6 public health is in the 
challenging position of advocating for vaccination while responding to disease outbreaks from 
those who choose to abstain from this remarkable preventive intervention. James Talbot and Paul 
Hess review the state of immunization in Delaware and how the Delaware Division of Public 
Health (DPH) has responded to recent vaccine preventable disease outbreaks. A pertussis 
outbreak in the Amish community in Delaware, as highlighted in the article by Paula Eggers et 
al., provides a local example of the repercussions of low vaccination rates. Margot Savoy 
enriches the immunization discussion with a closer examination of human papillomavirus 
vaccination and a call to action for us all to work collaboratively toward improved vaccination 
acceptance rates. A common theme throughout these articles is an emphasis on the importance of 
public health practitioners closely engaging with communities that have lower vaccination rates. 
HCV presents a multi-faceted story of incredible therapeutic success and implementation 
challenges. There is much work still to tackle as we strive to meet the four goals of the national 
Viral Hepatitis Action Plan in 2020: 

1. Prevention of new hepatitis infections, 
2. Reduction of death and improvement in health of those living with hepatitis, 

3. Reduction of viral hepatitis health disparities, and 
4. Effective implementation of viral hepatitis activities.7 



Continuing with the engagement of the community by public health professionals, William 
Mazur describes caring for patients with HCV who are incarcerated in Delaware’s correctional 
facilities. With recent advances in HCV therapeutics, treating individuals in an institutionalized 
setting represents an opportune time to improve the patient’s health and provide treatment as 
prevention of forward HCV transmission subsequently reduces the community HCV burden. 
Stephen Eppes highlights the unique opportunities surrounding HCV amongst women of 
childbearing potential and their children, while Navin Vij shares his profoundly personal story 
with HCV. While Eppes and Vij offer different perspectives, both share compelling arguments in 
support of universal HCV screening for all pregnant women and adults, respectively. 
We have also included several articles that focus on the programmatic management of infectious 
diseases in Delaware. Vital statewide efforts to improve antimicrobial stewardship are eloquently 
outlined by Marci Drees et al. The eBrightHealth Choosing Wisely Initiative emphasizes the 
importance of sustainable multidisciplinary collaboration in working toward appropriate 
antibiotic utilization in upper respiratory tract infections in inpatient and ambulatory settings. 
Joanna Suder tackles the sometimes difficult task of public health in the prevention, isolation, 
and quarantine of individuals who have tuberculosis, focusing on the medicolegal implications. 

This issue would be incomplete without including several articles focusing on HIV, both the 
successes and ongoing opportunities for improvement. Nguyen Tran and Seth Welles detail how 
understanding the epidemiology of HIV among sexual and gender minority communities, who 
have been particularly affected by HIV, is used to inform public health policy and action. As 
they discuss, the epidemiology of HIV has drastically changed since the disease was first 
recognized in the early 1980s. In large part due to the increase in HIV screening, reduction in 
stigma, and the development and roll-out of antiretroviral therapy (ART), HIV has transitioned 
from a death sentence to a chronic infection. Consequently, we are seeing an aging population 
with HIV, the focus of Brianne Olivieri-Mui’s article which considers a Medicare-eligible HIV 
population and implications for ART access in a nursing home setting. 

In closing, we hope you enjoy this issue and give pause to consider both the remarkable 
achievements of public health in reducing infectious disease sequalae and serious challenges that 
lay ahead. Lastly, we wish to express our sincere gratitude to the invited contributors who have 
devoted considerable time and energy to making this issue of the DJPH a success. 

References 
1. Omran, A. R. (2005). The epidemiologic transition: A theory of the epidemiology of 

population change. 1971. The Milbank Quarterly, 83(4), 731–757.  
PubMedhttps://doi.org/10.1111/j.1468-0009.2005.00398.x 

2. Adams, D. A., Thomas, K. R., Jajosky, R. A., Foster, L., Baroi, G., Sharp, P., . . . Anderson, 
W. J. (2017, August 11). Summary of notifiable infectious diseases and conditions - United 
States, 2015. MMWR. Morbidity and Mortality Weekly Report, 64(53), 1–143.  
PubMedhttps://doi.org/10.15585/mmwr.mm6453a1 

3. An, Q., Wejnert, C., Bernstein, K., & Paz-Bailey, G., & the NHBS Study Group. (2017, July 
1). Syphilis screening and diagnosis among men who have sex with men, 2008-2014, 20 
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PubMedhttps://doi.org/10.1097/QAI.0000000000001412 

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4. Valdiserri, R., Khalsa, J., Dan, C., Holmberg, S., Zibbell, J., Holtzman, D., . . . Compton, W. 
(2014, May). Confronting the emerging epidemic of HCV infection among young injection 
drug users. American Journal of Public Health, 104(5), 816–821.  
PubMedhttps://doi.org/10.2105/AJPH.2013.301812 

5. The Lancet. (2017, July 22). The global HIV/AIDS epidemic-progress and challenges. 
Lancet, 390(10092), 333. PubMed https://doi.org/10.1016/S0140-6736(17)31920-7 

6. Centers for Disease Control and Prevention. Measles Cases and Outbreaks. 
https://www.cdc.gov/measles/cases-outbreaks.html. Accessed March 15, 2019. 

7. Centers for Disease Control and Prevention. Viral Hepatitis Action Plan 2017-2020. 
https://www.cdc.gov/hepatitis/hhs-actionplan.htm. Accessed March 12, 2019. 

 

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	Comments on the Communicable Disease Issue by the Guest Editors
	References