A team of first responders practices donning PPE during a training exercise at the South Texas Regional Advisory Council (STRAC). The STRAC works with the task force to assure first responders have up to date information.
A team of first responders practices putting on personal protective equipment during a training exercise at the South Texas Regional Advisory Council, which works with the task force to assure first responders have up-to-date information. Credit: Courtesy / Cherise Rohr-Allegrini

Most Texans don’t regularly concern themselves with infectious diseases such as typhus, Ebola, Zika, or the plague. But in the aftermath of Hurricane Harvey, public health experts worry that tetanus and MRSA, an antibiotic-resistant skin infection, could become more prevalent.

Thanks to the establishment of the Texas Infectious Disease Readiness (TX IDR) task force, citizens now have access to online courses and other resources geared at increasing the public’s knowledge of a variety of infectious diseases.

The program was launched in late 2014 when then-Gov. Rick Perry signed an executive order establishing the Task Force on Infectious Disease Readiness and Response. The aim is to make health care providers more aware of previously unknown or uncommon infectious diseases in Texas.

Typhus, transmitted by fleas and potentially fatal, infected only 27 Texans in 2003.  In 2016, the state saw 364 cases, according to the Texas Department of State Health Services. With so few cases in the past, typhus’ symptoms – chills, muscle aches, a rash, and vomiting – were likely mistaken for something else.

Typhus cases in Texas between 2008 and 2016.

Described by some as a “Texas-specific CDC,” the task force gathers information from many sources and adapts it to Texas’ needs. In addition to sharing information on current cases, the TX IDR designs online courses specific to the diseases seen in Texas, explaining how the diseases are transmitted, who is at risk, and how to control their spread.

The need for such an initiative became evident after the first cases of Ebola were diagnosed in the United States.

On Sept. 25, 2014, Eric Duncan walked into to a Dallas emergency room complaining of a fever, dizziness, nausea, and abdominal pain. Unaware that Duncan had recently returned from Monrovia, Liberia, where a major Ebola outbreak was killing more than 70% of its victims, medical staff discharged him.

When Duncan returned four days later, he was in the full throes of the disease. The doctors diagnosed Ebola, and he was admitted to the hospital. Staff members took what they believed were appropriate precautions, but standard hospital protocols did not address diseases like Ebola.

“There was a lot of wondering what to do,”said Dr. Jan E. Patterson, chair of TX IDR. “How does this impact us? What is the game plan? How is everyone else responding?”

Dr. Jan E. Patterson, chair of the Texas Infectious Disease Readiness task force

The disease was known as “the nurse killer” in west Africa, but most assumed that U.S. hospital procedures would sufficiently thwart outbreaks.

“We didn’t know how communicable it could be in a health care setting here,” Patterson said.

The Dallas hospital staff followed the infection control protocols, but Ebola requires completely different procedures.

“For example, personal protective equipment is standard procedure, but it makes a difference how you put it on and take it off, particularly with a disease like Ebola,” Patterson explained.

In the four days before Duncan returned to the hospital, none of his close contacts were infected. By the time he went back, he was already near death. Duncan died on Oct. 8.

Two of the nurses treating Duncan got sick and were both diagnosed with Ebola.

They were transported to Atlanta’s Emory University Hospital, closely tied to the Centers for Disease Control (CDC). Both women survived.

Meanwhile, healthcare systems scrambled to develop new protocols for dealing with Ebola. Texas health leaders identified the need for timely access to information, prompting Perry’s executive order.

As the associate dean for quality and lifelong learning and professor of medicine and infectious diseases at UT Health San Antonio’s School of Medicine, Patterson and the Texas IDR partner with experts from public and private medical schools, hospitals, government agencies, and emergency response organizations throughout Texas.

In addition to educating traditional health care professionals, the program also targets first responders, who typically have limited access to resources about infectious diseases, Patterson said. With the establishment of the TX IDR website, they can now learn about infectious disease readiness and potentially avoid contracting a deadly disease.

“The excitement and unpredictability of disease outbreak is what drew me into the field of public health,” said Heather Mendizábal, a graduate student at the UT School of Public Health. “I appreciate that TX IDR keeps me notified and also offers online courses to prepare me should I encounter these infectious diseases in Texas.”

While the courses are geared to health care professionals and first responders, anyone can sign up for weekly email updates. The public is encouraged to join the 28,000 followers in the Task Force’s Facebook community where they can ask experts questions. You can also follow their updates on Twitter.

TX DIR is committed to monitoring new diseases as well as known ones that have re-emerged, such as measles. Health care providers and residents alike will be better informed, and most importantly, better prepared should an outbreak occur.

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Cherise Rohr-Allegrini

Cherise Rohr-Allegrini is an infectious disease epidemiologist and consultant. She is currently the San Antonio Program Director for The Immunization Partnership. Dr. Rohr-Allegrini was the Pandemic Flu...