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Journey to Health FINAL Script

TITLE: Lesson 14—Infectious Diseases

PREPARED FOR: Dallas TeleLearning

WRITER: Gretchen Dyer

PRODUCER: Julia Dyer

DRAFT: FINAL

DATE: 18 March 2003

FADE IN:

Segment One: TLC (4:34) Protecting Yourself

Learning Objective: Explain personal strategies for preventing infectious disease.

MUSIC: TITLE MUSIC UP


  1. B-roll: Laurie working in ER

Caption: Laurie



Laurie (nats): Are you Cindy?

Patient: Uh-huh.

Laurie: Hi, I’m Laurie. I’m one of the nurses here today. We’re going to get a little bit of blood work. We’re looking for infection, any source of infection.

  1. B-roll: Laurie working in ER

Laurie (8968, 01:13:44): The percentage of population that visits the emergency department with some type of infectious disease would be…I would guess 15 to 20% of the population.

Laurie (nats): I’ll tell you everything I’m going to do. I’m gonna put this tight band on your arm first.

Laurie (OC – cont.): I don’t think there’s ever not a person in the department being seen. Someone has some type of infectious disease.

Laurie (nats): Tell me about the cough.

  1. B-roll continued

Laurie (OC)(01:09:32): The most common ways that infectious diseases are transmitted – a very common one is airborne, air exchange, these millions of little particles that float through the air when you sneeze or cough…

Laurie (nats): Do it again.

Patient: coughs

Laurie (cont. from above): …sexually transmitted disease like we see quite frequently in the emergency department, that of course would be from any type of sexual contact without any proper protection…any type of bodily fluid, be it blood, vomit, urine. Those are things that you need to protect yourself from when you work specifically in an environment like this.

  1. Segment title: Protecting Yourself

Music transition

  1. Laurie on camera



Laurie (01:13:59): Precautions that the nurses take from spreading diseases to other patients, first and foremost, most important is hand washing. And you know, that can actually be practiced anywhere. You don’t have to be in the emergency department. When you’re at home, when you’re in a public restroom, when you’re anywhere, hand washing is so important.

  1. B-roll: Laurie in ER

If we’re exposed to any type of bodily fluids other than our own, we wear gloves. I frequently, if I’m in a very messy situation, for lack of a better word, would wear a gown.

  1. B-roll: Laurie leaving work, Laurie and Kathy at home

Laurie (01:17:58): I actually always think about, when I walk out of the hospital, about all the different things I’ve been around that day and what could possibly be on my clothes or my shoes. All our work clothes actually go in a separate pile and we wash our work clothes separately. So when I get home at night my shoes just go in the inside door. I don’t wear my hospital shoes anywhere else in the house. I don’t truly know if I’m taking anything out, but I’m sure chances are pretty great that I am.

  1. Laurie on camera

Laurie (01:18:56): I’m sure everywhere, everything I come in contact with, there is some type of germ, whether it be the public restrooms, sinks or counters. I don’t know if I’m in the hand washing mindset more because of where I work and I’m constantly doing it, but sure, you’re exposed everywhere you go.

  1. B-roll: Laurie outside

Laurie (01:20:35): All these germs flying around out in the public, you wonder why we don’t all get sick, or sicker. Probably we’ve all developed, and when I say we, I mean everybody out in the world, the population, general population, have developed immunities to all the different germs running around. That doesn’t mean we’re all immune to them. Some people are much more susceptible (01:21:46) if they’re tired, not getting a lot of rest. Certain medications might make you more susceptible. Certain chronic illnesses make you more susceptible. If you’re very healthy, that would make you less susceptible.

  1. B-roll: Laurie and Kathy at home

Laurie (01:23:28): The biggest educational tip would be to practice what is out there. If it has to do with sexual awareness – using the different precautions. (01:16:04) Again, washing your hands, not drinking out of the same cup as someone until after it’s been cleaned or sterilized in the dishwasher.

  1. B-roll: Laurie at work in ER, patients

Laurie (01:15:04) Other common stuff – covering your mouth when you cough or when you sneeze.

Laurie (nats): We’re going to send you out on an antibiotic. The doctor has written a prescription, okay.

Laurie (01:16:04): If you’re sick with any type of cold, sneeze, flu-like symptoms, I would probably encourage you not to go to work for a day or two.

  1. B-roll: working with patient

Laurie (nats): Now it’s very important you take the whole thing. It’s written for 7 days. Even if you feel better in the next couple of days, keep taking this. Okay?

  1. Laurie on camera

Laurie (01:15:04): The best methods for preventing disease are just very back-to-the-basic common teachings that we learned when we were little from our parents, is hand washing, hand washing, hand washing.


Segment Two: Expert (12:24) The Epidemiologic Triangle

Learning Objective: Analyze infectious disease, including transmission and prevention.

MUSIC: TRANSITION


  1. B-roll: vivid, disturbing, beautiful footage of microbes magnified to fill the screen

Narrator: Infectious diseases have evolved over millions of years and are spread via many and various routes. Although the forms of infectious disease are numerous and complex, its transmission can be understood according to a simple model.

  1. Segment title: The Epidemiologic Triangle

Music transition


  1. Graphic 1: The Agent-Host-Environment Model



Narrator: The transmission of infectious disease can be analyzed according to the interplay of three common factors: the agent, the host, and the environment.

  1. Graphic 1A: highlight Agent

  2. OC interview: Victor Garcia
    Caption: Victor Garcia-Martinez, Associate Professor of Internal Medicine, UT Southwestern Medical Center

Text: “…fungus, bacteria or virus…”

Victor Garcia (9007, 03:02:55): Disease agents are the pathogens that cause an infection and they can be of any number of different structures and types. It can be a fungus, it can be a bacteria, or it can be a virus and depending on what type it is, is the type of disease that you will observe in the patient.

  1. Graphic 1B: add Vector

Narrator: The disease agent can be passed directly from host to host, or it can be carried from host to host by a vector.

  1. B-roll: microbes



  2. B-roll: mosquitoes

Victor Garcia (03:22:02): The difference between a vector and an agent is that the vector doesn’t cause the disease. The agent causes disease. The vector is the vehicle that the infectious agent uses to get to you and from you to the next victim.

(03:01:55) For example, currently you might have heard a lot about West Nile. West Nile is a viral agent that is transmitted from birds to humans via mosquito bite.

(03:10:21) So a vector is an intermediary that is able to find an infectious agent in one species and then take it to another, or from one person to another, doesn’t have to be inter-species.

  1. B-roll: fleas, ticks, rats, mice

Text: “…disease-carrying vectors…:

Text: “…mosquitoes, fleas, ticks, rats, mice…”





Victor Garcia (03:28:41): Mosquitoes are not the only type of vector that can carry disease to you – fleas, ticks, rats, mice. Depending on what type of disease, you can think of things like Hanta virus that are transmitted by mice, Rocky Mountain spotted fever is transmitted by ticks. So vectors are ubiquitous the same way that infectious agents are.

  1. Graphic 1C: highlight Host

Narrator: Disease is transmitted when a pathogen finds a host and overcomes its defenses.

  1. Green screen interview: Victor Garcia



  1. B-roll: Person engaged in some form of exercise, focus on bare skin

Text: “…the most important defense mechanism that humans have is their skin…”



Victor Garcia (03:01:56): Over millions of years, there has been an evolution between the host and the pathogen and there are certain types of pathogens that have specifically evolved to attack certain hosts. (03:03:54) And hosts have developed certain types of defenses that allow them to be protected against the infection. The most important defense mechanism that humans have is their skin. If it can’t get through the skin, you’re protected. But if the pathogen somehow finds a way to get into the bloodstream, or below the skin, then infection takes place.

  1. Green screen interview: Victor Garcia


  2. B-roll: microbes

Text: “…immune system protects us from a variety of pathogens…”


Text: “..innate immunity…”
Text: “…adaptive immunity…”

Victor Garcia (03:07:11): Underneath the skin, we have probably the most sophisticated defense mechanism in the world. We’re better prepared to defend ourselves against infectious agents than virtually any other creature on the surface of the earth and the reason we are protected in that way is because we have developed an immune system that protects us, in many ways, from a variety of different pathogens. We have one type of immunity which is called innate, which happens no matter what. And then we have another type of immunity called adaptive that protects us against something that we haven’t seen before, so it adapts us to that new challenge.

  1. Green screen interview: Victor Garcia



  2. B-roll: microbes

Text: “…genetic make-up…”

Text: “…immune suppressed…”


Text: “…infected with HIV…”



Victor Garcia (03:11:39): For most of us, infectious diseases are just a nuisance. But there are certain types of individuals and there are certain clinical conditions that increase the sensitivity of that person to infectious diseases.

(03:06:00) Your genetic makeup plays a very important role in determining whether you will be susceptible to certain types of infections.

(03:11:39) If you are under treatment for a trans-blood related illness and you’re immune suppressed, there’s a pretty good likelihood that you will be much more susceptible to infections. And if you happen to be infected with HIV, you will be immune suppressed and you will be much more susceptible to infections.

  1. Green screen interview: Victor Garcia


  2. B-roll: person engaged in exercise

Victor Garcia (03:20:44): With regards to what you might be able to do with lifestyle or a diet to prevent infectious diseases, it’s a pretty gray area at this point. There are some people who believe very strongly that the healthier lifestyle you live, the better prepared you will be to contend with certain types of infections. And that’s true to a certain degree. But for the most part susceptibility, either genetic or not, is what determines whether or not you will be infected by any given agent.

  1. Graphic 1D: highlight Environment

Narrator: The final factor influencing the probability of developing an infection is the environment.

  1. Green Screen interview: Victor Garcia


Text: “…environment dictates the pathological agents you are exposed to…”





  1. B-roll: crowded elementary school classroom or playground


  2. B-roll: patients in hospital setting






  1. B-roll: images of Africa

Victor Garcia (03:22:02): Infectious agents live virtually everywhere.

(03:06:00) Now, the environment in which you live is going to dictate to a significant degree what is going to be the agents, the pathological agents that you’re going to be exposed to. If you are lucky enough to have a child in elementary school or in kindergarten, your chances are that you will get exposed to a variety of diseases that somebody who doesn’t have any kids will not be experiencing. (skip up) On the other hand, if you happen to be unlucky and go to the hospital for an operation of some kind or another, you will be exposed to pathogens that you will not find in your school.

(skip up) In Africa, you will be exposed to certain type of agents that you will not see in this country. So your environment plays a central role into what you will be exposed.

  1. Green screen interview: Victor Garcia


  2. B-roll: airport, planes landing, passengers disembarking at international terminal (JFK Airport, from Government series)

Victor Garcia (03:18:14): Where we happen to live, we have a major airport with flights from many different places around the world. We need to be aware of the fact that even though there are certain diseases that are not common to the U.S, they can come into the country in a matter of hours from many different places.

  1. B-roll: Urban New York, shots of crowded subway, garbage

Narrator: Aspects of one’s environment that may affect the spread of disease include population, sanitation, and the quality of the air, soil and water.

  1. B-roll: Hudson River (from program 25)

Victor Garcia (03:22:02): If I would have to put my hand on one most important element, it would be the water. (skip up) In certain parts of the world water can kill you…literally. And you need to be aware of what it is that you will find in any given location.

  1. B-roll: microbes


Music transition

  1. Green screen interview: Victor Garcia



Text: “…prevention, prevention, prevention…”

B-roll: person coughing or sneezing



Victor Garcia (03:13:55): When dealing with infectious diseases, the most important area is prevention, prevention, prevention.

(03:08:38) Infectious diseases are transmitted from person to person in many different ways and the best example is the flu. Right now, if you did not get your flu shot, there is a very good chance that you will be exposed to flu and if it’s not a type of flu that you’ve seen before, you will be very ill with influenza infection. So that’s an airborne pathogen. You can’t do anything about it except perhaps to have a high degree of hygiene. Washing your hands is very important as far as preventing a great number of infectious diseases from affecting you.

  1. B-roll: microbes


  2. B-roll: intravenous injection

Garcia (cont.) There are other types of pathogens that require blood to blood contact. For example, hepatitis.

(03:13:55) Blood borne pathogens are usually not a problem for most people in the sense that if they do not participate in needle exchanges with infected individuals they will be protected.

  1. Green screen interview: Victor Garcia

Victor Garcia (03:15:16): When everything is said or done, perhaps one of the best ways that we know of to protect individuals is with vaccines. Vaccines have eradicated a variety of diseases, virtually eradicated them from the earth’s surface. But every day we find new infections that we need to be protected against.




Transition

  1. Copystand: vintage photo of people being vaccinated

Edwin Kilbourne (18:03:54): Since the 1920’s, vaccines have reduced the toll of infectious disease enormously to a greater extent than antibiotics have, or any other manipulation beside the purification of water.

  1. OC interview: Edwin Kilbourne
    Caption: Edwin Kilbourne, M.D., Professor of Microbiology & Immunology, New York Medical College

Kilbourne (18:04:36): Vaccines prevent disease by stimulating what we call an immune response. There are cells in the body which can produce specific immune substances, which we call antibodies, that will combine with the infectious agent when it comes in and bind those infectious agents, so they cannot multiply in the body and produce disease.

  1. B-roll: stock footage of vaccinations.

Kilbourne (18:00:58): I’ve spent my life studying viruses with particular reference to the virus that causes influenza. And in the course of these studies, I’ve come up with some ideas for modifications of vaccines, new vaccines.

  1. B-roll: Flu shot day at Richland College, focus on sign reading “flu shots”

Kilbourne (18:06:32): The influenza vaccine is different from all other vaccines because it has to be changed every year or two, because the virus that it’s protecting against is also changing.

OC interview: Edwin Kilbourne





  1. B-roll: Kilbourne’s lab

Kilbourne (18:12:59): Every year a group of experts get together and make decisions about what to use in next year’s vaccine. The CDC and the WHO, World Health Organization, have a continual surveillance to look for changes in the viruses, particularly in China or Asia, other parts of Asia, where the new strains seem to come from. And when they identify a strain of virus which is different from the current strain, which is beginning to become epidemiologically important, that is to produce a lot of transmissible human disease, then that kind of strain is chosen and it’s then sent to our laboratory so we can make high yield re-assort and recombinant viruses which we then send back to CDC, back to the FDA, so they can check them out before they’re sent to industry for use of the vaccine.

  1. B-roll: lab footage

It takes about six months from that meeting and decision before a vaccine actually gets into a vial and is sent out to physicians. (18:06:32) So it’s kind of a foot race to keep up with this evolution, rapid evolution, of influenza viruses.

  1. B-roll: Flu Shot day at Richland College

Kilbourne (18:07:40): Given the fact that there are occasional shortages of vaccine, or vaccine can’t be made rapidly enough to beat the epidemic, we give high priority to elderly people, people with chronic underlying disease, such as cardiac or pulmonary disease, and also to children who may have cystic fibrosis or other diseases that compromise their immune systems. So there are special categories at high risk of death, but everybody’s at high risk of morbidity or illness.

Nurse (nats): I want you to relax your arms completely, relax your muscle.

  1. B-roll: Stock footage of vaccinations, especially children

Kilbourne (18:15:06): The importance of being immunized against infectious diseases for which we have vaccines is that it provides us with sort of a permanent shield of armor – coat of armor, if you will. So you can be bitten by mosquitoes, or you can be exposed to people coughing out influenza viruses, and you don’t care. It’s a convenient, economical, and for the most part, semi-permanent way of getting protected.

(18:09:10) The ratio of risk to benefit is extraordinarily high with almost all of our modern vaccines. The benefits are very large. The risks are very small.

  1. B-roll of children getting vaccinated turns into B-roll



transition

  1. B-roll: microbes




Victor Garcia (03:17:02): Underestimating an infectious disease can be catastrophic.

  1. OC interview: Victor Garcia



(03:15:16) If you are a mother, you have a great responsibility of providing your children with all the vaccines that are available to you. It’s very, very important that children get vaccinated. Vaccines are to prevent further infection and they save lives.


Segment 3: Swing (9:49) Focus: An Agent of History

Learning Objective: Explain the historical significance of infectious disease.

MUSIC: TRANSITION

  1. Copystand: images of prehistoric and early agricultural societies


  1. OC interview: Gerald Grob
    Caption: Gerald Grob, Professor Emeritus, History of Medicine, Institute of Health, Rutgers University

Gerald Grob (VO) (9049, 01:01:02): In prehistoric times, infectious diseases played a much smaller role than it does in modern times. In prehistory, you had nomadic food gathering groups which were relatively small. They moved around from place to place. And because of the small numbers, they could not sustain the pathogens that normally live side by side with us. When the transition from the food gathering and nomadic stage to the agricultural stage came about, there was a very sharp change, because in an agricultural society, you had people who lived in one place. They did not move. Because of a more stable food supply, the population began to grow and at that point, you began to create the conditions under which infectious diseases became much more significant.


  1. Segment title – Focus: An Agent of History

Music transition


  1. Copystand: historical images of plague

Narrator: Across the centuries, infectious disease played an increasingly significant role in the shaping of human history. One disease in particular haunted mankind through many civilizations. In its most virulent manifestation, the “Black Death” defined an era.

  1. Copystand: images of populous European ports, trade caravans and sailing ships of the 14th century (show rats if possible)

Gerald Grob (01:02:44): Plague has a long history. It emerged in Europe in its most deadly form in the mid-14th century (01:03:27) as the population of Europe began to increase, which it did from about the 9th to the 14th century. And for a variety of reasons, as rodents moved from Russia through Europe their fleas began to affect humans and these humans were bitten by the fleas which carried the organism that caused plague.

  1. Copystand: images of plague victims & plague-ridden towns

Gerald Grob (01:04:34): Once the plague gets started in epidemic form, it’s transmitted by droplet infection from human to human.

(01:06:06) Cities oftentimes came to an absolute halt and questions about the food supply, water and everything became very acute. It was a crisis of unprecedented proportions. In the 14th and 15th century, we estimate that perhaps half of the population of Europe was wiped out by plague.

  1. Copystand: European historical images from 15th century; sailing ships



  2. B-roll: ocean wake behind boat (from Shaping America)

Narrator: The drastic depopulation disrupted the old institutions of medieval Europe. It also created greater wealth and opportunity for those who survived. The uncertainties and opportunities of 15th century life contributed to an age that would be known for its far-flung explorations. The voyage of Columbus and those that followed would soon put infectious disease back on center-stage in the human drama.

  1. Copystand: images of contact between Spaniards and Indian peoples in the new world; images of disease among Indian peoples

Gerald Grob (01:08:10): At the time of the first contacts between Europeans and the indigenous population of the new world, smallpox was not a killer disease in Europe. In the new world, however, smallpox devastated the native population. We estimate that about 90% of the indigenous population of the Americas died of infectious diseases that were brought over by Europeans.

(skip up) Perhaps one of the reasons is that the genetic makeup of new world populations is quite different from the rest of the world because the Americas was biologically isolated. They’d also not been exposed to many of the infectious diseases that were prevalent in the rest of the world.

  1. B-roll/copystand: ocean wake combined with layer of images of European conquest; transition to layer of American soldiers aboard ship in World War I

Narrator: By most accounts, European germs played a bigger role in the conquest of America than European guns. Four hundred years later, they were also on board for the first war that Americans fought on European soil.

  1. B-roll/copystand: World War I soldiers, images of influenza epidemic

Gerald Grob (01:10:14): For reasons that are unclear, influenza emerged in a very virulent form in 1918 and 1919.

(01:11:44) During World War I, I think there were about 50,000 deaths from battlefield wounds and 45,000 deaths among servicemen from influenza. Influenza killed almost as many young men as were killed in combat.

(01:13:33) The virus could proceed through the population like wildfire because conditions in army camps and on ships transporting soldiers to Europe were extraordinarily crowded. (skip up) We’re not sure why the 18-35 group were so vulnerable. (skip down) The armed forces had preserved slides of tissues of soldiers who had died from influenza and it’s been studied, but they can’t figure out why it was so virulent. So it remains a mystery.

  1. Copystand/b-roll: vintage images of vaccinations

Narrator: In the years following the great flu epidemic of 1918, the advent of vaccines and antibiotics began to alter the world’s perception of the threat of infectious disease.

  1. B-roll: stock images of happy-go-lucky Americans of 50’s and early 60’s

Gerald Grob (01:20:39): After World War II, people assumed that infectious diseases were no longer significant because of the availability of various antibiotics.

(01:23:21): There were statements to the effect that infectious diseases no longer posed major threats to human populations.

  1. B-roll: stock images of AIDS victims

Gerald Grob (01:24:30): What has happened since the 1980s is that all of a sudden we’ve realized that infectious diseases can play a major role, and the best example is the emergence of AIDS. So that the thought that infectious diseases are no longer significant is really a myth.



Narrator: Even as some diseases are conquered, others emerge to take their place.

  1. OC interview: Lola Stamm
    Caption: Lola Stamm, Associate Professor of Epidemiology, University of North Carolina

Lola Stamm (10:25:53) An emerging disease is a newly recognized disease. It may be a new agent that has just been identified, or it may be a disease that’s been around for a while but we really didn’t know it was there.

  1. B-roll: images of emerging diseases, patients in quarantine, lab animals

Lola Stamm (10:23:44): One of the things about emerging infectious diseases is the effect that they have on human health.

(10:24:29) People who get an emerging infectious disease may have to have a longer hospital stay. Sometimes we don’t know exactly how to deal with the agent. We may not have appropriate antibiotics or vaccines.



Narrator: Even today, emerging infectious diseases can have an impact comparable to historical epidemics like plague and influenza.

  1. Lola Stamm on camera

Lola Stamm (10:23:44): A disease like HIV, for example – AIDS has gone global, so it’s now in pandemic proportions and it causes tremendous economic burden.

(10:24:29) There’s an economic burden to families. There’s an economic cost to the countries that are involved trying to provide health care, trying to provide medication for these individuals that are infected, trying to manage the situation.

  1. B-roll: international healthcare workers

Narrator: The global healthcare community must not only concern itself with new diseases. It must also deal with diseases that keep coming back.

  1. OC interview: Lola Stamm

Lola Stamm (10:25:53): A re-emerging infectious disease is really a classical disease like malaria or tuberculosis and it’s a disease where we think we’ve had it conquered. We think we have it under control and then it comes back.

  1. OC interview: Gerald Grob

Gerald Grob (01:20:39): The use of antibiotics has stimulated the emergence of resistant strains of diseases that we thought were no longer significant.

  1. Copystand: historical images of tuberculosis patients


  1. Copystand/b-roll: contemporary images of tuberculosis (Living With Health?)



Gerald Grob (01:18:44): Tuberculosis is an excellent example. Tuberculosis was one of the major killers. In the 18th and 19th century, it was known as the great white plague. In recent years, tuberculosis has begun to emerge once again, and sometimes in resistant forms, particularly among populations with compromised immune systems.

  1. Lola Stamm OC

Lola Stamm (10:27:10): Re-emerging infectious diseases can be very difficult to treat. It’s been estimated that a person with multi-drug resistant tuberculosis, the cost for treatment may be ten times that over what it would normally take to treat an individual with tuberculosis. And sometimes there is nothing that can be used to treat them effectively, so the individual may actually die as a consequence.

  1. Montage: AIDS activists, anthrax headlines, people getting blood drawn, vaccinations, microbes

Narrator: Even after a century of miraculous medicine, infectious disease is still an active agent of human history.




Gerald Grob (02:09:30): Infectious diseases have played, and will continue to play, a major role in the health of human beings for a very simple reason – (02:10:44) because any time one category of disease has declined as a cause of mortality, other diseases have risen to take its place.

(02:10:44) We think that medical intervention will eliminate disease and that is simply not the case.

  1. OC interview: Gerald Grob

Gerald Grob (02:13:30): The causes of mortality may change but the end result is fixed. Somewhere along the line, we will all unfortunately die, and when we die, we will die of something, and I cannot see that changing.

Wrap-Up/End Credits (00:49)


MUSIC: TRANSITION

  1. Edwin Kilbourne

Edwin Kilbourne (18:19:10) Infectious diseases pose an enormous burden on health. They’re probably, directly or indirectly in my view, the most important cause of illness and almost the most important cause of mortality.

  1. Victor Garcia

Victor Garcia (03:19:28): In this country, every year billions of dollars are lost to people that do not come to work because they have the flu. It hurts us in our pocketbooks. Infectious diseases are something to contend with.

  1. Lola Stamm

Lola Stamm (11:04:45): We have to always be on alert. We always have to think about development of new vaccines, looking for new antibiotics, anything that will tip the balance in favor of the human species.




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