The Unfortunate Nurse:
A Case Study of Dengue Fever and Social Policy

Before Class

Students should read the journal article, “Nosocomial Acquisition of Dengue,” by Dirk Wagner et al., Emerging Infectious Diseases, vol. 10, no. 10, pp. 1872–73, October 2004 (available online at http://www.cdc.gov/ncidod/EID/vol10no10/03-1037.htm). This is the article that inspired “The Case of the Unfortunate Nurse.” The event described in the article occurred in Freiburg, Germany, but in a global economy air travel for business and recreation have shrunk our world to a “global village” where infection can spread rapidly.

Notice that the article appears in Emerging Infectious Diseases, a journal of the Centers for Disease Control (CDC). The CDC is the agency of the United States government charged with monitoring incidence and patterns of infections in our country. The CDC is keenly aware of dengue infection. Endemic in Latin America and Puerto Rico as well as other parts of the world, dengue infection could one day become more common in the continental U.S.

As you read the article, circle all of the terms that you do not understand. You can find definitions for many of these terms using the Medline Plus Medical Dictionary (http://www.nlm.nih.gov/medlineplus/mplusdictionary.html) or the textbooks available on the PubMed Entrez Bookshelf (see Resources below). Be prepared with a few definitions, as we will go over some of these new words next time class meets. Also pay special attention to the information given in the figure and the table in the article, but do not be concerned if there is much that you do not understand. Do your best and we will demystify the rest together when we discuss the article in class.

We also will generate a list of questions that require further research if we are to accomplish the project outlines given below:

• Approach a scientific paper without fear, identifying and researching unknown terminology.
• Become familiar with the idea of nosocomial infection (note the title of the pre-class reading).
• Become familiar with the idea of emerging pathogens.
• Explore the complex virus/mosquito vector/host infection strategy of dengue virus.
• Become familiar with the following techniques: EIA (ELISA), differential cell counts, and RT-PCR (first introduced in the pre-class reading).
• Explore the idea of “agenda” in science and ethics and politics in public policy-making.
• Learn to communicate information with special attention to the intended outcome and the intended audience.

Resources

Note: Asterisked items 1 and 6 are required reading for the case study. You may pick and choose from the rest of the list as desired. Don’t be afraid to look further than this list. All Internet addresses were active as of May 5, 2007.

1. *Wagner, D., de With, K., Huzly, D., Hufert, F., Weidmann, M., Breisinger, S., Eppinger, S., Kern, W.V., and Tilman, M.B. 2004. Nosocomial acquisition of dengue. Emerging Infectious Diseases 10(10):1872–1873; see http://www.cdc.gov/ncidod/EID/vol10no10/03-1037.htm.

2. *Neves-Souza, P., Zeredo, E.L., Zagne, S., Valls-de-Souza, R., Reis, S., Cerqueira, D., Nogueira, R., and Kubelka, C.F. 2005. Inducible nitric oxide synthase (iNOS) expression in monocytes during acute dengue fever in patients and during in vitro infection. BMC Infectious Diseases 5:64; see http://www.biomedcentral.com/1471-2334/5/64.

3. *Dengue and Dengue Hemorrhagic Fever: Information for Health Care Practitioners, http://www.cdc.gov/ncidod/dvbid/dengue/dengue-hcp.htm. Contains good diagrams/slides and other information about the dengue virus, the mosquito vector, and the infectious strategy of the virus.

4. *Better Environmental Management for Control of Dengue, World Health Initiative, http://www.who.int/heli/risks/vectors/denguecontrol/en/index.html.

5. *Blood Groups and Red Cell Antigens, NCBI, http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=rbcantigen.chapter.ch1. Good textbook article on blood and the cells it contains.

6. *The White Blood Cell and Differential Count. http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=cm.chapter.4532 In: Clinical Methods, 3^rd ed., H. Kenneth Walker et al., Butterworths.

7. Wikipedia has a good article on white blood cells with photographs that will help you see the morphological differences that allow a trained microscopist to determine leukocyte number, lymphocyte number, neutrophil number, etc.—i.e., to make a “differential count” of white blood cells. See: http://en.wikipedia.org/wiki/White_blood_cell.

8. EpiNotes Disease Prevention and Epidemiology Newsletter. South Carolina 2006 List of Reportable Conditions. http://www.scdhec.gov/health/disease/index.htm. Look at this to get an idea of what the Reportable Disease forms look like, and where dengue sits on the list. Try to also find sites like this for other southern and southwestern states, which have large Mexican immigrant populations, and Florida, which has large populations of well-traveled retirees.

9. Reiter, P., Lathrop, S., Bunning, M., Biggerstaff, B., Singer, D., Tiwari, T. et al. 2003. Texas lifestyle limits transmission of dengue virus. Emerging Infectious Diseases 9(1): 86–89. Available at http://0-www.cdc.gov.mill1.sjlibrary.org/ncidod/eid/vol9no1/02-0220.htm.

10. Medline Plus Medical Dictionary at http://www.nlm.nih.gov/medlineplus/mplusdictionary.html.

11. PubMed’s Entrez BookShelf, at http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Books, is a free, searchable database of on-line college and medical life science textbooks. In the search box at the top of the page, type in your search words (e.g., “ELISA”). Many of the books include downloadable figures, etc., that you can use in your papers and presentations. Just be sure to cite your sources!

Date Posted: 05/13/07.

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