Attack scenarios with Rickettsial species: implications for response and management

Psychosocial consequences of infectious diseases

Historically, there has been an exaggerated fear related to infection compared to other conditions. Infection possesses unique characteristics that account for this disproportionate degree of fear: it is transmitted rapidly and invisibly; historically, it has accounted for major morbidity and mortality; old forms re-emerge and new forms emerge; and both the media and society are often in awe. Because, in an outbreak, the patient is both a victim and a vector, and because there exists the potential for infringement of personal rights in order to control an outbreak, infection may be viewed (and has been depicted in popular culture) as a foreign invasion. During recent outbreaks, fear, denial, stigmatization and loss have been recorded in the implicated individuals. Stigmatization and discrimination may further involve ethical correlations, and attempts to adress these issues through activism may also have unwarranted effects. Public health initiatives can address the public's fears by increasing health literacy, which can contribute to reducing stigmatization.

Q fever in Logroño: an attack scenario

Bioterrorism has emerged as an important infectious disease and public health challenge in the 21st century, and issues of preparedness and response are now prominent. The development of attack scenarios for assessing this problem contributes to the organization of response systems and identifies aspects that may need to be improved. The authors present an attack scenario involving Q fever in a specific area, the city of Logroño, Spain. The evolution of the outbreak is described and the attempts at diagnosis and implementation of public health measures are outlined. Knowledge of the pathogen in the specific scenario and the ability to directly diagnose the disease it causes may be of help to facilitate a fast response that will contain public unrest and the eventual outcome in terms of morbidity and mortality.