PHE 500 Module 10 Final Project Example

Preventable Every Time: A Public Health Analysis of Rabies in a Central Pennsylvania County

[Student Name]

Southern New Hampshire University

PHE 500: Principles of Public Health

Final Project

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Preventable Every Time: A Public Health Analysis of Rabies in a Central Pennsylvania County

Introduction

Few diseases show the logic of public health as clearly as rabies. Once symptoms begin, death is almost certain; before then, prevention almost always works. Whether a person lives therefore depends less on medicine than on a system of surveillance, investigation, law, vaccine and trust. This analysis examines that system across a composite Pennsylvania county home to some 90,000 people, where wildlife rabies is rising and the response is strained, and recommends how to strengthen it. Its lessons apply to many other preventable conditions.

The Issue and Its History

Rabies virus spreads mainly through bites, travels along nerves to the brain and, once it arrives, causes a fatal encephalitis. People have feared it for millennia; Tarantola (2017) traced its descriptions across four thousand years. Pasteur's vaccine in 1885 made prevention after a bite possible, and twentieth-century dog vaccination and leash laws ended dog rabies in the United States. Today the virus circulates in bats, raccoons, skunks and foxes, and public health's task has shifted from controlling dogs to managing human contact with wildlife.

Magnitude

Nationally, human rabies is rare. Of 89 cases acquired within the country from 1960 to 2018, 70% were linked to bats, and roughly two Americans die each year, yet about 55,000 people sought prophylaxis in 2018 (Pieracci et al., 2019). Because no national system tracks prophylaxis, estimates vary widely (Christian et al., 2009). In the county, animals sent for testing rose from 298 to 412 over three years, positives from 19 to 31 and residents starting vaccine from 118 to 214. There were no human cases. The burden, then, lies in exposures, cost and the work of prevention.

Stakeholders and the System's Response

The response draws on residents, farmers, camps, two hospitals, veterinarians, township animal control, the county health department, the state laboratory and federal agencies. Under the three core functions (Institute of Medicine, 1988): assessment relies on bite reports and laboratory results but misses late or unreported exposures; policy is set mainly by state law requiring pet vaccination and defining quarantine, while the county's plan is out of date; and assurance is strong in the hospital but weak in affordability and outreach. A spring partner meeting is the system's best asset, though farm worker advocates, wildlife rehabilitators and Amish leaders are absent from it.

Determinants and Equity

Braveman and Gottlieb (2014) asked public health to trace problems upstream. In this county, the conditions that raise exposure, such as farm work, older housing with bats and unvaccinated barn cats, cluster among the same residents who face barriers to protection: no insurance, limited English, distrust of agencies, long drives to the hospitals and no paid time off. A full course of prophylaxis costs several thousand dollars. The result is a response that works quickly for insured, English-speaking residents near the county seat and slowly, if at all, for others.

Ethics and Law

Rabies control relies on legal powers, including orders to quarantine or euthanize exposed animals. Tested against the conditions Childress et al. (2002) proposed, such orders are justified: they work, the harm prevented is grave, they are needed when a pet's vaccine has lapsed and quarantine is the less drastic option. They become unfair when the gentler option costs more than a family can pay, which argues for helping low-income owners comply and for preventing the dilemma through pet vaccination.

Interventions

Frieden (2010) ranked interventions by their reach, from socioeconomic change at the base to education at the top. The county leans heavily on the upper tiers: clinical care after exposure and advice to the public. Options lower on the pyramid include free pet vaccine clinics in every township, bat-proofing grants for camps and older homes and an extension of wildlife oral vaccine baiting, which has slowed raccoon rabies elsewhere at considerable cost (Slate et al., 2009). In the protection tier, pre-exposure vaccine for high-risk workers now requires only two doses (Rao et al., 2022). In the clinical tier, a fund with the hospitals would keep cost from delaying treatment.

Recommendations

Table 1 sets out the recommended package, the essential service each strengthens and its measure.

Table 1. Recommended package

Note. Each measure can be tracked with existing or minor new data.

Phasing

The first season should start with the lowest-cost steps, township clinics, bilingual guidance and the plan update, while the fund, pre-exposure program and regional rota are negotiated. Bat-proofing can begin at camps, where a single fix protects many children. A review after the first summer should report each measure to the board of health and adjust the package. Castrucci (2021) argued that the essential services offer a common language for explaining public health; reporting progress in those terms would help the board see the program as a system rather than a nursing task.

Limitations

This analysis relies on composite county data, department records and a small number of interviews. It cannot measure exposures never reported, which may be most common among the residents it is most concerned about. National estimates of prophylaxis vary widely. Costs for several recommendations are uncertain until partners commit. These limits argue for building measurement into the package from the start.

Conclusion

Rabies is preventable every time, provided the system reaches the person in time. In this county the system succeeds often, through a few dedicated people and trusted partners, but its default path serves some residents far better than others. Shifting effort toward pet vaccination, removing cost barriers, protecting high-risk workers and strengthening the workforce would move the program down the health impact pyramid and closer to protecting everyone.

References

Braveman, P., & Gottlieb, L. (2014). The social determinants of health: It's time to consider the causes of the causes. Public Health Reports, 129(Suppl. 2), 19-31. https://doi.org/10.1177/00333549141291S206

Castrucci, B. C. (2021). The "10 Essential Public Health Services" is the common framework needed to communicate about public health. American Journal of Public Health, 111(4), 598-599. https://doi.org/10.2105/AJPH.2021.306189

Childress, J. F., Faden, R. R., Gaare, R. D., Gostin, L. O., Kahn, J., Bonnie, R. J., Kass, N. E., Mastroianni, A. C., Moreno, J. D., & Nieburg, P. (2002). Public health ethics: Mapping the terrain. Journal of Law, Medicine & Ethics, 30(2), 170-178. https://doi.org/10.1111/j.1748-720X.2002.tb00384.x

Christian, K. A., Blanton, J. D., Auslander, M., & Rupprecht, C. E. (2009). Epidemiology of rabies post-exposure prophylaxis, United States of America, 2006-2008. Vaccine, 27(51), 7156-7161. https://doi.org/10.1016/j.vaccine.2009.09.028

Frieden, T. R. (2010). A framework for public health action: The health impact pyramid. American Journal of Public Health, 100(4), 590-595. https://doi.org/10.2105/AJPH.2009.185652

Institute of Medicine. (1988). The future of public health. National Academy Press. https://doi.org/10.17226/1091

Pieracci, E. G., Pearson, C. M., Wallace, R. M., Blanton, J. D., Whitehouse, E. R., Ma, X., Stauffer, K., Chipman, R. B., & Olson, V. (2019). Vital signs: Trends in human rabies deaths and exposures, United States, 1938-2018. MMWR Morbidity and Mortality Weekly Report, 68(23), 524-528. https://doi.org/10.15585/mmwr.mm6823e1

Rao, A. K., Briggs, D., Moore, S. M., Whitehill, F., Campos-Outcalt, D., Morgan, R. L., Wallace, R. M., Romero, J. R., Bahta, L., Frey, S. E., & Blanton, J. D. (2022). Use of a modified preexposure prophylaxis vaccination schedule to prevent human rabies: Recommendations of the Advisory Committee on Immunization Practices, United States, 2022. MMWR Morbidity and Mortality Weekly Report, 71(18), 619-627. https://doi.org/10.15585/mmwr.mm7118a2

Slate, D., Algeo, T. P., Nelson, K. M., Chipman, R. B., Donovan, D., Blanton, J. D., Niezgoda, M., & Rupprecht, C. E. (2009). Oral rabies vaccination in North America: Opportunities, complexities, and challenges. PLoS Neglected Tropical Diseases, 3(12), Article e549. https://doi.org/10.1371/journal.pntd.0000549

Tarantola, A. (2017). Four thousand years of concepts relating to rabies in animals and humans, its prevention and its cure. Tropical Medicine and Infectious Disease, 2(2), Article 5. https://doi.org/10.3390/tropicalmed2020005