Public Health Law Map - Beta 5 - Medical and Public Health Law Site

such as tuberculosis are also increasing. HIV has also overshadowed new epidemic
diseases, such as Lyme disease. Paradoxically, the legal risks of communicable
diseases are increasing because the diseases themselves are still relatively rare. If an
epidemic afflicts most of the population, it is difficult to link an individual case to a
workplace exposure. However, if outbreaks of the disease are infrequent, it will be
obvious when an employee’s exposure occurred at work.
a) Immunizations and Antibiotic Misuse
The root cause of the increase of immunizable diseases in the United States is
public complacency. After one or more generations of a successful immunization
program, the targeted disease becomes rare and no longer frightening. Once the
public is no longer concerned about a disease, the financial and political support for
disease control measures such as mass immunizations disappears. This creates
cohorts of susceptible adults who were neither immunized nor exposed as children,
a dangerous situation for employers because many childhood diseases are much
more serious in adults. For example, before mumps immunizations, epidemics of
mumps would pass through a community regularly, and most of the susceptible
population would become immune through having the disease. Complications in
these susceptible children were rare, and most children had the disease before
reaching puberty. Now, through vaccine failure, lack of exposure to disease or
vaccine, and waning immunity, workplace epidemics of mumps can occur. These
adult epidemics are dangerous because adults are prone to severe sequelae, with
attendant high workers’ compensation costs.
Controlling communicable diseases is complicated by the rise of drug resistance
secondary to the misuse of antibiotics. Overprescription by physicians, sharing
prescriptions by patients, the use of massive amounts of antibiotics in animal
husbandry, and the absence of international controls on antibiotics leads to the
evolution of antibiotic-resistant strains of common diseases. Tuberculosis is the best
example of the problem. The tuberculosis bacillus is hard to kill and prone to
developing drug resistance. The repeated exposure of tuberculosis carriers to
ineffective doses of antitubercular drugs dramatically increases the incidence of
drug- resistant tuberculosis. There are only a few effective antitubercular drugs.
These are all prescription drugs in the United States, but some are available in
over-the- counter cough syrup in Mexico.
b) Immunosuppression
The wide use of immunosuppressive drugs and HIV infection have resulted in a
large number of workers with suppressed immune systems who are more
susceptible to infectious diseases in the workplace. They also may spread diseases
such as tuberculosis to others. Until recently, significant immunosuppression was
not a workplace issue because it occurred only secondary to severe illness. Because
otherwise healthy immunosuppressed workers are a new phenomenon in the
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