Health opportunities for primary preventative measures

Mr. A is a 35-year-old man of Vietnamese descent who presented to his outpatient physician with a three day history of cough, fever, and myalgia. He is physically fit, with no past medical history, and currently takes no medications or supplements. He “doesn’t like doctors” and avoids receiving routine medical care for this reason, including never having received an influenza vaccination. He lives in an apartment with his female partner and three children, all younger than 10 years of age. Mr. A is employed as a security guard at a local college dormitory and is the only source of income for his family. He smokes two packs per day of cigarettes and denies any regular alcohol or illicit drug use.
Just over two weeks ago, in February, he took a vacation to visit extended family in Vietnam. Although he spent most of his time in downtown Hanoi, he did visit his cousins in the outlying country for three days prior to returning to the United States. His cousins were chicken farmers, and while staying with them he helped out with the daily chores, including tending to the flock. He noticed that many of the chickens seemed “ill,” and was told that this had been observed for several days. The cousins had not reported the sick poultry due to fear that they would be forced to cull their flocks out of concern for avian influenza, which would be financially devastating to their already meager subsistence. Due to limited space, Mr. A had been unable to stay in the main house, so he slept in a shack near where the chickens were penned. One of his cousins did have a “severe cold” at the time of his visit.
On the day of his return to the United States, Mr. A noted the acute onset of fever, myalgias, and cough. He had no further available leave from his job and did not want to risk termination, so he reported for work despite his illness. Over the next two days, Mr. A felt progressively more ill with profound fatigue and noticeable shortness of breath with exertion. During those two days, he went about his usual activities in the dormitory, which included the breakup of two large parties on the dormitory floors and supervising a crowded Family Day activity in a common room in that building. On the third day of his illness, Mr. A. found it difficult to accomplish his usual morning activities due to his worsening symptoms. He still insisted on reporting for work, and asked his girlfriend to drive him there, but she brought him to his outpatient physician instead. Mr. A believed that he picked up “a bad cold” from one of the students in the dormitory. He heard of avian influenza in the news a couple of years ago, but expressed to the physician that he is unconcerned, as clearly a pandemic has not occurred. He was initially unwilling to provide details of his trip to Vietnam to his physician, but did so only after insistent prompting from his girlfriend.

Question 1: There are several issues presented in this scenario. Name one issue and state why you believe it is a problem.
Question 2: Clearly, opportunities for primary preventative measures were missed in this case. Describe one primary preventative measure from a One Health perspective that could have been utilized to prevent this scenario. Feel free to ‘think outside of the box’ to answer this question.
Question 3: Consider all of the other people in contact with Mr. A throughout this time. In what ways did each person contribute to the development of a potential outbreak, both through specific actions and inaction? In what ways could One Health be used to address these points? If you answer this question, please just choose one person to focus on.

Sample Solution