A Health Department report out this week paints a largely positive picture of disease control in the territory, although it also raises some concerns about mental health, drinking water contamination and lead intrusion.
The 2022 Annual Report of the Epidemiology Division of Health highlights the fact that health providers in the territory have significantly improved the rate of formal reporting of transmissible diseases, as is required nationwide.
“Accurate enumeration of notifiable disease cases is important for informing effective public health prevention and control measures, especially critical during public health emergencies,” the report states.
Between 2021 and 2022, it says, reporting increased 149 percent in general. Moreover, during 2022, from January through December, there was a 23 percent increase in the number of private laboratories and health facilities in the territory doing direct electronic reporting to databases.
“We are (now) in line with national reporting,” Esther Ellis, the director of Epidemiology, told the Source in an email, responding to questions about the annual report.
“Epi (the Epidemiology Division) has been working incredibly hard since 2014 (when it was established) to increase disease reporting and spent almost a decade now developing mutually beneficial relationships with providers so that reportable disease data is available, and that data is analyzed and benefits the providers as well as the community,” she said.
Such reporting is obviously critical in dealing with the COVID-19 pandemic, which, as might be expected, was a major subject of the annual report.
In 2022, the third year of the COVID pandemic, the division detected a total of 13,675 cases territory-wide from 230,702 tests.
The numbers by island were: St. Thomas and Water Island, 5,565 cases and 23 fatalities; St. Croix, 7,528 cases with 15 fatalities; and St. John, 585 cases and no fatalities.
The report gives a brief summary of the division’s efforts to support and enhance both testing and vaccination services, including the distribution of 17,000 test kits, conducting testing in schools and group homes and tracking vaccination rates.
Early in the year, the territory was criticized for having a low vaccination rate. It was estimated at just over half the population, 51 percent.
However, the division recalculated the percentage once U.S. Census data for the territory was released, showing an 18 percent drop in the population, from 106,405 in 2010 to 87,146 in 2020. That meant the number of people vaccinated was actually closer to 63 percent of the population.
The division also conducted a COVID-related online survey in 2022. Although not a scientific sampling, the 370 respondents provided some food for thought.
More than half of them reported their employment and their income had decreased, rather than increased, because of the pandemic. Many reported difficulty sleeping and “agitated behavior.” Yet, one-third of them said they had not accessed behavioral health services during the pandemic as there was “No need.”
“Thus, it may be necessary to take the steps to educate the community on the importance of mental health, the mental health services available, and how mental health services can be utilized in response to sudden financial and other life changes during public health emergencies,” according to the annual report.
The Epidemiology Division keeps tabs on a wide scope of infectious diseases, excluding only tuberculosis, HIV-AIDS, and sexually transmitted diseases which are the province of Health’s Communicable Disease Division.
For example, the EPI report lists 89 laboratory-confirmed cases of influenza in 2022, zero cases of Mpox (formerly called monkeypox), one case of Anthrax that originated outside of the territory, 30 confirmed or probable cases of hepatitis B virus infections, and many others.
Of particular importance in the Virgin Islands are arboviral diseases, that is, ones transmitted by arthropods such as spiders and mosquitoes. High on the list for the territory are dengue, zika and chikungunya, all of which have appeared as outbreaks in the recent past.
The report says there were no reported cases of any of them in 2022.
Health officials have continually warned that the territory is likely to see another outbreak, however, since all three of those mosquito-borne diseases tend to appear in cycles of several years. The annual report notes, “It is important to continue all protective measures by eliminating mosquito breeding sites, wearing protective clothing, wearing insect repellent, and maintaining window screens or air conditioning in homes.”
In 2022, there were three reports of elevated blood lead levels in children. That was noteworthy since “(h)istorically, reports to (the division) for elevated blood lead levels have been low.”
High levels of lead, or actual lead poisoning, can be extremely serious, especially for young children, affecting mental and physical development. Amid a list of possible symptoms and results are headache, stomach cramps, muscle and joint pain, high blood pressure, and disorders of the brain, kidney and reproductive system.
Years ago, health concerns prompted regulations governing lead in various products, but it continues to show up in the environment. Lead-based paints and lead-contaminated dust in old buildings are potential sources of high lead in blood. So are contaminated soil, air and water.
The three 2022 cases have the division looking for resources to help fund a search for sources of lead contamination in the territory.
“In the past EPA (the federal Environmental Protection Agency) has helped us as requested,” Ellis said, “however we are also getting the basic equipment needed to do basic testing. We have federal funding to support the lead surveillance project.”
Another dangerous discovery noted in the 2022 report was the high level of contamination of cistern water — the primary source of drinking and all-purpose water in Virgin Islands households.
A study, already published, found that 80 percent of the 400 homes surveyed throughout the territory tested positive for E. coli contamination in water pulled directly from their cisterns. Results were a little better when researchers collected water samples from the kitchen tap: 58 percent of those samples contained E. coli contamination.
“The information gathered will help us develop guidelines specific to the USVI on the maintenance and treatment of cisterns and cistern water to protect USVI residents and travelers from waterborne biologic pathogens,” according to the annual report.
The report’s emphasis on the importance of the reporting of diseases and data collection illustrates the maxim that identifying a problem is the first step in solving it.