Infectious Disease Control

By Dr. Russell Wong
Interviewed by Guest Writer
Wednesday - April 22, 2009
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Dr. Russell Wong
Internal Medicine and Infectious Disease Medicine

Interviewed By Melissa Moniz

Can you describe what a typical work day is like for you?

I’m an infectious disease specialist. My primary role, and probably the most interesting aspect of what I do, is care for patients in the hospital. I have two half-days in my office and I spend one-half day a month at Queen’s specialty clinic in Hilo.

Why do you spend most of your time in the hospital? Is it because most people who have infectious diseases would go to a hospital rather than make an appointment?

We primarily see patients who are hospitalized with complicated problems. A large number of these complications are infections that present as fever or leukocytosis, which is an elevation in the white blood cell count. And the diseases are primarily pneumonias, cellulitis, which is infection of the skin, and urinary tract infections. When patients are in the hospital they have potential illnesses that can possibly cause death. So that’s why physicians will call us to help care for the patient.

What are the most common infectious diseases you see and treat?

Pneumonia is probably one of the more common problems. There are a fair amount of patients who don’t have to be hospitalized, but those who have to be hospitalized, some of these are people who require mechanical ventilation for respiratory support. There’s a reasonably high mortality from people who are hospitalized with pneumonia on ventilators. We also take care of patients with cellulitis, which are infections of the skin and soft tissue.

What is the difference between an infectious disease and a contagious disease?

Infectious diseases are related to infections, and contagious diseases are infections that are more readily transmitted from person to person. So there are many infections when a person will become ill, but they aren’t necessarily contagious. There are some infections that are highly contagious, which we treat.

As a chairman and member at REHAB Hospital and Hawaii Medical Center West, I help develop policies and procedures to try to minimize infections in the hospital. For example, there are policies for obtaining urine cultures and policies for contact isolation for MRSA (staph infections). Infectious disease specialists develop the hospital policies and the protocols for physicians and staff.

Dr. Wong checks the pulse of patient Ke’ale Carino, age 8

Can you discuss staph infections and how problematic it is here in Hawaii?

Over 50 percent of people in the hospital have MRSA, so it’s actually relatively common. Just because you have MRSA doesn’t imply infection. It’s when you have an active infection that you’re trying to treat it.

Because it’s infections you’re dealing with, are antibiotics the cure for most of what you treat?

Yes, antibiotics are primarily our tools for our trade.

Is it more dangerous when a child gets an infectious disease versus an adult?

Actually, the adult mortality is higher than in children. Children are actually much more resilient than adults. The elderly usually have multiple medical problems, which put them at higher risk for illness and death, rather than a child, who would often have just one problem. I think it comes down to the complexity of their underlying medical problems.

Are the number of infectious disease cases generally decreasing or increasing?

I would say it’s pretty stable. There are national initiatives from quality agencies to continue to try to develop policies and procedures to decrease infectious diseases in the hospital. This is to diminish or control the rate of infections in the hospital.

Do vaccines affect the number of infectious diseases cases?

Vaccines don’t play a role in a lot of hospital-related problems, but they play a general public-health role. I personally believe that vaccines are more important than many people give them credit for. Vaccines prevent infections effectively, but that’s not to say there hasn’t been the occasional patient who has had side-effects. But that’s extremely small. I see patients who are not immunized as children who have more severe adult problems.

With many of these types of infectious diseases, are you generally more susceptible to getting it again once you’ve had it?

Usually patients are more susceptible to recurrent infections because of underlying medical problems rather than the bacteria themselves. However, some people do have recurrent infections.

What has been the biggest medical advancement since you started practicing that has really helped in the treatment or prevention of infectious diseases?

AIDS/HIV medications. When I initially trained in 1989-1991, we had only one HIV medication, but now there are more than 20. In 1989, all AIDS patients died. Now AIDS is a chronic disease. The medication controls the infection.

Are there any new medical advancements on the horizon that you think will be beneficial?

There’s medication that’s continuing to be developed and released in different classes of anti-viral therapy. Basically, they are continuing to develop new classes of HIV medication.

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