Recently the Germans issued an alarm of what would have been the first publicly recognized translocation of a human Rift Valley fever (RVF) infection from endemic areas in Africa to a temperate zone country. We applaud them for their proactive release of this information, regardless of it being a false alarm.
This alarm brought contemplation of the potential impact RVF would have if introduced in a country with transmission-competent mosquitoes and an immunologically naive cloven-hoofed animal and human population. Many in the agricultural industry consider RVF to be every bit as potentially devastating to livestock exporting country's economy as hoof and mouth disease (FMD) if that country was previously RVF and FMD-free.
It is notable there was not a strong negative reaction (in fact, we have not seen any) to the false alarm. This is an excellent outcome. We do not want to get into the habit of penalizing or discouraging reporting if it is later found to be a false alarm. As general surgeons know, it is good to maintain a 10% rate of normal appendix removals so that none infected are missed. Same principle here: we cannot afford to miss an introduction of RVF or be slow to react if an introduction is suspected. Better to react and be wrong than to be slow to respond or hesitate and invoke serious damage to a national economy.
An imprecise but relevant comparison is the example of Vancouver's proactive response to situational awareness during SARS versus Toronto in 2003. Another example was presented to me just this week where I interviewed an adult infectious disease specialist whose differential diagnosis and index of suspicion was altered to consider West Nile virus as he monitored the westward spread of the virus through the southern states. He was subsequently the first person to diagnose a case of West Nile in the county in a patient with an unusual presentation of encephalitis. Presensitization is a key component to successful detection of an index case arriving at the recipient end of a translocation.
This then raises the question of the relevancy of informing local communities in non-endemic countries such as the United States about RVF in South Africa. When should a local medical or veterinary community be aware of such outbreaks? Presensitization is key to successful rapid detection of exotic cases. Therefore, decision points to inform should be biased to inform rather than not.
As demonstrated during the 2009 influenza pandemic, the introductions of HIV/AIDS, West Nile virus, and several other key infectious disease translocation events, the social reaction to perceived withholding of information is far more severe than the issuance of a false alarm. This has long been an observation of the disaster sociology community, a point public health after so many decades should internalize and embrace as a standard of practice.