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Also, in that same context of trade and imports, (See Table I)
we periodically hear of the importation of infectious diseases, such
as malaria, Zika, MDR-TB, leprosy and Chagas Disease to name
but a few, as well as vectors such as the Asian Tiger mosquito. We
pass over in silence the major economic pests such as the Asian
pine borer, the Asian and Formosan subterranean termites, and the
Spotted Lantern fly.
TABLE I: Exotic Diseases Periodically Imported into the USA
MDR-TB
Zika virus
Leprosy
Chagas Disease
Ebola (usually an exposed health care worker)

Suicide rates have been increasing in every state and increased
nationally by 25.4% between 1999-2016. It is now the 10th
leading cause of death here, with over 45,000 cases aged 10 years
and older. Three methods (firearms, 55%; suffocation, 27%; and
poisoning, 10%) account for 92% of all suicides.
Another important factor affecting these data is the extent
of our national Epidemic of Opioid Overdose Deaths. Drug
overdose deaths in the US numbered over 700,000 between
1999-2017, and 70,000 in 2017 alone (or an average of 190/day)
for all types of opioids, including heroin and illicit opioids which
accounted for over 2/3 of all OD deaths. Consequently, Congress
appropriated $476 million in FY 2018 to provide increased funding to all 50 states and 4 US territories for increased prevention
and response activities. PA had the 6th highest drug OD death rate
in the country. Here in Chester County, it should be noted that
the County's Dept. of Drug and Alcohol Services posts an Opioid
Epidemic Community Tool Kit on its website.

Monkey Pox (2003 outbreak)
Dengue
On a different tack, we have to mention the CDC's concern
about some of what we might call our nation's vital statistics. A
list of our leading causes of death is shown in Table 2. The CDC
notes that Chronic Diseases remain one of their top priorities.
Heart attacks, strokes, heart failure and other chronic diseases -
all of them largely preventable - caused 2.2 million hospitalizations, 415,000 deaths, and over $30 billion in health care costs.
For the first time, our national Life Expectancy at Birth
showed a drop of 0.1% (final 2016 data), reflecting worrisome
increases in mortality due to unintentional injuries, homicide,
Alzheimer's Disease, suicide, opioid overdose deaths, and Parkinson's Disease.

TABLE 2: Leading Causes of Death, USA
1. Heart Disease

6.Alzheimer's Disease

2. Cancer

7. Diabetes mellitus

3. Accidents

8. Influenza/pneumonia

4. Chronic lung disease

9. Kidney disease

5. Strokes

10. Suicide

Despite the importance and preventability of many of the foregoing issues, it is generally the area of Infectious Diseases which
grabs most peoples'attention, and the area which gets the most
media attention deals with "outbreaks," especially food-borne
outbreaks and related "product recalls." CDC lists 24 food-borne
outbreaks in 2018. Two of the most important of these are those
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WINTER 2019 | CHESTER COUNT Y Medicine 29

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Chester County Medicine Winter 2019

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