Diagnosing diseases with Dr. Jose Montero

For the last three years, Jose Montero, M.D., chief of New Hampshire’s Bureau of Communicable Disease Control and Surveillance, has been battling diseases statewide. The bureau is the state’s lead player in the investigation and reporting of infectious disease. With West Nile virus, anthrax, smallpox and SARS in the news, Montero has regularly appeared in the media to provide answers and information about these public health concerns and others.

What you might not see in front of the camera is a husband and father of two daughters dedicated to making his department a resource for businesses, other public health and governmental agencies — and, above all, keeping Granite Staters healthy.

Q: How does someone get to be the Chief of the Bureau of Communicable Disease Control?

A: I was trained as a family physician. Working as a physician and interacting with community services in Colombia, where I come from, I started to do more work in public health and then, later, epidemiology. Then I came to the States to look for a job in public health and started working in New York, and then here in New Hampshire.

Q: If there is such a thing as a typical day for you, what is it like?

A: There are mandates that require specific illnesses be reported to us by physicians and other health care providers. When somebody makes a diagnosis of one of these illnesses, they will call us and send us a copy of the lab results. We talk to the health-care provider and find out if they’ve already talked to the patient. If so, we then interview the patient and find out what the risk factors were.

If we have a GI illness in a food worker, we have to work with the company as well. We inform them that their employee can’t go back to work. We ask them about their food practices and procedures, because we need to protect the public as well as the other employees. At the same time, we offer education because we want those businesses to be successful, but follow the rules.

Most of the time we have individual cases, but sometimes there are outbreaks, such as at schools. It’s not an easy situation. From a public health standpoint, we may have to close the school, but we’re fully aware that each one of our recommendations has a lot of ramifications we have to consider.

Q: What advice can you give businesses as they put together an emergency safety plan that includes policies on how to handle bioterrorism threats?

A: We have a Web site with a lot of information and you can download instructions on how to prevent infections. In general, our advice for the public is to work with us if they have questions. Call us and we will provide information about clinical issues as they are appropriate. If in any given case you have infectious diseases, work with us. We have people always available, 24 hours a day, seven days a week that work with the general business community in dealing with these types of things.

Q: Are West Nile virus incidents down, or has it just become passŽ and is no longer in the media so much?

A: No, it’s still there. We are finding cases this year, and it was expected.

The risk of being infected in general is low, maybe about 3 percent. From that 3 percent, 80 percent will never know that they were infected. The other 20 percent of that 3 percent develop some symptoms. Seventeen percent will have low-grade fevers and malaise and that’s it. That remaining 3 percent will develop severe symptoms, encephalitis and meningitis. Ten percent of those may die.

New Hampshire didn’t have any cases last year that had encephalitis or meningitis. But we do know we have the disease here because we’ve had positive tests in birds which means we have local transmission. If a mosquito bites a bird with the disease, or if the mosquito already carries the virus, then bites a horse or the human, that’s how the disease spreads.

Q. What kind of infrastructure do you have for dealing with West Nile?

A. The amount of knowledge and experience we’ve built with this disease is fantastic. In New Hampshire, we didn’t have systems to look for dead birds or mosquitoes. We didn’t have the kind of testing necessary for this type of disease. In three years, we set up this entire system, testing hundreds and hundreds of birds every year. We created an infrastructure partnering with several other agencies. The state Department of Agriculture has been great in helping us out, as well as the USDA. The Nashua and Manchester health departments have been incredibly helpful. The APHIS (Animal and Plant Health Inspection Service) program has been wonderful. They are the ones doing the bird collection. We have a company that does mosquito collection and we test them right here in our public lab. We set up this whole new program in just three years.

Q: You can use this as a model for another program.

A: And that’s what we’re doing with all these new diseases. We build on our experience. To create the West Nile program, we built upon our experience with Lyme disease and rabies. In order to create our smallpox clinics for vaccination, we built upon our experience doing flu vaccinations. It’s like a business. You learn and you build all these new products at the market’s request. That’s what we do here.

Q: What was the most difficult public health situation you’ve been in and how did you handle it?

A: I’ve had several different kinds of experiences that were tricky. Once we got a call at midnight reporting a child who had severe bacterial meningitis and was going to die. We had our team at the child’s school at 7 a.m. on the other side of the state waiting for the teachers, waiting for the students, explaining what the disease was, doing an assessment of risk, interviewing the kids that might have been exposed to this child and getting all that done in a matter of hours.

For us, everything is a matter of death or life and a race against time. This happened on midnight of a school night, and we had to be ready the next day with the physicians, with the teachers and other governmental departments, with our assessment tools. And it worked. We didn’t have one other case. It was a sad situation and difficult to manage, but it showed that we are always alert. It was an incredible job.