Journal Article

The History of Contact Tracing and the Future of Public Health

Brandt, Allan M.

2022

Overview

In the years after the elucidation of the germ theory of disease in the late 19th century, public health officials began to explore new strategies to reduce transmission of infections. Public health programs tracking infectious disease transmission became an important element of infection control and response to epidemics. From an historical perspective, contact tracing focused on the idea that if those infected could be identified, isolated, and persuaded to report their contacts, outbreaks could be slowed and, in some instances, stopped.As a result, contact tracing has frequently been used to address infectious diseases over the course of the past century. A recent review by El-Sadr etal.1 traces the use of contact tracing for syphilis and gonorrhea, tuberculosis, HIV, Ebola, and, most recently, COVID-19. Awide range of approaches, however, fall within the general rubric of contact tracing. These strategies have been based on the authority of the state to surveil and track epidemics; require physicians and public health agencies to report certain diseases; and identify individuals for surveillance, investigation, and contact by public health authorities.2The first major contact tracing programs targeted syphilis (Figure 1). Historically, the tracking of sexually transmitted infections led to stigmatization. Tracing required individuals to name sexual contacts, revealing intimate details about sexual relationships, as well as perceived indiscretions and infidelities, sometimes compromising marriages, families, other personal relationships, and employment. In the 1930s, tracing of syphilis infections required what officials often called \"shoe leather epidemiology\" to hunt down cases (often targeting prostitutes, minorities, and immigrants), as well as the interrogation of \"suspects,\" mandating Wassermann tests, and eliciting \"confessions.\" Contact tracing augmented the existing fear, shame, guilt, and stigma of syphilis.3 Not surprisingly, already vulnerable communities have often viewed these programs as both intrusive and dangerous. The threat of public exposure, isolation, and possible quarantine often encouraged individuals to avoid the \"public health police.\" This historical legacy of contact tracing programs continues to serve as an important obstacle to their widespread and effective implementation. Recognizing that such approaches could have the effect of limiting the voluntary identification of contacts, public health officials duringthe HIV epidemic began to adopt \"partner notification programs,\" which emphasized the contact case's personal and ethical responsibilities to the health of their sexual partners.

• Publisher: American Public Health Association
• Subject: 19th century / Acquired immune deficiency syndrome / AIDS / Automation / Bacterial diseases / Confessions / Conspiracy / Contact / Contact tracing / Coronaviruses / COVID-19 / Disease / Disease control / Disease transmission / Ebola virus / Employment / Epidemics / Epidemiology / Ethics / Gonorrhea / Guilt / Health authorities / Health Policy / Health surveillance / Historical development / History / HIV / Human immunodeficiency virus / Immigrants / Infections / Infectious diseases / Interpersonal relations / Interrogation / Leather / Marriage / Minority groups / Opinions, Ideas, & Practice / Other Infections / Pandemics / Physicians / Police / Privacy / Prostitution / Public health / Public Health Practice / Quarantine / Questioning / Sexual behavior / Sexual partners / Sexual relationships / Sexually transmitted diseases / Shame / STD / Stigma / Surveillance / Syphilis / Tracking / Tuberculosis / Viral diseases