Tertiary prevention

Tertiary prevention aims to reduce the long-term impact of communicable diseases by alleviating complications, preventing disability, and improving quality of life for those already affected. In the context of field epidemiology, tertiary prevention goes beyond clinical care and includes strategic interventions that promote recovery, functionality, and psychosocial well-being. These efforts are often disease-specific and require collaboration across public health, clinical medicine, and social services.

For instance, in HIV/AIDS management, multidisciplinary rehabilitation programs play a vital role in addressing physical deconditioning, social stigma, mental health concerns, and vocational reintegration. These programs help individuals cope with the chronic nature of the disease and support their participation in society.

In tuberculosis (TB) control, adherence support strategies are central to tertiary prevention. The Directly Observed Treatment Short-course (DOTS) strategy, endorsed by the WHO, ensures completion of therapy, thus reducing the risk of relapse and drug resistance. Long-term support may also include rehabilitation from lung damage and re-integration into the workforce after extended treatment.

For viral hepatitis, particularly chronic hepatitis B and C, tertiary prevention encompasses patient education, regular monitoring of liver function, and antiviral therapies to prevent progression to cirrhosis or hepatocellular carcinoma. Psychosocial support is also essential to address stigma and facilitate lifestyle adjustments that reduce hepatic stress.

In the context of emerging infectious diseases such as COVID-19 or Ebola virus disease, tertiary prevention includes structured long-term follow-up to manage post-acute sequelae (e.g., “long COVID” or post-EVD syndrome), inform rehabilitation strategies, and guide future clinical preparedness.

Field epidemiologists contribute to tertiary prevention by:

• Designing surveillance systems that capture long-term outcomes of infectious diseases.
• Coordinating with clinical and rehabilitation services to ensure comprehensive care.
• Conducting operational research to identify best practices for chronic disease management after infection.

These activities help minimize the burden of disease on individuals and society, strengthen health systems’ resilience, and close the loop between acute response and sustained recovery.