Keeping the world safe from superbugs
During the Revenge of the Superbugs session at Global Conference, some of the nation’s top medical and policy experts delivered a resounding call for greater political will and public action against microbial pathogens. The event was moderated byManny Alvarez, senior managing editor of health news at Fox News.
As our lives become increasingly globalized, invisible yet potentially deadly viruses and bacteria have more opportunities to spread. Centers for Disease Control and Prevention Director Thomas Frieden described three pathogenic risks: 1) new drug-resistant infections 2) globalization and 3) intentional creation of dangerous organisms.
We hear it in the news every day. The CDC is monitoring the progression of the Middle East respiratory syndrome (MERS), which originated in Saudi Arabia. Measles is surging among unvaccinated children because parents were persuaded by misinformation from non-health-care professionals. The New York Times reported recently that five children tragically died at Children’s Hospital in New Orleans in 2008 and 2009 from a flesh-eating fungus that was transported in unsanitary linens. Although antibiotic stewardship and infection control programs are more widespread, there are still more than 700,000 hospital-acquired infections and 99,000 deaths annually.
Antibiotic-resistant bacteria typically found in health-care settings such as methicillin-resistant Staphylococcus aureus (MRSA) have also infiltrated homes. A recent study found 161 homes in New York City were “major reservoirs” of the bacteria. Infections from antibiotic-resistant bacteria are difficult, and at times impossible, to treat, especially for immune-compromised patients. Depending on the exposure, MRSA infections may result in sepsis in the bloodstream, toxic shock, and can infect individual organs. And to give a whole new meaning to “dirty money,” researchers recently found 3,000 types – including those that cause food poisoning and staph infections – of bacteria on a set of dollar bills.
Taking antibiotics and eating meat from farm animals treated with antibiotics are major drivers of the proliferation of antibiotic-resistant bacteria, said Lance Price, professor of environmental and occupational health at the Milken Institute School of Public Health at the George Washington University. In the U.S., about half of all hospitalized patients receive an antibiotic during their stay. Among those, one-third are unnecessary or inappropriate.
The CDC now recommends that all hospitals have an antibiotic stewardship program and publicly urges appropriate antibiotic use. It was clear that a major shift in culture and acceptable norms in physician practice was needed. Leonard Cole, adjunct professor of emergency medicine and director of the Program on Terror Medicine and Security at Rutgers New Jersey Medical School, said public health should be embedded in medical education.
To curb the spread of infections, many hospitals today also have some type of hand-washing initiative, with uneven success. Price said the historical reliance on new drugs – the belief that they’ll compensate for bad habits such as poor hand hygiene – is no longer an option. “We have to relearn lessons of hygiene like before we had antibiotics,” he said.
While antibiotic control and hygiene initiatives are increasingly promoted in health-care settings, antibiotics are widely used in agriculture and largely unregulated. Price said that each year, industrial farmers use about 30 million pounds of the stuff. “This is a crisis point,” he said. “We have bugs now resistant to all antibiotics. We need to look at all the places we’re using antibiotics, and we’re not doing that.”
Preparedness for a widespread pandemic was a major point of discussion for the panel. Larry Brilliant, president and CEO of the Skoll Global Threats Fund and consultant on the Steven Soderbergh film “Contagion,”said that although vectors are increasing, there are also important new developments such as advanced molecular detection. However, as portrayed in the film, the consequences of unpreparedness are potentially catastrophic. Instead of a perfectly shrink-wrapped plan to use in case of emergency, Frieden emphasized the need for a robust everyday system that could be scaled up when necessary.
All the panelists agreed on the need to boost the nation’s pandemic preparedness infrastructure and technology. Detection speed, Brilliant noted, is the sine qua non of pandemic prevention. If “you give a bug a six-month head start, you’re looking at millions of incidents,” he said. “If we can move the speed of detection down to one incubation period, then you’re only going to have four to six incidents. You can squash that with old-fashioned treatments.”
The CDC is working to expand global pandemic protection by training other countries in detection techniques and infection control. The agency’s goal is to have 30 countries covering 4 billion people advance the Global Health Security agenda. Frieden and Brilliant also pointed to new regulations from the World Health Organization aimed at better surveillance and more vigilant reporting.
Even with all the risks, Brilliant offered a reprieve. “We need public will that this is an achievable target worth fighting for, and that we’re all going to join in this battle today.”