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Antibiotic-resistant superbugs spread across U.S. – m.washingtonexaminer.com/Brian Hughes

October 13, 2014

Health, USA

As Americans worry about Ebola, the swiftly spreading virus that has traveled from West Africa to Texas, a more silent killer poses a greater danger. It sounds pedestrian, easy to dismiss.

That’s what makes it so devastating.

The U.S. health system is now under assault by antibiotic-resistant superbugs.

Drug-resistant bacteria killed 23,000 people in America last year and caused 2 million illnesses. It is getting worse, health experts say.

Fears of Ebola have ratcheted up since the Centers for Disease Control and Prevention announced last week that the first case of the disease had been diagnosed on U.S. soil. But unlike Ebola, which officials insist has little chance of getting out of control domestically, some bacterial infections are now resistant to all antibiotics and are completely untreatable.

Doctors and others in American medicine have unparalleled knowledge about the spread of illness, but they can do little to fend off superbugs unless there is a big decline in the use of antibiotics and a rapid increase in the development of new drugs to treat seemingly routine ailments.

Put another way, Americans could start to die from some of the same illnesses that cut down people living in the Dark Ages.

“The growth of anti-microbial resistance threatens to end the antibiotic era, returning us to a time when even simple infections were often fatal,” CDC Director Tom Frieden told the Washington Examiner.

The Great Influenza of 1918 killed between 50 million and 100 million people worldwide, the Black Death of 1347 to 1351 wiped out half of Europe’s population, and cholera caused seven pandemics in the 19th and 20th centuries.

The World Health Organization put the health risks bluntly in a report earlier this year on the threat of antibiotic resistance.

“A post-antibiotic era — in which common infections and minor injuries can kill — far from being an apocalyptic fantasy, is instead a very real possibility for the 21st century,” the organization warned.

Long prescribed by doctors as a fix for a variety of maladies, antibiotics have been relied on too heavily, both through personal use and in the nation’s food supply, causing bacteria to evolve to the point of resisting them.

About half of all antibiotic prescriptions, the CDC estimates, aren’t even needed to treat the ailments in question. And the drugs do nothing to fight off the common cold or the flu.

Doctors would prefer that Americans focus on using antibiotics properly and keeping their vaccinations up to date, and worry less about Ebola.

Respiratory viruses such as the flu have proved far deadlier. Because such viruses spread through the air or by simple human contact, and do so before symptoms appear, they have higher transmission rates that create conditions for a full-blown pandemic.

In comparison, Ebola spreads solely by direct contact with infected bodily fluids such as blood, sweat or saliva.

The difference, government officials say, is that even with Ebola arriving in the United States, the health infrastructure is in place to contain the virus, isolate it and prevent the type of outbreak ravaging West Africa.

Government officials believe they have history on their side. They point to an outbreak of a similar disease in Germany in the 1960s which killed only a quarter of the number who have died recently from Ebola in Africa. There were more tools to contain the epidemic in Germany than in Africa, as there are in America today.

Dr. Frieden, the public face of the Obama administration’s Ebola response, said the virus “poses no significant threat” to the American health system, and there was “no doubt” that health officials would corral a virus which has killed about half the people it has infected this year.

In a lengthy discussion with the Washington Examiner, Frieden rejected the idea that the United States might experience a crisis resembling the one in West Africa, where 1.4 million are expected to be infected by January. Many Americans are unlikely to find those words comforting.

A recent federal audit found that the Department of Homeland Security is ill-prepared to handle pandemics, and noted that most of the agency’s antiviral drugs are due to expire next year. The audit also found shortages of hand sanitizer and protective gear.

But the Ebola scare, and the nation’s shrug in response to flu, antibiotic-resistant bacteria and other public health problems, says more about broad cultural perceptions of disease than it does the medical community’s ability to treat them, analysts say.

“Even when people are told not to be afraid, there is a culture that pre-exists a particular epidemic. Ebola is presented almost as a horror story,” said Duke University professor Priscilla Wald, author of the book Contagious: Cultures, Carriers, and the Outbreak Narrative.

“The flu is a much more dangerous thing, but no one is going to be terrified of it because saying ‘your lungs fill up with liquid’ doesn’t mean the same thing as ‘your organs melt,’ ” she added. “It’s like trying to explain to people that you’re at a greater risk of dying in a car accident [than other transportation].”

Ebola does not actually cause organs to melt, as movies and television dramas suggest, but it does fatally shut down the body.

The first American doctors and aid workers who contracted Ebola in West Africa were able to beat the virus after returning to the United States, where they were given drugs not yet widely available and were monitored by a small army of health professionals.

Re-evaluating health dangers

Health experts demand a broad rethink of health risks.

The CDC estimates that as many as 49,000 people die from the flu every year, and there are also other diseases that could reach pandemic proportions here.

Enterovirus D68, which is linked to extreme muscle weakness in children, has spread to more than 40 states. It is usually associated with the common cold, but the current strain of enterovirus has required hundreds of children to be hospitalized and left medical teams scrambling to understand how it produces paralysis. One 10-year-old girl in Rhode Island died from the virus.

Federal officials recently confirmed several cases of the mosquito-borne chikungunya virus, which causes debilitating pain in arms and legs and has wreaked havoc on the Caribbean. It is not fatal but there is no vaccine to prevent it or any treatment to cure it.

There have been no new cases of Severe Acute Respiratory Syndrome, known as SARS, in more than a decade, but health experts still worry about another outbreak. SARS, a form of severe pneumonia, has been declared “here to stay” by the National Institutes of Health and has killed 10 percent of the people it has infected in Asia, Australia, Europe, Africa, and the Americas. It is far more contagious than Ebola.

Officials also are monitoring Middle East Respiratory Syndrome, or MERS, which has similarly dangerous potential. The CDC confirmed two cases of the illness in the United States in May, both in health workers traveling from Saudi Arabia. They were both treated effectively, although about three in 10 MERS sufferers have died.

The 2009 H1N1 flu virus, often called “swine flu,” turned into a worldwide pandemic. This year it has had the most significant presence in the United States since the outbreak five years ago.

Building up resistance

Millions of Americans are already feeling the effects of antibiotic resistance. Health officials and drug companies are years, if not decades, behind the evolution of mutating bacteria.

Antibiotic-resistant strains of tuberculosis, malaria and some sexually transmitted diseases now exist. Experts fear that gonorrhea could become untreatable. Hospitals are recording rates of resistance to treatment of up to 60 percent, according to health professionals.

“We could face a situation where we have larger numbers of people with cancer, diabetes, very common problems, who will then develop infections that can’t be treated,” warned Arthur Reingold, head of epidemiology at the University of California, Berkeley School of Public Health.

“Any individual could get an antibiotic-resistance infection. It’s the luck of the draw,” added Maryland Secretary of Health and Mental Hygiene Joshua Sharfstein. “There’s an expectation that if you get an infection there will be a medication to treat it. Instead, a lot of people are dying.”

Doctors also need to become more restrictive when writing prescriptions, analysts said.

“People don’t have the resistance concept down very well,” explained William Schaffner, an infectious disease specialist at Vanderbilt University. “They think they are resistant, not the bacteria. That concept is still very fuzzy in the minds of people. They haven’t figured out that by using antibiotics a lot … you still have this pressure from moms, by the time their child is in the fourth day of illness, they bring them to the pediatrician and they want a resolution — treat with antibiotics.”

Parents facing a barrage of drug advertisements and doctors fearful of looking unresponsive to their patients’ needs have accelerated antibiotic resistance.

Rapid testing could help determine when a virus rather than a bacterium is causing illness, but that diagnostic technology is not yet widely available.

Washington responds

The Obama administration is scrambling to catch up with mutating bacteria.

In the same week the president dispatched 3,000 military personnel to fight Ebola in Africa, he also issued an executive order that called for enhanced surveillance of antibiotic-resistant bacteria, ways to increase the effective lifespan of current antibiotics, and more development of new treatments by 2020. Obama has requested a detailed plan by February, and the administration is offering a $20 million prize for more effective testing to track resistant infections.

At stake, the president said, is the ability of the nation to “protect our children and grandchildren from the re-emergence of diseases and infections that the world conquered decades ago.”

Concern is bipartisan. Republican lawmakers went out of their way to praise Obama for taking executive action on the issue. Conservatives have greeted virtually every other major executive order recently with charges of overreach.

But both Republicans and Democrats agree that the unilateral action is just a small step in trying to fix the broader problem.

“It’s critical that we take swift action to stop its rise,” said Sen. Sherrod Brown, D-Ohio, who recently introduced legislation “to increase the emphasis on federal antimicrobial resistance surveillance, prevention and control, and research efforts.”

Brown’s bill would establish an Office of Antimicrobial Resistance at the Department of Health and Human Services and require greater reporting from the CDC on antibiotic-resistant infections and trends. Much of the data now being used is out of date and does not reflect the bacterial environment as it now is, he said.

Republicans are also offering fixes.

“We need to raise awareness about this antibiotic resistance, and not enough is known about it or said about it,” said Rep. Joe Pitts, R-Pa., who recently convened a hearing on the issue.

“The Ebola crisis is a humanitarian crisis in Africa, but as far as America is concerned, we’re seeing thousands of deaths from antibiotic resistance that need to be addressed now,” he added in an interview with the Examiner. “Our pipeline [of antibiotics] is dangerously empty.”

Therein lies the problem over how best to proceed. A crisis that was formed because of an overreliance on antibiotics now demands a surge in production of such drugs, and then the next batch and the next batch and so on.

“It’s like running on a treadmill,” explained Scott Podolsky, director of Harvard University’s Center for the History of Medicine.

“If we pat ourselves for saying [antibiotic resistance] surfaced as a problem and therefore will take care of itself, we’re fooling ourselves,” he added. “I don’t think it will ever totally go away. You just want to right the balance in keeping up with it.”

Elusive balance

But finding that balance remains elusive, especially because business and public health interests conflict.

Drug manufacturers have shown little interest in developing new antibiotics, preferring to focus on high-profit chronic problems such as cholesterol, diabetes or arthritis. It’s a better business model, they say, to make products that won’t lose their effectiveness and don’t require expensive new testing.

Vaccinations to combat the new strains of bacteria are also nowhere near wide-scale production.

Lawmakers want drug companies to produce new antibiotics, but not too many of them because overdependence is the cause of the current crisis.

If a pharmaceutical company spends hundreds of millions of dollars on a new drug, it requires mass sales to recoup the costs of research and development. But the need to sell a lot of any drug runs contrary to the need to prevent patients being prescribed antibiotics unnecessarily and thereby speeding that drug toward the day when it becomes ineffective.

Lawmakers have sought to tackle this dilemma by giving drug companies five more years of market exclusivity once the Food and Drug Administration approves their treatment.

But critics say this has done little to fix the shortage of antibiotics and warn about rising healthcare costs.

“Exclusivity rewards drug companies by allowing them to charge higher prices,” said Rep. Henry Waxman, D-Calif., in a recent hearing devoted to antibiotic resistance. “As a result, it also imposes a significant burden on patients and the healthcare system overall. We need to approach this particular form of incentive with great caution.”

Another option being explored by lawmakers is a special pathway to speed the approval of antibacterial drugs designed to treat life-threatening conditions.

Nevertheless, fixing the production issue would not by itself solve the riddle of how to prolong the effectiveness of antibiotics.

Don’t forget the cows

Without curtailing the use of the drugs, antibiotic resistance will fester, and it’s not just humans that health professionals worry about.

Perhaps even more important, scientists argue, is rooting out the use of antibiotics in poultry, cattle and other animals in the food supply.

While the FDA has called for limiting antibiotics used to make animals grow faster and bigger, little has changed to alter the drinking water and feed used in the agricultural industry. Furthermore, the suggested reforms are voluntary.

Obama’s executive order on antibiotic resistance mainly focuses on human consumption and provides few new reforms focused on fixing the problem in food production. Those who track the evolution of a bacterium don’t expect major changes in how food companies raise animals.

“Getting antibiotics out of the animals and animal feed is very politically difficult,” said UC Berkeley’s Reingold. “People have been calling for that for decades without much success.”

Congress is likely to consider legislation after November’s midterm elections, but questions remain over how quickly lawmakers would agree to reforms.

Even as they sought to downplay the Ebola threat, observers of infectious diseases said the crisis in Africa provides valuable lessons for a variety of rising threats in the United States, including antibiotic resistance.

The main takeaway, they argue, is that too many public health systems wait until disaster strikes before laying the foundation for a large-scale response to an obvious threat.

“We could have made a stockpile of vaccines,” said Joseph McCormick, regional dean at the University of Texas School of Public Health Brownsville Regional Campus, who was involved in investigating the first recorded Ebola outbreak in 1976. “Why didn’t we do that? We depend on drug companies, and they depend on making money. There’s no market.

“Everybody’s response has been rather slow,” he lamented. “I think it calls into question not only what we are doing in terms of basic medical facilities in developing countries but how we look at our own defenses.”

MONDAY, OCTOBER 13, 2014. 1:45 p.m. [GMT]

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One Comment on “Antibiotic-resistant superbugs spread across U.S. – m.washingtonexaminer.com/Brian Hughes”

  1. emotanglobal Says:

    We are all learners. Start small and take a step at a time.

    Thanks,
    TOLA.

    Like

    Reply

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