Expert Says Recent Spate of Emerging Infectious Diseases Not Historically Unusual
By Kelly M. Pyrek
In the midst of the SARS outbreak this spring, infectious disease expert Edward J. Septimus, MD, FACP, shared his perspectives on the recent spate of emerging infectious diseases. Septimus is medical director of Memorial Hermann Healthcare System in Houston, Texas. He earned his medical degree from Baylor College of Medicine. He is a fellow in the American College of Physicians and in the Infectious Diseases Society of America. He is board certified by the American Board of Internal Medicine and the American Board of Infectious Diseases. He is a member of the Medical Advisory Steering Committee for the Houston Task Force on Terrorism, created in October 2001 to develop regional procedures for responding to a bioterrorist attack.
Q: There has been a great deal of infectious activity in the last few years: West Nile, anthrax, smallpox and now SARS is this historically unusual? Or are we just better informed by 24/7 media saturation and it appears there is more activity than there really is?
A: Historically, this is not unusual, and there has always been a lot of media hype. In the last two decades we have had HIV, toxic shock syndrome, crytosporidisis, lyme disease, hepatitic C, hantavirus, Ehrilichosis, etc.
Q: From what is known, is there any remote connection between SARS and any other infectious outbreak weve seen lately?
A: So far the genetic analysis of this coronavirus cannot be traced back to a prior human or animal virus.
Q: Can you point to any reasons that might explain why we seem to be under attack by pathogens? Are there natural or manmade factors at work here?
A: Its probably multi-factorial. These factors include overcrowding and increased immuno-suppressed patients and transplants. With increased population we are disturbing areas where man has not been before (hantvirus was in part due to the disturbance of the rodent population), and there are more invasive procedures and implants today, so some reasons are manmade and some are natural.
Q: How concerned about SARS should healthcare professionals be and what can they do to better prepare for a sustained outbreak in the U.S.?
A: I think the Centers for Disease Control and Prevention (CDC) has done an excellent job at informing the health profession. Since we are still trying to define the new outbreak it is too early to tell if we in the U.S. will have a long-term problem; we must keep up our guard and do careful community surveillance to pick up any new patterns of disease and/or transmission.
For SARS, if this is like many other respiratory viruses, it may go away during the summer but be back again next winter. I am confident that from the federal level, the CDC and others have benefited from bioterrorism and have improved our ability to respond to these challenges. However, I am concerned about local health departments, which are funded by state and local resources, and as you are aware, most states and local governments are now facing budget shortfalls and are asking for cuts across the board including the health departments. I think this is short-sighted, since any attack or introduction of a new agent will usually occur in a local area and we need to be able to detect and respond with adequate resources. We need to think of public health the same way we think about police and firemen.
Q: What do you think a national bioterrorism needs assessment would look like now, some 20-plus months after Sept. 11? Are we more prepared to face infectious agents or is there more work to be done? How can infection control practitioners arm themselves against outbreaks and bioterrorism?
A: Infection control personnel use public health surveillance techniques and are ideally suited to work with local health departments for surveillance and early detection especially if it involves a biological attack. I think from the federal level we are in good shape; locally, it depends upon the community.
Some cities have done a good job, others the minimum.
Q: Nosocomial infections kill tens of thousands of patients annually, yet not much is made of this; however, the anthrax deaths created a wave of panic what does this say about our perceptions and values?
A: I think you have hit upon a really good point. Except for sensational articles like The Chicago Tribune series last summer, infection control doesnt get the credit it deserves. What we do is risk avoidance and lower infection risk in ways that the average public never sees; this unfortunately doesnt sell newspapers unless there is some terrible outcome they want to highlight.
We have raised the level of visibility in the Memorial Hermann Healthcare System by creating an annual infection control award and doing an article in our local newspaper to inform our employees about all we do behind the scenes.
Q: MRSA, VRE and VISA are just a few of the superbugs that are gaining on us ... are we winning or losing this battle against them? Do you think we can realistically curtail multi-drug resistance?
A: I think until we develop a better way to use antibiotics, we will always be facing the possibility of multi-drug resistant organisms. This must be approached not just in hospitals, but in physicians offices. We need to educate the public about the potential harm of unnecessary antibiotics. There have been some success stories in this area, but these are the exceptions. In the past we have been rescued by the pharmaceutical industry, which has come up with new antibiotics a half a step ahead of the organisms developing resistance, but I see us slipping a little behind in the last decade with not just MRSA, VRE, and now VRSA, but also Acinetobacter, Pseudomonas, and now Candida species which have increased in absolute and relative numbers with a shift to more resistant species.