Infection Control Today - 08/2003: Expert Says Recent Spate of Emerging Infectious Diseases Not Historically Unusual

August 1, 2003

Expert Says Recent Spate of Emerging
Infectious Diseases Not Historically Unusual

By Kelly M. Pyrek

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

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.