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

Expert Says Recent Spate of EmergingInfectious Diseases Not Historically Unusual

By Kelly M. Pyrek

Inthe midst of the SARS outbreak this spring, infectious disease expert Edward J.Septimus, MD, FACP, shared his perspectives on the recent spate of emerginginfectious diseases. Septimus is medical director of Memorial Hermann HealthcareSystem in Houston, Texas. He earned his medical degree from Baylor College ofMedicine. He is a fellow in the American College of Physicians and in theInfectious Diseases Society of America. He is board certified by the AmericanBoard of Internal Medicine and the American Board of Infectious Diseases. He isa member of the Medical Advisory Steering Committee for the Houston Task Forceon Terrorism, created in October 2001 to develop regional procedures forresponding to a bioterrorist attack.

Q: There has been a great deal ofinfectious activity in the last few years: West Nile, anthrax, smallpox and nowSARS is this historically unusual? Or are we just better informed by 24/7media 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 havehad HIV, toxic shock syndrome, crytosporidisis, lyme disease, hepatitic C,hantavirus, Ehrilichosis, etc.

Q: From what is known, is there any remoteconnection between SARS and any other infectious outbreak weve seen lately?

A: So far the genetic analysis of thiscoronavirus cannot be traced back to a prior human or animal virus.

Q: Can you point to any reasons that mightexplain why we seem to be under attack by pathogens? Are there natural ormanmade factors at work here?

A: Its probably multi-factorial.These factors include overcrowding and increased immuno-suppressed patients andtransplants. With increased population we are disturbing areas where man has notbeen before (hantvirus was in part due to the disturbance of the rodentpopulation), and there are more invasive procedures and implants today, so somereasons are manmade and some are natural.

Q: How concerned about SARS shouldhealthcare professionals be and what can they do to better prepare for asustained outbreak in the U.S.?

A: I think the Centers for DiseaseControl and Prevention (CDC) has done an excellent job at informing the healthprofession. Since we are still trying to define the new outbreak it is too earlyto tell if we in the U.S. will have a long-term problem; we must keep up ourguard and do careful community surveillance to pick up any new patterns ofdisease and/or transmission.

For SARS, if this is like many other respiratoryviruses, it may go away during the summer but be back again next winter. I amconfident that from the federal level, the CDC and others have benefited frombioterrorism and have improved our ability to respond to these challenges.However, I am concerned about local health departments, which are funded bystate and local resources, and as you are aware, most states and localgovernments are now facing budget shortfalls and are asking for cuts across theboard including the health departments. I think this is short-sighted, since anyattack or introduction of a new agent will usually occur in a local area and weneed to be able to detect and respond with adequate resources. We need to thinkof public health the same way we think about police and firemen.

Q: What do you think a nationalbioterrorism needs assessment would look like now, some 20-plus months afterSept. 11? Are we more prepared to face infectious agents or is there more workto be done? How can infection control practitioners arm themselves againstoutbreaks and bioterrorism?

A: Infection control personnel usepublic health surveillance techniques and are ideally suited to work with localhealth departments for surveillance and early detection especially if itinvolves a biological attack. I think from the federal level we are in goodshape; locally, it depends upon the community.

Some cities have done a good job, others theminimum.

Q: Nosocomial infections kill tens ofthousands of patients annually, yet not much is made of this; however, theanthrax deaths created a wave of panic what does this say about ourperceptions and values?

A: I think you have hit upon a reallygood point. Except for sensational articles like The Chicago Tribune serieslast summer, infection control doesnt get the credit it deserves. What we dois risk avoidance and lower infection risk in ways that the average public neversees; this unfortunately doesnt sell newspapers unless there is some terribleoutcome they want to highlight.

We have raised the level of visibility in theMemorial Hermann Healthcare System by creating an annual infection control awardand doing an article in our local newspaper to inform our employees about all wedo behind the scenes.

Q: MRSA, VRE and VISA are just a few ofthe superbugs that are gaining on us ... are we winning or losing this battleagainst them? Do you think we can realistically curtail multi-drug resistance?

A: I think until we develop a betterway to use antibiotics, we will always be facing the possibility of multi-drugresistant organisms. This must be approached not just in hospitals, but inphysicians offices. We need to educate the public about the potential harm ofunnecessary antibiotics. There have been some success stories in this area, butthese are the exceptions. In the past we have been rescued by the pharmaceuticalindustry, which has come up with new antibiotics a half a step ahead of theorganisms developing resistance, but I see us slipping a little behind in thelast decade with not just MRSA, VRE, and now VRSA, but also Acinetobacter,Pseudomonas, and now Candida species which have increased in absolute andrelative numbers with a shift to more resistant species.