Infectious Disease Threat May Be Growing Again

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Infectious Disease Threat May Be Growing Again

WASHINGTON (Reuters Health) - A real and growing threat of bioterrorism, an explosive increase in drug-resistant bacteria and a new generation of
parents who are complacent about vaccinations for their children or even afraid to have their children vaccinated, are combining to seriously undermine society's battle against infectious disease, US health experts charged on Thursday.

In addition, they asserted that an underfunded and undertrained public health system is ill-prepared to deal with the rising problem.

That was the message of experts from the American Medical Association (AMA) Thursday at a press briefing in Washington, DC. "The level of preparedness (of the US public health system) is not what it should be," noted Dr. Reed Tuckson, AMA senior vice president of professional standards.

"There is more that we can and must do," he argued. The medical breakthroughs achieved with antibiotics starting in the mid-20th century, lead to a feeling that "we were winning the battle," against infectious disease, noted J. Edward Hill, AMA board of trustee
member.

But that confidence began to erode with emerging new diseases such as AIDS and powerful strains of drug-resistant "super" bacteria, proliferated largely through gene mutation that can withstand not one
but several antibiotics, he said. This new breed of resistant bacteria "has stronger armor, and weapons more advanced," Hill stressed.

And another new worry: the ability of the American military and other law enforcement entities to respond to a bioterrorist strike.

In fact, terrorists attacking US cities with deadly bioagents or even viruses such as smallpox, are no longer the stuff of science fiction novels, argued Dr. Michael Osterholm, chair and CEO of the Infection
Control Advisory Network, Eden Prairie, Minnesota. Likely to take on the proportions of a modern day Pearl Harbor, bioterrorism could "define our history," Osterholm argued, adding that the question is "when" not "if" an attack will occur.The vital elements of an attack by bioterrorists, the perpetrators and means, are in place today, he said, noting that 17 nations currently maintain biowarfare programs and that many of the lethal agents terrorists could use are easily accessible by credit card over the Internet.

Yet, the US public health system's current philosophy of looking to the "first responders" such as the military, National Guard units and local law enforcement to respond to any such attack is the wrong one, Osterholm contended.

Instead, it would be the local medical community which would be on the front lines if bioterrorists struck, he said, yet overzealous "cost containment" in US healthcare has left overworked physicians and
hospitals stripped to the bare essentials, and thus, unable to respond to such a crisis, Osterholm said.

For example, of $10 billion of federal funds set aside to deal with bioterrorism, only one billion went to the Department of Health and Human Services, while the remainder was given to the Department of Defense and other "first responders." Osterholm noted.

The solution, he argued, is to "reinvest in the (public health) infrastructure to build a system that can respond to bioterrorism. Any funding plan should include increased funding for medical education, Osterholm contended. "We have gutted our medical schools," where public health experts are trained, he said.

Meanwhile, the fight against bacteria on another front, namely the use of vaccines, faces a formidable, but more insidious adversary--complacency--noted panelist Dr. Bruce Gellin, executive director of Vanderbilt University Medical School's National Network for Immunization Information in Nashville.

Younger-generation parents are not familiar with diseases such as measles, which went from status as a "usual childhood disease" to a "vaccine-preventable" one, and are often less concerned than previous generations about the dangers the disease can pose to their children, Gellin said. But such attitudes create a situation ripe for new outbreaks of diseases that the public thought were under control, he said.

Moreover, the Internet-driven "information age," has spread misinformation and unsubstantiated rumors about vaccines, which has caused parents of young children to increasingly "question the value of vaccines," he noted. For example, one popular but unfounded theory, said Gellin, is that vaccines' risks are not worth their benefits.

While healthcare providers struggle with the question of how to get sound information about vaccines to patents, Gellin said that "a lot of misunderstanding" remains. He cited a survey done by his group last
spring that showed 20% of parents surveyed did not know that vaccines are extensively tested for safety and effectiveness before marketing, while 25% of survey respondent s thought that vaccines damaged the immune system.

Some of the misunderstandings are fed by studies of vaccines "taken out of context" and the increasing complexity of vaccine schedules, he noted. Gellin said his group is developing a website for disseminating "up-to-date information" about vaccines.

Regarding the problem of drug-resistant bacteria, Dr. Stuart Levy, director of Tufts University's Center for Adaptation Genetics and Drug Resistance, Atlanta, noted that the issue is a "global" one, as
international travel affords the continuous opportunity for new and resistant strains to enter the US.

Levy argued the problem has also arisen in part due to antibiotic over-prescribing by doctors, often fueled by demands from patients.

"We need to relearn the use of antibiotics," Levy said. He advocated a more controlled application of antibiotics for therapeutic use only, so bacterial strains susceptible to drugs will begin to re-emerge.