Post and Courier
September 21, 2014

Battling the bad-news bugs

Posted: 12/03/2013 12:01 a.m.

Public health menaces originating in such disparate places as Asian slums and American hospitals are proving very difficult to eradicate even though they kill tens of thousands of victims a year.

Obamacare isn’t the only health care issue that needs attention.

The Haitian cholera epidemic that has killed nearly 9,000 and sickened 715,000 in Haiti and the Dominican Republic since it broke out in 2010 has now spread to Mexico, from whence it could possibly cross the border into the United States.

Evidence of the disease have also been found in Cuba, Chile, Venezuela, Italy, Germany and The Netherlands.

That epidemic has its origins in Bangladesh and was very likely transmitted to Haiti by a United Nations peacekeeper from Nepal billeted at a camp where sewage wastes spilled into streams used as water supply by Haitians. The U.N. is being sued in a U.S. federal court case seeking financial compensation for victims.

Cholera can spread rapidly in countries with poor sanitation. The last time it reached Mexico, in 1992, it was not eradicated until 2002. That time the epidemic was stopped at the U.S.-Mexico border. But the U.S. might not be so fortunate this time. Likening cholera to the plague, Ebola and pandemic influenza, Dr. Edward Ryan of Massachusetts General Hospital told National Public Radio, “It is one of the ones that tests the [public health] system.”

Unfortunately, a recently developed vaccine against cholera is not widely available.

Another threat comes from drug-resistant “superbugs,” bacteria that have evolved immunity from available antibiotics.

The federal Centers for Disease Control reported in September that more than 2 million Americans are infected by these bacteria every year and that they cause 23,000 deaths. It announced that three of these bugs were “particularly frightening,” and said that finding cures should be considered “urgent.”

Clostridium difficile, know as C. diff, kills about 14,000 a year out of roughly 250,000 infections. It attacks individuals using antibiotics that kill off good bacteria in the intestines that fight C. diff. Drug resistant forms of E. Coli and related germs known collectively as CRE cause some 9,000 infections each year resulting in about 4,500 deaths. A drug resistant form of sexually transmitted gonorrhea afflicts about 270,000 a year.

Antidotes to these drugs are not in the pharmacological pipeline because antibiotics are a relatively small market compared to drugs to control chronic health problems.

“If we are not careful, the medicine chest will be empty when we go there to look for a lifesaving antibiotic for somebody who has a deadly infection,” CDC director Dr. Tom Frieden recently told reporters.

Solutions must be found to these mounting menaces.

The administration and a divided Congress should be paying attention to the problem, and providing support to public health and research agencies, as needed.