Tuesday, November 27, 2007

Is there an MRSA epidemic on our hands?

http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_posters.html

Honestly no pun intended; however, a very interesting segment of 60 Minutes on CBS that was recently broadcasted: “Controlling the Superbug” sure caught my attention. I also believe that the heart of this discussion further emphasizes our previous in class epidemiology assignment. Only now the focus is not only on methicillin-resistant Staphylococcus aureus (MRSA) infections that occur more exclusively in hospital and healthcare settings, nursing homes and dialysis centers, or in those individuals that are elderly or immunocompromised. Becoming more prevalent are acquired infections in otherwise healthy people and young students, including athletes, which are typically signified as the epitome of health. These infections are known as community-associated MRSA (CA-MRSA) as defined by the Centers for Disease Control and Prevention (CDC) and are cause for great concern. 60 Minutes correspondent Lesley Stahl reported on an increasing number of outbreaks. One such case, “Mt. Lebanon High School in Pennsylvania has been hit hard: 13 members of its football team, the Blue Devils, came down with MRSA infections this year” (Stahl 1). Further adding to the problem, “parents are understandably frantic and want to know what causes it, and how to protect against it. Problem is: there aren't many answers” (Stahl 1). Top that off with “Everyone agrees that this is an epidemic. And not only is it an epidemic. But, it's an epidemic of our times. It's here in huge numbers," says Dr. Robert Daum, an infectious disease pediatrician at the University of Chicago Medical Center (Stahl 1), and voila: a recipe for panic stricken people who live in a society driven by fear and misinformation or worse, lack of information, reacting to the emergence of a serious problem.

Behold, the proclamation of a witch-hunt or modern day lynching on “the cockroach of bacteria” (AP 1). So now we have a mob gathering their weapons with a “shoot first and ask questions later” mentality. Case in point: "I understand that one parent wanted you to put all the kids on an antibiotic, Bactrim, as a preventative," (Stahl 3). Perfect. Why don’t we add some more selective pressure and further test Darwin’s theories? Is this not part of the reason that our society is in such a predicament in the first place? How about what will happen when the mob runs out of “silver bullets”? One of the most serious threats to public health on a global scale is the conjugation of drug-resistant pathogens. New strains known as meticillin-resistant (formerly methicillin-resistant) MRSA have developed resistance to the antibiotic used as the last line of defense, giving way to new strains of vancomycin-resistant S. aureus (VRSA) and enterococci (VRE) (Willey, et al).

http://www.cbsnews.com/stories/2007/11/08/60minutes/main3474157.shtml

It is becoming increasingly more apparent that the general public requires some type of authority or regulating body to intervene when such circumstances arise and foresight is required. The high school at Mt. Lebanon quite appropriately enlisted Dr. Bruce Dixon, director of the public health department for Allegheny county, otherwise absolute chaos might have ensued. Even still, parents in dozens of school districts had demanded that schools be shut down, classrooms sterilized, and rooms fumigated (Stahl 3). According to Dixon, “They thought that the field was contaminated. There were people that wanted the field replaced. There were people who wanted the field somehow sterilized… I'm concerned that we have schools that are spending inordinate amounts of money trying to sterilize the school. As soon as the students and the faculty return, the school is no longer sterile" (Stahl 3). Needless to say, the football team has new rules about personal hygiene and the players may actually now become “hand washers” (Stahl 4). It then occurred to me that we also have international initiatives to prevent the spread of infectious disease in many third world nations, by providing the most basic of necessities, developing infrastructures for fresh, clean, running water and teaching hygiene to children. Julie Gerberding head of the Centers for Disease Control and Prevention, held a CDC staph awareness poster and stressed prevention largely by common sense hygiene, “Soap and water is the cheapest intervention we have, and it's one of the most effective” (AP 1) while testifying on Capitol Hill in Washington over the recent headlines. Nevertheless, there are some authoritative figures that have a different perspective. "To think we control community MRSA epidemics by asking people to wash their hands is foolish. I'm not gonna sit here and say washing your hands is bad. Because it's wonderful. But, it's not going to control the community MRSA epidemic," said Dr. Daum (Stahl 4).

I strongly support community education projects which address the problems related to antibiotic resistance as they promote knowledge and awareness to a diverse audience, and may even dispel some common myths regarding bacteria and viruses. For example: “a survey done in February 2000 by the National Information Program on Antibiotics indicates that 54 per cent of adults in Canada believe antibiotics are effective against viruses” (Blondel-Hill MD, FRCP, et al). One such program, Do Bugs Need Drugs?® is a cooperative effort in Alberta and British Columbia, funded for provincial implementation in B.C. by the Ministry of Health, Pharmacare Division. In fact this organization’s website has specialized sections ranging from the general public to more specific demographic targets, such as parents, teachers, kids, daycares, health care, occupational health, and assisted living professionals. Some of the information is even available in ten other languages.

It is apparent that cooperation on all fronts is not only desirable, but is mandatory for such efforts to be successful. We can only hope that the prospective consequences of an epidemic are enough incentive for individuals to adopt these responsibilities themselves, transforming such a simple chore as personal hygiene into a simple habit. I do not pretend to have all of the answers, yet I can personally confirm antibiotic misuse in our own community when I was misdiagnosed with bacterial pneumonia last spring. This is a common occurrence. Antibiotics are being appallingly overused, mostly for respiratory tract infections. Many are being prescribed inaccurately, for a multitude of other symptoms. I am quite sure that many of us have similar experiences. As an aspiring medical scientist, I only respectfully offer that there is no substitution for intelligent preventative measures combined with proactive education to promote knowledge and awareness. So please, for your own personal health as well as for others, do your part and remember to wash your hands!


Resources:

Stahl, Lesley, 60 Minutes. (Nov. 11, 2007). CBS News.
<http://www.cbsnews.com/stories/2007/11/08/60minutes/main3474157.shtml>.
Accessed November 12, 2007.

Department of Health and Human Services, Centers for Disease Control and Prevention.
<http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca.html>.
Accessed November 12, 2007.

Associated Press. (Nov. 7, 2007). CBS News.
<http://www.cbsnews.com/stories/2007/11/07/health/main3468069.shtml>.
Accessed November 12, 2007.

Willey, Joanne M, et al, “Prescott, Harley, and Klein’s Microbiology”, Seventh Edition, McGraw-Hill, New York, 2008, pp. 849-851.

Blondel-Hill MD, FRCP, Edith, et al. Do Bugs Need Drugs?®.
<http://www.dobugsneeddrugs.org/index.html>.
Accessed November 23, 2007.

1 comment:

Dominic B. said...

Washing hands is the simplest of things, but it seems that the simplest of things do not register in our brains as being important. It's almost like this:" It's simple, so it probably does not have much of an impact. Antibiotic are prescribed by professionals so they must work better that washing hands"

Again, it's not taking responsibility for our own actions. We see so much of that these days...nobody seems to be responsible for anything