Four reported outbreaks of unusual infections around the world have illustrated the surprising potential of new microbes to emerge and old ones to return with a vengeance.
"On a good day, we hold them at bay. On a bad day, they're winning," said Dr. Michael Osterholm of ican Inc. of Eden Prairie, Minnesota, an Internet information company focusing on infectious diseases.
Osterholm, who was Minnesota's state epidemiologist for 24 years, wrote an editorial on emerging infections in Thursday's New England Journal of Medicine, which carried reports on the four outbreaks.
The cases include a Nebraska farm boy who caught drug-resistant salmonella from infected cows that had apparently been given antibiotics; Malaysian pig farmers killed by microbes caught from their animals; and hundreds of Italian schoolchildren sickened by bacteria-contaminated cold corn salad. Finally, a diabetic Atlanta boy needed bowel surgery twice for a severe bacterial infection after a holiday feast.
"The microbes are challenging us in ways we wouldn't have imagined 10 years ago and for which we're not prepared," said Dr. James Hughes, director of the National Center for Infectious Diseases at the Centers for Disease Control and Prevention.
Bacteria and viruses multiply quickly, and can therefore evolve rapidly into more aggressive strains.
While Osterholm said it is impossible to predict what will be "the next HIV," another deadly microbe is inevitable. Likewise, Hughes said it is only a matter of time until another deadly flu epidemic hits the world.
Infectious diseases are the world's No. 1 killer, claiming 13 million lives annually.
The deadly microbes appearing in the last quarter-century include: Legionnaires' disease, toxic shock syndrome, AIDS, rodent-borne hantaviruses, the airborne Ebola virus, Lyme disease, a fatal brain disease in England caught from eating "mad cows," West Nile encephalitis in the New York City area and new, drug-resistant tuberculosis strains in many cities.
The experts cite numerous factors for the emergence - and re-emergence - of deadly germs, including:
-increased international travel and shipment of food.
-unprecedented population growth cramming people together in unsanitary conditions.
-changes in how food is grown and handled.
-decaying public health infrastructure in many areas.
-more people living with immune systems suppressed by AIDS, cancer, diabetes and organ transplants.
-increased use of antibiotics in people and livestock, which contributes to germs' growing resistance to antibiotics. Potentially deadly staph infections are becoming resistant to even the antibiotic of last choice.
"Imagine trying to deal with all those at one time," Osterholm said. "It's like a city fire department trying to put out 30 fires at one time with one truck."
A 1992 Institute of Medicine report spelled out those threats and the international implications, spurring the CDC and the World Health Organization to tackle some of the problems.
Hughes said food safety has been improved, a computerized CDC network can quickly spot emerging disease outbreaks, and the agency has a comprehensive plan to address the other threats, but Congress has only funded half of it.
On the Net: CDC site on how to prevent getting infectious diseases
World Health Organization report on infectious diseases
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