Heather Dugmore: Are superbugs like Ebola winning the war?

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Well researched, well argued. well concluded. At a 55% fatality rate, we need to be worried about Ebola. All of us. But what’s scary about this Heather Dugmore piece is that Ebola is only one of many threats to humanity’s health. Superbugs are mushrooming. – AH

By Heather Dugmore

In Africa, outbreaks of deadly viruses or ‘superbugs’, such as Ebola and Marburg, are on the increase, causing a rising number of deaths over the past ten years. The 2014 Ebola outbreak is the largest in history, affecting multiple countries in West Africa.

But it’s not just the West Africans who are in the frontline. Superbugs are a danger to us all, including in hospital environments. People the world over are being admitted to hospital for a particular problem, only to acquire secondary infections there, which can be fatal.

What is happening to our world? Are we in the grips of a global 21st superbug plague?

“We are indeed seeing a worrying increase in superbugs that cause fatal infections as well as infections that used to be curable but are no longer,” says Professor Adriano G. Duse, the Head of Clinical Microbiology and Infectious Diseases in the School of Pathology at Wits University.

He has firsthand of experience of people infected with Ebola and Marburg. In December 2012 Prof Duse was appointed World Health Organisation Expert Consultant for the Infection Control Group for the Ebola haemorrhagic fever outbreak response team in Uganda. In April 2014 he was deployed to Liberia following the Ebola virus outbreak.

“Superbugs are microorganisms, such as viruses and bacteria, which modern medicine is struggling to combat because they are becoming increasingly virulent and resistant to antibiotics or vaccines. At the same time, very few new drugs or vaccines are coming out of the pharmaceutical pipeline,” he explains.

“We are talking about a crisis where people in ever-greater numbers are no longer responding to the available treatments and the problem is growing, with disastrous consequences,” adds Professor Guy Richards, the Academic Head of the Division of Critical Care in the Faculty of Health Sciences, Wits University, and the Director of the Department of Critical Care at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Why is this happening?

Where viruses like Ebola are concerned there are currently no licensed vaccines, but the infection crisis in general, says Prof Richards, “is largely as a result of the abuse of antibiotics – both their incorrect prescription and over prescription”.

In short, antibiotic abuse destroys people’s infection-fighting, good bacteria and replaces them with hostile, antibiotic-resistant bacteria or superbugs. Which is why, when you accompany Prof Richards on his ward rounds, you immediately notice how strict he is about the administering of antibiotics.

“All doctors, veterinarians and hospitals have to, as a matter of urgency, become extremely circumspect about when and for what they prescribe an antibiotic and which antibiotic they prescribe, because we are at the end of the antibiotic era. Pharmaceutical companies, in general, are not producing new generations of antibiotics because it is not profitable for them, and we therefore have to make sure that we extend the lifespan of existing antibiotics,” he explains.

Prof Richards says that doctors and hospitals that do not pay immediate attention to this are exacerbating the infection crisis in communities and hospitals worldwide. Vets, too, have to play their role, as he explains:

“Antibiotics are used in certain livestock situations as growth stimulants and the overuse of them leads to the growth of resistant superbugs, which are easily passed from animal to person and from person to person, or they make their way into the sewer systems and multiply.”

Zoonotic infections are those that can be transmitted between animals and humans. “Approximately two-thirds of human infections are zoonoses and caused by microorganisms as diverse as viruses, bacteria, fungi and parasites,” Prof Duse explains.

It is thought that fruit bats of the Pteropodidae family are a key Ebola virus host. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines. These are widely eaten as ‘bush meat’.

It spreads to people by contact with the skin or bodily fluids of an infected animal, like a monkey, chimp, or fruit bat. Then it moves from person to person the same way. Those who care for a sick person or bury someone who has died from the disease are at risk of infection. Other ways to get Ebola include touching contaminated needles or surfaces.

“The health of humans is inextricably linked to the health of animals and the environment. Addressing the connections between health and the environment requires an urgent expansion of interdisciplinary collaborations and strong political and global will,” adds Prof Duse.

It also requires of all hospitals, government and private, to closely assess and monitor the bacteria and virus profile in each and every ward. Outbreaks of Ebola can occur in hospital or healthcare settings when patients seek treatment in facilities where appropriate infection-control may not be practised.

“We are seeing an increase in a range of hospital-acquired infections or what we call nosocomial infections,” continues Prof Richards, who cites the following studies:

The European Prevalence of Infection (EPIC) study demonstrated 21% of patients in ICUs had nosocomial sepsis, the European Study of GN Infection (ESGNI)-007 found an overall infection rate of 9.9% and the ESGNI-008 study found an overall infection rate of 26.8% post-major heart surgery.
“There are more than two million nosocomial infection per year in the United States, with 90 000 deaths and annual hospital costs of US$ 5.7billion,” says Prof Richards who believes that certain hospital groups and medical aids in South Africa have data on nosocomial infection rates in South Africa that is not shared with the public.

“Our levels of resistance and infection are possibly higher than the United Kingdom or United States because our infection control practices are not always as specific as they should be,” he suggests.

“Every hospital and every ward has a different microbe profile and it is critical to know what bacteria or viruses patients are likely to encounter in each unit, in order to be precise about the type of antibiotics prescribed.

“In addition, hospital staff must take extreme care to follow anti-infection protocol because infections are all too easily contracted, either intravenously or via other procedures. This is especially critical in ICU where patients are seriously ill or at risk and their immune systems are often already compromised.”

So are we winning the war against the Superbugs? It would appear not, and the situation will not improve until we address the multi-pronged underlying causes of superbugs ‘gone viral’, as the good professors suggest.

Article by: Heather Dugmore.

Article Source: BIZ News