Infectious Disease Threat Rising in U.S., Panel Warns : Medicine: It’s a competitive relationship between microbes and humans, and medical experts say complacency is tipping the scales.
The emergence of new infectious diseases and the reappearance of old scourges such as tuberculosis and malaria pose a serious public health threat that the United States is ill-prepared to address, an expert panel of the Institute of Medicine warned Thursday.
“This much is certain: We have to come to terms with the fact that the microbial world is in competition with us,” said Joshua Lederberg, a professor at Rockefeller University in New York, who served as co-chairman of the panel. “. . . it is rapidly evolving at our expense, and . . . we haven’t applied the knowledge we have to the extent we should to give us the level of security we deserve.”
The group attributed the problem to an era of complacency dating back to the late 1950s, when many public health officials began to believe that the war on infectious diseases had been won and shifted their attention to more chronic, degenerative diseases.
But in fact, “infectious microbes have been around all along” and will continue to create public health crises, the panel said in its report.
“We can also be confident that new diseases will emerge, although it is impossible to predict their individual emergence in time and place,” the report said.
The institute is part of the prestigious National Academy of Sciences, a congressionally chartered, private organization that advises the federal government on matters of science and technology. It typically wields considerable influence with policy-makers.
The panel cited numerous prominent examples, including the current AIDS epidemic that is raging “virtually everywhere,” multi-drug-resistant tuberculosis, which has broken out in frightening proportions in several U.S. cities, Lyme disease, which is transmitted through the bite of a tick and is afflicting “more and more people every year,” a recent cholera epidemic in Peru that is moving northward, and malaria in Africa, Asia and South America.
And the panel pointed out others, some quite rare but equally deadly, like the newly identified strain of streptococcal bacteria that killed puppeteer Jim Henson, creator of the Muppets, in 1990 and “has been killing otherwise healthy people (like Henson), and doing so in a frighteningly rapid fashion.”
Researchers also are now discovering that numerous widely occurring conditions whose causes were unknown are probably the result of microbial infection, the report said. A recently described bacterium, Helicobacter pylori , for example, is now considered the probable cause of peptic ulcer.
The committee released a series of recommendations to deal with the problem, among them a strong plea that the United States beef up its vigilance in tracking and responding to new outbreaks.
Without enhanced surveillance, “we’re vulnerable to something along the lines of the 1918-19 influenza pandemic that killed 20 million people worldwide,” said Dr. Robert E. Shope, co-chairman of the committee and a research director at the Yale University School of Medicine.
The committee called for greater federal and state efforts to develop and carry out surveillance strategies, suggesting that the Centers for Disease Control, the federal agency that has traditionally been at the forefront of disease surveillance, develop such a master plan.
The panel urged that CDC be given additional resources to track infections acquired in hospitals. In the United States, one of every 20 patients entering a hospital--some 2 million individuals--develops an infection that he or she did not have when admitted, the panel said. More than 20,000 of these patients die every year, the report said.
The panel urged the federal government to develop a comprehensive plan for vaccine development, including a means for generating stockpiles of selected vaccines and a “surge” capacity to enable quick mobilization for vaccine production in the event of an emergency.
