Can We handle a Flesh Eating Bacteria Epidemic?

May 19, 2012

By Melissa Bynes Brooks

The recent news of flesh eating bacteria incidents has heightened the consciousness of many people regarding their susceptibility to being infected with this deadly disease. The idea that a simple scratch or minor injury can trigger the onset of life threatening circumstances is frightening.

Even more alarming, is wondering whether the public health care system would be prepared to handle a flesh eating bacteria epidemic or something similar if there was an outbreak.

Flesh eating disease is also known as necrotizing fasciitis. It is a rare but severe, group A streptococcus (GAS) bacterial infection. It can destroy the muscles, skin, and underlying tissue. The word “necrotizing” refers to something that causes body tissue to die.

About 20% of patients with necrotizing fasciitis die.

A variety of bacteria can cause this infection. Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape.

The bacterium begins to grow and release harmful substances (toxins) that kill tissue and affect blood flow to the area. As the tissue dies, the bacterium enters the blood and rapidly spreads throughout the body.

Most notable, is the case of Aimee Copeland, a 24 year old graduate student currently fighting for her life due to complications from the flesh-eating bacteria. She received a cut on her left calf when a homemade zip line she stopped to ride along the river broke.

The type of bacteria causing her infection was an organism named Aeromonas hydrophila. It invaded her body through the cut causing doctors to amputate her left leg. She was later told that her hands and remaining foot would need to be amputated in order to improve her chances of survival.

Aeromonas hydrophila is a species of bacterium that is present in all freshwater environments and in brackish water. Humans may acquire infections through open wounds or by ingestion of a sufficient number of the organisms in food or water.

By now, many people may be wondering how likely it is for them to get the disease.

Persons with impaired immune systems are more susceptible to getting infected. They include diabetics, intravenous drug users, infants, the elderly, and individuals suffering from leukemia, cirrhosis of the liver, and those undergoing chemotherapy for cancer.

The risk increases for pregnant women in the postpartum period if the mother has diabetes and with procedures such as cesarean section or episiotomy.

Visible infections to the skin, hair, and nails are more likely to be noticed and treated than some deep infections. Deep infections to the muscle, bone, and joints are less noticeable and have a higher risk of becoming life threatening.

Most cases of flesh eating bacteria have been sporadic rather than associated with large outbreaks. But, there are increasingly more reports from clinical centers. The disease is difficult to treat and immediate treatment is needed to prevent death.

For this reason, the public health system’s ability to contain a flesh eating bacteria epidemic or similar outbreak remains questionable in the minds of many.

The discovery of the 2009 H1N1 influenza pandemic and the emergence of other diseases such as SARS have highlighted the important role that diagnostic tools can play in improving the surveillance of infectious disease threats at the population level.

Experiences with these events have shown that recognition of outbreaks, management of epidemics, and development of countermeasures can depend heavily on having access to highly specific surveillance information that is typically obtained from testing clinical specimens.

Consequently, the rising threat of emerging diseases and concern about biological weapons has led to an emphasis in governments on improving laboratory and diagnostic capacity in order to improve global bio-surveillance for infectious diseases.

Bio-surveillance is the technique of tracking communicable diseases such as sexually transmitted diseases (STDs) and streptococcal infections. Using special software, doctors, hospitals, clinics and emergency rooms all report individual cases of any communicable disease.

The program requires information on the patient such as location, age, gender, race, and other specifics designed to create a demographic portrait of the current victim and potential victims. Names are not used to preserve the anonymity of the patients.

In 2009, the U.S. National Security Council (NSC) identified enhanced disease surveillance, detection, and diagnosis as priority goals that the United States government (USG) should work toward. This was done for the purposes of improving national security and improving the ability to report any public health emergency of international concern.

The Obama Administration’s Global Health Initiative includes efforts to promote the development and acquisition of infectious disease diagnostic tools. A robust and strong regulatory process is necessary to ensure that diagnostic tests produce accurate and reliable results.

Data Mining is another indicator that could be used to predict epidemics before they spread based on mass behavior. Use of this technology could help prepare first-responders and other health professionals for emergencies.

For example, the National Retail Data Monitor (NRDM), tracks transactions of over-the-counter healthcare items from 21,000 outlets across the United States. The purchasing information of these items assists health care officials with preliminary trends in illness transmission.

Furthermore, Data from the NRDM show that sales of over-the-counter products like cough medicines and electrolytes actually spike before visits to the emergency room do. The lead time can be significant in the case of respiratory and gastrointestinal illnesses. In this scenario, it was about two and a half weeks, according to one paper.

Public health components have been incorporated into the National Response Framework and the National Incident Management System. Public health bodies at the local, state, and federal levels now routinely use this system to ensure that everyone has the same focus, whether responding to daily incidents or major disasters.

In 1999, the Centers for Disease Control and Prevention (CDC) established the Laboratory Response Network (LRN). The LRN and its partners maintain an integrated national and international network of laboratories that are fully equipped to respond quickly to acts of chemical or biological terrorism, emerging infectious diseases, and other public health threats and emergencies.

Although preparedness and response capabilities for public health emergencies have been difficult to determine and measure, reports from the CDC and the Trust for America’s Health have documented substantial improvements.

Public health departments are now better equipped to identify health threats rapidly and have improved their abilities to respond e­ffectively and communicate emergencies. For example, 48 of 50 states (96%) have shown their ability to activate staff­ and their emergency operations centers.

There is always room for growth but there have been improvements in public health preparedness from 1999–2011.

One sign of progress is the CDC’s Strategic National Stockpile which ensures the availability of key medical supplies. 100% of states have plans to receive, distribute, and dispense these assets.

The eff­ectiveness of responses is judged by accurate communications of emerging health threats in addition to response and health outcomes.

Another sign of progress is the CDC’s secure, web-based Epidemic Information Exchange (Epi-X) which allows state and local public health officials to access and share health surveillance information about illnesses.

Some of these have included cases about: human bubonic plague (2010); reports about airline travelers potentially exposed to communicable disease (2010); and the recreational use of designer drugs that were components of items marketed as bath salts (2011).

The Food and Drug Administration (FDA) has also developed a program for granting Emergency Use Authorization for devices and medicines that are likely to be needed during public health emergencies.

Finally, what would be the response to high risk communities or low income communities with limited access to health care?

Government has the obligation to protect the health of all its citizens.

Distribution and rationing decisions for vaccination and treatment should be based on the goal of minimizing the detrimental health effects of an epidemic or pandemic. Public health measures must not be based on race, color, ethnicity, national origin, religion, gender or sexual orientation.

However, some would argue it can be based on age or disability when there is good reason to believe particular groups are either at much higher risk of death or have a much higher likelihood of spreading the disease if not vaccinated or treated.

More emphatically, there are special obligations to those in custody who should be a priority regarding vaccination and treatment. Consideration and advance planning should take place for high risk populations with physical or mental conditions and socio economic disparities.

Melissa Bynes Brooks is the editor of BrooksSleepReview.

Contact information: melissabynesbrooks@comcast.net

Follow on Twitter @Mlbbrooks

References

Adalja, A.A., Cicero, A., and Inglesby, T.V., Nuzzo, J.B., Rambhia, K.J., Toner, E., and Wollner, S.B. (2011). Diagnostics for Global Biosurveillance: Turning Promising Science into the Tools Needed in the Field. Retrieved May 19, 2012, from http://www.upmc-biosecurity.org/website/resources/publications/2011/2011-09-13-global-biosurveillance-DTRA.html

American Civil Liberties Union (2008). Pandemic Preparedness: The Need for a Public Health- Not a Law Enforcement/National Security– Approach . Retrieved May 19, 2012, from http://www.aclu.org/pdfs/privacy/pemic_report.pdf

Centers for Disease Control and Prevention, Emergency Preparedness and Response (2012). Facts About the Laboratory Response Network. Retrieved May 18, 2012, from http://www.bt.cdc.gov/lrn/factsheet.asp

Fung, F. The Atlantic (2012). Using Data Mining to Predict Epidemics before They Spread. Retrieved May 18, 2012, from http://www.theatlantic.com/health/archive/2012/05/using-data-mining-to-predict-epidemics-before-they-spread/256605/

Jaslow, R., CBS News (2012). Flesh-eating bacteria victim Aimee Copeland on amputations: “Let’s do this.” Retrieved May 18, 2012, from http://www.cbsnews.com/8301-504763_162-57437136-10391704/flesh-eating-bacteria-victim-aimee-copeland-on-amputations-lets-do-this/

Khan, Dr. A, S., Lancet (2011). Public health preparedness and response in the USA since 9/11: a national health security imperative. Retrieved May 19, 2012 from http://www.cdc.gov/phpr/documents/Lancet_Article_Sept2011.pdf

Medline Plus. A service of the U.S. National Library of Medicine, National Institutes of Health (2012). Necrotizing soft tissue infection Retrieved May 18, 2012 from http://www.nlm.nih.gov/medlineplus/ency/article/001443.htm

National Center for Immunization and Respiratory Diseases: Division of Bacterial Diseases (2008). Group A Streptococcal (GAS) Disease (strep throat, necrotizing fasciitis, impetigo. Retrieved May 18, 2012, from http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm

National Response Framework Homeland Security (2008). Retrieved May 19, 2012, from http://www.fema.gov/pdf/emergency/nrf/nrf-core.pdf

Spring, M. Healthguide Information.com (2008). Bio-Surveillance and Pandemic Surveillance, What’s the Difference? Retrieved May 19, 2012, from http://www.healthguideinfo.com/health-informatics/p19091/

U.S. Food and Drug Administration (2012). BBB – Aeromonas hydrophila. Foodborne Pathogenic Microorganisms and Natural Toxins Handbook. Retrieved May 19, 2012 from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm

U.S. Food and Drug Administration (2012). Emergency Use Authorization of Medical Products Guidance – Emergency Use Authorization of Medical Products. Retrieved May 19, 2012 from http://www.fda.gov/RegulatoryInformation/Guidances/ucm125127.htm

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