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Wednesday, January 17, 1996
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Infectious diseases increasing
The Associated Press
WASHINGTON — Infectious diseases are on a global rebound, killing thousands more Americans, surviving potent antibiotics and possibly evolving into stronger bugs as the climate changes, a coalition of doctors warned yesterday.
The world is more vulnerable than ever before, said Nobel Laureate Joshua Lederberg, who led a call by the Journal of the American Medical Association and 35 other international medical journals for a global battle against infections.
Doctors in 21 countries yesterday published 242 studies to illustrate the scope of the threat. Among the most alarming: The U.S. death rate from infectious diseases rose 58 percent between 1980 and 1992, and a snapshot of middle America found antibiotic resistance growing quickly.
That doesn't mean people should panic, Lederberg emphasized. Instead, the findings should persuade world governments and drug makers to finance research to fight back — and doctors to stop overprescribing antibiotics, a practice that boosts drug-resistant bacteria.
The development of antibiotics once had doctors predicting infectious diseases would be conquered by now. Instead, in the past decade new infections such as the AIDS virus began killing hundreds of thousands, older diseases like tuberculosis returned and bacteria began evolving to defy treatment.
"We have the rumbles of volcanoes that are going to erupt," he said. "We don't know if the eruptions will be tomorrow or in 30 years, but the scene is set for any number of outbreaks. Our technical abilities could give us the necessary defenses."
Here, infectious diseases became the third-leading killer of Americans in 1992, claiming more than 166,000 lives, the Centers for Disease Control and Prevention reported.
CDC's Robert Pinner examined every death certificate filed from 1980 to 1992. The mortality rate from infections rose to 65 deaths among every 100,000 people in 1992, up from 41 per 100,000 in 1980.
The AIDS virus caused most of the jump. When Pinner excluded HIV-related deaths, infectious disease mortality rose 22 percent.
Mortality from septicemia, a rapid form of bacterial blood poisoning, increased 83 percent, and deaths from respiratory tract infections rose 20 percent. The increase in respiratory deaths stems mostly from an aging population, but Pinner couldn't explain the septicemia increase.
In Columbus, Ohio, antibiotic resistance is rising among patients with a dangerous form of bacterial pneumonia that spreads to the bloodstream, said Joseph Plouffe of Ohio State University.
In 1994, 14 percent of Columbus pneumonia patients weren't helped by penicillin, up from 4 percent in 1991, he found. Two penicillin alternatives didn't work in up to 24 percent of cases.
Infectious diseases on the rise
Deaths from infection, including AIDS, rose 50% between 1980 and 1992,
becoming the third-leading killer of Americans.
Leading causes of death
Classes of infectious disease
causes of infectious disease
In 1980
1 Heart disease
2 Cancer
3 Stroke
4 Accidents
5 Infectious disease
Respiratory tract infections
57,000
77,300
Blood diseases
9,400
33,600
Kidney/urinary infections
8,000
19,700
Heart infections
2,500
12,400
Tuberculosis
2,300
4,000
Chronic lung disease
Knight-Ridder Tribune
Vancomycin, the antibiotic of last resort, was still effective in Columbus, although doctors have seen it fail elsewhere sometimes.
If all this weren't enough, Jonathan Patz of Johns Hopkins University said global warming — just the degree or two forecast for the next 100 years — might strengthen infections. Doctors already knew dengue fever, which caused a Latin American epidemic last year, was threatening the United States as warmer winters made spots like Texas attractive to dengue-bearing mosquitoes.
But there is some good news. Iceland, for instance, began encouraging doctors in 1993 to slow antibiotic use after cases of penicillin-resistant pneumonia more than tripled in two years. The effort is paying off already, dropping drug-resistant pneumonia from rates of 20 percent in 1993 to 16.9 percent the following year, researchers reported.
Lenses duplicated or made from Doctor's prescription
The CDC has developed plans to fight the infection threat, but it needs $100 million a year to fully implement it and this year won only $10.7 million from Congress. The World Health Organization has even less — $1.5 million — for its own efforts to contain infectious outbreaks.
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