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The Top 10 stories of 2008
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It’s December already, and so we present the top 10 news stories published in Infectious Disease News during 2008. About 30 stories believed to be among the most important were gleaned from the previous 2008 issues, then ranked by members of the Infectious Disease News editorial advisory board. What emerged is a consensus opinion of the board members. We make no attempt to rank order the top 10 stories; that is best left up to you, the reader.
The top 10 stories are:
- Increasing risk of antibiotic resistance demands immediate global action.
- ACIP expands influenza vaccine recommendations.
- U.S. Senate passes legislation to end HIV travel ban.
- CDC recommends herpes zoster vaccine for everyone aged 60 and older.
- ECDC urges rigorous infection control measures to combat C. difficile.
- CDC: Vaccines are saving more lives than ever.
- WHO: MDR-TB worldwide prevalence at highest level.
- STDs among adolescent girls more common than previously believed.
- Hospitals often fail to treat MRSA appropriately.
- Connecticut attorney general and IDSA settle Lyme Disease case.
I will comment on at least some of these stories as space permits.
Antibiotic resistance
The calls to action to combat growing antibiotic resistance are not new. In fact, such calls have been heard for more than 50 years now since Maxwell Finland and others first sounded alarms in the 1950s.
What is new is that these calls grow louder and more insistent and are heard increasingly from all over the world. The medical profession has proved either unwilling or unable (or both) to police themselves in regard to antibiotic abuse, although we do improve with intensive educational campaigns directed both at the profession and the public. Is this enough or is some more formal restriction needed in the future?
The other side of the equation is the dearth of new and promising antibiotics, and the disinterest of all but a few pharmaceutical manufacturers in continuing infectious disease drug research. This is the target of the IDSA’s “Bad Bugs, No Drugs” initiative, which so far is beginning to show some promise of effect.
Influenza
Influenza is another story that seems never to go away. It’s not simply that it happens to be one of my own pet interests, but other members of the editorial board agreed. The year was filled with controversy about the efficacy of influenza vaccine in the elderly, particularly in preventing death. The number of skeptics appears to be growing and they make valid points, about which I commented in this column earlier this year. I doubt that 2009 will bring any more clarity to this issue, but I hope I’m wrong. Meanwhile, like William Schaffner, MD, wrote in a column last month, I urge all of us as health care providers to be vaccinated each year.
The real story this year, however, is not influenza among elderly patients, but children. Influenza vaccination is now recommended for all children aged 6 months to 18 years – annually! This, of course, represents a major shift in influenza vaccine policy in the United States. There is an influenza morbidity – and even mortality – burden among children with influenza – enough of a burden to justify the ACIP recommendation. The real beneficiaries, however, are expected to be adults and the elderly, who will be infected less frequently by vaccinated children. This has now been established by several controlled studies.
In another vaccine-related top 10 story, CDC has reported that the number of vaccine-preventable diseases in the United States is at an all-time low, with a concomitant decrease in hospitalization and death due to these diseases. This is a major achievement, to be sure, and it is appropriate to call the public’s attention to it. Yet the number of naysayers and objectors seems to grow steadily. These range from the politically far right who don’t want government telling them how to raise their children to the thousands of concerned parents and grandparents who firmly believe that certain vaccines cause or contribute to autism. Many simply do not accept or thoroughly distrust science in general and vaccine studies in particular. They have not yet done lasting damage to U.S. vaccine programs, but they are already a voice that must be reckoned with – that appears likely to continue or worsen.
TB
Once again, our top 10 list includes a story about MDR-TB and XDR-TB. This issue is likely to remain in the news for many years. It is quite comparable to the antibiotic resistance issue and, in fact, is a subset of that issue. The calls for action grow louder and louder, and from all over the globe. Anthony Fauci, MD, director of NIAID, has pointed out that concerted global action is necessary and that it will be costly indeed. For patients with HIV, XDR-TB is literally a time bomb, especially in the developing world. This issue is gaining the attention of private philanthropy, particularly the Bill and Melinda Gates Foundation, but they cannot do it alone. WHO is ready to lead, but the financial needs are enormous.
MRSA
MRSA is another story that will be with us for years. That as many of 40% of MRSA-infected patients in some American hospitals do not receive appropriate therapy comes as a shock; one can only imagine what it might be in other parts of the world. Hopefully, at least in the developed world, one can expect them to do better. The issues with MRSA are many, but those relevant to treatment include improved and rapid diagnostics and improved therapies. Overall, evidently a large segment of the medical profession – hopefully not including any infectious disease physicians – remain ignorant about the recognition and management of MRSA infections. Thus, we face a major educational challenge. Any serious student of staphylococcal infection must wonder about the future: will the USA 300 CA-MRSA strain continue to plague us for the next century, or will it – like the phage type 80/81 strain of 60 years ago – gradually disappear for some unknown reason?
Other important issues
CDC’s report that as many as 26% of adolescent girls in the United States have an STD was also a real shock to many. For those with three or more lifetime sexual partners the STD prevalence was 50%. While many of us may personally believe in abstinence, there is abundant evidence that it does not work as a public health policy. We are – as a society – seemingly blind to adolescent sexuality and sexual behavior. Though I have generally avoided expressing my own political views in these columns, I hope the incoming administration abandons the “abstinence only” policy in favor of emphasizing adolescent sexual education and condom use.
The U.S. “HIV travel ban,” which has long prevented the entry into the United States of HIV-positive foreign nationals has long been a huge thorn in the side of the academic community worldwide. It is the reason none of the major global HIV/AIDS research meetings have been held in the United States for many years. It was a hugely discriminatory and wholly unnecessary policy that amounted to a “slap in the face” of anyone who was HIV-positive. Fortunately that will now be ending and it was long overdue.
I’ve used up all the available space, with a few stories left. Hopefully, next year might bring IDSA’s reworked Lyme Disease Guidelines, which I don’t expect to be significantly different from the current one.
Happy Holidays!