6 infectious disease types that continue to burden US

There have been major advances in the control and prevention of infectious diseases in the United States, but some diseases continue to pose serious threats to human health and require immediate action from health care professionals, according to experts.

Rima F. Khabbaz, MD, director of the CDC’s Office of Infectious Diseases, and colleagues recently published an article in the Lancet, outlining six examples of ongoing public health challenges in the US related to infectious diseases. It is part of a new series on health in America.

Based on their findings, here is what you need to know:

Vaccine preventable diseases

According to Khabbaz and colleagues, up to 20 million illnesses and 40,000 deaths are averted in each US birth cohort receiving the recommended childhood immunizations. Significant progress has been made in the prevention of certain infections, including pneumococcal disease and rotavirus infection — especially in children.

However, other diseases require immediate attention. For example, uptake of the HPV vaccination series has been inadequate, and outbreaks of measles, mumps and pertussis continue to occur.

Although health officials declared measles to have been eliminated in the US in 2000, cases are now at a 20-year high — most of which were imported from unvaccinated travelers. According to Khabbaz and colleagues, these outbreaks underscore the importance of maintaining high vaccination coverage, especially among travelers.

HAIs

One in five patients acquire a health care-associated infection (HAI) in the US each year, according to the CDC researchers. HAIs can result in significant health problems and medical costs. So far, preventive strategies have largely focused on more widespread infections, including catheter-associated urinary tract infections, central line-associated bloodstream infections and surgical-site infections. Local, state and national efforts have been successful in decreasing certain types of nosocomial infections.

“Despite these successes, additional efforts are needed, with intensified actions aimed at reduction of antibiotic-resistant threats,” the researchers wrote. “Comprehensive approaches are needed to prevent introduction and spread of infections as patients move between and within health care facilities and into communities.”

Zoonotic and vector-borne diseases

“Zoonotic and vector-borne diseases represent most emerging infections in the USA and worldwide,” Khabbaz and colleagues wrote.

The researchers noted examples of two recent outbreaks of zoonotic infections in the US caused by Sin Nombre virus, which was carried by deer mice in Yosemite National Park. Additionally, West Nile virus was first reported in the US in 1999 and is now the leading arboviral disease in the country. Dengue virus, the most prevalent vector-borne disease in the world, has been reported in Florida, and chikungunya virus has affected up to 32 states and territories. Lyme disease also has spread from the northeast to the mid-Atlantic region and upper Midwest.

To prevent further spread of these and other zoonotic and vector-borne diseases, the researchers said public health efforts should focus on improvements to disease surveillance, public health education and prevention.

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Foodborne illness

Foodborne outbreaks are common in the US — up to 1,000 each year, according to Khabbaz and colleagues. Approximately 48 million cases of foodborne illness are reported annually, resulting in 128,000 hospital admissions and 3,000 deaths. Nine million cases are connected with major pathogens like norovirus, Salmonella, Campylobacter and Clostridium perfrigens.

Although most of these outbreaks are local, multistate outbreaks are on the rise. Major factors driving these larger outbreaks include centralized food production and processing and wide distribution of these products.

Legislation aimed at improving food production, active surveillance of foodborne outbreaks and the availability of molecular testing technology at the point of care are important measures to reduce infections related to foodborne illness, the researchers said.

HIV and STIs

Advances in treatment and prevention have successfully reduced the incidence of HIV infection in the US. However, significant challenges remain. According to the CDC, 1.1 million people in the country are infected with HIV, but only one in six are aware of their infection status. Although the incidence of HIV has stabilized over the past decade, certain populations remain at significant risk, particularly young black MSM.

According to Khabbaz and colleagues, several large-scale efforts have been made to address the US epidemic. These include the National HIV/AIDS Strategy (NHAS), launched in 2010 to reduce HIV incidence, increase access to care and improve health outcomes. Improved disease surveillance in high-burden areas is another approach.

“As new prevention options such as PrEP emerge, operational research will guide implementation of interventions, whether biomedical, behavioral, or structural, to strengthen efforts to mitigate the US epidemic,” they wrote.

Similar to HIV, sexually transmitted infections (STIs) disproportionately affect racial and ethnic minorities in the US. The emergence of cephalosporin resistance in gonorrhea is another significant challenge. To address this, enhanced surveillance of drug resistance and improved prevention, screening and partner services in primary care are required, according to the researchers. Treatment guidelines have also been updated to preserve the last effective antibiotic treatment for gonorrhea.

Chronic hepatitis

Despite significant treatment advances, chronic hepatitis still poses a serious health risk to Americans. According to the researchers, between 800,000 and 1.4 million people in the country are infected with hepatitis B, and 2.7 to 3.9 million have hepatitis C virus infection. Racial and ethnic minorities are disproportionately affected by chronic hepatitis as well, and many people are unaware of their infection status.

Increased screening among high-risk populations, including those born between 1945 and 1965, is crucial to identify new infections and link people to care, they wrote.

For more information:

Khabbaz RF. Lancet. 2014;doi:10.1016/S0140-6736(14)60890-4.