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IDWeek 2016: Experts highlight threats to human health
NEW ORLEANS — During a special opening plenary session here at IDWeek 2016, top experts in the field of infectious diseases addressed several major threats to global health, including antimicrobial resistance, HIV/AIDS and Zika, as well as the growing importance and potential of the human microbiome.
Those who headlined Saturday’s opening session included CDC Director Thomas R. Frieden, MD, MPH; Ambassador-at-large Deborah L. Birx, MD, coordinator of the United States Government Activities to Combat HIV/AIDS and U.S. Special Representative for Global Health Diplomacy; Mauro Schechter, MD, PhD, professor of infectious diseases at Federal University of Rio de Janeiro, Brazil; and David A. Relman, MD, FIDSA, the Thomas C. and Joan M. Merigan Professor in Medicine, and Microbiology and Immunology, and co-director of the Center for International Security and Cooperation at Stanford University.
A public health crisis
Frieden spoke about putting a human face on the public health crisis of antibiotic resistance, which the CDC estimates causes more than 2 million infections and at least 23,000 deaths every year in the U.S.
“Truly we face a scary situation,” Frieden said. “And while we look at numbers at CDC, we also need to focus on lives.”
As part of an “outside-the-box” approach to drug resistance, coordination among critical care hospitals to track the complex movement of patients between facilities can help identify outbreaks more quickly and drive infection numbers down, Frieden said. Such cooperation — facilitated by public health departments — can lead to improved care.
“Patients move, and the bacteria and infections move with them,” Frieden said. “By working together, coordinating within the community, facilities can make an enormous difference, much more than any one facility can make on its own.”
Ending the HIV epidemic
Birx looked back at 20 years of ART and discussed today’s challenges in the global HIV epidemic, including reducing the number of new infections in adults in Africa, where life expectancy has returned to pre-HIV/AIDS numbers, but where increased testing and access to treatment is still needed.
“If we’re going to end AIDS as we know it, we still need the cure for those who are on treatment and we need a vaccine,” she said.
Lessons learned from Zika
Schechter provided a summary of the epidemiological evolution of Zika virus, highlighting data confirming the relationship between Zika virus infection and neurological conditions such Guillain-Barré syndrome and microcephaly in fetuses. He also discussed new vector control strategies, including the use of Wolbachia pipientis to obstruct Zika transmission, and vaccines. Although early data of an inactivated vaccine appeared to be promising, many questions regarding the antibodies’ efficacy in fetuses and the duration of immunity remain unanswered.
According to Schechter, the Zika epidemic underscored the significant role of deforestation, climate change and international travel in the dissemination of emerging infectious diseases as well as the importance of clinical acumen.
“Clinicians trained only to follow protocols would not have promptly recognized the link between microcephaly and rash during pregnancy,” he said.
However, the epidemic also demonstrated how media hysteria may affect response efforts during infectious disease outbreaks. Many people debated whether to cancel the Olympic games in Rio, which had no reported Zika cases in August. However, other than for pregnant women, there were no discussions on travel restrictions for Puerto Rico, which continues to be widely impacted by the epidemic.
“The main lesson learned is we should not follow media hysteria …we should follow hard data,” he said.
The role of the microbiome
On a lighter note, Relman discussed what ID clinicians can learn from bacteria.
“They have a lot to teach us about what it takes to cooperate,” he said during his presentation.
For example, some bacterial species exhibit properties that only benefit other species, not themselves.
“Bacteria have been doing charitable work far longer than we’ve even been on this planet,” Relman said. “Their charitable work is a form of cooperation in which they seek to enhance a population-wide feature, like resistance to an antibiotic.”
To put the importance of bacteria in context, he explained how many bacteria inhabit the planet — approximately 5 x 1030, with billions of different species — only a tiny fraction of which cause disease.
“As much as we’d like to think that we’re in command of this universe, we really don’t … at all. This is a microbial planet,” Relman said. – by Gerard Gallagher, Stephanie Viguers and John Schoen
References:
Birx DL, et al. Abstract 16. Presented at: IDWeek; Oct. 26-30, 2016; New Orleans.
Frieden T, et al. Abstract 17. Presented at: IDWeek; Oct. 26-30, 2016; New Orleans.
Schechter M, et al. Abstract 18. Presented at: IDWeek; Oct. 26-30, 2016; New Orleans.
Relman D, et al. Abstract 19. Presented at: IDWeek; Oct. 26-30, 2016; New Orleans.
Disclosures: Birx, Frieden, Relman and Schechter report no relevant financial disclosures.