Unless we have had a serious or even life-threatening infection in ourselves or in a family member, we tend to think of infectious diseases as only nuisances, easily diagnosed and easily controlled with an antibiotic.

WRONG!  As most physicians know, and as was recently articulated by Dr. Keith Joiner (Chief of Infectious Diseases at Yale Medical School),  we are now in a period of “re-emerging infectious diseases”, expanding in types, increasing in frequency and in severity,  and becoming ever more resistant to our antibiotics.  This problem encompasses not only the traditional bad actors of Tuberculosis, Malaria, Pneumoccal pneumonia and the more recent  HIV/AIDS  epidemic, but such newer starlets like Legionaires  disease, Lyme disease, Toxic Shock Syndrome, Hanta Virus, Ebola Virus, E. coli, parasitic diseases (usually restricted to the Third World) , Anthrax (an  apparent  favorite of terrorists), Chlamydia organisms, Mycoplasma, and  especially Influenza - with the potential  for  a repeat of the 1918 pandemic.

It’s not that we haven’t made progress in health care for infections in recent decades.  In 1900,  30%  of deaths were due to T.B., pneumonia, and diarrheal diseases.  In 1999, the number had been reduced to  5%  due to all infectious diseases.  But the percentage and numbers are now increasing.

Why?  The following are some of the many factors contributing to this situation:
1)  The general use of day-care centers , efficient incubators for disease, in our economy.
2)  Increasing national and world-wide mobility of the population, enabling the spread of both common and of exotic diseases.
3)  The increase in very risky behavior, especially sexual behavior, the primary cause of HIV/AIDS and of other sexually transmitted diseases.
4)  Increasing average age of our elderly population, always subject to one aspect of aging called “immune senescence”.
5)  The emergence and popularity of “fast foods”, dependent on processing  and preparation techniques which at times break down, enabling bacterial contamination to flourish and spread widely.
6)  The widespread practice of using antibiotics  in animal feed, promoting antibiotic resistance.
7)  The inappropriate use of antibiotics by physicians and by patients, including use where unnecessary as well as use at inadequate dosage and for inadequate duration of treatment.
8)  Environmental changes of all sorts.  One example is the exploding deer population, enabling the increase in deer tick-borne diseases like Lyme Disease, Ehrlichiosis and Babesiosis.
9)  The global economy,  with its importation of foodstuffs from areas without adequate preventive hygiene practices.
10) Microbial adaptation to change - including to antibiotics.  They are very good at that.

The problematic infectious diseases receiving the most attention at the present time are drug-resistant TB, vancomycin-resistant enterococcus (VRE), methicillin-resistant staphylococcus (MRSA),  vancomycin-resistant staph., and developing resistance ot the Pneumococcus organism.  But the biggest risk, according to experts in the field, is an “antigenic drift” of certain elements of the Influenza virus.  This could repeat the pandemic of 1918, which resulted in many more deaths world-wide than occurred throughout World War 1.

WHAT CAN WE DO?

A)  Recognize and resist the complacency that has resulted from the constant barrage of “medical miracles” to which we are treated by a popular press that no longer awaits the results of peer-reviewed reports and evidence-based research  before writing their articles.
B) Improve airline air exchange filtration.  The technology has been available for many years.
C) Educate and motivate people world-wide to pursue less risky and more healthy behavior.  In the United States,  50%  of the entire monies and resources expended for health care  are used to treat life-style related  conditions.  What a waste!
D) Demand  Federal and State oversight  and regulation regarding many of the causal issues noted above.  And enforce compliance through the prospect of criminal prosecution of corporate leaders - rather than relying on only civil monetary penalties that are merely passed on to the consumer.
E) Question your physician regarding the need for an antibiotic.  Then comply with all instructions; or, get another doctor.
F) Seek accurate and rapid  testing to enable specific antibiotic selection, when possible.  Also, discontinue an inappropriate antibiotic when test results indicate, and with the advice of your physician.
G) WASH YOUR HANDS, the #1 public health practice, especially in hospitals.
H) Use “active immunization”, Vaccines, whenever they are available.  Vaccines, such as Pneumovax, Flu Vaccine,  Tetanus toxoid,  Hepatitis B vaccine, and all the childhood vaccines, are effective, safe and cheap protection, making use of your own immune system as the first line of defense.
I) Promote and preserve your immune system with a healthy life-style and by minimizing stress.  Methods for stimulating non-specifically your immune system are also under study.
J)Especially in the elderly and chronically ill individuals, detect and report any significant change in health, including fever, fatigue, muscle aches, rashes, respiratory or gastro-intestinal or urinary symptoms.

Remember: the best health care is public information and motivation

GS