The recent news of flesh eating bacteria incidents has heightened the awareness of the general public regarding their susceptibility to being infected with this deadly disease. It’s a frightening prospect: the idea that a simple scratch or minor injury can trigger the onset of life threatening circumstances.
Is our public health care system prepared to handle a flesh eating bacteria epidemic or something similar if there was an outbreak? It’s an important question in this age of health care reform and debates over the future of our stresses public health system. Lost in the political back and forth is a real conversation on whether or not we’re prepared. But, general public nervousness about our system’s ability to really handle such outbreaks could result from public anxiety over political gridlock in Washington.
Flesh eating disease is also known as necrotizing fasciitis. It is a rare, but severe group A streptococcus (GAS) bacterial infection. It can destroy the muscles, skin, and underlying tissue. The word “necrotizing” refers to something that causes body tissue to die. And about 20% of patients with necrotizing fasciitis die.
A variety of bacteria can cause this infection. Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape. The bacterium begins to grow and releases harmful substances (toxins) that kill tissue and affect blood flow to the area. As the tissue dies, the bacterium enters the blood and rapidly spreads throughout the body.
Most notable is the case of Aimee Copeland, a 24 year old graduate student currently fighting for her life due to complications from the flesh-eating bacteria. She received a cut on her left calf when a homemade zip line she stopped to ride along the river broke.
The type of bacteria causing her infection was an organism named Aeromonas hydrophila. It invaded her body through the cut causing doctors to amputate her left leg. She was later told that her hands and remaining foot would need to be amputated in order to improve her chances of survival.
Aeromonas hydrophila is a species of bacterium that is present in all freshwater environments and in brackish water. Humans may acquire infections through open wounds or by ingestion of a sufficient number of the organisms in food or water.
By now, many people may be wondering how likely it is for them to get the disease.
Persons with impaired immune systems are more susceptible to getting infected. They include diabetics, intravenous drug users, infants, the elderly, and individuals suffering from leukemia, cirrhosis of the liver, and those undergoing chemotherapy for cancer.
The risk increases for pregnant women in the postpartum period if the mother has diabetes and with procedures such as cesarean section or episiotomy. Visible infections to the skin, hair, and nails are more likely to be noticed and treated than some deep infections. Deep infections to the muscle, bone, and joints are less noticeable and have a higher risk of becoming life threatening.
Most cases of flesh eating bacteria have been sporadic rather than associated with large outbreaks. But, there are increasingly more reports from clinical centers. The disease is difficult to treat and immediate treatment is needed to prevent death.
For this reason, the public health system’s ability to contain a flesh eating bacteria epidemic or similar outbreak remains questionable in the minds of many.
The discovery of the 2009 H1N1 influenza pandemic and the emergence of other diseases such as SARS have highlighted the important role that diagnostic tools can play in improving the surveillance of infectious disease threats at the population level.
Experiences with these events have shown that recognition of outbreaks, management of epidemics, and development of countermeasures can depend heavily on having access to highly specific surveillance information that is typically obtained from testing clinical specimens.
Consequently, the rising threat of emerging diseases and concern about biological weapons has led to an emphasis in governments on improving laboratory and diagnostic capacity in order to improve global bio-surveillance for infectious diseases.
Bio-surveillance is the technique of tracking communicable diseases such as sexually transmitted diseases (STDs) and streptococcal infections. Using special software, doctors, hospitals, clinics and emergency rooms all report individual cases of any communicable disease.
The program requires information on the patient such as location, age, gender, race, and other specifics designed to create a demographic portrait of the current victim and potential victims. In 2009, the U.S. National Security Council (NSC) identified enhanced disease surveillance, detection, and diagnosis as priority goals that the United States government (USG) should work toward. This was done for the purposes of improving national security and improving the ability to report any public health emergency of international concern.
The Obama Administration’s Global Health Initiative includes efforts to promote the development and acquisition of infectious disease diagnostic tools. A robust and strong regulatory process is necessary to ensure that diagnostic tests produce accurate and reliable results. Data Mining is another indicator that could be used to predict epidemics before they spread based on mass behavior. Use of this technology could help prepare first-responders and other health professionals for emergencies.
For example, the National Retail Data Monitor (NRDM), tracks transactions of over-the-counter healthcare items from 21,000 outlets across the United States. The purchasing information of these items assists health care officials with preliminary trends in illness transmission.
Furthermore, Data from the NRDM show that sales of over-the-counter products like cough medicines and electrolytes actually spike before visits to the emergency room do. The lead time can be significant in the case of respiratory and gastrointestinal illnesses. In this scenario, it was about two and a half weeks, according to one paper.
Public health components have been incorporated into the National Response Framework and the National Incident Management System. Public health bodies at the local, state, and federal levels now routinely use this system to ensure that everyone has the same focus, whether responding to daily incidents or major disasters.
Although preparedness and response capabilities for public health emergencies have been difficult to determine and measure, reports from the CDC and the Trust for America’s Health have documented substantial improvements. Public health departments are now better equipped to identify health threats rapidly and have improved their abilities to respond e¬ffectively and communicate emergencies. For example, 48 of 50 states (96%) have shown their ability to activate staff¬ and their emergency operations centers.
One sign of progress is the CDC’s Strategic National Stockpile which ensures the availability of key medical supplies. 100% of states have plans to receive, distribute, and dispense these assets. The effectiveness of responses is judged by accurate communications of emerging health threats in addition to response and health outcomes.
Another sign of progress is the CDC’s secure, web-based Epidemic Information Exchange (Epi-X) which allows state and local public health officials to access and share health surveillance information about illnesses.
The Food and Drug Administration (FDA) has also developed a program for granting Emergency Use Authorization for devices and medicines that are likely to be needed during public health emergencies.
Finally, what would be the response to high risk communities or low income communities with limited access to health care?
Distribution and rationing decisions for vaccination and treatment should be based on the goal of minimizing the detrimental health effects of an epidemic or pandemic. Public health measures must not be based on race, color, ethnicity, national origin, religion, gender or sexual orientation.
However, some would argue it can be based on age or disability when there is good reason to believe particular groups are either at much higher risk of death or have a much higher likelihood of spreading the disease if not vaccinated or treated.
More emphatically, there are special obligations to those in custody who should be a priority regarding vaccination and treatment. Consideration and advance planning should take place for high risk populations with physical or mental conditions and socio economic disparities.