Do we have a forgotten U.S. pandemic?

June 1, 2010
The emergence and reemergence of many virulent, infectious microorganisms in the last decade has had a profound impact on the public health of the U.S. and other countries.

For more on this topic, go to www.dentaleconomics.com and search using the following key words: infection control, pandemic, SARS, MRSA, swine flu, HIV, Dr. John Molinari.

The emergence and reemergence of many virulent, infectious microorganisms in the last decade has had a profound impact on the public health of the U.S. and other countries. Initially, we were surprised to find that a seemingly mild viral respiratory virus could mutate to cause a rapidly progressive systemic infection with a 15% fatality rate. As a result, we were forced to protect ourselves from the new SARS coronavirus that was responsible for the first pandemic of the 21st century, severe acute respiratory syndrome. This aggressive, fatal viral infection had global attention in 2002 and 2003 as it spread from China to Hong Kong to 30 other countries.

Development of rapid diagnostic assays and compliance with effective fundamental infection-control practices reinforced by the World Health Organization, CDC, and other health agencies eventually limited the pandemic to fewer than 9,000 global cases with less than 800 deaths.

Soon thereafter, methicillin-resistant Staphylococcus aureus assaulted the public’s consciousness. This hardy, adaptable bacterial strain is resistant to many antibiotics used to treat infections, and has been known to be a dangerous human pathogen since the mid-1970s. Cross-infection with MRSA commonly occurs by direct skin-to-skin contact, or contact with shared items or surfaces that have come into contact with someone else’s infection (e.g., towels, used bandages).

A few years ago, extensive media reports describing specific instances of tragic deaths in the U.S. sparked a massive health care, public health, and community response. In part, these were aimed at eliminating MRSA by using aggressive disinfection procedures, which were implemented in schools and other facilities where people carrying MRSA were identified or suspected. Unfortunately, these types of actions are only temporarily effective since humans remain major hosts in carrying the organisms.

This pathogen continues to present major treatment and infection-control problems. It is responsible for the majority of skin infections seen in hospitals, and is becoming a more common cause of community-acquired infections.

Recently, “swine flu” has been the emergent disease. It is caused by the highly infectious A/H1N1 influenza virus. This outbreak has not been as lethal as other influenza pandemics. However, the CDC has estimated that, since the first reports appeared in April 2009, approximately 45 million cases have occurred in the U.S. through mid-February 2010. In the past year, an all-out effort was launched to prepare for and respond to this disease. The public has received detailed information about the etiology, origin, transmission, and progression of pandemic influenza. An effective monovalent vaccine also was prepared in time for the onset of flu season, and millions have subsequently been immunized

Are we forgetting something? Yes. In contrast to the above descriptions, limited public attention has been given to the human immunodeficiency virus epidemic in the U.S.

While the pandemic AIDS problem throughout Africa deserves to receive much of the world’s efforts, information about the increasing HIV incidence in certain U.S. groups is difficult to find in media reports. As representative examples, epidemiological data continues to be collected, showing:

  • From 2004 to 2007, the estimated number of newly diagnosed HIV/AIDS in the 34 states with the recently developed confidential name-based HIV infection reporting system increased 15%. While this may reflect changes in an improved reporting system, it may in fact indicate a rise in the HIV infection.
  • The current prevalence of HIV infection within certain subpopulations actually challenges rates observed in areas of Africa. Think about it for a moment. The incidence of HIV-infected adults in Washington, D.C. (one in 30) is actually higher than reported numbers for Ethiopia, Nigeria, and Rwanda.
  • In addition, incidence of HIV infection among men who have sex with men in some cities and urban areas increased in 2007, and was higher than the population incidence in severely affected countries such as Kenya (7.8%) and South Africa (16.9%).

For more information about the status of HIV/AIDS in the U.S., go to the CDC Web site at www.cdc.gov. You might be surprised to learn about current disease trends, control and prevention strategies currently in place, and those being developed to address other issues presented by the HIV/AIDS pandemic. This is not a scourge that is going away anytime soon, even if we do not hear as much about it as swine flu.

Dr. John A. Molinari is director of infection control for THE DENTAL ADVISOR. Previously, he was professor and chairman of the Department of Biomedical Sciences at the University of Detroit Mercy School of Dentistry. Contact him at [email protected].

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