1998 Richard J. Duma/NFID Annual Press Conference and Symposium on Infectious Diseases

Contact: Terry LaMotte
(301) 656-0003

Embargoed for Release: April 14, 1998, 12:00 p.m.

Biological Terrorist Attacks and Increasing Antimicrobial Resistance

WASHINGTON, D.C.-- Health experts painted a bleak future today with predictions of biological terrorist attacks and life-threatening diseases caused by microbes resistant to antibiotics. Extremists groups worldwide are learning how to use biological agents, such as bacteria, viruses and toxins, to develop weapons and methods of delivery. This coupled with the increasing problem of resistant bacteria, lack of physician education and inadequate preparedness could pose a potential health threat worldwide, health officials warned today at a news conference sponsored by the National Foundation for Infectious Diseases (NFID).

U.S. Biological Terrorist Attack Likely

According to Michael T. Osterholm, Ph.D., M.P.H., state epidemiologist and chief, Acute Disease Epidemiology Section, Minnesota Department of Health, "It is likely that a biological terrorism disaster will occur in the United States in the near future," and "we will be ill-prepared." His concern lies with recent world events, such as the break-up of the former Soviet Union, the perceived dominance of the United States as the leading world power and the rise of international extremist groups.

In the event of this type of attack, Dr. Osterholm is concerned that the United States and other countries will not be properly prepared. "For example, today we have inadequate supplies of smallpox and anthrax vaccines for civilian use, and there are no current efforts to improve upon this situation." In addition, he said the current federal legislation is "seriously lacking" in this area, and he warned that in the event of an attack, health care providers will be overwhelmed.

Drug-Resistant Staphylococcus aureus Rising

Staphylococcus aureus, a bacteria which is a common cause of both community- and hospital-acquired infections, has become resistant to several of the antibiotics used to treat it in the last decade, said William R. Jarvis, M.D., acting director of the Hospital Infections Program at the Centers for Disease Control and Prevention (CDC). Vancomycin, known as the antibiotic of last resort, has been used in many cases to treat these drug-resistant strains of S. aureus. "This led to increasing concern that vancomycin- or glycopeptide-resistant S. aureus would emerge--an organism, which if it were resistant to other commonly used agents, would be virtually untreatable," he said.

However, Dr. Jarvis added that the spread of antimicrobial-resistant pathogens is "secondary to both over- and misuse of antimicrobials and incomplete compliance with recommended infection control precautions." Some studies have indicated that as much as 63 percent of vancomycin use is inappropriate.

Dr. Jarvis is concerned that it is only a matter of time before fully-resistant vancomycin S. aureus will emerge. His views were echoed by William E. Scheckler, M.D., hospital epidemiologist, St. Mary's Hospital Medical Center and professor, Department of Family Medicine at the University of Wisconsin Medical School: "Despite monitoring and containment activities, vancomycin-resistant S. aureus clusters will occur and will be associated with both geographic dispersal and patient death."

To help reduce this risk as well as the risk of other antimicrobial resistance, CDC has published recommendations for the appropriate use of vancomycin. Keys to preventing further emergence include enhanced laboratory methods in identifying resistant strains, active surveillance for these types of infections and using proper infection control procedures once patients have been identified.

Resource Concerns Prompt Hospital Infection Control Standards

Concern about decreasing resources available to hospital infection control personnel has forced health care societies and organizations to establish standards for hospital infection control infrastructure. Dr. Scheckler announced the recommendations of a consensus panel report which he hopes will be adopted by all hospitals in the United States.

Alfred S. Buck, M.D., executive vice president, Division of Measurement and Research, Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and one of the co-authors of the report, expects JCAHO to evaluate this report for possible incorporation into hospital accrediting standards. "This report summarizes an unprecedented effort to produce a set of recommendations that are evidence-based and comprehensive--arrayed in a fashion consistent with expert opinion and experience," said Dr. Buck.

The recommendations fall into eight categories: managing critical data and information; setting and recommending policies and procedures; compliance with regulations, guidelines and accreditation requirements; employee health; direct intervention to prevent transmission of infectious diseases; education and training of health care workers; personnel resources; and nonpersonnel resources.

Flu Epidemics and Outbreaks Predicted to Continue

According to Nancy J. Cox, Ph.D., chief, Influenza Branch and director, WHO Collaborating Center for Influenza Reference and Research at the CDC, influenza A (H5N1), or the avian flu, which occurred in Hong Kong this past winter infected 18 people. "The emergence of the influenza A (H5N1) viruses in humans was an alarm bell for the entire world," said Dr. Cox. She believes that although this virus appears to be contained, there remains the possibility that this type or similar type of flu strain could appear and be detected in more locations as well as in the United States.

Dr. Cox discussed the studies undertaken during the Hong Kong investigation and outlined several key issues. She said that we must continue our surveillance of these types of flu and improve our readiness for the next pandemic of influenza. "We must remain vigilant because the next influenza pandemic could strike at any time, even if influenza A (H5N1) viruses are contained." By understanding the reasons for each outbreak, she is hopeful that we will be better able to implement the most effective control measures possible given a particular situation.

Challenges for influenza prevention and control include optimizing national and international collaborations for the early detection of new flu strains so that the new strains may be included in the vaccine as well as in the development of improved flu vaccines.

Influenza, or flu, is caused by viruses that infect the respiratory tract and generally results in more severe illness than other respiratory infections. Severe flu epidemics in the United States have cost as much as $10 billion, causing as many as 40,000 deaths and 150,000 hospitalizations.

"Much of the illness and death caused by influenza can be prevented by annual influenza vaccination," Dr. Cox said. Unfortunately, many people do not take advantage of this prevention measure, putting themselves at risk each year. High risk groups include all people over 65 years of age, people with chronic pulmonary and cardiovascular conditions, diabetes, immunosuppression and severe forms of anemia. The vaccine is also recommended for residents of nursing homes and health care workers.

New Vaccination Strategies Underway for Pain-Free Experiences

Can we finally throw away the needle and syringe? Apparently, we may be coming closer, according to Bruce G. Weniger, M.D., M.P.H., assistant chief for vaccine development, National Immunization Program at the CDC. CDC is currently studying creative ways to deliver vaccines.

Some of the new methods being considered are aerosol vaccines delivered as sprays through the nose, skin contact, by eating plants that contain vaccines and by swallowing vaccine pills. CDC is very interested in this research since more and more diseases are becoming vaccine-preventable, but health experts want to allay the "needle phobia" that many people face when going to the doctor.

As of March of 1998, the national immunization schedule requires 14 injections of vaccine for children up to 16 years of age, including as many as four injections in just one visit. "Many providers and parents, however, are reluctant to administer so many injections during a single visit because of the child's fear of needles and pain," Dr. Weniger said.

As a result, many vaccinations are missed or delayed, increasing the risk of developing disease. In addition, Dr. Weniger cited other drawbacks of using needles, such as unsterile reuse in developing countries, improper disposal and needle stick injuries.

Due to the high number of injections that children primarily face, health experts are looking for better ways to deliver new vaccines or improved methods to deliver existing vaccines. For example, Dr. Weniger said the new rotavirus vaccine to prevent infant diarrhea will be administered orally by drops, and the influenza vaccine sprayed into the nose appears promising. Additionally, steps have been taken to combine several existing vaccines into a single injection, much as the measles, mumps and rubella vaccines have been combined.

About the Press Conference

The 3rd Richard J. Duma/NFID Annual Press Conference and Symposium on Infectious Diseases was sponsored by NFID and was supported, in part, through unrestricted educational grants from Bayer Corporation, Glaxo Wellcome Inc., Pfizer Inc., Pharmacia & Upjohn, Inc., RhÙne-Poulenc Rorer Inc., Roche Laboratories and Zeneca Pharmaceuticals. This event was named for former NFID President and Executive Director Richard J. Duma, M.D., Ph.D., director of infectious diseases at Halifax Medical Center in Daytona Beach, FL. Dr. Duma is an internationally renowned infectious disease expert.

NFID is a national, nonprofit public foundation established in 1973, to support infectious diseases research, to sponsor public and professional education programs and to aid in the prevention of infectious diseases.