Wednesday, September 12, 2007

Public health policy: staph and superbugs


Besides the various infectious diseases discussed on the Aug. 30 on my “public health policy inconsistency” blog entry, there is another one of note, CA-MSRA, antibiotic resistant Staphylococcus aureus The August 2007 issue of Readers Digest has, on p 84, a layman’s article by Lisa Collier Cool, “Deadly Super Bugs: They can be transmitted by a hug or a handshake, on a playground or a locker room. And can kill within 72 hours.” The article starts with a horror story of a 16 year old football player who came close to death and lost 50 pounds before gradually recovering from sudden CA-MSRA pneumonia. The “CA” refers to “community acquired” and the acronym is connected to nosocomial infections common in hospitals, nursing homes or other confined environments (even college dorms). They tend to affect the weak and immunocompromised, but a subset can attack young, healthy people, sometimes because of unusual immune responses, sometimes because of lack of time (over life span) to have developed immunity. Some infections may be more dangerous to a twenty year old than a fifty year old. Some forms of meningitis, for example (that occur in dorms) fit this category because of the horrific complications resulting from unusual bacterial toxins. Most of us have heard of the horror stories of unusual flesh-eating bacteria.

Staph seems to be unpredictable, given the article. There is a banner page “How to protect your family.” Some of these infections may not affect single people who live alone (and have a predictable and steady exposure to crowds that keeps their immune systems alert), or even couples, and may be an issue only in households where there are people of varying immunities, especially with infections that remain asymptomatic with so many people. Staph may fit that description. Some infections may be occurring because of overuse of antibiotics, that eliminate germs that otherwise would compete with them. Middle aged people who do not become sick often are protected not only by their own immunity but by steady state internal environments where organisms keep each other at bay.

I once had a bizarre jaw infection (in 2004), resulting in huge swelling and a cat scan (malignancy suspected at first), apparently when a tiny seed went down a periodontal pocket space. It resisted tetracycline and various penicillins but responded immediately to clindamycin. It did not come back, which probably shows that my own body became immune to the germ, which was likely an anaerobic staph or strep infection.

All of this unveils another dirty fact about the health care debate. We live longer, with questionable health habits. We complain about the expense of dental treatment, but forty years of carbonic acid and pop and incomplete flossing are bound to lead to risks.

Here is a New Scientist reference on CA-MSRA by Clara Penn, April 2005, "Pandemic bug returns as community MSRA Strain, here.

Is there a moral lesson in all of this? Maybe.

Update: October 10, 2007

Several high schools in Maryland, Virginia and Washington DC have reported student cases of MRSA. One school in Rappahannock County, VA was closed for one day so that staff (teachers?) and "volunteers" could disinfect the school. One student, a football player, had to have several surgeries to remove infected skin or flesh. The infection may be spread in locker rooms. It's not clear whether school system employees (like substitute teachers) could bring the bug into a school environment as "carriers," since in many people the bacterium adapts in some kind of equilibrium with the person's immune system and then does not cause symptoms. The NBC4 news story is here. During the month of October, additional reports of DC area school closings appeared in the media. On October 17, 2007, iVillage on NBC (with Bill Rancic) had a doctor discuss staph.



Update: April 1, 2008

Dr. Phil had a program, first minomered "a deadly virus" but then formally titled "The Superbug Scare," link here, about MRSA. The misnomer comes from the fact MRSA is a bacterium, not a virus (staphlyococcus aureus). There were several real cases, and now there is "community acquired MRSA" as well as "hospital acquired" (or nosocomial) MRSA. Community acquired is becoming an issue for high school and college (and perhaps professional) sports. The best measure seems to be thorough disinfection of surfaces repeatedly used (like training tables).

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