Health Spectator

The World Health Organization released its annual report today, with emphasis on the changing world situation regarding communicable diseases. In her report, Inspector General Dr. Margaret Chan noted that since 1951, when the WHO issued its first set of legally binding regulations to prevent the international spread of disease, much has changed.

In 1951, Chan noted, the disease situation was “relatively stable,” with only six quarantinable diseases of relative concern: cholera, plague, relapsing fever, smallpox, typhus, and yellow fever. “New diseases were rare,” Chan said, “and miracle drugs had revolutionized the care of many well-known infections.”

Fast forward to 2007, when the WHO is dealing with several diseases of lesser concern in 1951–such as tuberculosis–making a dangerous comeback in drug-resistant form, plus an array of diseases not heard of in 1951: AIDS, SARS, avian flu, Ebola, Mad Cow disease, hemorrhagic fever–just to name a few.

“The disease situation [now] is anything but stable,” Chan said. “Population growth, incursion into previously uninhabited areas, rapid urbanization, intensive farming practices, environmental degradation, and the misuse of antimicrobials have disrupted the equilibrium of the microbial world.”

Perhaps most alarmingly, Chan noted that “new diseases are emerging at the historically unprecedented rate of one per year.” What’s more, she said, “during the last five years, WHO has verified more than 1100 epidemic events worldwide.”

Air travel, she pointed out, moves over 2 billion people per year, making it possible for a disease to spread internationally as soon as it emerges.

Consequently, she is urging worldwide adoption of the International Health Regulations (2005) that came into effect in June 2007. These new regulations are designed to be more proactive than previous WHO regulations, and if fully enforced and practiced globally, would give the WHO far greater power to deal with international health emergencies.

The Ministry of Health of Indonesia has announced a new case of human infection of H5N1 avian influenza. A 28-year-old female from Tabanan District, in Bali Province, developed flu symptoms on August 14, was hospitalized on August 18, then died in hospital on August 21. She was a poultry trader.

Case investigators found that she collected poultry from villages where outbreaks of avian influenza had occurred.

Of the 105 cases confirmed to date in Indonesia, 84 have been fatal.

Andrew Speaker, the lawyer who boarded international airline flights with what was believed to be “extensively drug resistant tuberculosis” has had his diagnosis downgraded to “multi-drug resistant tuberculosis” by the National Jewish Medical and Research Center in Denver, Colo. While that distinction might appear to be splitting hairs, it is important for two reasons, according to Charles Daley, head of the center’s infectious disease division.

“Number one, it allows us to change the way we treat him,” Daley said, “and if someone has become infected by Mr. Speaker… we now have some drugs available to… treat them and prevent them from developing TB.”

“However,” Mitchell Cohen, Director of the Coordinating Center for Infectious Diseases at the Centers for Disease Control (CDC) pointed out, “MDR TB remains difficult to treat. It will require approximately two years of medication and relatively toxic drug regimens to achieve the desired outcome, very different from drug-susceptible TB.”

Cohen then went on to discuss the public health issues at stake.

He first explained that the CDC and the National Jewish Medical and Research Center used different methods to test Speaker’s dominant strain of TB. He pointed out that the augur proportion method used by the CDC “is the approved standard of the Clinical and Laboratory Standards Institute,” then added that the “CDC acts as the TB reference laboratory not only for the United States but also internationally. ” He then reiterated that the CDC tests “found resistance to both first- and second-line TB medications, meeting the definition of XDR [extremely drug resistant] TB.”

Unfortunately, Cohen said, the initial bronchoscopy specimen obtained by a hospital in Atlanta was no longer available for retesting.

Cohen then cautioned that “there is a tendency to want to think about XDR TB and MDR TB as two different illnesses. ” In fact, he said, “they are only describing a level of drug resistance found in the bacteria attained from the patient specimen. This is a serious illness that can be transmitted to others, and thus puts others at risk for getting a difficult-to-treat disease.”

Most tellingly, Cohen pointed out that “the public health response to drug-resistant TB infections, either MDR TB or XDR TB is the same under the World Health Organization’s TB and airline travel guidelines that were published in 2005.” He then emphasized that “Without question, people with these infections should not be flying on commercial airlines.”

CDC continues to recommend the follow-up and retesting of passengers and crew who traveled on the transatlantic flights with Andrew Speaker and says it “will continue to ensure the well-being of patients who may have been exposed and infected by this patient,” according to Cohen.

Today is national HIV Testing Day. You may be able to find locations in your area that provide free testing. In any case, if you are conceivably at risk, it is a good idea to know where you stand. Early treatment is your best option for survival.

For more information on HIV testing, or to find a testing location in your area, please visit: http://www.hivtest.org.

or contact the HHS Office of Public Health and Science Communications

Phone: 202-690-7694

SOURCE U.S. Department of Health and Human Services

By now, most readers have heard of Andrew Speaker, the attorney infected with a dangerous form of tuberculosis who left the U.S. to be married in Greece despite attempts by health officials to keep him from traveling. Speaker was portrayed but not named in our May 30 report of the incident.

Since that time, Speaker has testified before Congress by phone and apologized publicly for the health scare he caused, claiming that doctors had told him he was not contagious. Emails obtained a few hours ago by the Associated Press portray a different view of the story.

The AP reports that Speaker’s father, also a lawyer, claimed not to know how to reach him when contacted by the CDC. His then-future father-in-law was urged by a CDC researcher to stop the wedding. Instead, he flew to Greece to attend it. The father in law, Robert Cooksey, is a CDC microbiologist.

At least 188 have died from bird flu worldwide since 2003

clipped from news.wjla.com A 19-year-old Chinese soldier has died of the virulent strain of bird flu, the country’s 16th reported death from the virus, the World Health Organization said Tuesday. The man, who was stationed in the southern province of Fujian, died Sunday after being hospitalized May 14 with a fever and a cough, said Joanna Brent, a spokeswoman for the WHO’s Beijing office.