The dramatic infectious agents like MRSA, Ebola and bird flu get the headlines but there are a lot of others out there, some of them capable of being just as nasty. Consider the new variant of adenovirus serotype 14, for example:
Infectious-disease expert David N. Gilbert was making rounds at the Providence Portland Medical Center in Oregon in April when he realized that an unusual number of patients, including young, vigorous adults, were being hit by a frightening pneumonia.
“What was so striking was to see patients who were otherwise healthy be just devastated,” Gilbert said. Within a day or two of developing a cough and high fever, some were so sick they would arrive at the emergency room gasping for air.
“They couldn’t breathe,” Gilbert said. “They were going to die if we didn’t get more oxygen into them.”
Gilbert alerted state health officials, a decision that led investigators to realize that a new, apparently more virulent form of a virus that usually causes nothing worse than a nasty cold was circulating around the United States. At least 1,035 Americans in four states have been infected so far this year by the virus, known as an adenovirus. Dozens have been hospitalized, many requiring intensive care, and at least 10 have died. (Washington Post, hat tip Melanie, Just a Bump in the Beltway)
CDC alerted us to Ad14 about a month ago:
Adenovirus serotype 14 (Ad14) is a rarely reported but emerging serotype of adenovirus that can cause severe and sometimes fatal respiratory illness in patients of all ages, including healthy young adults. In May 2006, an infant in New York aged 12 days died from respiratory illness caused by Ad14. During March–June 2007, a total of 140 additional cases of confirmed Ad14 respiratory illness were identified in clusters of patients in Oregon, Washington, and Texas. Fifty-three (38%) of these patients were hospitalized, including 24 (17%) who were admitted to intensive care units (ICUs); nine (5%) patients died. Ad14 isolates from all four states were identical by sequence data from the full hexon and fiber genes. However, the isolates were distinct from the Ad14 reference strain from 1955, suggesting the emergence and spread of a new Ad14 variant in the United States. No epidemiologic evidence of direct transmission linking the New York case or any of the clusters was identified.
Most people who get an adenovirus infection don’t become seriously ill. But some do, even healthy young adults. Then there’s XDR TB, MRSA and seasonal influenza. If you live in West Africa you have to worry about Ebola, Marburg and much else. What’s going on?
Two things. The first is the same old thing. These diseases have been with us for a long time. The second is something new. We are interconnected and mobile in ways we have never been before. At the same time we produce new ecological niches for infectious diseases (like massive poultry operations) or expand old ones (like huge wet markets catering to a fashion for “wild food”).
The natural response is to feel overwhelmed by the scope and variety of the threat. Maybe you’ve got a stash of Tamiflu or a full larder but there’s seems to be too much other stuff. Which brings me back to a favorite theme, one we’ve been harping on since the blog began over three years ago. The best defense against whatever may come along is a robust and balanced public health and social service infrastructure. Whatever treatment is possible, if it’s possible, won’t happen in today’s brittle health care delivery system. Even moderate stresses break it and the Emergency Department is overwhelmed. Surveillance systems and public health laboratories that could sound an early warning vital for many of these diseases are in disrepair or designed around unlikely events, like a bioterrorist attack. Social services to care for the families left after the heads of household are out sick are tattered.
Repairing public health is a national security issue. If we can spend $300 million dollars a day in Afghanistan and Iraq (to little effect), we could spend a fraction of that making us safe at home.