Public Health Experts Discuss Infectious Diseases Threats

Updates on the impact of sexually transmitted diseases, infection risk from animals in the home and public settings, seasonal and H1N1 influenza, and foodborne diseases were presented today at a news conference at the National Press Club in Washington, D.C. The news conference was sponsored by the National Foundation for Infectious Diseases (NFID).

"Each year we face new and reemerging infectious diseases threats," said Susan J. Rehm, MD, NFID’s medical director and vice chair, Department of Infectious Disease, at the Cleveland Clinic. "Our goal as medical professionals is to ensure that we identify these threats in a timely manner and educate the public to minimize the overall impact on society."

Influenza is currently the leading cause of vaccine-preventable death in the United States. Seasonal influenza causes an estimated 36,000 deaths and 200,000 hospitalizations in the United States. Most of the deaths occur in the elderly, but the hospitalization rate for children 2 years of age and younger is comparable to the hospitalization rate of the elderly. As of June 30, 2009 the Centers for Disease Control and Prevention had received 89 reports of influenza-associated pediatric deaths with 67 being attributed to seasonal influenza and 22 pandemic influenza cases.

"Unfortunately, seasonal influenza immunization has never been a health priority for Americans," said Carol J. Baker, executive director of the Texas Children's Hospital Center for Vaccine Awareness and Research and professor of pediatrics, molecular virology and microbiology at Baylor College of Medicine in Houston. "Influenza is not easy to recognize and is often confused with less severe respiratory viral infectious such as the common cold."

Novel H1N1 influenza virus, which was recognized in late April 2009, has caused 1 million cases of influenza worldwide and the age groups most affected are the young rather than the elderly. Cases of the pandemic (novel H1N1) influenza are expected to rise during this fall and winter.

"Seasonal influenza vaccine should be available soon. We should start immunizing as soon as the vaccine is available to prevent the seasonal influenza. In addition to vaccines, we should remember hand hygiene, cough etiquette and social distancing also helps to prevent the spread of both types of influenza," said Baker.

Additional topics discussed at the 14th Richard J. Duma/NFID Annual News Conference and Symposium on Infectious Diseases included:

• Sexually Transmitted Diseases - Neither Gone Nor Forgotten: David Martin, MD, chief, section of Infectious Diseases and Harry E. Dascomb Professor of Medicine and Microbiology at Louisiana State University School of Medicine in New Orleans, discussed the most common reportable infectious diseases in the United States is Chlyamydia trachomatis. The number of reported cases is growing each year due to increased screening efforts. "Excellent C. trachomatis diagnostic tests are now available and can be performed on urine specimens. Treatment is inexpensive and safe. Therefore, theoretically, this common STD could be dramatically curtailed in the United States population if broad-based screening efforts were undertaken," said Martin. He outlined the need to eliminate barriers associated with screening including lack of access to healthcare, health care provider reticence to address sexual health issues, limited budgets to support screening programs, insufficient treatment of exposed sex partners, and lack of knowledge on the part of young sexually active individuals about the true risk of unprotected sexual intercourse with multiple partners. Martin also provided updates on treatment options for gonorrhea, the increased incidence of syphilis and medical advances which lead to discoveries of new STDs.

• Infection Risk from Animals in the Home and in Public Settings: Larry K. Pickering, MD, FAAP, senior advisor to the director of the National Center for Immunization and Respiratory Diseases of the Centers for Disease Control and Prevention, executive secretary of the Advisory Committee on Immunization Practices (ACIP) and professor of pediatrics in the department of pediatrics at Emory University School of Medicine outlined the risks associated with animal exposures to non-traditional pets in the home and to animals in public settings. "The majority of households in the United States own a pet, and exposure to animals in public settings (petting zoos, state fairs, pet stores, animal swap meets, carnivals, child care centers) results in millions of human-animal interaction each year. Many pet owners, people in the process of choosing a pet and people exposed to animals in public settings are not aware of the potential risk posed by certain animals, especially non-traditional pets such as rodents, reptiles and weasels," stated Pickering. "Infections with organisms acquired from these animals can involve many organ systems including the gastrointestinal tract, skin, lungs, blood and central nervous system. Organisms which have been associated with outbreaks include Salmonella species, E. coli 0157:H7, Campylobacter species, Cryptosporidum species, and lymphocytic choriomeningitis. Dr. Pickering discussed regulations and recommendations applicable to these exposures and defined measures which can minimize or prevent illness in children from exposure to these animals.

• Foodborne Diseases: The Continuing Challenges to Public Health: Robert V. Tauxe, MD, MPH, deputy director, Division of Foodborne Bacterial, and Mycotic Diseases at the Centers for Disease Control and Prevention (CDC) provided an overview on the prevention of foodborne diseases, how they can be prevented and the roles the CDC plays in detection and prevention. "Educating consumers and food handlers is important, but not sufficient," said Tauxe. "Through studying various outbreaks we can learn how to prevent disease through targeted prevention strategies."  Since 1996 the CDC has utilized a national surveillance network which allows for sharing of DNA 'fingerprint' patterns, permitting rapid detection of clusters of strains from ill persons that have matching patterns. This system facilitates the detection and investigation of dispersed common sources of outbreaks. Each year 50,000 strains are reported to the surveillance system. In recent years the system has detected multi-state outbreaks including E. coli, Salmonella, and Botulism.

The 14th Richard J. Duma/NFID Annual News Conference and Symposium on Infectious Diseases was supported, in part, by unrestricted educational grants to NFID from Cubist Pharmaceuticals, Inc.; Merck & Co., Inc; Roche; and Wyeth Pharmaceuticals. This event is named for former NFID president and executive director Richard J. Duma, MD, PhD, currently director of infectious diseases at Halifax Medical Center in Daytona Beach, Florida.