Archive for the ‘CDC’ Category

The Thousand Natural Shocks That Flesh Is Heir To

via Wikipedia

via Wikipedia

I don’t know about you, but I don’t like reading the words “bacteria” and “apocalyptic” in the same sentence – especially in the lead paragraph of a World Health Organization Report. The report, released last month, tells us in no uncertain terms that we are now entering the post-antibiotic world. Almost a century after the discovery of penicillin, humanity is once again vulnerable to simple infections we thought we had confined to the dustbin of medical history.

All the ills that flesh is heir to, the countless ailments and fevers that have plagued humanity for millennia, were seemingly in retreat with the flurry of antibiotics that followed on penicillin’s heels. Ten years ago, a simple urinary tract infection or a scrape from a rose bush would pass without incident – a simple course of antibiotics saw to that. Now, increasingly, even the most minor infections can take an ominous turn, thanks to the relentless evolution of the microbes antibiotics are designed to destroy. The prospect of expiring from simple infections is growing daily, in every corner of the globe.

The WHO report is a hypochondriac’s nightmare. According to the Organization, resistance to common bacteria has reached alarming levels around the world. The post-antibiotic era, far from being an apocalyptic fantasy, is a very real possibility for the 21st century. Antimicrobial resistance, it says, threatens the effective prevention and treatment of an ever-increasing range of infections. Resistance to common bacteria, parasites, viruses and fungi has reached alarming levels in many parts of the world. In some settings, there are few, if any, effective treatment options. One of the greatest achievements of modern medicine is teetering on the verge of collapse. And it isn’t simply preventing or treating hitherto minor infections which is problematic. Many pillars of modern medicine rest on defeating microbes: without antibiotics routine surgery, transplants, and chemotherapy would be impossible.

In an ironic twist, it was in hospitals themselves where resistant bacteria first appeared, and they have spread steadily outward. In 2005, approximately 100,000 Americans had severe anti-biotic resistant infections, of whom nearly 20,000 died. That’s a higher fatality rate than HIV and tuberculosis combined. In the words of Katherine Xue, writing in Harvard Magazine, this state of infectious affairs is the new normal. The relentless spread of antibiotic resistant super bugs raises the grim specter of a return to the medicine of a century ago.

Dr Jennifer Cohn, medical director of Medecins sans Frontier, says the WHO report “should be a wake-up call to governments to introduce incentives for industry to develop new, affordable antibiotics.”

Developing antibiotics is extraordinarily expensive and time consuming. Encouraging innovation in the field will likely require close coordination on a global scale and significant government intervention and support. Given that Britain’s chief medical officer has compared the rise in drug-resistant infections to the threat of global warming, we’ll have to cross our well-scrubbed fingers and hope the nations of the world can pull together on this. An ounce of prevention, as they say, is worth a pound of cure.






High Levels of Lead, Low Levels of Communication

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Centers for Disease Control and Prevention (CDC) got a public lesson in post-publication clarification when the GAO’s report “CDC Public Health Communications Need Improvement” was published earlier this week.

The GAO report takes us back to Washington, D.C., in the year 2001, when the District’s Water and Sewer Authority became aware of lead levels in the area’s tap water that were surpassing the EPA’s limit of 15 parts per billion. The elevated levels – now attributed to a change made in the disinfection process in 2000 – were reported to both the EPA and the public starting in 2002.

In early 2004, the District of Columbia Department of Health (DCDOH) asked the CDC to assess the effects of the elevated lead levels on D.C. residents. CDC is generally responsible for developing lead poisoning prevention programs, as well as collaborating with federal and state partners to prevent lead poisoning. Elevated blood lead levels (BLLs) can cause behavior problems and learning disabilities in young children, as well as miscarriage in pregnant women.

In April of 2004, the CDC published their preliminary assessment in an article in the Morbidity and Mortality Weekly Report (MMWR), the agency’s “primary vehicle” for disseminating public health information.

But this particular dissemination of public health information backfired.

While the article suggested that no children tested had been found to have concerning BLLs, it was later established that some children’s BLLs had exceeded CDC’s “established level of concern.” According to CDC officials, the article “may have led some people to improperly minimize concerns about lead exposure and conclude that lead in the water had never been a problem.”

CDC took several steps toward addressing the confusion surrounding the article – for instance, the original online article is now preceded by two links to “Notices to Readers” published in 2010 that note the “limitations of methods employed and the manner in which findings were communicated.”

But it wasn’t enough. According to the GAO, “as of January 2011, CDC had no plans to publish an overview of the current knowledge about the contribution of elevated lead levels in tap water to BLLs in children, as suggested by a CDC internal incident analysis of issues surrounding the 2004 MMWR article.”

The GAO reports that the CDC has begun an initiative to revise procedures designed to “help ensure the accessibility and clarity of CDC public health communications,” but that the initiative does not address “how and when to take action about confusion after publication.” (emphasis added)

Therefore, the GAO recommends that CDC do the following: (1) publish an article providing a comprehensive overview of tap water as a source of lead exposure and communicating the potential health effects on children and (2) develop procedures to address any confusion after information is published. CDC has “generally concurred” with the recommendations.

You can find further resources on lead in drinking water – including specifics on the Washington, D.C. incident – from the CDC and EPA here and here, respectively.

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