Health IT and Infectious Disease – There is a Big Role!

The following release appeared a few days ago:

Press Release

For Immediate Release: October 29, 2008

New Report Finds Rising Risk of Infectious Diseases in America

Washington, D.C., October 29, 2008 - Trust for America's Health (TFAH) released a new report today, Germs Go Global: Why Emerging Infectious Diseases Are a Threat to America; which finds that at least 170,000 Americans die annually from newly emerging and re-emerging infectious diseases, a number that could increase dramatically during a severe flu pandemic or yet-unknown disease outbreak. Factors including globalization, increased antimicrobial (drug) resistance, and climate and weather changes are contributing to the increased threat.

"Infectious diseases are not just a crisis for the developing world. They are a real threat right here, right now to America's economy, security, and health system," said Jeffrey Levi, PhD, Executive Director of TFAH. "Infectious diseases can come without warning, crossing boarders, often before people even know they are sick. Americans are more vulnerable than we think we are, and our public health defenses are not as strong as they should be."

The report also finds that the nation's defenses against emerging infectious diseases are insufficient, creating serious consequences for the U.S. health system, economy, and national security. Some major threats currently in the U.S. include:

• Emerging diseases, like the potential of a pandemic flu outbreak or another new diseases like severe acute respiratory syndrome (SARS);
• Dengue fever sickens 100 to 200 Americans each year, usually brought back by foreign travelers, and is of particular concern along the U.S.-Mexico border;
• More than 90,000 Americans have been infected by Methicillin-resistant Staphylococcus aureus (MRSA), which is the sixth leading cause of death in the U.S.;
• An estimated 3.2 million Americans have hepatitis C infections, costing the country an estimated $15 billion annually in health care costs;
• An estimated 1.2 million Americans are living with HIV/AIDS, and nearly 566,000 Americans have died from AIDS since 1981. Last year total federal spending on HIV/AIDS-related medical care, research, prevention, and other activities was $23.3 billion; and
• Remerging diseases, which were thought to be nearly eliminated in the U.S., including measles, mumps, and tuberculosis (TB).

Worldwide, infectious diseases are the leading killer of children and adolescents, and are one of the leading causes of death for adults. According to the National Intelligence Estimate, "newly emerging and re-emerging infectious diseases ... will complicate U.S. and global security for the next 20 years. These diseases will endanger U.S. citizens at home and abroad, threaten U.S. armed forces deployed overseas, and exacerbate social and political instability in key countries and regions in which the U.S. has significant interests."

The Germs Go Global report examines major vulnerabilities in the current U.S. strategy for combating infectious diseases, including:

• Treatment: While the U.S. government has invested significantly in treatments that could counter an intentional biological attack, new drugs to treat emerging diseases and new antibiotics to address growing antimicrobial resistance have received far less attention. The development of new, improved therapies to treat drug resistant bacterial infections, as well as influenza and other viruses, is essential.
• Surveillance: Every state and local health department should be part of a disease surveillance system that is interoperable among jurisdictions and agencies to ensure rapid information sharing. Health information technology (HIT) should be mobilized far more effectively to support public health surveillance. And, the U.S. needs to be a leader in efforts to accurately assess the burden of infectious diseases in developing countries, detect the emergence of new microbial threats, and direct global prevention and control efforts.
• Diagnostics: New rapid diagnostic tests are needed across the spectrum of emerging infectious diseases. Improving point-of-care testing is particularly important.
• Vaccines: There are still no highly effective vaccines available to prevent three of the world's largest killers: HIV/AIDS, TB, and malaria. And, a large proportion of the world's children do not have access to currently available, highly effective vaccines.

"Recent history provides numerous reminders that infectious diseases are continuing to emerge in the United States and around the world," said James Hughes, MD, Professor of Medicine and Public Health at the School of Medicine and Rollins School of Public Health at Emory University and Former Director of the National Centers of Infectious Diseases at the U.S. Centers for Disease Control and Prevention. "There are a number of examples, including West Nile virus, SARS, monkeypox, and H5N1 influenza, which remind us that in today's world, microbes can spread rapidly across borders and from continent to continent. Trends in factors influencing infectious disease emergence -- for example, population growth and urbanization, international travel and commerce, climate and ecosystem changes -- generally operate in favor of the microbes. It is in our national interest to demonstrate the political will and commitment to act to address microbial threats domestically and globally in collaboration with a broad range of partners."

"The optimal preparedness for emerging, reemerging, and deliberately introduced infectious diseases requires a professionally trained and adequately funded public health infrastructure," said Kathleen F. Gensheimer, MD, MPH, State Epidemiologist, Division of Infectious Disease, Maine Department of Health and Human Services. "Epidemics, pandemics and other public health emergencies require a solid public health laboratory diagnostic and epidemiological surveillance system to detect aberrance in disease trends, allowing rapid response and targeted preventive actions to be instituted in a timely fashion."

"We need to improve our capability to protect the American people from emerging infectious diseases, whether naturally occurring or man-made, which includes developing new diagnostics, drugs and vaccines," Senator Richard Burr (R-NC) said. "To help, Congress created the Biomedical Advanced Research and Development Authority (BARDA) to partner with industry and fund the advanced development of these needed medical countermeasures. I am pleased this new report recommends fully funding BARDA and I will continue to work with my colleagues in the Senate to ensure its continued success."

"Antimicrobial resistance undercuts the effectiveness of essential medicines and reverses years of progress made in the treatment of infectious diseases. Left unchecked, antimicrobial resistance is as destructive and deadly as any global health threat," said Senator Sherrod Brown (D-OH). "That's why I've introduced the Strategies to Address Antimicrobial Resistance (STAAR) Act. By accelerating efforts to combat antimicrobial-resistance, this bill would prevent further erosion in the effectiveness of critical medical treatments. Today's report underscores the need to pass the STAR Act and protect Americans from dangerous superbugs."

"This report by the Trust for America's Health provides a timely warning about the vulnerability of our nation's public health system because of the emergence of infectious diseases, like SARS, Lyme disease and hepatitis C, and the resurgence of measles, mumps and malaria," said Representative Betty McCollum (D-MN), Co-founder of the Congressional Global Health Caucus. "As a leader in global health, our nation must be proactive and take the necessary steps to improve America's capacity to immediately respond to the healthcare needs of families, especially those with children, both here and abroad."

TFAH calls for improving America's capabilities to fight emerging infectious diseases through a well-funded federal effort, coordinated with international initiatives, to spur public-private breakthroughs in research, next-generation diagnostics, treatments, and vaccines. The report features a series of recommendations, many of which reinforce those made by the Board on Global Health and the Institute of Medicine (IOM) in 2003, including that the U.S. government should:

• Partner with state and local governments to allocate the necessary resources to build and sustain the nation's public health capacity to respond to threats of bioterrorism and naturally occurring disease;
• Further its leadership role to improve the global capacity to respond, control, and eliminate infectious disease threats;
• Enhance and promote the implementation of a comprehensive system of surveillance for global infectious diseases;
• Develop a comprehensive, multi-year, government-wide research agenda for emerging infectious disease prevention and control in collaboration with state and local public health partners, academia, and industry;
• Recruit, retain, and train public health professionals capable of identifying, verifying, preventing, controlling, and treating emerging infectious diseases.

The report was supported by a grant from the de Beaumont Foundation.

Trust for America's Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.www.healthyamericans.org

The de Beaumont Foundation promotes public health by strengthening the capacity and efficiency of local public health systems.

The release is found here:

http://healthyamericans.org/newsroom/releases/?releaseid=146

The full report can be found on this page for download:

http://healthyamericans.org/report/56/germs-go-global

As late breaking news (November 12, 2008) we now have the following:

Google Uses Searches to Track Flu’s Spread

By MIGUEL HELFT

SAN FRANCISCO — There is a new common symptom of the flu, in addition to the usual aches, coughs, fevers and sore throats. Turns out a lot of ailing Americans enter phrases like “flu symptoms” into Google and other search engines before they call their doctors.

That simple act, multiplied across millions of keyboards in homes around the country, has given rise to a new early warning system for fast-spreading flu outbreaks, called Google Flu Trends.

Tests of the new Web tool from Google.org, the company’s philanthropic unit, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention.

In early February, for example, the C.D.C. reported that the flu cases had recently spiked in the mid-Atlantic states. But Google says its search data show a spike in queries about flu symptoms two weeks before that report was released. Its new service at google.org/flutrends analyzes those searches as they come in, creating graphs and maps of the country that, ideally, will show where the flu is spreading.

More here:

http://www.nytimes.com/2008/11/12/technology/internet/12flu.html?_r=2&em&oref=slogin&oref=slogin

The critical point from my perspective in these reports is the importance of Health IT in surveillance and in protection against bio-terrorism. We must never forget there a still some out there who would do great mischief if they could. I am not sure our alert systems are anywhere up to the task at present – and I doubt anyone in the world is there yet. More work in progress!

David.