Tuesday, 25 August 2009

Dig deeper

Pandemic flu may have fallen off the news agenda but over the summer more scientific evidence has been gathering of how our underlying health could be a crucial factor in its severity.
Most people know about MRSA - and some avoid hospital out of fear they may get it there - but few people are aware of community associated MRSA.
CA-MRSA infections are known to be circulating among healthy members of the community and yet they have never been tested for in the UK population. The USA has undertaken studies and found that one in every 100 people carries CA-MRSA.
The SA in the abbreviation is Staphylococus aureus, a rather nasty family of microbes.
When the lungs of the young victims of the 1918 Spanish flu were studied, they were found to have been destroyed by a pneumonia which killed them within 72 hours. The weight of evidence since then has led infectious disease specialists to conclude that the extra factor in these swift deaths was Staph aureus.
One study by epidemiologists Noymer and Garenne of US 1918 flu deaths postulated that the Staph infection could have taken hold in the chest because apparently healthy people had undiagnosed tuberculosis, which makes little 'pockets' in the lungs.
Now two brand new studies by virologists - in Rotterdam, and Atlanta, Georgia - have found out exactly how different the pandemic H1N1 virus is from seasonal influenza virus - it particularly attacks the lungs.
Seasonal flu virus bound to the cells in the nose but they observed that pandemic H1N1 binds much deeper, in the trachea, bronchi and bronchioles of the lungs.
The US team also found the virus bound to cells in the intestine, explaining the nausea and vomiting associated with swine flu.
New Scientist magazine reported on this discovery: 'Individuals differ in the way they react to viruses. A virus that binds deep in the lungs can trigger potentially fatal pneumonia if the person infected mounts a strong inflammation in response to it.'
So where does that leave people with an autoimmune disease, like sarcoidosis or rheumatoid arthritis, where the immune system is apparently overreacting? Or people who always have sudden and severe reactions in the chest or gut whenever they take antibiotics?
These unknowns are part of the 'evolving threat' from community infections, and the NHS is ill-prepared for it, according to an expert.
Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham, said last month: 'It took the UK over 10 years to start to get to grips with the problems of hospital MRSA infections and we are still fighting this war. We are not yet ready to fight the next one against CA-MRSA infections.'
He complains that the NHS is: not testing for this known community health risk factor; has not got enough intensive care beds to cope with even a low number of cases of swift-acting pneumonia in swine flu patients; and has failed to invest in laboratories and advanced diagnostic testing.
He is trying to raise £1.4m in charitable donations to fund new research in to infections because of the lack of public funding.
Meanwhile 37,000 people have died in the last ten years from MRSA or another serious infection C.diff. That's twice as many deaths as those from road traffic accidents - and the extra treatment costs incurred by these infections in the NHS is £1 billion each and every year.
Infectious disease specialists have been asking for UK investment in advanced laboratory testing for a long time now.
Emeritus Professor at the University of Aberdeen, Hugh Pennington warned in a Radio 4 investigation last year that the current system of two main laboratories for the whole country, with results delivered at a snail's pace, was inadequate. The national Health Protection Agency lacks enough resources to track infections.
He told File on Four: "The scandal here is that we know what to do, the technology's there to spot these things as they are appearing and we know how to react to them. It would be quite wrong if we allow these things to develop and of course history tells us that if we do neglect these bugs, we neglect them at our peril."
Can someone in charge of NHS resources please wake up and smell the coffee?

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