Infection Control Today

OCT 2018

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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26 ICT October 2018 www.infectioncontroltoday.com cover story E ven with the 2017-2018 infuenza season — a high severity, H3N2-predominant season — behind us, fall brings new anticipation of the next bout with an old foe. This year marks the 100th anniversary of the 1918 Spanish infuenza pandemic, an event that experts have called the worst acute infectious disease outbreak in modern history. This pandemic, triggered by infuenza virus H1N1 killed an estimated 20 million to 50 million people, with a high mortality in young adults aged between 20 and 40 years. A war-ravaged population was further decimated by this pathogen. As Sands, et al. (2016) reminds us, "Pandemics and epidemics have ravaged human societies throughout history. The plague, cholera, and smallpox killed tens of millions of people and destroyed civilizations. In the past 100 years, the Spanish fu of 1918-1919 and HIV/AIDS caused the deaths of nearly 100 million people. Advances in medicine have transformed our defenses against the threat of infectious disease. Better hygiene, antibiotics, diagnostics, and vaccines have given us far more effective tools for preventing and responding to outbreaks. Yet the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS), and the recent West African Ebola outbreak show that we cannot be complacent. Infectious-disease outbreaks that turn into epidemics and potential pandemics can cause massive loss of life and huge economic disruption. Indeed, Ebola demonstrated how ill-prepared we are for such infectious-disease crises. There were failures at almost every level. Identifying the outbreak in the community and raising alerts took too long. Local health systems were quickly overwhelmed. Response teams did not adequately engage communities and deepened distrust in health authorities. The international response was slow, cumbersome, and poorly coordinated. Rapid diagnostics, protective equipment, effective therapeutics, and a vaccine were lacking. Ultimately, the crisis was contained, thanks to the courage and commitment of medical staff and communities on the ground and a massive deployment of international resources. Yet the cost in human lives and economic and social disruption was far greater than it should have been." 100 Years after the Spanish Flu: Lessons Learned and Challenges for the Future Barclay and Openshaw (2018) point to 1918 as a lesson not soon forgotten: " A century ago, as the First World War drew to an end, Spanish infuenza brought terror to an already shell-shocked world. Industrialized warfare had caused the loss of many young lives and there must have been a sense that things couldn't get any worse. And yet they did: a virus unlike any other in recent memory unleashed itself onto a weakened and highly mobile population, causing more than 50 million additional deaths. Now is a good time to refect on this tragic episode and to apply knowledge gained from a century of progress to understand how it happened and to consider whether it could happen again. What do we know about the 1918 virus, where it came from and why the outbreak it caused was so devastating? Was the severity of the pandemic attributable to the susceptibility of the human population after four years of wartime stress, to other factors (such as co-infecting bacteria), or was the particular virus that emerged endowed with an unusual highly pathogenic phenotype?" They add, "Understanding the exceptional impact of the 1918 influenza pandemic, including the immunological explanations for the atypical age-related sensitivity to virus infection, might have important implications for dealing with future infuenza pandemics: at a time when the world is calling for new approaches to infuenza vaccination, we are embarking on novel vaccination strategies that induce quite different arms of the immune response to those engaged by traditional vaccines or natural immune responses. It is important that we consider the possible immunological ramifications of these innovations on the outcome of infection by contemporary and future infuenza viruses." An editorial in The Lancet Infectious Diseases (2018) asks us to consider what we have learned from being unprepared: "Why the 1918 pandemic was so severe is still a matter of debate, but immunological factors and secondary bacterial infections were major contributors to the heavy death toll. Other infuenza pandemics, albeit less severe, have then occurred in 1957, 1968, and 2009, so a new one appears inevitable at some point in the future. Thus, on the centenary of the 1918 pandemic, it is timely to ask ourselves whether the world would be prepared now for such an event. The answer sadly is no: we do not know what virus will cause the next pandemic, there is no way to rapidly develop and deploy an effective vaccine against a pandemic virus, differences in quality of health systems hamper a prompt response, and surveillance data on infuenza have major gaps." "We are probably a plane ride away from a major threat in the U.S.," says Keith Kaye, MD, MPH, president of the Society for Healthcare Epidemiology of America (SHEA) and professor of internal medicine and infectious diseases at the University of Michigan. "That sounds overly dramatic but it's true. One positive development that I have seen related to preparedness — fueled by Ebola and conjointly with recognition of antimicrobial resistance and the CRE threat — is a greater regional effort through with joint hospital and public health partnerships. I've noticed many more joint initiatives around either preparedness for pandemics or emerging infections as well as for more commonly encountered resistant organisms like CRE or Acinetobacter or even MRSA and VRE. One advantage that we have compared to fve years ago, is stronger collegiality and cohesiveness between public health and healthcare, which puts us in a much better position to combat pathogens such as Ebola or SARS." Kaye continues, "With greater familiarity between these two entities comes more constructive work and improved communi- cation; if you know the people in your local public health department, you are much more likely to pick up the phone and call them as opposed to not knowing them. Some hospitals now have experience with dealing with anxiety-provoking, relatively unknown or unusual foe like Ebola, so this is not brand new to them. We must ask ourselves, what percentage of hospitals could care for and manage a patient with an infectious By Kelly M. Pyrek Spanish Infuenza in American Army hospitals. Masks and cubicles were used at Fort Porter, where patients' beds are reversed, so breath of one will not be directed toward another. Nov. 19, 1918. Source: Library of Congress

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