As infectious disease doctors, we routinely care for patients with meningitis, but never have we treated a case of aspergillus meningitis, the type of fungal infection that has caused more than a dozen deaths and sickened nearly 200 people in Tennessee and other states.
Vigilance on the part of an astute physician identified the first case of fungal meningitis, and then well-trained epidemiologists at the Tennessee Department of Health discovered additional cases, identified the causative agent and alerted the Centers for Disease Control and Prevention.
This outbreak of meningitis is an opportunity for us to recognize the importance of our public health infrastructure and explore ways to further improve it.
When an infectious outbreak occurs in a health-care facility, state and federal health officials -- like crime detectives -- search for a possible culprit: a product, a procedure, or a person. In this case, the contaminated product, the methyprednisalone, a steroid injection, was the cause. The contamination likely occurred at the compounding pharmacy that distributed the medicines.
In other outbreaks, the culprit has been poor technique in a procedure or a lack of proper hand hygiene. For example, in Nevada, an endoscopy clinic reusing syringes led to the transmission of hepatitis C to eight patients and placed 50,000 patients at risk. And in Georgia, five patients developed joint infections from MRSA, an antibiotic-resistant staph bacterium, in part due to poor hand-washing among health-care staff at a primary care clinic.
Such infections are a stark reminder of the cat-and-mouse game that humans and pathogens play in our complex health-care settings. So how can we get the upper hand?
First and foremost, we need to bolster our surveillance of both rare and common diseases. For example, we need to hardwire our communication among providers and the health department through laboratory systems and electronic medical records.
Secondly, regulations and guidelines related to potential infections need to be enforced. Last year, the CDC developed a detailed checklist for both administrators and frontline personnel to prevent infections in outpatient settings, yet no one knows if the recommendations are being followed.
Lastly, transparency and public reporting of infections from hospitals and outpatient settings is necessary to reduce infection rates. For example, in 2008 after Tennessee's legislature mandated that hospital infections due to central lines (catheters that go into the patients' veins) be publicly reported, we experienced a nearly 40 percent drop in our central line infection rates in intensive care units. State legislatures around the country can demand public reporting of other health-care setting infections.
Recently, much of the upgrade at the state health departments has been possible due to the Affordable Care Act, aka Obamacare, which allocated $270 million for public health infrastructure training as well as research and tracking.
We worked with the Tennessee Department of Health, which has received part of this funding over the past two years, and believe it has undoubtedly strengthened Tennessee's infection control infrastructure and allowed for a rapid and meticulous response to this fungal meningitis outbreak. Unfortunately, such support for state health departments is often inaccurately called a "slush fund," and is at risk of being cut.
We, as infectious disease doctors and as epidemiologists, are confident that the fungal meningitis outbreak will be contained and eliminated -- yet unquestionably, other infections and potential outbreaks are lurking.
We must use this opportunity to recognize the success of our public health infrastructure, which saves countless lives every day. Ironically, we only recognize this when an outbreak occurs.
Manoj Jain MD MPH
Infectious-diseases specialist and adjunct assistant professor at the Rollins School of Public Health at Emory University
William Schaffner MD MPH
Professor and chairman of the department of preventive medicine, Vanderbilt University School of Medicine.
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David Katz, M.D.: Science and Smoke Signals
Who wrote the headline?
Regulated marijuana=bad
Unregulated steroids=good
Your republican congressman and Romney don't want the government to fund these programs! They would rather wait for an outbreak of thousands before bringing an emergency bill to the floor. Romney thinks people don't die early or young because they don't have health ins.
Are people that dumb!
change is for the best. By the way, their acquisitions had nothing to do with Obamacare as they happened years ago. Now they are building health care campuses in many of the suburbs. Once again, this was purely business decision - not Obamacare.
Doctors job satisfaction is also a function of doctor compensation (being driven down as they become just another employee), free will and freedom from oppressive over-site activity (regulatory and tort). Who will be going into medicine? I wonder. Clearly, many of our brightest went into finance and business instead of medicine in the last 25 years and the medical profession has suffered. A medical degree used to mean a house at the top of the hill (country club membership included, golf every Thursday afternoon!!) and now it is just an upper middle class struggle for most..Independence and success are what attracts those with the most to offer in intellect and energy and we are heading in the opposite direction.
There are no easy answers!!!
such infections in place for years. ACA just allowed
for computer and personell additions because of extra
available funding. The result would have been the same
even without the ACA. This article seems to have more
of a political slant than a scientific one.
Some people won't bother to read the whole article and quote 'some doctor' as having said the ACA is a hindrance to reporting and/or 'responsible' somehow which is, of course, NOT true.
I don't know about the rest of you, but I don't want every Tom, Dick, Harry, and Jane looking at my Medical Records if they aren't supposed to be...and by that I mean directly involved in my Medical Care/Treatment.
http://www.ohio.com/news/akron-general-fires-employees-for-patient-privacy-violations-in-hospital-shooting-case-1.341300
As far as I know, no doctor can prescribe any narcotic through electronic submission. The federal government requires those type of prescriptions to be on actual prescription pads.
Hopefully, we are done because I find myself drifting way off the topic of this article. Not to mention I don't think I can be persuaded.