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Taking emerging infections to task

European Task Force Says Clinicians on the Front Lines Should Look for the Unexpected

Taking Emerging Infections to Task
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Emerging infections—an increasingly important topic: review by the Emerging Infections Task Force

E. Petersen, N. Petrosillo, M. Koopmans, the ESCMID Emerging Infections Task Force
Clinical Microbiology and Infection
Volume 24, April 2018, Pages 369-375

When a patient goes to the doctor today with respiratory symptoms, chances are they’ll be sent home with instructions to wait out what is assumed to be a run-of-the-mill cold or other common viral illness. But, what if they’ve really got the next bird flu?

In fact, the list of pathogens known to cause potentially serious infections in humans continues to grow. And in light of this reality, an Atlas Award-winning team of experts is pushing for greater attention and awareness among clinicians to the increasingly urgent issues presented by emerging infectious diseases. As members of the European Society for Infectious Diseases and Clinical Microbiology’s (ESCMID) newly established Emerging Infections Task Force, they argue that the discovery of new trends in infectious diseases now requires that doctors begin to look routinely for “the unusual and unexpected.”

“It might surprise you that many patients never get a diagnosis in terms of a microbe,” said Eskild Petersen of Aarhus University, Denmark. “Only half of those with pneumonia ever find out what it is and, often, we don’t care because patients get well and get discharged.

“What is happening now is you have molecular methods you can use to diagnose things you couldn’t 5 or 10 years ago. We think it’s important that when you have somebody with an infection that’s serious and routine methods don’t answer what it is—it’s important to know there are methods that can give an answer even if they haven’t been part of a routine microbiology lab.”

In the review published in the journal Clinical Microbiology and Infection, Petersen and his colleagues on the task force consider the factors that have contributed to major infectious disease outbreaks over the last 20 years. They identify several major drivers of emergent infections, including a growing human population often living in close quarters, the expansion of farmland into natural areas, and the popularity of international travel.

ESCMID established the task force in March 2017 to address the challenges presented by emerging infectious diseases. Their primary aim was to begin a discussion about the role of clinical microbiologists and virologists on the front lines of clinical care and disease detection in catching emerging infections early in an effort to stem potential outbreaks. Ultimately, they argue that everyday clinical practice needs to adjust such that emerging infections become part of the workup of every patient with a suspected infection.

“Mathematical modeling has not been able to predict outbreaks,” they write. But, there are also many challenges. For instance, they continue, “emerging infectious diseases rarely stand out as unusual, and the continuous pressure on health care budgets [often] force clinicians and laboratories to prioritize their diagnostic work-up to common and treatable conditions.”

The task force aims to establish a network of experts who can raise awareness on emerging infectious diseases and connect with other relevant networks to develop a foundation of knowledge and begin to address such challenges. They hope to encourage more focus and research on emerging infections including surveillance and diagnostics. Their review is just one first step of many.

“Just as travel history is mandatory for all patients, the thought that an illness may be important when it defies standard diagnostic investigations should be in the mind of every specialist in infectious diseases and microbiology,” they conclude.

A Conversation with Eskild Petersen

Atlas spoke with Eskild Petersen from Aarhus University in Denmark about emerging infections, the need for increased clinical and laboratory surveillance, and what members of the general public can do to help.
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Atlas: What constitutes an emerging infectious disease?

Eskild Petersen: These are infections that show a changing pattern. Sometimes it’s the discovery of a new virus we haven’t heard of before. But it may also be a known infection that shows a changed pattern, appearing in new places or developing resistance to antibiotics, for example. So, it’s a term that shows these diseases are dynamic not stable and change over time.

Atlas: What makes emerging infectious diseases such a concern right now?

Eskild Petersen: In our paper, we identify four major drivers of emergent infections. We have more people on the planet, so people are living closer together. We use more antibiotics, which drives resistance. There are also stresses related to the expansion of farmland into natural areas, globalization of the food market, and environmental contamination. In addition, we have an aging population and more people traveling around the world. All of these factors present new opportunities for emerging infections to take hold and spread.

Atlas: Tell me about the newly established Emerging Infections Task Force you are a part of? What are the goals of the Task Force?

Eskild Petersen: The Task Force was established by The European Society for Infectious Diseases and Clinical Microbiology in an effort to strengthen efforts around emerging infections and to ensure that emerging infections are considered in everyday clinical practice. The goal is to encourage awareness about the threat posed by these infections and to establish a panel of experts who can assist in evaluating emerging infection threats and how and where to diagnose emerging infections including the identification of unknown pathogens.

Atlas: In terms of prevention, what can we do?

Eskild Petersen: Well, if you know a virus, you can try to develop a vaccine, which is very difficult, of course. When it comes to antibiotic resistance, you can try and use public health measures to ensure the appropriate use of antibiotics, so that you use them when needed but not too much.

Atlas: What are challenges to getting to point of making that reality?

Eskild Petersen: There are several challenges. One is to have the knowledge of possibilities and that’s what we are working on. The next challenge is cost. Who will pay for it? If this isn’t a guarantee for better treatment, for example, you find a virus but there’s no treatment then the authorities might say you’ve wasted money on a diagnostic assay because it didn’t offer another possibility of treatment. But, it is providing insurance for all of us because if we know what is going on we also know how to prevent it. If we have an infection, we can avoid getting out in public or wear a facemask. It’s also a kind of insurance to know what is going on and what we’re up against.

Atlas: What are next steps for task force?

Eskild Petersen: We are working on courses, other publications and organizing sessions on this topic on the European Congress on Clinical Microbiology and Infectious Diseases, ECCMID, and many other initiatives all over the world. These are major challenges. We’re running out of antibiotics. We have multi-resistant bugs in the hospital. It will be a challenge because of the increasing population density increases the risk of transmission. It’s going to be important for there to be more focus on emerging infections by clinicians on the front lines and our focus for now is to raise awareness on these issues.

Atlas: What can members of the general public do to make a difference?

Eskild Petersen: One of the things you can do is to wash your hands. But perhaps most importantly: get your vaccinations. Many people are afraid of childhood vaccines. As a result, measles is an emerging infectious disease. Thirty years ago we didn’t have to worry about it, but we do today because some people fear vaccines. Another thing you can do is: don’t run to the family physician for antibiotics every time your child gets sick. Oftentimes, these will be viral infections and you will not need antibiotics.

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About Clinical Microbiology and Infection

Clinical Microbiology and Infection (CMI) is a monthly publication in English of the European Society of Clinical Microbiology and Infectious Diseases and publishes peer-reviewed papers that present basic and applied research relevant to therapy and diagnostics in the fields of microbiology, infectious diseases, virology, parasitology, immunology and epidemiology.

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