You are here: MEDICA Portal. Our Topics in 2009. Topic of the Month February: Forgotten Diseases. Antibiotics.
Out of Sight, out of Mind
In the 17th century physicians tried
to protect themselves with a plague
In the end the disease was extinguished by a serum. In the late 1960s, a global vaccination programme was set up against smallpox, finally leading to its extinction. The last case was reported from Somalia in 1977, two years later the World Health Organization (WHO) declared that smallpox were officially defeated. This great but so far unique success has made the disease a malady of the past. However, other diseases have been wrongly forgotten – sometimes with detrimental consequences.
For instance, nobody should have to be afraid of measles nowadays. A well-tolerated and effective vaccination was developed decades ago. However, the number of people protecting themselves against the virus infection has been too small over the last years. It appears that the seriousness of measles including the inherent late effects such as pneumonia or encephalitis, are long forgotten. Encephalitis, for instance, causes permanent damage in 20 to 30 percent of all patients and sometimes even leads to death.
A heavy disease outbreak in North Rhine-Westphalia brought measles back to our minds in the year 2006: over 1,700 people fell ill, and 15 percent of them had to be treated in hospital. Germany, Rumania, Italy, Great Britain and Switzerland are especially problematic in Europe. Time and again, people are forced to stay in bed suffering from high fever and rash. In contrast to these countries, there are no more measles in Finland or the USA. However, states without measles are still threatened by imported viruses, among others from Germany.
Anette Siedler of the Robert Koch Institute hopes, that offensive PR-campaigns help to reach the American status. “We are on the right track”, said the epidemiologist. Especially the infants’ vaccination rates have considerably increased. In 2007 almost 95 percent of all children just starting school have already received the first injection. 87 percent of them have got the second and finally protecting one as well.
The Black Death is not forgotten
Plague is not only a long forgotten medieval horror. The Black Death is reality today, especially in some African countries. One of the most affected regions is northwestern D.R. Congo. The WHO reports on over 1,000 cases per year. Cases of plague also occurred in the southwest of the USA from time to time since the plague bacterium remains endemic in many wild rodents, especially in rats.
„Plague is spread from rodents to humans by fleas. If there are bad hygienic conditions, there will be more fleas and people will have closer contact to rats”, explains Kai Braker, health advisor at “Doctors Without Borders”. Untreated pneumonic plague can lead to death within 24 hours. However, when rapidly diagnosed and promptly treated, plague may be successfully managed with antibiotics. Therefore the Black Death is not horrifying any more. Though, Braker believes that the disease cannot be eradicated: “If the medical and hygienic conditions get worse, for example during a civil war, plague will break out again and again.”
Tuberculosis: drug-resistance is increasing
Old diseases do not stop developing. Bacteriums react on human measures and may get resistant against treatment. Major anti-tuberculosis drugs fail at fighting the agents more and more frequently. “This is caused by inconsistent or partial treatment which does not kill the bacterium. Instead it gets resistant against any therapy,” explains Bonita Brodhun of the Robert Koch Institute. The WHO estimates that 1.7 million deaths resulted from tuberculosis in 2006. Therefore it is the most dangerous disease after AIDS.
Brodhun warned: “We better not believe that Germany is not threatened”, as drug-resistant tuberculosis can be imported into Western Europe by migrants or travellers from all over the world.
Last year 5020 new tuberculosis cases were documented in Germany, and almost half of them were migrants. Lots of infected people come from the successor states of the Soviet Union where drug-resistant tuberculosis is wide-spread. The problem is also growing in other states, especially in Africa, where extensively drug-resistant tuberculosis emerged. This kind of tuberculosis cannot be treated with any existing antibiotic. Braker believes: “The problem will expand in the future.”
The disease should have been much better under control by now, but during the last decades almost no research has been conducted. “The newest tuberculosis drugs are older than forty years”, deplores Braker. Tuberculosis is still diagnosed via Robert Koch’s method, the sputum microscopy (the bacterium is proven in the secretion). Unfortunately, this method does not identify infected people in a large part. There is also no effective vaccine. “The drug industry has not supported further research as tuberculosis has seemed to be no problem any more in wealthy industrial countries”, says Braker.
Only after extensively drug-resistant tuberculosis had emerged, new research activities have started. According to the latest study of “Doctors Without Borders” the research spending in Germany is still insufficient and so will not prevent the death of an increasing number of patients. It is sad to say that therefore tuberculosis cannot be forgotten for a long time yet.