Our Infected Land

There is an alarming increase in infectious diseases in America, fueled in part by the easy flow of food and people around the world, newly appointed Surgeon General David Satcher warned Tuesday.

The United States death rate from infectious diseases, excluding HIV/ AIDS, rose by 22 percent between 1980 to 1992, Satcher said, because of outbreaks of new diseases, a resurgence of longtime killers such as tuberculosis, and development of antibiotic-resistant strains of other infections.

“Emerging infectious diseases are a continuing threat to the health of U.S. citizens and of people around the world,” Satcher told a congressional hearing. “They cause suffering and death and impose an enormous financial burden on society.”

Infectious diseases are the third-leading cause of death in the United States, Satcher said, and the No. 1 killer worldwide, causing more than 17.3 million deaths in 1997.

An outbreak of a previously unknown strain of influenza, known as the Hong Kong bird flu, raised awareness of infectious diseases around the world last year, and there were several multistate outbreaks of food-borne diseases affecting strawberries, raspberries, apple juice and ground beef in the United States last year.

Satcher said new technologies that allow people and food to travel thousands of miles across the world in a matter of hours helped set the stage for the recent surge of outbreaks.

“Changes in food production have led to new safety concerns,” he said. “Many foods, previously thought to be safe, such as eggs and fruit juice, have both transmitted salmonella in recent outbreaks.”

More resources are needed to permit increased monitoring, more vigorous responses to outbreaks and to train doctors in developing countries, Satcher told a subcommittee of the Senate Labor and Human Resources Committee.

The National Institute of Health has launched a $1.9 million program to provide infectious disease training for scientists in developing countries, where infectious diseases kill two-thirds of all children under the age of 5, Satcher noted.

And he said the Center for Disease Control and Prevention in Atlanta is working with the World Health Organization and others in 15 countries to establish a network for global surveillance and investigation of disease outbreaks.

In a world that has been shrunk by airplanes and e-mail, Sen. Bill Frist, R-Tenn., said America’s overall health is directly linked to the health of the world.

“We can consider no site too remote, no person too removed and no organism too isolated to affect our citizens,” said Frist, who also is a doctor. “Most cities in the United States are within 36 hours of any area of the world - a short time for an infectious disease to reach our shores.”

The number of infectious diseases has grown by more than three dozen since the mid-1970s, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. Some of these new diseases and syndromes include: AIDS, liver disease from hepatitis C, tick-transmitted Lyme disease, Hantavirus, and food-borne illness caused by E. coli.

Satcher said protection from biological terrorism has become increasingly important over the past few years, and that the public health system is working on early-warning detection systems, training medical workers on how to respond and making sure appropriate counter-agents are available.

“It’s really sad that we have to be worried about people using biological weapons, but we do, so we will be prepared,” Satcher said.

But along with new killers, decades-old diseases are also making a comeback in the U.S. and around the world as they mutate and become resistant to drug therapies.

Tuberculosis, which annually kills 3.1 million worldwide, has increased by 7 percent a year from 1980 to 1992 in the U.S., CDC records show. One in 10 cases of tuberculosis are now resistant to at least one of four drugs used to treat the lung-disease.

“We are making efforts worldwide to monitor drug resistance,” said David Brandling-Bennett, deputy director of the Pan American Health Organization. “There is considerable misuse of antibiotics.”

Graphic: Infectious diseases increasing