Thursday, January 09, 2014

NDM-1 the "Nightmare Scenario": The Ignored Pandemic Threat

This might well be the biggest public health concern since H.I.V, perhaps even dwarfing it.

We have all heard of superbug outbreaks in hospitals. Until a few years ago, antibiotic resistant infections were mostly confined to healthcare facilities such as hospitals. These outbreaks have, sadly, killed many hundreds of people, in Canada, however, they have been contained within these very tiny hospital patient population groups.

NDM-1 is changing all that. NDM-1 isn't a bacteria or a virus, it is a non-living enzyme containing genes. Bacteria with the NDM-1 gene produce NDM-1 enzymes containing genetic material that can spread this antibiotic resistance gene to non-resistant bacteria, bacteria which are easily treated with antibiotics, thereby passing on the ability.

More well know resistant bacteria spread vertically. Patient zero will infect a few others who, in turn, infect yet others. Outbreaks are handled by isolating and treating infected people so person to person transmission is halted.

NDM-1 bacteria can spread horizontally, too. They produce copies of the resistance gene in the NDM-1 enzyme, in a form which passes the gene and its ability to other treatable, non-resistant bacteria. Even more frightening, this enzyme has been shown to pass the gene between different strains of bacteria. 

So what does this mean? Bacteria, having this resistance gene, have been found in otherwise normal gut bacteria in people showing no symptoms. Since these are normal good gut bacteria, they continue on as part of normal GI function as they aide healthy digestion. The only difference with these gut superbugs is they now produce the NDM-1 enzyme. Any location in which there may be fecal matter contamination could also be contaminated with the enzyme which passes on the resistance ability.


Also, it is possible that treatable non-resistant bacteria present in an active infection, which is open to further contamination, could be supercharged simply by coming into contact with the NDM-1 enzyme. Contact with living bacteria isn't required.

P.B.S. Frontline has a good episode about the NDM-1 threat. The two really important points this documentary makes are these: Drug companies seem to have dropped all research on new antibiotic medications--the most effective antibiotic was developed in the 40s and is highly toxic. The Centres for Disease Control, in the U.S., have used the phrase, "nightmare scenario", in describing the public health risk, yet there is no American federal government policy to prepare for it or even coordinate disparate resources and research.

So, what does this mean for Canada? Are we prepared? Are policy makers even thinking about the issue? 


If policy makers have created a plan to address the public health threat NDM-1 poses, they certainly aren't telling anyone publicly. I searched all websites, using Google, for articles containing NDM-1, from the last three years or so, and there were only three results. Two of them contained overviews and addressed infection control in the greatly limited scope of health care facility infection control. The third provides information on a few basic research initiatives sponsored by government.

While basic research is extremely important and the federal government deserves credit for funding research, which has been orphaned by the pharmaceutical industry, to look for new drug treatments, any new medication is likely five to ten years away, at a minimum.

There seems to be no effort to plan for any outbreak in the environment at large. If one should occur, it will likely dwarf outbreaks such as H1N1 and S.A.R.S. This is because there are many different pathways of infection due to the range of bacterial strains which can be augmented by the NDM-1 enzyme. The following are just a few: e.coli (food poisoning with risk of kidney failure), k.pneumoniae (pneumonia), and acinetobacter (the second most common normal and healthy skin microbe, can cause post surgical infections and perhaps infections in open wounds such as serious cuts.)

Since there are so many different illnesses which can be caused by so many different bacteria, it is conceivable that a general outbreak in a community at large could swamp many different departments, within a given hospital, simultaneously.

This issue desperately needs multifaceted attention from both the federal and provincial government now.

For more information on the NDM-1 threat, Wikipedia has a great article: