Top 10 Infectious Diseases Hot Topics: 2010-2011

John G. Bartlett, MD

Disclosures

January 05, 2011

In This Article

Influenza

Influenza is always a hot topic, but the 2009 pandemic was particularly instructive with respect to this largely preventable disease that claims 3000-49,000 lives in the United States every year. Recent lessons include the following:

  • We learned well, despite a field that is dense with great academicians, that our ability to predict is humbling. For example, the next pandemic was expected to come from Asia where the major surveillance systems are established, to be a new strain (such as H5N1), and to have a high mortality rate. Instead, it came from Mexico, involved the oldest strains (H1N1), and had a low mortality.

  • The long controversy over the relative merits of surgical vs N95 masks was finally resolved in the study by Loeb and colleagues,[20] which showed that surgical masks were as effective as the N95 masks. The CDC changed their guidelines accordingly.

  • Despite the fact that mortality was relatively low compared with other influenza pandemics, the average age of patients who died was only 37 years, making the 2009-2010 season one of the most severe in terms of life-years lost.[21]

  • We learned with great pain the problems associated with an egg-based vaccine supply, technology that is now about 50 years old. The 2009 pandemic flu vaccine experience provided most of the incentive to push forward with cell-based vaccine production with preliminary results that seem promising in terms of speed and effectiveness.[22]

  • Mandatory vaccination of healthcare workers became a major unsettled controversy, pitting the rights of healthcare workers against rights of patients to protection from unnecessary risks. IDSA and the Society for Healthcare Epidemiology of America favored mandatory vaccination, but the CDC stopped short of this. Nevertheless, some systems were successful in increasing the rates of vaccination of healthcare workers from less than 50% to more than 98%.[23,24] It seems likely that more systems will adopt a mandatory vaccination policy, and for good reason.

  • The influenza vaccine recommendations were finally changed to include all persons older than 6 months of age, and obesity was added to the high-risk category.

  • Investigators from Ontario, Canada, demonstrated enormous benefit in health, cost savings, and reduced antibiotic prescriptions by making influenza vaccine free and readily available.[25] Quite incredibly, they showed that this policy seemed to reduce flu-related mortality by 40% and reduce physician visits for flu-like illnesses by 70%!

These observations collectively suggest extraordinary progress in dealing with one of the major health issues that virtually all physicians need to manage in some way.

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