Bugs and Outbreaks That Scared Us in 2014

At the end of every year, some of us tally – in a retrospective – the most remarkable epidemics, newly recognized pathogens or resistance issues that occupied the headlines in the past 12 months.  Here a sneak preview what you are likely to see in the coming December issue of your favorite ID Journal or Medscape.

Unquestionably, 2014 will go down as the year of the largest Ebola epidemic ever on the African continent.  This outbreak showed the remarkable ability of a pathogen which should be easy to reign in but isn’t:  because initial symptoms are so non-descript, isolation measures often come too late.  The scarce medical resources and inadequate medical facilities of a third world country are no match for this virus.  The transmission of infection to HCW shows the logistical difficulties even for personnel that is well trained and aware of the risk.

Here is my admittedly subjective list of Top 10 news-making events (Sept ’13 – Sept ’14); please give me your thoughts on what else you would include and how you would have ranked it:

1. Ebola
   Still not under control, with more than 2000 deaths by last count and spreading to more countries.  It has rekindled efforts to expedite drug development.  There is now regulatory acceptance of risk allowing treatment with experimental drugs whose efficacy data in humans are sparse.
2. MERS
   The Hajj pilgrimage seems like a set-up for disease transmission.  In the past, we were more concerned about meningococcal disease but MERS with its high mortality proved to be as much of a threat.
3. Chikungunya
   A new arrival in the US (Florida and Gulf Coast), with presentation similar to Dengue but less severe.  It is transmitted by the same vector, Aedes mosquitos.
4. New Polio and Polio-like cases
   Just as we are about to eradicate the virus in the last few pockets of the world, we learn that new cases were again reported in Pakistan, Iraq, and Syria.  Then there is news about a new strain that emerged in California which is not covered by the current vaccines.
5. Measles
   Overreliance on herd protection and the discussion about the safety of existing vaccines has led to underuse, with the sad result of re-emergent measles.  By mid-2014, more cases have been reported in the US than in any year since 2000.
6. KPC
   “Superbug kills 16 in Manchester hospital” was the headline in The Guardian [1]. It could happen not just in the UK – the recent outbreak the NIH Bethesda Hospital was a nightmare to deal with.  So far, cases in the US are rare but the trend line points upward.
7. HEV / Human Enterovirus D68
   Enteroviruses generally  behave in a benign fashion, but sometimes they don’t:  This HEV can cause severe respiratory disease.  It has spread to several states in the US and some patients needed ICU care.  There was appreciable mortality.
8. Mumps
   A remarkable outbreak starting in Ohio, with cases also reported from NYC and New Jersey. In Ohio, approx. 500 people were infected.  Overall, a benign and largely vaccine-preventable disease.
9. Heartland virus
   How many more tick-related diseases are there to remember? It presents as leukopenia and thrombopenia.  Transmitted by the Lone Star tick (Amblyomma), it will certainly show up in ID Board exams.
10. Avian Influenza
    A constant threat

There are a few more pathogens that emerged this year and could arguably be included.  We keep Rift Valley Fever, West Nile Virus, Dengue (an old friend making further inroads), and Hantavirus on the Watch List for now.

Mycobacterium canettii is another interesting newcomer: The “smooth, glossy” colonies and faster growth in culture differentiate his pathogen from MTB with which it shares many clinical features.  Cases with lymphadenopathy and pulmonary involvement have been reported from South Africa.

References:

[1] http://www.theguardian.com/science/2014/mar/07/superbug-kills-16-manchester-hospitals