Because the Chinese are not vegetarians and they don't worship dumb animals as their gods?
Here's What's Causing India's 'Superbug' Problem
It's not as simple as reducing the nation's massive antibiotic consumption.
Hindustan Times via Getty Images
Last August, a Nevada woman in her 70s was hospitalized after returning from an extended trip to India. She was infected with multidrug-resistant
Klebsiella pneumoniae — what doctors call a “
nightmare superbug” — that showed immunity from 26 antibiotics. She died in September from multiple organ failure and
sepsis.
Superbugs — the term unofficially refers to bacterial and fungal infections resistant to various antibiotics ― are a growing health problem worldwide. The World Health Organization warned in 2015 of an approaching “
post-antibiotic” era. Current estimates are that drug-resistant infections annually kill about
700,000 peoplearound the world — a figure that could reach
10 million by 2050.
“It’s just a fact of evolution — the more antibiotics that are around, the more bacteria has been exposed to antibiotics, the more opportunity they have to acquire these resistances,” Sarah Fortune, a professor of immunology and infectious diseases at Harvard University, said. “And, we’ve been living with antibiotics for 60 years now and bacteria has had plenty of time to develop their defenses.”
India is a
notorious hotbed for antibiotic resistance. According to a study on antimicrobial resistance published last year,
60,000 newborn lives are claimed each year in the country by antibiotic-resistant infections.
Another
2016 study examining the evolution of resistant microbes in India found that the over-prescribing and unregulated use of antibiotics, antibiotic use in agriculture and for livestock, and a lack of regulation of the discharge of antimicrobial waste into the environment all contribute to the superbug problem.
These factors exist in other countries, Barun Mathema, an assistant professor in epidemiology at New York’s Columbia University and an expert in infectious diseases, told HuffPost. Superbugs exist across the globe; it’s a problem rearing its ugly head in
China, South Africa,
Australia and even in
U.S. hospitals.
Even so, India is considered the global breeding ground for the problem. What makes India’s situation unlike other developing nations, says Mathema, is the “extent and degree” of the factors that fuel superbugs.
According to the 2016 study, “antibiotic use is a major driver” of the development of diseases that become resistant to the drugs. Indeed, in 2010 India consumed
more antibiotics for human health per person than any other country. What’s more, the nation’s intake spiked by 62 percent from 2001 to 2010.
Such consumption is spurred by overprescription and overuse. Previous
researchfound that antibiotics are prescribed and sold in certain parts of India for conditions ― such as
diarrhea and upper respiratory infections caused by viruses ― that don’t require them. There’s also conflict of interest:
one study found doctors are compensated by pharmaceutical companies and pharmacists for prescribing antibiotics.
Recently, the Indian Council of Medical Research (ICMR) issued
guidelines for antibiotic stewardship, which include advising hospitals on how to administer treatment that best suits the patient’s needs. Kamini Walia, a senior scientist at ICMR, told HuffPost there’s growing interest in the voluntary guidelines.
Informing the public is also important.
“The culture in India, in some parts of the U.S. and many countries around the globe is to lean on antibiotics for most illnesses, even if there is a low chance they are due to bacteria at all,”
Kavita Trivedi, adjunct clinical assistant professor of medicine at California’s Stanford University, told HuffPost. “We must educate the public about when it is appropriate to demand antibiotics because if we don’t, the burden is solely on the prescribers.”
Prescriptions contribute to overuse, but so does the over-the-counter availability of many antibiotics until recently. For example, India has had one of the highest over-the-counter sales of carbapenems, an antibiotic used to treat multidrug-resistant bacteria.
In 2014, the government re-categorized many antibiotics, including carbapenems, to make them prescription-only. But implementation of the regulation remains murky. According to Walia, antibiotics are still obtainable over the counter to serve those who do not have access to doctors. Previous
research found poor access to affordable and effective antibiotics kills more children in India than drug-resistant infectons.
“The per capita consumption of antibiotics is high but uneven,” Ramanan Laxminarayan, the New Delhi-based director of the Center for Disease Dynamics, Economics & Policy and lead author of the
2016 study of India’s superbug problem, told HuffPost. “There are many that are dying in rural areas because of lack of access to antibiotics while others in urban settings are using them indiscriminately. There is a serious inequity issue here.”
Other factors come into play. A
2013 study found “waste water treatment plants serving antibiotic manufacturing facilities” to be responsible for transferring resistance genes. Laxminarayan, who calls India an “epicenter” of superbugs, said that with India being is one of the world’s largest manufacturers, the levels of reported antibiotic pollution are “appalling.”
Walia said there is also a “huge amount” of antibiotic use in animals in India. Laxminarayan said mixing antibiotics with animal feed is a practice that should be stopped immediately.
Jean Patel, the science team lead for the Antimicrobial Resistance Coordination & Strategy Unit at the U.S. Centers for Disease Control, said “stopping even some of the inappropriate and unnecessary use of antibiotics in people and animals would help greatly in slowing down the spread of resistant bacteria.”
Patel added that concern is growing “about travelers who might be become infected with resistant bacteria as a result of receiving health care abroad or in areas of the United States where resistant bacteria might be more prevalent.”
With antibiotic resistance popping up in many nations, India is in a unique position: according to Laxminarayan, its battle with superbugs provides the opportunity for the nation to be “on the forefront of addressing [antimicrobial resistance] and setting up an example for other countries.”
And given that India’s problem doesn’t stay within its borders ― as illustrated by the Nevada woman’s death ― the nation’s superbug issue is a global public health challenge.
“In this day and age, any country’s problem is another country’s problem too,” Mathema said.
Superbug From India Spread Far and Fast, Study Finds
Researchers find a gene first discovered in bacteria from India 8,000 miles away in the Arctic, raising fears about the global reach of antibiotic-resistant bugs
Brianna Abbott
Jan. 27, 2019 7:00 p.m. ET
An antibiotic-resistant gene originally discovered in bacteria from India was found 8,000 miles away in a remote Arctic environment, according to a new study. Researchers believe the gene, found in bacteria in the soil of a Norwegian archipelago, made the trek in less than three years, highlighting the speed with which antibiotic resistance can spread on a global scale.
Antibiotic resistance is a persistent and growing global health concern. At least 700,000 people die globally each year from antibiotic-resistant infections, according to a 2014 report from the British government. As some bacteria have evolved to fight off even last-resort treatments, that number is on track to increase as much as 10-fold in the coming decades, according to the report.
These
so-called superbugs have spread through hospitals and health-care facilities due to overuse of antibiotics in medicine and in farming. But they also crop up throughout the environment via water and food, carried in the guts of animals or humans, researchers say. Resistance without human intervention continuously occurs as bacteria evolve genes to compete with each other—a process millions of years older than humans. All of these factors make it difficult for scientists to track exactly how some antibiotic-resistant genes emerge and proliferate.
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“We’re trying to understand these other factors that come into play,” said David Graham, an ecosystems engineer at Newcastle University in the U.K. and lead researcher on the study. “If we don’t know the pathways, we can’t come up with the right solutions.”
Dr. Graham and his team collected soil samples from eight locations in Svalbard, a Norwegian island chain in the Arctic Ocean. The team chose an isolated area with minimal human impact to discount human antibiotic use. The team then analyzed the DNA from the bacteria and other organisms in the dirt.
“The arctic is a perfect microcosm for studying pathways,” said Clare McCann, an environmental engineer at Newcastle University in the U.K. and first author on the study. “You can very quickly and easily discount any human use there.”
Researchers found 131 genes linked to antibiotic resistance. That level of genetic diversity isn’t unusual, says Dr. Graham, though two genes and their high abundance caught the team’s attention. The gene called pncA creates
resistance to the tuberculosis drug pyrazinamide. The other gene produces the notorious “superbug” protein NDM-1.
The findings were published Sunday in the journal Environment International.
New Delhi metallo-beta-lactamase-1, or NDM-1, makes some
certain gut bacteria resistant to the last-resort group of antibiotics known as carbapenems. Since its discovery in 2008, NDM-1 has spread to over more than 100 countries, including the U.S. “This is a gene that’s causing havoc in hospitals,” said Gerry Wright, the director of the Institute for Infectious Disease Research at McMaster University in Canada, who wasn’t involved with the study.
Researchers were analyzing samples that had been collected in 2013. NDM-1 emerged in Indian groundwater in 2010, so researchers believe that the gene made the 8,000-mile journey to the Arctic in just three years. “This gene has spread around the world so incredibly fast,” said Dr. Wright. “It’s something that’s not surprising to me, but it should be frightening to everybody.”