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A team of scientists at Heinrich-Heine Universität Düsseldorf have identified a potential new player in the fight against tuberculosis (TB). Researchers have isolated several compounds with the ability to combat Mycobacterium tuberculosis, the bacteria that causes TB, from a collection of marine sponges indigenous to Indonesia. Initial experiments suggest that resistance to the compounds is possible, but develops slowly. Moving forward, the team will examine how the compounds target and combat TB and how resistance can be averted. A study published in Immunity journal last week answers critical questions in the search for a malaria vaccine. Antibodies alone have proven ineffective in fighting malaria; new research, however, indicates that malaria antibodies enlist proteins in the blood to aid in the immune response. These proteins, known as complements, help coat the malaria organism, which blocks it from infecting red blood cells. Researchers at the Burnet Institute in Melbourne, Australia, hope to work with pharmaceutical companies to develop a vaccine that triggers the necessary response from complement proteins. In an op-ed for the New York Times, Bill Gates, co-chair of the Bill & Melinda Gates Foundation, contended that the world is not prepared to fight a global pandemic. Gates cited the recent Ebola epidemic in West Africa, calling for increased investments in health systems strengthening, disease surveillance, and research and development (R&D) for drugs, vaccines, and diagnostics. Gates also emphasized the need for regulatory policies that expedite R&D in emergency situations.

In this guest post, Beth P. Bell, MD MPH—director of the National Center for Emerging and Zoonotic Infectious Diseases at the US Centers for Disease Control and Prevention (CDC)—discusses the growing problem of antibiotic drug resistance and what we can do to address this challenge. The spread of drug-resistant tuberculosis could undermine advancements in HIV and AIDS prevention. Photo: CDC. I am pleased to have the opportunity to write about what is perhaps today’s most vexing public health challenge—the growing threat of antibiotic resistance. Super-resistant bacteria have become a worldwide crisis. In India, 58,000 babies died in 2013 of an infection with resistant bacteria usually passed on from the mother during childbirth. In Thailand, 38,000 people die each year from “superbug” infections. And the numbers are only slightly better in the European Union, which loses 25,000 people each year, or in the United States, which annually attributes 23,000 deaths and two million illnesses to antibiotic-resistant infections. Currently, global health faces enormous challenges from both well-established epidemics like HIV and AIDS and malaria and new epidemics like Ebola and pandemic influenza. But antibiotic-resistant infections are steadily spreading across the globe and could soon eclipse them all. Unfortunately, this is not an apocalyptic fantasy but a real and growing threat. But the good news is that we can do something about antibiotic resistance and, like most public health problems, the more we collaborate today, the more we mitigate the threat tomorrow. Turning the tide on the “superbugs” requires a coordinated international response from all sectors. It will be especially critical for international non-governmental organizations and global foundations to build and support portfolios of work in this area and to collaborate with the World Health Organization (WHO), CDC, and other international partners to stop this threat. The threat of antibiotic resistance is two-fold: it creates infections that are untreatable, and it undermines the progress that we have made in other areas of public health and healthcare improvement. Not surprisingly, drug-resistant infections result in costlier treatments, extended hospital stays, and higher mortality. They also can dismantle some of our most significant public health achievements. For example, the benefits of antiretroviral therapies, which have saved countless lives of people with HIV and AIDS across the globe, may be negated by the burden of drug-resistant tuberculosis, gonorrhea, and other resistant infections to which people with HIV and AIDS are more vulnerable. Increasing global travel further compounds the problem by making it easy for drug-resistant germs to spread across borders and oceans. The new reality is that all countries, regardless of the sophistication of their medical care, have become vulnerable to these infections. The United States has both imported and exported drug-resistant threats. The first outbreak of carbapenem-resistant Enterobacteriaceae (CRE)—the “nightmare bacteria” that are resistant to most available antibiotics—occurred in New York City. From there, the infection migrated to France by way of an infected US traveler. Another type of CRE known as New Delhi Metallo-beta-lactamase (NDM) was first identified in South Asia, then introduced to other parts of the world, including the United States, by infected travelers. Once established in a new country, these resistant bacteria often become endemic in communities and healthcare environments. Many current NDM infections are in patients with no travel history. Developed countries have been working to define the scope and address antibiotic-resistant threats inside their borders. In many developing countries, the ability to accurately estimate the burden of antibiotic resistance or know what forms of resistance are evolving is even more limited. The CDC is working globally to increase investments in combatting antibiotic-resistance bacteria through bilateral partnerships, such as the Global Health Security Agenda, as well as via multilateral efforts in partnering with WHO. But we need your help. We need your partnership to help us reduce antibiotic resistance around the world. A top priority is ensuring that countries everywhere have sustainable healthcare infrastructures, because the lesson of Ebola is that a vulnerability in one country can become a vulnerability in our country. Now it’s time to join together and focus on how we can help countries strengthen basic capacities and provide the tools they will need to defeat antibiotic resistance. This includes: Laboratory detection of antimicrobial resistance—Countries need medical laboratory infrastructure to diagnose the cause of infections and to identify the best drugs for treatment. We also need to invest in rapid diagnostics to guide appropriate antibiotic use and identify which antibiotics will be effective. We need rapid and easy-to-use diagnostic tests that can distinguish between infections that do or do not require antibiotics. This will reduce unnecessary antibiotic use. National antibiotic resistance tracking programs—Countries need the infrastructure to collect resistance data from hospital laboratories and report these data in national and global surveillance reports. These data are necessary to: Drive appropriate prevention interventions. Develop policies that support prevention efforts. Measure the impact of prevention efforts. Antibiotic stewardship programs—We need to work collaboratively globally to ensure that antibiotics are available to treat infections, while at the same time making certain that antibiotic use is appropriate to limit the development of new forms of resistance. Infection control programs—Improving hygiene and infection control practices in healthcare settings is critical for preventing the transmission of antibiotic-resistant pathogens between patients and between hospitals, and the benefits extend to other global infectious disease threats such as Ebola, Middle East Respiratory Syndrome (MERS), and emerging infectious diseases. Healthcare environments and poor infection control are major drivers of antibiotic resistance. Technologies that improve infection control have the potential to significantly reduce infection rates. This is especially important in low resource environments—how to best support hand washing where there is a lack of clean water and how to best deploy rapid diagnostics that can work, like dipsticks and other technologies that don’t require electricity.

Scientists at Karolinska Institutet in Sweden have identified the protein that explains why people with blood type O are protected from coma and death resulting from severe cases of malaria. Plasmodium falciparum, the parasite responsible for nearly all fatal cases of malaria, releases the RIFIN protein, which causes red blood cells to stick to one another and restrict blood flow, resulting in tissue damage and death. The study, published last week, establishes that the RIFIN protein insufficiently attaches to type O blood cells, despite its strong adherence to type A blood cells. This results in different health outcomes for those with type O blood, as they avoid the severe effects of the parasite. An article in Al Jazeera explored the history of Ebola vaccine research and development (R&D) and the barriers to conducting clinical trials in Sierra Leone today. While Ebola vaccine research began more than ten years ago, multiple promising vaccine candidates have remained in limbo due to a paucity of funding. Last fall, the US government partnered with pharmaceutical companies to expedite the R&D of experimental Ebola vaccines in light of the epidemic in West Africa. The US Centers for Disease Control and Prevention (CDC) and pharmaceutical company Merck & Co. are preparing for clinical trials in Sierra Leone involving 6,000-8,000 health workers. Health workers have expressed concern regarding the safety of the vaccine, and outreach to health workers and potential participants—which the CDC plans to conduct a few weeks prior to the start of the trial—may present a greater challenge than originally anticipated. A new diagnostic device, called the Microlife Vital Signs Alert, could save up to 70,000 mothers each year by alerting health care workers when a woman is at risk of going into shock due to blood loss during childbirth, or if her blood pressure is dangerously high. The device, which only costs US $20, is easy to use and interpret, enabling health care workers—regardless of education and training—to identify when a woman needs to be taken to a hospital with a simple red light.