Public Health: NDM-1 - the new threat that may go global

SARS, H1N1 and other diseases have caused havoc as they have "gone global," at least until something else - like the viral effects of the global financial crisis took over the media's front pages.

Domestically, within the UK - and to a degree the USA MRSA (which some have decided to pronounce as a word - Mersa) has had some publicity. But not too much: home grown diseases are just not as much fun as something that people bring back from abroad.

The National Health Service in the UK is upset: their service is so rubbish - and the cost of private treatment so expensive - that many in the UK elect to travel abroad for medical care.

It's no surpise: in Malaysia, to see the person other doctors say is the leading orthopeadic surgeon is a matter of a phone call and, during a busy period, a wait of perhaps two days. Operation? Two days's notice. Cost of consultation? Excluding medicines, a half-hour consultation costs less than GBP20. Qualifications? FRCS and more. Attitude? "Let's see if we can fix this without cutting you up. If we can get you working until new treatments are proven, there's no need for us to be barbaric." Return visits? Every two to three weeks at similar cost.

According to a report published in the UK today, that's all very well. But there's a very big but. So far, 50 people who went to India or Pakistan for surgery, including elective (cosmetic) surgery, have come back with more than they bargained for.

And what is, of course, worrying the NHS is that the NHS will have to pick up the tab for fixing problems resulting from treatment overseas.

The battleground chosen is a "bug" that is resitant to all known antibiotics. It's called NDM-1 and it's very devious, even by the standards of devious bugs.

First, it's the infection-equivalent of a computer trojan: it hides inside something else e.g. E.Ccoli. Kill the E.coli and the NDM-1 isn't touched - but by that time it has spread into the patient's system.

The infection passes from patient to patient in hospital and so far, says the HNS report, no guaranteed method of killing it has been identified. Reserach is needed, they say.

In the meantime, strains of the infection have been found in the USA, Canada, Australia and The Netherlands. It's feared that it can jump around the world on planes and, once it reaches a critical mass, will spread as quickly as SARS N1H1 and other flu type diseases.

The research is published in The Lancet by researchers at Cardiff University, the Health Protection Agency and others around the world. David Livermore, one of the authors, says that "far and away the greater number of cases appear to be associated with travel and hospital treatment in the Indian subcontinent." He says that the real danger lies if it infects a bacterium that is easily and quickly transmissable.

Some patients have died: but most have suffered mild infection and one suffered a form of blood poisoning. However, what the report did find was a signifant common factor: 17 of the 37 cases had visited India or Pakistan in the year before becoming ill - with visits for cosmetic surgery being the primary reason for the trip.

The paper in The Lancet looks at cases over several years: indicating that this is a real but as yet remote possibility. So the message, despite somewhat hysterical media coverage, particularly by broadcast media in the UK this morning is simple: DON'T PANIC.

(*Douglas Adams wrote The Hitch-Hiker's Guide to the Galaxy. It is a real book but work of fiction.There is no such thing as The Hitch-Hiker's guide to the Galaxy in real life although some would say that Apple's iPad, Amazon's Kindle and similar devices are coming remarkably close in terms of technology if not content. If there was, it would have DON'T PANIC written in large letters on the cover. And if you've never read The Hitch-Hiker's Guide to the Galaxy, get a copy. But make a point of getting one in the original English, not the stream of dismal translations into American where it loses its impact)