Revenge of the Microbes

 

THE 20th century has seen marvelous advances in medical science. For thousands of years, humans have been virtually helpless against the scourge of deadly microbes. But things began to change in the mid-1930’s when scientists discovered sulfanilamide, the first substance that could defeat bacteria without seriously harming the infected person.

In the years that followed, scientists developed powerful new drugs to fight infectious diseases—chloroquine to attack malaria and antibiotics to subdue pneumonia, scarlet fever, and tuberculosis. By 1965 more than 25,000 different antibiotic products had been developed. Many scientists concluded that bacterial diseases were no longer of great concern or research interest. After all, why study diseases that would soon no longer exist?

In the world’s developed countries, new vaccines dramatically decreased the toll of measles, mumps, and German measles. A mass polio vaccination campaign, launched in 1955, was so successful that cases of the disease in Western Europe and North America plummeted from 76,000 in that year to fewer than 1,000 in 1967. Smallpox, a major killer disease, was eradicated worldwide.

This century has also seen the invention of the electron microscope, a device so powerful that it enables scientists to see viruses that are a million times smaller than a man’s fingernail. Such microscopes, along with other technological advances, have made it possible to understand and fight infectious diseases as never before.

Victory Seemed Assured

In the wake of these discoveries, the medical community was full of confidence. The microbes of infectious disease were falling to the weapons of modern medicine. Surely the victory of science over microbe would be swift, decisive, complete! If a cure for a specific disease was not already available, it soon would be.

As early as 1948, U.S. secretary of state George C. Marshall boasted that the conquest of all infectious diseases was imminent. Three years later, the World Health Organization (WHO) asserted that Asian malaria could soon be a disease “no longer of major importance.” By the mid-1960’s, the belief that the era of plague and pestilence had passed was so widespread that U.S. surgeon general William H. Stewart told health officers it was time to close the book on infectious diseases.

Old Diseases Return

However, the book on infectious diseases was in no way ready to be closed. Microbes did not vanish from the planet just because science had invented drugs and vaccines. Far from being defeated, well-known killer microbes returned with a vengeance! In addition, other deadly microbes surfaced—microbes previously unknown to doctors. Thus, microbes both old and new are on the rampage, threatening, afflicting, or killing countless millions of people worldwide.

Killer diseases once thought to be under control have surfaced again, more deadly than ever and more difficult to treat with drugs. One example is tuberculosis (TB). WHO stated recently: “Since 1944, TB drugs have been put to extensive use in Japan, North America and Europe to dramatically reduce TB cases and deaths. However, TB control efforts in less developed countries have been neglected, . . . enabling the disease to return to wealthy countries in more dangerous, multidrug-resistant forms.” Today TB, usually caused by airborne bacteria that lodge in the lungs, kills about three million people every year—over 7,000 per day. By the year 2005, the death toll could soar to four million each year.

Other old-time killers are also on the rise. Cholera is now endemic in many parts of Africa, Asia, and Latin America; it afflicts and kills increasing numbers of people. An entirely new strain has emerged in Asia.

Dengue, spread by the Aëdes aegypti mosquito, is also rapidly on the rise; it now threatens 2.5 billion people in over 100 countries worldwide. Since the 1950’s, a deadly new hemorrhagic form of the disease has emerged and spread throughout the Tropics. It is estimated that it kills about 20,000 people each year. As with most viral diseases, there is no vaccine to protect against the disease and no drug to cure it.

Malaria, which science had once hoped to eradicate, now kills about two million people each year. Both the malaria parasites and the mosquitoes that carry them have become increasingly difficult to kill.

Devastating New Diseases

Perhaps the best known of the new diseases that have recently arisen to plague humankind is deadly AIDS. This incurable disease is caused by a virus unknown only a dozen or so years ago. Yet, by late 1994 the number of people worldwide who were infected with the virus was between 13 and 15 million.

Other previously unrecognized infectious diseases include hantavirus pulmonary syndrome. Transmitted by field mice, it appeared in the southwestern United States and proved fatal in more than half the reported cases. Two types of hemorrhagic fevers—both new, both fatal—have developed in South America. Other dreadful diseases have also arisen—viruses bearing strange, exotic names—Lassa, Rift Valley, Oropouche, Rocio, Q. Guanarito, VEE, monkeypox, Chikungunya, Mokola, Duvenhage, LeDantec, the Kyasanur Forest brain virus, the Semliki Forest agent, Crimean-Congo, O’nyongnyong, Sindbis, Marburg, Ebola.

Why Are New Diseases Emerging?

With all the knowledge and assets possessed by modern medical science, why are killer microbes proving so difficult to defeat? One reason is the increased mobility of today’s society. Modern transportation can quickly make a local epidemic global. Jet travel makes it easy for a deadly disease to move, harbored inside an infected person, from one part of the world to any other part of the world within hours.

A second reason, which favors the microbe, is the explosive growth of the world’s population—especially in cities. Of course, garbage is produced in cities. Garbage contains plastic containers and tires filled with fresh rainwater. In the Tropics, that results in the multiplication of mosquitoes that are carriers of killer diseases such as malaria, yellow fever, and dengue. In addition, just as a thick forest can fuel a fire, so high-density population provides ideal conditions for the rapid spread of tuberculosis, influenza, and other airborne diseases.

A third reason for the return of the microbe has to do with changes in human behavior. Microbes that are transmitted sexually have flourished and spread as a result of the unprecedented scale of multiple partner sex relations, which have characterized the latter part of the 20th century. The spread of AIDS is just one example.

A fourth reason why killer microbes are proving so difficult to defeat is that man has invaded the jungles and rain forests. Author Richard Preston states in his book The Hot Zone: “The emergence of AIDS, Ebola, and any number of other rain-forest agents appears to be a natural consequence of the ruin of the tropical biosphere. The emerging viruses are surfacing from ecologically damaged parts of the earth. Many of them come from the tattered edges of tropical rain forest . . . The tropical rain forests are the deep reservoirs of life on the planet, containing most of the world’s plant and animal species. The rain forests are also its largest reservoirs of viruses, since all living things carry viruses.”

Humans have thus come into closer contact with insects and warm-blooded animals in which viruses harmlessly reside, reproduce, and die. But when a virus “jumps” from animal to human, the virus may become deadly.

The Limitations of Medical Science

Other reasons why infectious diseases are making a comeback relate to medical science itself. Many bacteria now defy antibiotics that once killed them. Ironically, antibiotics themselves have helped to create this situation. For example, if an antibiotic kills only 99 percent of the harmful bacteria in an infected person, the surviving one percent that resisted the antibiotic can now grow and multiply like a superstrain of weeds in a newly plowed field.

Patients aggravate the problem when they do not finish a course of antibiotics prescribed by their doctor. Patients may stop taking tablets as soon as they begin to feel better. While the weakest microbes may have been killed, the strongest survive and quietly multiply. Within a few weeks, the disease reoccurs, but this time it is harder, or impossible, to cure with drugs. When these drug-resistant strains of microbes invade other people, a serious public-health problem results.

Experts at WHO stated recently: “Resistance [to antibiotics and other antimicrobial agents] is epidemic in many countries and multi-drug resistance leaves doctors with virtually no room for manoeuvre in the treatment of an increasing number of diseases. In hospitals alone, an estimated one million bacterial infections are occurring worldwide every day, and most of these are drug-resistant.”

Blood transfusions, used increasingly since the second world war, have also helped to spread infectious diseases. Despite the efforts of science to keep blood free of deadly microbes, blood transfusions have contributed significantly to the spread of hepatitis, cytomegalovirus, antibiotic-resistant bacteria, malaria, yellow fever, Chagas’ disease, AIDS, and many other dreadful diseases.

State of Things Today

While medical science has witnessed an explosion of knowledge during this century, there remain many mysteries. C. J. Peters studies dangerous microbes at the Centers for Disease Control, America’s foremost public-health laboratory. In an interview in May 1995, he said concerning Ebola: “We don’t know why it’s so virulent for man, and we don’t know what it’s doing [or] where it is, when it’s not causing these epidemics. We can’t find it. There’s no other virus family . . . that we have such a profound ignorance about.”

Even when effective medical knowledge, drugs, and vaccines exist to fight disease, applying them to those in need requires money. Millions live in poverty. WHO’s World Health Report 1995 states: “Poverty is the main reason why babies are not vaccinated, why clean water and sanitation are not provided, why curative drugs and other treatments are unavailable . . . Every year in the developing world 12.2 million children under 5 years die, most of them from causes which could be prevented for just a few US cents per child. They die largely because of world indifference, but most of all they die because they are poor.”

By 1995, infectious diseases and parasites were the world’s biggest killers, snuffing out the lives of 16.4 million people each year. Sadly, countless millions of people live in conditions that are ideal for the emergence and spread of deadly microbes. Consider the lamentable situation today. Over a billion people exist in extreme poverty. Half the world’s population lack regular access to medical treatment and essential drugs. On the streets of polluted megacities wander millions of abandoned children, many of whom inject drugs and practice prostitution. Millions of refugees languish in unhygienic camps amid cholera, dysentery, and other diseases.

In the war between man and microbe, conditions have increasingly favored the microbe.

[Footnotes]

Sulfanilamide is a crystalline compound from which sulfa drugs are made in the laboratory. Sulfa drugs can inhibit bacterial growth, allowing the body’s own defense mechanisms to kill the bacteria.

Other examples of sexually transmitted diseases: Worldwide there are some 236 million people infected with trichomoniasis and about 162 million people with chlamydial infections. Each year there are approximately 32 million new cases of genital warts, 78 million of gonorrhea, 21 million of genital herpes, 19 million of syphilis, and 9 million of chancroid.

[Blurb on page 6]

“In hospitals alone, an estimated one million bacterial infections are occurring worldwide every day, and most of these are drug- resistant.” World Health Organization

[Box on page 7]

When Microbes Fight Back

A small microbe known as a bacterium “weighs as little as 0.00000000001 gram. A blue whale weighs about 100,000,000 grams. Yet a bacterium can kill a whale.”—Bernard Dixon, 1994.

Among the most feared bacteria found in hospitals are drug-resistant strains of Staphylococcus aureus. These strains afflict the sick and the weak, causing deadly blood infections, pneumonia, and toxic shock. According to one count, staph kills about 60,000 people in the United States each year—more than those who die in car accidents. Over the years, these strains of bacteria have become so resistant to antibiotics that by 1988 there was only one antibiotic effective against them, the drug vancomycin. Soon, however, reports of vancomycin-resistant strains began to surface from around the world.

Yet, even when antibiotics do the job they’re supposed to do, other problems may arise. In mid-1993, Joan Ray went to a hospital in the United States for a routine operation. She expected to be home in just a few days. Instead, she had to remain in the hospital for 322 days, primarily because of infections she developed after surgery. Doctors fought the infections with heavy doses of antibiotics, including vancomycin, but the microbes fought back. Joan says: “I couldn’t use my hands. I couldn’t use my feet. . . . I couldn’t even pick up a book to read it.”

Doctors struggled to find out why Joan was still sick after months of antibiotic treatment. Laboratory work showed that in addition to staph infection, Joan had another kind of bacteria in her system—vancomycin-resistant enterococcus. As the name suggests, this bacteria was unharmed by vancomycin; it also seemed to be immune to every other antibiotic.

Then doctors learned something that flabbergasted them. The bacteria not only resisted the drugs that should have killed it but, contrary to what they expected, it actually used vancomycin to survive! Joan’s doctor, an infectious-disease specialist, said: “[The bacteria] need that vancomycin in order to multiply, and if they don’t have that they won’t grow. So, in a sense, they’re using the vancomycin as food.”

When the doctors stopped giving Joan vancomycin, the bacteria died, and Joan got better.

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Sickle-Cell Anemia—Knowledge Is the Best Defense

BY AWAKE! CORRESPONDENT IN NIGERIA

THERE were 32 people in the conference room, mostly women and children. Six-year-old Tope, frail, dressed in pink, sat quietly beside her mother, on a wooden chair. She listened as the nurse spoke to them about what to do when the pain comes.

Tope knew about pain—pain that comes terribly and suddenly and lasts for days before it subsides. Perhaps it was the pain that made her serious beyond her years.

“She is my firstborn,” said her mother. “From the beginning she was always sick. I went to many churches, and they prayed over her. But she still got sick. Finally, I took her to the hospital. They tested her blood and found she was a ‘sickler.’”

What Is It?

At the Center for Sickle-Cell Anemia in Benin City, Nigeria, Tope’s mother learned that sickle-cell anemia is a disorder of the blood. Contrary to superstitious beliefs, it has nothing to do with witchcraft or spirits of the dead. Children inherit sickle-cell anemia from both parents. It is not contagious. There is no way you can catch the disorder from another person. Either you are born with it or you are not. Tope’s mother also learned that while there is no cure, the symptoms can be treated.

Sickle-cell anemia occurs mostly in those of African descent. Dr. I. U. Omoike, director of the Center for Sickle-Cell Anemia, told Awake!: “Nigeria has the largest black population of any nation and therefore has the largest number of sicklers of any nation. That makes this country the sickle-cell capital of the world.” According to the Daily Times of Lagos, about one million Nigerians have sickle-cell anemia, and 60,000 die of it each year.

A Problem in the Blood

To understand the disorder, we need to know what blood does and how it moves through the body. An illustration helps. Imagine a country that depends on imported food to feed people living in rural villages. Trucks drive to the capital city where they are loaded with food. They leave the city along major highways, but as they enter the rural areas, the roads narrow.

If everything goes well, the trucks reach their destination, drop off their food, and then return to the city to collect more food for the next delivery. If many of the trucks break down, however, the food spoils and other trucks are blocked from passing. Then the people in the villages have little to eat.

In like manner, the red cells in the blood travel to the lungs where they pick up a supply of oxygen—food for the body. They then leave the lungs and travel swiftly through major arteries to all parts of the body. Eventually, the “roads” become so small that the red cells can move only in single file through tiny blood vessels. It is there that they deposit their load of oxygen, which feeds the cells of the body.

A normal red blood cell is round like a coin and moves through the smallest blood vessels quite easily. But in people who have sickle-cell anemia, the blood cells break down. They lose their round shape and take the form of a banana or a sickle—a farmer’s implement. These sickled blood cells get stuck in the small veins of the body, like a truck in the mud, blocking other red blood cells from passing. When the flow of blood to a part of the body is reduced, the oxygen supply is cut off and the result is a painful crisis.

A typical sickle-cell crisis results in excruciating pain in bones and joints. Crises are unpredictable; they can occur rarely or as often as every month. When they do occur, they are distressing to both child and parent. Ihunde is a nurse who works at the sickle-cell center. “It is not easy to manage a sickler child,” she says. “I know, because my daughter has the disorder. The pain comes suddenly. She screams and cries, and I cry. Only after two or three days, maybe after a week, will the pain subside.”

Symptoms

Symptoms often appear after the child reaches the age of six months. One of the first signs is painful swelling of the hands or the feet or both. The child may cry frequently and not eat much. The whites of the eyes may appear yellow. The tongue, lips, and palms may be paler than normal. Children showing these symptoms should be taken to a hospital, where a blood test can show if the problem is sickle-cell anemia.

When sickled cells clog blood vessels, pain most commonly affects the joints. A severe crisis can also disrupt the work of the brain, the lungs, the heart, the kidneys, and the spleen—sometimes with fatal consequences. Leg ulcers in the ankle region may persist for years. Children risk seizures or strokes. Those with sickle-cell anemia are especially prone to infectious diseases, since the disorder weakens natural defenses. Infection is a common cause of death.

Of course, not everyone with sickle-cell anemia develops all these symptoms. And some do not experience problems until they reach their late teens.

Treatment

Many parents have wasted both time and money pursuing treatments that promised a cure for their children. But presently there is no cure for sickle-cell anemia; it is a lifelong disorder. There are, however, simple things that can be done to minimize the frequency of crises, and there are ways to deal with them when they happen.

When a crisis occurs, parents should give their child plenty of water to drink. They can also give a mild pain-relieving drug. Severe pain may require stronger drugs that can be obtained only from a doctor. Sadly, though, sometimes even powerful drugs bring little relief. There is no need to panic, however. In almost all cases, after a few hours or days, the pain subsides and the patient recovers.

Scientists are searching for drugs to help treat the disorder. Early in 1995, for example, the National Heart, Lung, and Blood Institute in the United States announced that the drug hydroxyurea reduced by half the frequency of painful crises in sickle-cell patients. It is thought to do this by preventing red blood cells from changing their shape and clogging the blood vessels.

Such drugs are not readily available everywhere, nor are they helpful in every situation. And despite the well-known dangers, doctors in Africa and elsewhere regularly administer blood transfusions to treat sickle-cell patients in emergency situations.

Prevention of Crises

“We tell patients to drink plenty of water to help prevent crises,” says Alumona, a genetic counselor at the sickle-cell center. “Water makes it easier for blood to flow in the vessels of the body. Adults with sickle-cell anemia should drink three to four quarts of water every day. Children, of course, will drink less. We teach children with sickle-cell anemia to carry water bottles to school. Teachers should understand that these children may more often ask to be excused to relieve themselves. Parents should know that these children might wet their beds more often than those who do not have the disorder.”

Since illness can cause a dangerous crisis, those with sickle-cell anemia need to work hard to maintain good health. They can do this by maintaining personal cleanliness, by avoiding prolonged strenuous activity, and by eating a balanced diet of good food. Doctors also recommend that the diet be reinforced by multivitamins and folic acid.

In areas where malaria is common, those with sickle-cell anemia are wise to protect themselves, both by avoiding mosquito bites and by taking drugs to protect against the disease. Since malaria destroys red blood cells, it can be particularly dangerous to a person with sickle-cell anemia.

Those with sickle-cell anemia should also have regular medical checkups. Any infections, illnesses, or injuries should receive prompt medical attention. By carefully following such guidelines, it is possible for many with sickle-cell anemia to live normal, happy lives.

How It Is Passed On to Children

To understand how the disease is passed on from parents to their children, we need to know about blood genotypes. A blood genotype is different from a blood group; a genotype has to do with the genes. Most people have a blood genotype called AA. Those who inherit an A gene from one parent and an S gene from the other parent have an AS blood genotype. People with AS blood do not have sickle-cell anemia, but they can pass the disorder on to their offspring. People who inherit an S gene from one parent and another S gene from the other parent have an SS blood genotype, the genotype of sickle-cell anemia.

Thus, for a child to inherit SS-type blood, he or she must inherit the defective S gene from each parent. Just as it takes two people to have a baby, it takes two people to pass on sickle-cell anemia. Usually, the disorder is passed on when both parents have AS-type blood. When a person with AS-type blood marries another person with AS-type blood, there is a 1 in 4 chance that any child born to them will have SS-type blood.

This does not mean that if they have four children, one will have sickle-cell anemia and the other three will not. While it might be that one of the four is SS, it could also happen that two, three, or even all four of them are SS. It could also happen that none of the children are SS.

Informed Decisions Before Marriage

People of African descent are wise to find out what their blood genotype is long before they consider marriage. This can be done by a blood test. People who have AA blood can be assured that none of their children will develop sickle-cell anemia, no matter whom they marry. Those who have AS blood should understand that if they marry a person who also has AS blood, they run a high risk of producing a child that will have sickle-cell anemia.

While many doctors strongly discourage AS from marrying AS, the counselors at the sickle-cell center let people make their own decision. Dr. Omoike says: “Our job is not to frighten people or to tell them who they should or should not marry. No one can predict for sure that children born to an AS couple will have SS blood, since that is a matter of chance. Even if they do have an SS child, that child may tolerate the disorder without too many problems. But we do want people to know what their genotype is. And we try in advance to help people to be aware of what could happen so that if they do have SS children, it will be no surprise. That way, they are in a position not only to make decisions based on knowledge of the facts but to prepare themselves mentally to accept the consequences of those decisions.”

[Footnote]

Other inherited sickle-cell disorders that affect the ability of blood to carry oxygen are sickle-cell hemoglobin C disease and sickle beta thalassemia.

 

The Importance of Love

Joy, who is now in her early 20’s, suffers from sickle-cell anemia. Since she is one of Jehovah’s Witnesses, she has never accepted a blood transfusion. Her mother, Ola, says: “I have always made sure that Joy has had good food to help build up her blood. I believe that loving parental care means a lot. Her life, like that of all my children, is very precious to me. Of course, all children need love, but how much more so do those struggling with an illness!”

Tope has sickled cells, like those indicated by the arrows

[Credit Line]

Sickle cells: Image #1164 from the American Society of Hematology Slide Bank. Used with permission

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What is the Solution?

“THERE is a growing belief that mankind’s well-being, and perhaps even our survival as a species, will depend on our ability to detect emerging diseases. . . . Where would we be today if HIV were to become an airborne pathogen? And what is there to say that a comparable infection might not do so in the future?” said D. A. Henderson—who played a leading role in the eradication of smallpox—to a group of scientists in Geneva, Switzerland, in 1993.

How might emerging diseases be detected? An early warning system for tropical disease epidemics is a global network of 35 laboratories that report to the World Health Organization (WHO). Yet, a survey of these laboratories showed that fewer than half of them were equipped to identify Japanese encephalitis, hantaviruses, and Rift Valley fever—all deadly diseases. Only 56 percent could spot yellow fever, a mosquito-borne virus that causes vomiting, liver failure, and internal bleeding. In 1992 at least 28 people died in Kenya of yellow fever before doctors discovered the cause. For six months they thought they were fighting malaria.

Another weakness of surveillance programs is that they cannot recognize the emergence of slow-acting viral diseases. HIV, for example, can hide inside a person, spread to others, and then manifest itself as AIDS up to ten years later. The present AIDS pandemic emerged almost simultaneously on three continents and quickly invaded 20 different nations. Clearly, there was no early warning for that!

Despite the problems, many scientists still look to the future with confidence, speaking optimistically of major discoveries and breakthroughs that will surely come in the years ahead. The International Herald Tribune reports: “The best hope for true breakthroughs, many scientists say, is biotechnology, the manipulation of hereditary material in living cells. Scientists at biotech firms hope to create cells that produce germ-killing substances, that is, a new generation of genetically engineered antibiotics.”

There is, however, a dark side to this. Genetic engineering has made it possible to insert genes into a harmless virus so that the virus can deliver the genes to people. This technology can be used beneficially, perhaps actually making possible the production of so-called genetically engineered antibiotics. But this technology may also be used for sinister purposes.

For example, possibly genes from Ebola could be inserted by accident or design into a virus, such as influenza or measles. Then that deadly virus might be spread by a cough or a sneeze. Dr. Karl Johnson, who has spent a lifetime investigating viruses such as Machupo and Ebola, said that the time may soon come when “any crackpot with a few thousand dollars’ worth of equipment and a college biology education under his belt could manufacture bugs that would make Ebola look like a walk around the park.” Other biologists share his concern.

The Solution

Solving the problems of infectious disease is not simply a matter of developing new drugs. It involves solving the disease-related problems of poverty, war, refugees, abuse of drugs, overcrowding of cities, unhealthy life-styles, pollution, and destruction of the environment. Be honest with yourself. Do you think humans are likely to solve these complex problems?

God’s Word cautions: “Do not put your trust in nobles, nor in the son of earthling man, to whom no salvation belongs.” In whom, then, should we trust? The scripture continues: “Happy is the one who has the God of Jacob for his help, whose hope is in Jehovah his God, the Maker of heaven and earth.” Only Jehovah, mankind’s Creator, can solve the dilemmas that face humankind.—Psalm 146:3-6.

Jehovah’s inspired Word, the Bible, in recording Jesus’ great prophecy concerning “the sign . . . of the conclusion of the system of things,” foretold the medical miseries that afflict our generation. Jesus said: “There will be . . . in one place after another pestilences.”—Matthew 24:3-8; Luke 21:10, 11.

However, the Bible also points to a future time on earth under the rule of God’s Kingdom when “no resident will say: ‘I am sick.’” (Isaiah 33:24; Matthew 6:9, 10) Those who trust in Jehovah thus have strong reason to believe that obedient mankind will soon receive a permanent release from not only the deadly diseases that plague humans but also the problems that contribute to disease. True Christians appreciate the efforts of the medical community in the difficult battle against deadly microbes. Yet, they know the lasting solution to disease and death rests with God, the one “who is healing all your maladies.”—Psalm 103:1-3; Revelation 21:1-5; 22:1, 2.

The Bible promises a time when no one will say, “I am sick”

 

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