Last week was World Antibiotic Awareness week, an initiative of the World Health Organization (WHO) to raise awareness and understanding of antibiotic-resistant superbugs. To follow, here at Te Pūnaha Matatini we are launching a week-long conversation about the health, social, economic, and environmental impacts of infectious diseases in Aotearoa New Zealand. Where possible, in collaboration with Figure.NZ, we’ll bring you publicly available data to help illustrate the issues. Welcome to #InfectedNZ!
Infectious diseases: complexity personified
The phrase ‘infectious diseases’ describes a multitude of life forms which differ in their genetic make-up, life-styles and habitats. They lurk, hidden and unseen, on our skin, up our noses and in our guts. On our pets and livestock, too. And amongst our plants, rivers and soils. And when some of them get into our bodies, or into our plants and animals, they can cause devastation to human and animal health, our environment, and our economy. So there is no one single threat from infectious diseases, or indeed, no simple one-size-fits-all solution. Like so much in life, the issue is complex and complicated.
But experts do all agree on one thing: we are running out of ways to treat infectious diseases.
The prediction is that without urgent action, within the next 5-10 years we could see a return to the pre-antibiotic era, when something as simple as a stubbed toe could mean amputation or death. That’s a big part of why we need to have a national conversation about infectious diseases and what the future holds.
Aotearoa New Zealand: we are not immune
Many people think of infectious diseases as a third world problem. And it’s not hard to see why when we are all surrounded by friends and family being diagnosed with various cancers or heart disease. But in the year July 2013 to June 2014, almost 91,000 Kiwis had infectious diseases listed as the primary cause for why they were hospitalised, accounting for around 8% of all hospitalisations that year. It’s also worth noting that many other people in hospital will also be battling an infectious disease as a result of having a compromised immune system, either because they’ve had surgery, or have a non-communicable disease like cancer or diabetes. These people will not feature in the numbers though, as their underlying disease would be listed as the primary cause for them being in hospital.
As you can see, two-thirds of infectious disease hospitalisations were for bacterial infections, with the major contributors being food and water-borne infections, Staphylococcus aureus (also known as Staph, or MRSA, which stands for methicillin-resistant S. aureus) and Streptococcus pyogenes (also known as Group A Strep, or sometimes, the ‘flesh-eating disease’, as this bacterium can sometimes carry an enzyme that can digest human flesh).
Fortunately, the majority of infectious diseases that Kiwis are exposed to are still treatable. In 2013, just over 1,200 (about 4%) of the 29,636 people who died that year had infectious diseases listed as the primary cause of their demise. As in the hospitalisations, the figures cover what was recorded on the death certificate which may not always be the immediate cause of death. For example, many of those who are recorded as having died of Alzheimer’s disease are more likely to have died of pneumonia or a urinary tract infection.
We’re bucking international trends, but not in a good way
As countries become more developed, their rates of infectious diseases fall, and their rates of non-communicable diseases like cancer and heart disease rise as people live longer. Most Kiwi’s will probably be surprised to find out that here in Aotearoa New Zealand we are bucking those international trends: our rates for many infectious diseases are going up, not down. We wanted to show you the data, but can’t. It is publicly available on the web but Figure.NZ were denied permission to turn it into nice charts for you to see. What we can tell you is that a study of hospital admissions over the last twenty years, carried out by Prof Michael Baker and colleagues and published in the prestigious medical journal The Lancet, showed that while overnight admissions to hospital due to non-communicable diseases have increased by 7%, those due to infectious diseases have gone up by a staggering 50% (1).
“Surely it’s them, not us?!”
What you might also be surprised to hear is that we have higher rates of many infectious diseases than the USA, Australia and the UK. And just in case the thought crosses your mind that perhaps all those infectious diseases are being imported into New Zealand by ‘foreigners’, and if we curb immigration infectious diseases will all go away…How can I put this politely?! I think you’ll find it’s a little more complicated than that!
Yes, some infectious diseases can be ‘imported’ into New Zealand by ‘foreigners’. But guess who also goes overseas? We do. In droves. According to Statistics New Zealand, in 2014 there were more than 700,000 overseas departures from Auckland Airport by resident New Zealander’s going on holiday. Another 600,000 were people going to visit friends and relatives overseas. As an island nation, we travel a lot. And each of those trips is an opportunity to bring back an invisible infectious passenger. So, unless you never want to go on holiday again, or visit friends and family overseas, let’s nip that line of thinking in the bud. The reality is, we don’t need travel or foreigners to bring infectious diseases or antibiotic-resistant superbugs to our Clean Green/100% Pure(TM) island paradise.
So, to sum up. Not only are infectious diseases becoming more widespread here, they are also becoming more difficult to treat. It’s time we stopped thinking of infectious diseases as a third world problem, and have a national conversation about how we all, the public, health workers, policymakers and the agricultural sector, can solve this crisis. I hope you’ll join us across the week to participate in this important discussion. Follow #infectedNZ on Twitter or Facebook, or leave a comment below.
(1) “Baker MG, Barnard LT, Kvalsvig A, Verrall A, Zhang J, Keall M, Wilson N, Wall T, Howden-Chapman P (2012). Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study. Lancet. 379(9821):1112-9. doi: 10.1016/S0140-6736(11)61780-7.
Dr Siouxsie Wiles is Deputy Director (Outreach and Public Engagement) of Te Pūnaha Matatini. She describes herself as a microbiologist and bioluminescence enthusiast. As Head of the Bioluminescent Superbugs Lab at the University of Auckland, Siouxsie combines her twin passions to understand infectious diseases.
What is InfectedNZ?
Hey, Aotearoa. It’s time we had a chat about infectious diseases and what we’re going to do about the looming antimicrobial armageddon. That’s why we’ve asked leading health, social and economic researchers, and people with personal stories, to help us get real about our vulnerability and discuss solutions. Follow their blogs right here at tepunhahamatatini.ac.nz and watch the conversation spread across social media with #infectedNZ.
Backing it all up, wherever possible, is data from the good folk at Figure.NZ. Their super duper charts are based on data sourced from public repositories, government departments, academics and corporations. Check out their #infectedNZ data board and sign-up to create your very own data board on any topic that floats your boat.
Great article and great topic.
It’s worrying to think that things we take for granted could soon be gone. The golden age of antibiotics could be merely a blip in history.
Additionally, we’re now more connected than ever. Viruses which were previously too aggressive to spread far now have the aid of long distance transport. Pandemic on a global scale is a credible possibility.
As a country we need to make sure we have the capability to respond. A successful response would probably involve community level interventions so awareness is key. Good work starting the conversation.
For interest, more complex systems perspectives here: http://www.necsi.edu/research/overview/endingpandemics.html