The top 10 stories of 2007

December 2007

Bound by tradition, we again present what the members of the Infectious Disease News Editorial Advisory Board consider the top 10 Infectious Disease News stories of the year. (See Top 10 Stories of 2007.)

These stories are presented in the rank order as voted by editorial board members; there were undoubtedly many differences in individual voting. These stories were considered the most newsworthy, not necessarily in terms of new or cutting edge science, but rather in terms of newsworthiness to infectious disease physicians in terms of patient care, news of emerging infectious diseases to be alert for, new methods of infectious disease prevention or treatment and finally, newsworthiness in terms of public attention.

Space will not permit detailed comment on each of these topics, but some comments follow on several of these topics together with related issues.

MRSA

Methicillin-resistant Staphylococcus aureus was almost universally voted the top news story of the year, probably not so much in terms of new science, but rather in terms of finally capturing the attention of the public and the U.S. Congress as well. As I discussed last month, it was a rather simple CDC descriptive surveillance study reported in The Journal of the American Medical Association that did it. The media coverage that accompanied and followed that publication was astonishing! For the first time, signs appear in many public places, notably near or in public restrooms, emphasizing personal and hand hygiene as a means of MRSA infection prevention.

In terms of MRSA science, however, one of the best stories – if not the best story – of the year received relatively little coverage. I refer to a multicenter study by R. Wang, et al, recently published in Nature Medicine online (2007;doi:10.1038/nm1656. Accessed Dec. 4, 2007). Although the work was carried out in several centers, most of it was performed at the National Institute of Allergy and Infectious Diseases Rocky Mountain Laboratory in Hamilton, Mont. In essence, these investigators described a new class of peptides elaborated by many community associated-MRSA strains that are capable of recruiting, activating and then lysing human neutrophils, thereby rendering inactive the main defense mechanism against S. aureus infection. This previously undetected virulence factor not only appears to account in part for the aggressive nature of many CA-MRSA strains but also offers a whole new avenue to approach intervention targets, both drug and vaccine. (See page 30 in this issue for coverage of this study.) I’m confident we’ll hear more in the future as this avenue of research develops further.

HIV/AIDS

The year 2007 was a mix of good news and bad news in HIV/AIDS. Among the best of the good news was the finding that male circumcision reduced the risk for HIV transmission by about 50% in studies carried out in Kenya and Uganda. These findings therefore mandate consideration of widespread implementation as an HIV prevention policy at the national level. Whether there is the will and the ability to do this at a national level in African countries remains to be seen.

Other good news included the findings in a study from Yale University that universal HIV screening, in contrast to the previous risk-based screening, was cost-effective at any HIV prevalence level. As you will probably recall, CDC changed its HIV screening recommendations in 2006 from risk-based to universal screening; this study, in a sense, provided validation for this recommendation. Nonetheless, protests continue to be aired from time to time from those opposed to this policy change. The approvals of two new antiretroviral drugs, maraviroc and raltegravir, were other good news.

The bad news, however, was the decision by Merck to discontinue its clinical trial of the investigational V520 HIV vaccine. This was a major disappointment and was based on the realization that the primary endpoints would not be achieved. The vaccine itself consisted of an attenuated type 5 adenovirus containing three synthetic HIV genes. Although the final findings have not yet been released, it is of interest that recipients of the active vaccine proved to be at increased risk for adenovirus infection, as compared with placebo recipients. This finding may ultimately provide further insight into disease pathogenesis and future vaccine development.

TB

XDR-TB and MDR-TB were also very much in the news in 2007. This was largely due to the international adventures of Andrew Speaker, a young lawyer from Atlanta, engaged and subsequently married overseas to the daughter of a well-known tuberculosis investigator at CDC. Speaker was alleged to have XDR-TB disease prior to his departure for Europe. (The number of apparent coincidences in this story are almost beyond belief.) It finally emerged that he was infected with MDR-TB rather than XDR-TB and that he transmitted the infection to no one on either of his overseas flights. Nonetheless, a number of issues are under litigation at this time. The whole story did serve one very useful purpose: to call public and professional attention to the emerging problems of drug-resistant TB and hopefully to shake loose more funds for improved diagnostic and resistance testing, particularly in the African countries where MDR-TB and XDR-TB are already major public health problems. The combination of HIV infection and XDR-TB coinfection is an almost 100% lethal combination. As pointed out by Michael Iseman, MD, in this column several months ago, we in the developed world ignore this emerging problem at our peril.

Vaccines

There was a great deal of news on vaccines in 2007 as well. Merck backed away from its ill-advised efforts to mandate human papillomavirus vaccine for school-age children by legislative processes as they near adolescence but succeeded in getting the point across. It is now widely used in girls as they approach sexual “debut,” as it is referred to. The issue of HPV vaccine for boys in the same age range is still under study but seems to be a sensible idea that I suspect will eventually be recommended. One important recommendation that infectious disease physicians should whole-heartedly endorse is for essentially universal use of meningococcal conjugate vaccine in adolescents. Early reports of Guillian-Barré syndrome associated with administration of this vaccine have proven thus far to be no more than would be expected by chance alone.

Another vaccine story of great interest was the contrasting views of influenza vaccine efficacy published this fall that surely must have left readers scratching their heads, wondering what it all meant. These two studies will be the subject of next month’s editorial comments, so I’ll go no further for now.

Avian influenza

Finally, avian influenza continues among the top 10 stories for the year, although it has been relatively quieter this year. Human-to-human transmission has been documented, although this is hardly a surprise. Such transmission remains at a very low level. Slow progress is being made on the vaccine front, both with promising adjuvants and with cell culture propagation methodology.