[Marxism] ‘Superbugs’ Kill India’s Babies and Pose an Overseas Threat

Louis Proyect lnp3 at panix.com
Thu Dec 4 01:32:19 MST 2014


ASIA PACIFIC

NY Times, Dec. 4 2014
‘Superbugs’ Kill India’s Babies and Pose an Overseas Threat
By GARDINER HARRIS

AMRAVATI, India — A deadly epidemic that could have global implications 
is quietly sweeping India, and among its many victims are tens of 
thousands of newborns dying because once-miraculous cures no longer work.

These infants are born with bacterial infections that are resistant to 
most known antibiotics, and more than 58,000 died last year as a result, 
a recent study found. While that is still a fraction of the nearly 
800,000 newborns who die annually in India, Indian pediatricians say 
that the rising toll of resistant infections could soon swamp efforts to 
improve India’s abysmal infant death rate. Nearly a third of the world’s 
newborn deaths occur in India.

“Reducing newborn deaths in India is one of the most important public 
health priorities in the world, and this will require treating an 
increasing number of neonates who have sepsis and pneumonia,” said Dr. 
Vinod Paul, chief of pediatrics at the All India Institute of Medical 
Sciences and the leader of the study. “But if resistant infections keep 
growing, that progress could slow, stop or even reverse itself. And that 
would be a disaster for not only India but the entire world.”

In visits to neonatal intensive care wards in five Indian states, 
doctors reported being overwhelmed by such cases.

“Five years ago, we almost never saw these kinds of infections,” said 
Dr. Neelam Kler, chairwoman of the department of neonatology at New 
Delhi’s Sir Ganga Ram Hospital, one of India’s most prestigious private 
hospitals. “Now, close to 100 percent of the babies referred to us have 
multidrug resistant infections. It’s scary.”

These babies are part of a disquieting outbreak. A growing chorus of 
researchers say the evidence is now overwhelming that a significant 
share of the bacteria present in India — in its water, sewage, animals, 
soil and even its mothers — are immune to nearly all antibiotics.

Newborns are particularly vulnerable because their immune systems are 
fragile, leaving little time for doctors to find a drug that works. But 
everyone is at risk. Uppalapu Shrinivas, one of India’s most famous 
musicians, died Sept. 19 at age 45 because of an infection that doctors 
could not cure.

While far from alone in creating antibiotic resistance, India’s 
resistant infections have already begun to migrate elsewhere.

“India’s dreadful sanitation, uncontrolled use of antibiotics and 
overcrowding coupled with a complete lack of monitoring the problem has 
created a tsunami of antibiotic resistance that is reaching just about 
every country in the world,” said Dr. Timothy R. Walsh, a professor of 
microbiology at Cardiff University.

Indeed, researchers have already found “superbugs” carrying a genetic 
code first identified in India — NDM1 (or New Delhi metallo-beta 
lactamase 1) — around the world, including in France, Japan, Oman and 
the United States.

Anju Thakur’s daughter, born prematurely a year ago, was one of the 
epidemic’s victims in Amravati, a city in central India. Doctors assured 
Ms. Thakur that her daughter, despite weighing just four pounds, would 
be fine. Her husband gave sweets to neighbors in celebration.

Three days later, Ms. Thakur knew something was wrong. Her daughter’s 
stomach swelled, her limbs stiffened and her skin thickened — classic 
signs of a blood infection. As a precaution, doctors had given the baby 
two powerful antibiotics soon after birth. Doctors switched to other 
antibiotics and switched again. Nothing worked. Ms. Thakur gave a puja, 
or prayer, to the goddess Durga, but the baby’s condition worsened. She 
died, just seven days old.

“We tried everything we could,” said Dr. Swapnil Talvekar, the 
pediatrician who treated her. Ms. Thakur was inconsolable. “I never 
thought I’d stop crying,” she said.

A test later revealed that the infection was immune to almost every 
antibiotic. The child’s rapid death meant the bacteria probably came 
from her mother, doctors said.

Health officials have warned for decades that overuse of antibiotics — 
miracle drugs that changed the course of human health in the 20th 
century — would eventually lead bacteria to evolve in a way that made 
the drugs useless. In September, the Obama administration announced 
measures to tackle this problem, which officials termed a threat to 
national security.

Some studies have found that developing countries have bacterial rates 
of resistance to antibiotics that are far higher than those in developed 
nations, with India the global focal point.

Bacteria spread easily in India, experts say, because half of Indians 
defecate outdoors, and much of the sewage generated by those who do use 
toilets is untreated. As a result, Indians have among the highest rates 
of bacterial infections in the world and collectively take more 
antibiotics, which are sold over the counter here, than any other 
nationality.

A recent study found that Indian children living in places where people 
are less likely to use a toilet tend to get diarrhea and be given 
antibiotics more often than those in places with more toilet use. On 
Oct. 2, the Indian government began a campaign to clean the country and 
build toilets, with Prime Minister Narendra Modi publicly sweeping a 
Delhi neighborhood. But the task is monumental.

“In the absence of better sanitation and hygiene, we are forced to rely 
heavily on antibiotics to reduce infections,” said Ramanan Laxminarayan, 
vice president for research and policy at the Public Health Foundation 
of India. “The result is that we are losing these drugs, and our 
newborns are already facing the consequences of untreatable sepsis,” or 
blood infections.

Some health experts and officials here say that these killer bugs are 
largely confined to hospitals, where heavy use of antibiotics leads to 
localized colonies.

But India’s top neonatologists suspect the large number of resistant 
infections in newborns in their first days of life demonstrates that 
these dangerous bacteria are thriving in communities and even pregnant 
women’s bodies.

“Our hypothesis is that resistant infections in newborns may be 
originating from the maternal genital tract and not just the 
environment,” Dr. Paul said in an interview.

In a continuing study in Delhi at several government-run hospitals that 
has so far included more than 12,000 high-risk newborns, and was made 
available to The New York Times, about 70 percent of the babies’ 
infections were found to be immune to multiple powerful antibiotics, 
confirming the results of earlier and smaller studies.

Doctors interviewed in hospitals across India said that a large number 
of the infections they found in newborns were resistant to many 
antibiotics. Awareness of the problem has begun to grow, with Indian 
medical associations calling for efforts to reduce unnecessary 
antibiotic use. But there is keen sensitivity here to any alert to the 
dangers. A 2010 discovery of a New Delhi “superbug” caused intense 
controversy because of fears that publicity would threaten India’s 
profitable medical tourism industry. Government officials have stopped 
some studies of the problem, Dr. Walsh said.

The effects of antibiotic-resistant bacteria on treating disease in 
India could be enormous. Tuberculosis is just one example of the 
challenges doctors face. India has the world’s largest number of cases, 
and recent studies using the latest genetic tests have shown that as 
many as 10 percent of untreated patients in places as far apart as 
Mumbai and Sikkim have resistant infections. These patients are catching 
resistant bugs at home, not hospitals, making the epidemic very 
difficult to control, Dr. Soumya Swaminathan, director of the National 
Institute for Research in Tuberculosis, said in an interview.

“It’s startling and very worrying,” Dr. Swaminathan said. Unless the 
government makes profound and drastic changes, tuberculosis in India may 
soon become untreatable, she said.

Although resistant bugs are everywhere here, hospitals have become 
factories for untreatable “superbugs.” A government program that pays 
women to have babies in hospitals has in 10 years more than doubled the 
share of hospital-born babies to 82 percent, but the government did 
little to increase hospital capacity to deal with the crush. Maternity 
wards often have two and three women in each bed, allowing infections to 
spread rapidly.

Besides being desperately crowded, many hospitals are unhygienic, 
allowing the bugs to flourish. A Unicef survey of 94 district hospitals 
and health centers in Rajasthan last year found that 70 percent had 
possibly contaminated water and 78 percent had no soap available at 
hand-washing sinks, while 67 percent of toilets were unsanitary.

Doctors across India have responded to the sanitation crisis in 
hospitals by giving antibiotics freely.

In Haryana, for instance, almost every baby born in hospitals in recent 
years was injected with antibiotics whether they showed signs of illness 
or not, Dr. Suresh Dalpat, deputy director of child health in the state 
of Haryana, said in an interview. “Now, with proper training, we are 
bringing that down.”

All those drugs create resistant bacteria that find their way into 
hospital sewage, which is mostly dumped untreated into rivers, canals 
and pits in the surrounding community where pregnant women can become 
infected.

The most frequent causes of resistant newborn infections in India are 
bacteria like Klebsiella and Acinetobacter, which are found in untreated 
human waste. Such bacteria rarely infect newborns in developed nations, 
said Dr. Paul.

India and other developing nations are by no means alone in threatening 
the future of antibiotics. Overuse of the drugs in chicken, hog and 
cattle farms in the United States has led to the rise of resistant 
strains there, and research has shown that as much as half of antibiotic 
prescriptions in the United States are unnecessary.

The Centers for Disease Control and Prevention estimated last year that 
two million people are sickened by resistant bacteria every year in the 
United States and 23,000 die as a result. But efforts to crack down on 
inappropriate antibiotic use in the United States and much of Europe 
have been successful, with prescriptions dropping from 2000 to 2010. 
That drop was more than offset, however, by growing use in the 
developing world.

Global sales of antibiotics for human consumption rose 36 percent from 
2000 to 2010, with Brazil, Russia, India, China and South Africa 
accounting for 76 percent of that increase. In India, much of that 
growth has been driven by private doctors who deliver about 90 percent 
of care here and are often poorly trained. Much of these doctors’ income 
comes from drug sales.

Just as worrisome has been the rapid growth of India’s industrialized 
animal husbandry, where antibiotics are widespread. Most large chicken 
farms here use feed laced with antibiotics banned for use in animals in 
the United States. A New Delhi science group recently found antibiotic 
residues in 40 percent of chicken samples tested.

But the effects in children are perhaps the most heart-wrenching. After 
her baby’s death a year ago, Ms. Thakur, 21, was soon pregnant again. 
She gave birth on Sept. 21 to a baby girl. On a visit shortly after the 
baby’s birth, Ms. Thakur was shivering from a severe infection while 
staying in a home with no toilet or running water. She nursed her tiny 
infant, Khushi, under a small shrine with pictures of Durga and Krishna.

Nearly two months later, she reported that she and the baby were fine.





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