During what is proving to be one of Japan’s hottest summers in recent memory, most people are concentrating on ways to beat the heat. Heat-related ailments pose a great health risk, especially among the very young and very old. It appears, however, that this summer the public should be paying even more attention to the possible threat of infectious disease. The Health and Welfare Ministry has just announced an outbreak in this country of Q-fever, an illness contracted from animals that is so rare most people have never heard of it. It can cause pneumonia and serious liver ailments, but because many hospitals are unaware of how to treat the disease it may be wrongly diagnosed, with possibly fatal results.
The bacterium responsible for the illness is found in pets as well as livestock, but only one previous case had been reported in Japan. Now, following a two-year study of patients suffering from lung ailments of unknown cause at hospitals in Miyagi Prefecture, the ministry has announced that eight were infected with the pathogen responsible for Q-fever. Once the disease advances in the body, it becomes increasingly difficult to treat.
While the outbreak does not yet represent a major health emergency, it does underscore the need for immediate action to inform hospitals nationwide of the correct diagnostic and treatment procedures. Specialists warn, for example, that Q-fever must be treated with antibiotics of the tetracycline type, not the penicillin type used to treat pneumonia.
Adding an unexpected note of urgency to the ministry’s report is the fact that it comes hard on the heels of worrying news about other unusual infections among inpatients being treated in hospitals in Tokyo and in Nagano Prefecture. Seven patients at a hospital in Tokyo’s Sumida Ward, including three elderly women who died in late July and two patients in their 80s who are in critical condition, are reported to have been infected with the Serratia bacterium. Healthy individuals are not usually considered to be at risk from the Serratia organism, but inpatients whose resistance is low because of surgery or serious illness are in particular danger, and the proper treatment remains in dispute. While the source of the infection technically remains unknown, experts say it is nearly always traceable to hospital staff or equipment.
Even as the Public Health Bureau of the Tokyo Metropolitan Government was reported to be inspecting the Sumida hospital to determine the possibility of further infections, cases of another type of infection resistant to almost all types of antibiotics, even the most powerful, at hospitals in Tokyo and Nagano Prefecture were coming to light. This infection is caused by the vancomycin-resistant enterococcus, or VRE.
The case in Tokyo involved a man in his 50s being treated for liver disease who died of pneumonia in April. Although VRE was detected in a posthumous blood test, a direct link to his death has not been shown. A 76-year-old woman in Nagano died in July while being treated for a malignant tumor. She was one of four patients at the same hospital found to be infected with VRE. Hospital officials there understandably, if tardily, are reported to be taking “extra precautions” to see that no other patients become infected and to disinfect all visitors who come to see them.
The first instance of VRE infection in Japan was detected in Kyoto in 1996, and nearly 20 cases have been discovered since then, with the first death involving a VRE-infected patient occurring at a university hospital in Kyushu last year. No death in Japan has yet been linked directly to VRE infection, but that is no reason not to recognize the danger since there is no treatment for it. Although so far it remains relatively rare here, six cases were reported just between April and mid-July. It has been said that as much as 20 percent of the infectious disease occurring inside hospitals in the United States and Europe is caused by VRE bacteria.
With three infectious outbreaks now raising serious concern, and the unexpected return of tuberculosis as a major health threat in Japan, Health and Welfare Ministry officials have their hands full both in alerting citizens to the potential dangers and in taking all necessary steps to investigate sanitary and other conditions inside the nation’s hospitals — and to impose disciplinary penalties where possible when required. Nothing less should be demanded by the public, which also should insist on even stronger action than the ministry’s previous calls for more frequent hand washing by hospital personnel as a means of reducing infection risks.
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