December 31, 2014


A new year has begun. What were the major infectious diseases events of the past year? The following two are my personal picks, reflecting on what I have read or experienced in 2014:

  1. Ebola outbreak in West Africa. This is the Ebola outbreak that dwarfs all previous outbreaks combined, and is still ongoing in Sierra Leone, Liberia and Guinea. The last case count as of 30th December 2014 is 20,115 cases, with 12,850 laboratory-confirmed cases and 7,857 deaths. Much has already been written about this outbreak, which has exposed the fragile healthcare systems (and general infrastructure) of the affected western African countries, as well as the uncoordinated global response to such outbreaks. The World Bank appears to be considering the establishment of a “reserve corps” – an emergency response team that can be activated in the event of future large-scale outbreaks. I tend to agree with most of the commentators that more efforts should be made to strengthen the World Health Organization rather than to create yet another separate body. The impact of Ebola has been felt even in Singapore – approximately 3 flights away from the Ebola-affected western African countries – where there was a scramble to come up with emergency preparedness plans should a case of Ebola ever be imported.
  2. Global focus on antimicrobial resistance. Even the White House has gotten into the act, with executive orders issued by the Obama administration in September 2014 to contain the rise of antimicrobial resistance. The Longitude Prize challenge of 2014 was antibiotics and the problem of antimicrobial resistance, trumping other major issues such as clean water or restoring movement to the paralysed. In Singapore, several hospitals are struggling with the increase in carbapenem-resistant Enterobacteriaceae (CRE) cases – mostly gut colonisation but also an increase in actual clinical infections. If a paradigm-changing solution is not found in Singapore, then CRE will become entrenched with ever greater numbers in local hospitals much like MRSA or ESBL-producing Enterobacteriaceae.

I was tempted to include the question of oseltamivir (Tamiflu) effectiveness, but the 4-year saga isn’t quite over, even after the release of all clinical trial data by Roche to Cochrane investigators. Hopefully there will be a conclusion in 2015. The drug is still being prescribed fairly liberally in Singapore. Avian influenza likewise seems to be have been rumbling along in 2014, with both H7N9 and H5N1 circulating and causing several deaths, but no major outbreaks. Likewise, dengue caused several deaths in Singapore in 2014, with multiple clusters of cases, but this is essentially unchanged from previous years.

Happy 2015, and may there be fewer outbreaks!

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Antimicrobial resistance, Infectious diseases, Outbreak, Singapore


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