# Govt Says Unfair To Blame India On Alarm Over 'New Delhi' Bug



## kds1980 (Aug 12, 2010)

An international team of scientists has discovered a new superbug in many people who have recently been in India, and they say there are virtually no drugs to treat it. 

In a study published in The Lancet Infectious Diseases Journal Wednesday, the researchers reported a new gene called New Delhi metallo-beta-lactamase, or NDM-1, which they said makes bacteria resistant to nearly all antibiotics, including the most powerful class called carbapenems. 

Lead researcher Timothy Walsh, from Britain’s Cardiff University, was quoted by Reuters as saying that with more and more foreigners traveling to countries like India for medical treatment and cosmetic surgery, he feared the new superbug could soon spread across the world. 

“This is a real concern. Because of medical tourism and international travel in general, resistance to these types of bacteria has the potential to spread around the world very, very quickly. And there is nothing in the pipeline to tackle it,” Walsh was quoted as saying. 

Walsh’s team studied bacterial isolates from Chennai and Haryana in India to conclude that NDM-1 has made two common bacteria, E. Coli (which causes urinary 

tract infections) and K. Peumoniae (which causes pneumonia), resistant to most antibiotics, including carbapenems. 

In the UK, the study said, of the 29 patients who were screened, “at least 17 had a history of traveling to India or Pakistan within one year, and 14 of them were found to be admitted to a hospital in these countries”. 

Health experts in India said it was unfair to blame the existence of a superbug on a particular country. “Multi-drug resistance can be found anywhere in the world. It is unfair to blame India for that,” said Dr V M Katoch, Secretary, Health Research. 

Dr Anoop Misra of Fortis Hospitals said the findings underscore the dangers of overuse and misuse of antibiotics, which fuel the rise of drug-resistant super-bug infections. “This just goes to show that indiscrimate use of antibiotics is dangerous. A rational policy for usage of antibitocs is needed in India,” Dr Anoop Misra said. 

Dr Anita Kotwani of Patel Chest Institute, University of Delhi, agreed: “Most hospitals in India do not have a policy on antibiotics. Doctors prescribe them indiscriminately, leading to drug resistance in patients. The developed world has realised the importance of the rational use of drugs, but India hasn’t.

http://www.indianexpress.com/news/g...me-india-on-alarm-over-new-delhi-bug/659291/1


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## kds1980 (Aug 12, 2010)

There are many people Who believe that  Words of western scientists are like words of god
so in these type of studies what are their views as Indian doctors clearly rejected it and said that this is just a conspiracy to ruin medical tourism business of India


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## ugsbay (Aug 12, 2010)

SSA.
kanwardeep Ji i think i agree with the Indian Doctors on this topic. Every now and then we seem to have a massive pandemic. Mad Cow, E Coli, Bird Flu, Swine Flu etc. They mostly seem to point fingers at Asia, last time it was China. It seems to me something we dont know about is happening behind closed curtains.


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## Seeker9 (Aug 12, 2010)

I think Indian Medecine is gaining respect on the world scene...I remember the ground breaking operation last year on the 8 limbed girl...

But in this case, as noted in the article, there could very much be an Indian element to the problem in that antibiotics are easy to purchase and then people fail to finish the course

So against that background, it would not be surprising if stronger bacterial strains were to emerge and grow


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## spnadmin (Aug 12, 2010)

Epidemic spread of viruses and bacteria _can be tracked and in fact_ is tracked using epidemiological methods back to their source. The source often gives the name to the problem. In the case of influenzas, these spread from East to West because of travel patterns more than anything else. There are exceptions. The biggest killer in modern times was the Spanish Flu which eliminated more than 10 percent of the world's population (10 percent is the normal kill rate for pandemic flu). More than 1/2 million Americans were killed in one month alone in 1918, and some societies were wiped out. 

http://www.cnn.com/books/beginnings/9911/flu/

Feeling injured as a matter of national pride is a natural feeling. 

However,  IMHO, this is one of those subjects where it is important to feel and express our natural indignation, and then get over our feelings asap, because the bigger issue is not whether India is blamed or not, but whether the over-prescription of anti- biotics is going to be addressed.

At the end of the article it was Dr. Misra and Dr. Kotwani, both Indian doctors in India, who had literally the last word. Over-use of  anti-biotics is a growing problem and the effects of it are not pretty.


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## ugsbay (Aug 12, 2010)

Thats exactly how i was feeling Narayanjot Ji when i heard this on the news last night, it was a feeling of letting National Pride get the better of me. I understand how important this matter is and we must look at the bigger picture. I have just read your link which was very informative thanks. Oh i had to laugh at the conspiracy theories especially the one about the little old lady who saw a dodgy looking cloud at the harbour lol.


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## spnadmin (Aug 12, 2010)

The problem of drug resistant bacterial infections has become a worldwide problem. A report from Pakistan.

*Reducing antibiotics not enough to stem resistance*

             Zulfiqar A Bhutta and Syed Rehan Ali

                          26 March 2008 |                                                             |  






                   Xray of lungs infected by pneumonia
                   CDC

*Reducing antibiotic use is not enough to curb the rise of resistance in the developing world, say Zulfiqar A. Bhutta and Syed Rehan Ali*.

 Ever since the advent of antibiotics, the phenomenon of increasing resistance to commonly used antibiotics has been well-recognised. 

 Excessive and uncontrolled use of antibiotics in humans and animals are major contributors to the spread of resistance. In a rapidly globalising world where people have easy access to long-distance travel, antibiotic-resistant organisms can easily cross continents and infect individuals.

  Resistance can also be transferred between different disease-causing bacteria, with deadly consequences for health systems in both developed and developing countries.

  While the extent of resistance and its health and economic costs are well-documented in developed countries, relatively little is known about the burden and consequences of resistance in developing countries, where data are sp{censored} and monitoring systems poor. 

Nevertheless, given that many developing countries have enormously high rates of infectious disease, the directly attributable economic costs of resistance must be considerable. Lack of access to effective treatment for resistant infections is an important additional contributor to morbidity. 


*Poverty and inequity*

  Poverty and inequity are major drivers of antimicrobial resistance. In developing countries they are linked to inadequate access to effective drugs, unregulated dispensing by unqualified staff and truncated therapy for reasons of cost.

  In addition, substandard generics — and counterfeit medications — are burgeoning because of the cost of branded antibiotics. Poor people often buy them from uncontrolled street vendors and even then cannot afford to complete a full course of treatment.

 This vicious cycle promotes the emergence of antimicrobial resistance and can make treatment less effective.

  The widespread and frequently unnecessary use of antibiotics is also related to health system weaknesses, with poorly trained care providers and lack of suitable laboratory facilities frequently resulting in inappropriate treatment. 

  For example, because of limited capacity to obtain a bacteriological diagnosis of typhoid fever, treatment is often initiated with ineffective antibiotics and changed to second line therapy following clinical treatment failure. In other instances, physicians may choose to initiate treatment unnecessarily with second line antibiotics. Sometimes alternative antibiotics may not be available at all. 

* Extra costs *

  As a result of widespread resistance among common bacterial pathogens such as _Streptococcus pneumoniae_ and _Hemophilus influenzae_ that cause childhood pneumonia, it is no longer feasible to treat cases of moderate-to-severe pneumonia with first line antibiotics like co-trimoxazole. Although health systems are gearing to change to amoxicillin for the treatment of childhood pneumonia, this will take time and considerable resources.

 Resistant bacteria are often more virulent, leading to more severe illness. Multidrug-resistant (MDR) typhoid, for example, is associated with greater clinical severity of illness and more complications than the non-resistant form of the disease. 

 One study showed that despite treatment with injectable ceftriaxone, the mean time before children with MDR typhoid lost their fever was 7.2 days, compared with 6.3 days for sensitive typhoid. The drug treatment costs for an episode of MDR typhoid fever, a common childhood infection, are considerably higher than for sensitive typhoid. So increasing antibiotic resistance is associated with higher economic burden on health systems from the combination of higher rates of complications and enhanced health care costs.

  This extra economic burden can be considerable. Our findings from population-based studies on typhoid fever in urban Karachi indicate that the average cost of illness was more than US$50 per episode, most of which was out-of-pocket costs for antibiotics. 

* Pragmatic action*

  Rational drug use is a cornerstone for reducing inappropriate antimicrobial use and requires physician and patient education as well as industry collaboration. In addition, given widespread over-the-counter availability of antibiotics in many developing countries, regulation and oversight of antibiotic use are key interventions. 

  In addition, every effort needs to be made to “protect” newer and second line antibiotics from widespread use in health facilities or general practice. Merely reducing antibiotic use may be simplistic. But selective and appropriate use of antibiotics (with the correct dose and duration of therapy) may make a difference. 

  The challenge is to implement these strategies within health systems by engaging both the public and private sectors. This may require a series of measures including staff training, strengthening of health systems and rational prescribing, as well as regulation of antibiotic use and over-the-counter prescribing. 

_Zulfiqar A Bhutta is the professor and chairman, department of paediatrics & child health, and Syed Rehan Ali is an assistant professor, both at the Aga Khan University, Karachi, Pakistan._


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## kds1980 (Aug 12, 2010)

One of the big question here is why the bug is named New Delhi----.I don't think we have bugs named New york,London then why New Delhi?


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## spnadmin (Aug 12, 2010)

Kanbwardeep Singh ji

This can easily been seen as a case of cultural imperialism. It all depends on the glasses you wear. And the case you are trying to present to the world.

I thought I explained this. If epidemiologists traced the spread of a bacterium or virus to New York then it would be named after New York City. Similarly the Spanish flu was so named. So the Hong Kong flu was so named.

I think the doctors in the article were focused on one thing and the government was focused on something else.


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## kds1980 (Aug 12, 2010)

Narayanjot Kaur said:


> Kanbwardeep Singh ji
> 
> This can easily been seen as a case of cultural imperialism. It all depends on the glasses you wear. And the case you are trying to present to the world.
> 
> ...



Well if doctors have solid proof then they can name some flu according to city or country but in this case there is hardly any proof that this bacteria is specifically originated from New Delhi.I was just hearing debate between Dr.shetty and doctor from UK on TV and this question was raised again and again by Dr.shetty that why you named it New Delhi --- and the doctor from UK continously skipped this question


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## Seeker9 (Aug 12, 2010)

I'm just guessing here but there appears to be a consensus in the western media that the bug was transported by "medical tourists" seeking cosmetic surgery who went to India as it was a lot cheaper

I think I read somewhere that those who had been affected had been to clinics in New Delhi

Will try and find out more


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## spnadmin (Aug 13, 2010)

Well maybe it would be better to call it the Bangladeshi bug or the Pakistani bug, instead of the New Delhi bug.winkingmunda


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## spnadmin (Aug 13, 2010)

Kanwardeep Singh said:


> There are many people Who believe that  Words of western scientists are like words of god
> so in these type of studies what are their views as Indian doctors clearly rejected it and said that this is just a conspiracy to ruin medical tourism business of India



Whatever you call it I don't see Indian doctors clearly rejecting anything. They seem to be clearly concerned about the over use of antibiotics. In fact they seem to be doing a lot of the talking. In fact we have triangulation going in the thread: Indian doctors, Pakistani doctors and UK doctors are all concerned about the indiscriminate use of anti-biotics. 

IMHO They have their priorities straight.

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New 'superbug' found in UK hospitals
August 11, 2010 by Michelle Roberts	 
Source: www.bbc.co.uk

A new superbug that is resistant to even the most powerful antibiotics has entered UK hospitals, experts warn.

They say bacteria that make an enzyme called NDM-1 have travelled back with NHS patients who went abroad to countries like India and Pakistan for treatments such as cosmetic surgery.

Although there have only been about 50 cases identified in the UK so far, scientists fear it will go global.

Tight surveillance and new drugs are needed says Lancet Infectious Diseases.

NDM-1 can exist inside different bacteria, like E.coli, and it makes them resistant to one of the most powerful groups of antibiotics - carbapenems.

These are generally reserved for use in emergencies and to combat hard-to-treat infections caused by other multi-resistant bacteria.

And experts fear NDM-1 could now jump to other strains of bacteria that are already resistant to many other antibiotics.

Ultimately, this could produce dangerous infections that would spread rapidly from person to person and be almost impossible to treat.

At least one of the NDM-1 infections the researchers analysed was resistant to all known antibiotics.

Similar infections have been seen in the US, Canada, Australia and the Netherlands and international researchers say that NDM-1 could become a major global health problem.

Infections have already been passed from patient to patient in UK hospitals.



The way to stop NDM-1, say researchers, is to rapidly identify and isolate any hospital patients who are infected.

Normal infection control measures, such as disinfecting hospital equipment and doctors and nurses washing their hands with antibacterial soap, can stop the spread.

And currently, most of the bacteria carrying NDM-1 have been treatable using a combination of different antibiotics.

------------------------------------------------------------------
Analysis

Geeta Pandey BBC News, Delhi

The Indian health ministry and the medical fraternity are yet to see the Lancet report but doctors in India say they are not surprised by the discovery of the new superbug.

"There is little drug control in India and an irrational use of antibiotics," Delhi-based Dr Arti Vashisth told the BBC.

Doctors say common antibiotics have become ineffective in India partly because people can buy them over the counter and indulge in self-medication. They also take small doses and discontinue treatment.

Gastroenterologist Vishnu Chandra Agarwal says in the past year he has come across many patients with E.coli infections who have not responded to regular antibiotics.

"In about a dozen cases, I have used a chemical - furadantin - to treat my patients. And it has worked. It makes them horribly nauseous, but it works," he says.

But the potential of NDM-1 to become endemic worldwide is "clear and frightening", say the researchers in The Lancet infectious diseases paper.

The research was carried out by experts at Cardiff University, the Health Protection Agency and international colleagues.

Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said: "There have been a number of small clusters within the UK, but far and away the greater number of cases appear to be associated with travel and hospital treatment in the Indian subcontinent.

"This type of resistance has become quite widespread there.

"The fear would be that it gets into a strain of bacteria that is very good at being transmitted between patients."

He said the threat was a serious global public health problem as there are few suitable new antibiotics in development and none that are effective against NDM-1.

The Department of Health has already put out an alert on the issue, he said.

"We issue these alerts very sparingly when we see new and disturbing resistance."

---------------------------------------------------------------------

Travel history

The National Resistance Alert came in 2009 after the HPA noted an increasing number of cases - some fatal - emerging in the UK.

The Lancet study looked back at some of the NDM-1 cases referred to the HPA up to 2009 from hospitals scattered across the UK.

At least 17 of the 37 patients they studied had a history of travelling to India or Pakistan within the past year, and 14 of them had been admitted to a hospital in these countries - many for cosmetic surgery.

For some of the patients the infection was mild, while others were seriously ill, and some with blood poisoning.

A Department of Health spokeswoman said: "We are working with the HPA on this issue.

"Hospitals need to ensure they continue to provide good infection control to prevent any spread, consider whether patients have recently been treated abroad and send samples to HPA for testing.

"So far there has only been a small number of cases in UK hospital patients. The HPA is continuing to monitor the situation and we are investigating ways of encouraging the development of new antibiotics with our European colleagues."

The Welsh Assembly Government said it would be "fully considering" the report.

"The NHS in Wales is used to dealing with multi-resistant bacteria using standard microbiological approaches, and would deal with any new bacteria in a similar way," said a spokesperson.

http://www.sikhnet.com/news/new-superbug-found-uk-hospitals


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## kds1980 (Aug 13, 2010)

http://www.deccanherald.com/content/88032/centre-trashes-superbug-link.html

Centre trashes superbug link
New Delhi/Bangalore, Aug 12, DHNS:

An angry government on Thursday described as ''totally irrational'' claims of some British scientists linking a new antibiotics-resistant superbug to India. However, the government said it was responding to an alert issued by Britain in this regard. 


The government’s stand was echoed in the Rajya Sabha where members suspected the hand of multinational pharmaceutical and hospital companies behind the claims. 

Demanding a response from the government, BJP Rajya Sabha member S S Ahluwalia, who was supported by Congress’ Jayanti Natarajan, said: “When India is emerging as a medical tourism destination, this type of news is unfortunate and may be a sinister design of multinational companies to defame the Indian medical sector.”

As the so-called scientific claims snowballed into a controversy, it has emerged that the New Delhi Metallo-1 (NDM-1) superbug that can resist almost all types of antibiotics has been found in Bangalore too. The country’s IT capital was among 11 Indian cities where researchers spotted the superbug in two common hospital bacteria, making them highly drug-resistant and extremely difficult to treat. 

The other cities where NDM-1 mutation––a change in genetic structure––was found are Guwahati, Mumbai, Varanasi, Pune, Kolkata, Hyderabad, Port Blair, Delhi and Rohtak along with eight Pakistani cities and Dhaka.

Unacceptable

*In Bangalore, several senior doctors felt that blaming India for the origin of the resistant enzyme was unacceptable as it is prevalent in developed countries as well. “In the west, people use more antibiotics leading to resistance among bacteria and enzymes. So, potentially, a person getting infected with superbugs is more in western countries,” said Dr Devi Shetty of Narayana Hrudayalaya. 

On behalf of the Centre, Indian Council of Medical Research director general V M Katoch said the government would soon draft a reply to the British scientists’ claims after a meeting of the National Centre for Disease Control, a nodal agency under the Health Ministry.

“Its not a public health threat. Drug resistance can develop anywhere in world. Bacteria with similar genetic profile was found in UK, Greece and Israel,” Katoch told 
Deccan Herald.

“When you link it to something to our anti-biotics policy, say India specific, and say it is dangerous to get operated in India and so you will get more infections, then it is totally irrational,” Katoch said.

He said the Health Ministry will examine the issue in detail but it was “unfortunate that this new bug, which is an environmental thing, has been attached to a particular country which is India in this case”.*

“I am surprised,” he said, adding that, “this (the bug) is present in nature and is a biological phenomenon. It is a random event and cannot be transmitted”. 

Katoch said:“Nobody should be scared of Indian hospitals. They are good and if the hospitals follow sound infection prevention strategies, there is no question of infection by drug-resistant bacteria and their spreading.”

The ICMR chief, however, admitted that NDM-1 appeared to be more dangerous that MRSA (another super-bug known as methicillin-resistant staphylococcus aureus). While MRSA is a “gram positive bacteria” for which more drug options are available, NDM-1 is a “gram negative” bacteria with limited treatment options.

Gram negative bacteria are more complicated to treat because they have an additional membrane around their cell walls, because of which many antibiotics could not kill them. 
Bacteria with NDM-1 potentially herald the end of treatment with (drugs like) beta-lactams, fluoroquinolones and aminoglycosides – the main antibiotics for gram negative bacteria. The researchers indicated widespread non-prescription use of antibiotics as the reason for the development of drug-resistance.


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## spnadmin (Aug 13, 2010)

A public health threat is being discussed. No one was  "blaming" any country or its hospitals. What ensued was a discussion of a growing number of incidents.



> Demanding a response from the government, *BJP Rajya Sabha member S S Ahluwalia, who was supported by Congress’ Jayanti Natarajan, *said: “When India is emerging  as a medical tourism destination, this type of news is unfortunate and may be a sinister design of multinational companies to defame the Indian medical sector.”



All hospitals have problems with infection control. That is one of the themes in the coverage so far. Have doctors now become politicians?

Either people want to get to the bottom of an infectious disease problem. Or they want to take offense . When hurt feelings and/or talk of conspiracies trump evidence of spreading disease, then for sure nothing will happen very soon. It is really very childish.

Once the Lancet report referred to earlier  is read and digested perhaps its implications will become clear.

We now have the medical name of the agent involved NDM 1. So the next step should be cooperation internationally. These drug resistant infections are medical nightmares. They are nightmares whether they originate in Europe, Asia or for that matter the South Pole. What is the point or purpose or benefit of taking umbrage and making this into a controversy about countries and cultures?


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## spnadmin (Aug 13, 2010)

Companion thread
http://www.sikhphilosophy.net/healt...ic-resistance-mechanism-india.html#post131558


I have posted the full text of the study published in the pre-eminent medical journal as a separate thread in the Health and Nutrition section so that forum readers can draw their own conclusions. Is this serous? Or is it a conspiracy? Here is the summary. A number of physicians listed are in fact Indian, and study data was collected in India as well as UK and other countries. The article concludes that international surveillance is needed.

Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study

Karthikeyan K Kumarasamy MPhil a, Mark A Toleman PhD b, Prof Timothy R Walsh PhD b , Jay Bagaria MD c, Fafhana Butt MD d, Ravikumar Balakrishnan MD c, Uma Chaudhary MD e, Michel Doumith PhD c, Christian G Giske MD f, Seema Irfan MD g, Padma Krishnan PhD a, Anil V Kumar MD h, Sunil Maharjan MD c, Shazad Mushtaq MD c, Tabassum Noorie MD c, David L Paterson MD i, Andrew Pearson PhD c, Claire Perry PhD c, Rachel Pike PhD c, Bhargavi Rao MD c, Ujjwayini Ray MD j, Jayanta B Sarma MD k, Madhu Sharma MD e, Elizabeth Sheridan PhD c, Mandayam A Thirunarayan MD l, Jane Turton PhD c, Supriya Upadhyay PhD m, Marina Warner PhD c, William Welfare PhD c, David M Livermore PhD c, Neil Woodford PhD c

Summary

Background
Gram-negative Enterobacteriaceae with resistance to carbapenem conferred by New Delhi metallo-β-lactamase 1 (NDM-1) are potentially a major global health problem. We investigated the prevalence of NDM-1, in multidrug-resistant Enterobacteriaceae in India, Pakistan, and the UK.

Methods
Enterobacteriaceae isolates were studied from two major centres in India—Chennai (south India), Haryana (north India)—and those referred to the UK's national reference laboratory. Antibiotic susceptibilities were assessed, and the presence of the carbapenem resistance gene blaNDM-1 was established by PCR. Isolates were typed by pulsed-field gel electrophoresis of XbaI-restricted genomic DNA. Plasmids were analysed by S1 nuclease digestion and PCR typing. Case data for UK patients were reviewed for evidence of travel and recent admission to hospitals in India or Pakistan.

Findings
We identified 44 isolates with NDM-1 in Chennai, 26 in Haryana, 37 in the UK, and 73 in other sites in India and Pakistan. NDM-1 was mostly found among Escherichia coli (36) and Klebsiella pneumoniae (111), which were highly resistant to all antibiotics except to tigecycline and colistin. K pneumoniae isolates from Haryana were clonal but NDM-1 producers from the UK and Chennai were clonally diverse. Most isolates carried the NDM-1 gene on plasmids: those from UK and Chennai were readily transferable whereas those from Haryana were not conjugative. Many of the UK NDM-1 positive patients had travelled to India or Pakistan within the past year, or had links with these countries.

Interpretation
*
The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed.
*
Funding
European Union, Wellcome Trust, and Wyeth.


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