MRSA, PTSD, and Your Family

Eighteen-year-old MRSA survivor Bethany Burke: “These things on my face were taking over. It’s like my face was being invaded. I looked like I had been stung by some venomous insect. They were all over. They were swelling. And it seemed like the more I was taking antibiotics it was like feeding these things on my face. They just kept getting bigger and eventually the one on my eye became so large that I couldn’t open my eye anymore.”



As Sanjay Gupta, MD, reports, Bethany’s ordeal began at age 15 when she developed an irritation on her forehead. After being diagnosed with methicillin-resistant Staphylococcus aureus (MRSA) at a local emergency room, Bethany was treated with several different antibiotics, and the skin abscesses had to be lanced and drained. Health issues related to the infection persisted for the next two years.

“I missed so much school,” says Bethany, then a freshman at Southwestern University in Texas. “Just getting dressed would exhaust me so much that I didn’t have any energy left. While other girls were taking bubble baths, I was checking my body for abscesses and taking diluted bleach baths.”

Although they got the infection under control “it left some pretty deep scars, physically and emotionally,” Bethany says. In fact, she was eventually diagnosed with post-traumatic stress disorder. “Not being able to control what’s going on with your body… nothing makes you feel more helpless.”

And Bethany wasn’t the only one diagnosed with PTSD – so was her mother. “I looked at her and could not believe what I was seeing,” her mother Mary recalls. “The blemish on her forehead was now just enormous. They also spread to her nose and eyelid.”

There’s a saying in the cancer field: when somebody gets cancer, the whole family gets cancer. “Cancer moves in, like a rude and unwanted guest. And, as the patient, you have to understand – as hard as that might be – that it’s not just you alone who has to cope with the disease,” cancer patient Dana Jennings wrote in The New York Times.

It’s easy to see how “MRSA” and “Cancer” are interchangeable in Jennings’ statement, especially since MRSA is contagious. For example, how would you cope when the MRSA patient is your partner with whom you so intimately share living quarters? Or if you’re infected with MRSA and have children, how do you cope with the possibility of infecting them? Or worse, what if, like with the flu, family members started contracting MRSA, one after the other?

A few years ago, the Centers for Disease Control and Prevention conservatively estimated that there are over 80,000 “severe” MRSA infections in the United States each year. However, maybe a better way to understand what the CDC is telling us is this: Each year in the U.S., over 80,000 families are infected with a severe case of MRSA.




The Post-Antibiotic World: “If I need one of these [Antibiotics] down the road is it going to have the effect I need it to? I don’t know the answer to that.”

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“If we are not careful, we will soon be in a post-antibiotic era,” said Dr. Tom Frieden, then director of the Centers for Disease Control and Prevention (CDC). “And for some patients and for some microbes, we are already there.”

If you want a glimpse into that post-antibiotic world, take a look at the case of Nicole Scott (pictured above). After a fall she had reconstructive surgery to her left shoulder. The procedure itself went fine but during recovery an excruciating pain set in signaling an infection: “It literally looked like I had a softball sitting on top of my shoulder and I mean I just barely touched it and my shoulder just ruptured,” she said.

Surgery was needed to open and clean the site followed by a night of IV antibiotics. Underneath her skin her doctors found a large pocket of infection that spread from her shoulder to – but not into – her heart.

Weeks later the stitches were removed and the wound was covered till her next follow-up. At the follow-up her bandages were removed and they were shocked to find that the tiny pinpoint hole at the site of the infection had become a hole the size of a quarter – the infection had eaten through the tissue and her skin. That required yet another surgery – and more antibiotics.

The CDC conservatively estimates 2 million such antibiotic-resistant infections in the US alone – every year. Each case will vary in its detail but what happened to Nicole Scott illustrates some of the broad themes: hospitalization, multiple surgeries, pain & disfigurement – and living with the dread of going through it all again.

That dread is what Nicole lives with: Have too many antibiotics taken after her surgery created a harmful tolerance? “If I need one of these down the road is it going to have the effect I need it to? I don’t know the answer to that.”

Nicole Scott is interviewed in this compelling video, which also nicely covers the a, b, c’s of when to use antibiotics. Be sure to click on the full screen icon.


The Responsibility to Protect



Vaccinations protect more people than just those who are vaccinated – they also protect the unvaccinated. Health authorities call this protection “herd immunity” (people around us are referred to as our “herd”). But there’s a catch: there has to be a threshold number of people who get vaccinated before this collective immunity takes effect. Conversely, low levels of herd immunity are often associated with epidemics, such as the measles outbreak in 2014 – 2015 that was traced to exposures at Disneyland in California.

Tara C Smith, PhD, of Kent State, wrote a popular essay this month explaining how vaccination and herd immunity go together. Note that the necessary level of (herd) immunity in the population isn’t the same for every disease:

For measles, a very high level of immunity needs to be maintained to prevent its transmission because the measles virus is possibly the most contagious known organism. If people infected with measles enter a population with no existing immunity to it, they will on average each infect 12 to 18 others. Each of those infections will in turn cause 12 to 18 more, and so on until the number of individuals who are susceptible to the virus but haven’t caught it yet is down to almost zero. The number of people infected by each contagious individual is known as the “basic reproduction number” of a particular microbe (abbreviated R0), and it varies widely among germs.”

For instance, the R0 of pertussis (whooping cough) is 12-17; polio and smallpox 5-7; mumps 4-7; HIV 2-5; influenza, including the 1918 influenza pandemic 2-3; and Ebola 1.5-2.5.

Here’s the thing. If you know how many secondary cases to expect from each infected person, you can figure out the level of herd immunity needed in the population to keep the microbe from spreading. Tara Smith:

This is calculated by taking the reciprocal of R0 and subtracting it from 1. For measles, with an R0 of 12 to 18, you need somewhere between 92 percent (1 – 1/12) and 95 percent (1 – 1/18) of the population to have effective immunity to keep the virus from spreading. For flu, it’s much lower — only around 50 percent. And yet we rarely attain even that level of immunity with vaccination.

Based on that arithmetic, the following table shows what percentage of the population needs to be vaccinated by disease to prevent its outbreak:

R values

Notice that the higher the R0 value, the higher the percentage of people in the community that need to be vaccinated.

Which brings us to the question of who it is that we need to protect – who are the unvaccinated? In general it’s people who are immune-compromised. For example, children who cannot be vaccinated because their immune system is too immature to develop the adaptive immune response that the vaccine is supposed to illicit. Infants who have not yet been vaccinated or have just received a vaccination. The elderly who, because of their age, are often immune-compromised. The sick, whose immune systems can’t withstand the dose of a weakened virus in a vaccine. Those for whom the vaccine didn’t take. And here’s a detailed eye-opening list provided by the CDC that pairs a particular vaccine with health status and warns against vaccination in such cases. All told, we’re talking about a huge swath of people that need protection from infectious disease through herd immunity.

In other words, vaccination campaigns for the flu and other diseases are about much more than individual health. They’re about achieving a collective resistance to disease that involves the whole community.

In the field of international relations there’s a UN doctrine called the Responsibility to Protect. It says that if a nation can’t or won’t protect its own people from harm, then other nations have a right and an obligation to step in and do so. Similarly, on the level of community relations, we know that the very young, the old, and the sick, can’t protect themselves from harm – disease – through vaccination. And so it falls on each one of us to do so: to vaccinate, thereby protecting not just the vulnerable but ourselves and our families at the same time.

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