Riechel Reports.... CA Senate: Legislation to Require Reporting of Superbug Infections

Senator Jerry Hill Announces Legislation to Require Reporting of Superbug Infections Leader in Policy Efforts to Combat Antibiotic Resistance Turns Anew to Hospitals to Increase Patient Protection

SACRAMENTO – Senator Jerry Hill announced today that he will introduce legislation in December to compel hospitals throughout the state to report cases of patients with superbugs – antibiotic-resistant bacterial infections.

“We have a crisis on our hands,” said Senator Hill, D-San Mateo and Santa Clara Counties. “The growth of antibiotic resistance threatens our very way of life. Anything we can do to slow down its development, we should do. We have an imperative to act.”

Los Angeles County recently declared that it aims to require hospitals in the county to report cases of patients ill with carbapenem-resistant enterobacteriaceae, or CRE, a superbug infection so dire that it can kill half its victims.

The move prompted Senator Hill to pursue anew his efforts to require the reporting of antibiotic-resistant infections. State law already requires local health officials to report cases of typhoid, and cases of diphtheria, listeria, salmonella, shigella and streptococcal infection in dairy workers and food, as well as dozens of other communicable and noncommunicable diseases. However, incidences of severe antibiotic-resistant infections are not among them.

In 2014, Senator Hill introduced SB 1311, to mandate tracking of superbug infections that are deemed “urgent, serious, or concerning threat” by the Centers for Disease Control and Prevention. While the legislation was successful in requiring hospitals to set up antibiotic stewardship programs to prevent overuse of antibiotics, the provision to track superbug infections was stripped out amid concerns about costs and reporting standards.

“It’s time to revisit the issue,” Hill said. “Tracking superbug infections can help doctors, public health experts and scientists better understand the problem of antibiotic resistance and better target solutions. This is about saving lives.”

The CDC estimates that at least 2 million Americans are infected with – and at least 23,000 Americans die as a result of – antibiotic-resistant infections every year, resulting in at least $20 billion in direct health care costs and at least $35 billion in lost productivity in the United States. In California, the state Department of Public Health estimates that antibiotic-resistant infections are responsible for at least 3,000 deaths and 260,000 illnesses every year.

A recent study commissioned by the United Kingdom determined that by 2050, more people will die from antibiotic-resistant infections worldwide than from cancer.

Underscoring the threat to global health, all member states of the United Nations declared in September that they would fight the problem, marking only the fourth time in history that the UN convened to confront a health crisis. UN Secretary-General Ban Ki-moon called antimicrobial resistance “a fundamental, long-term threat to human health, sustainable food production and development.”

In California, Senator Hill has championed legislative efforts to slow the development of antibiotic resistance, making the Golden State a leader in the nation:

· In 2015, Senator Hill authored SB 27, which was signed into law by Governor Brown, making California the first state in the nation to regulate the use of antibiotics in livestock.

· His SB 361, also signed into law in 2015, requires antibiotic stewardship programs in nursing homes to reduce inappropriate antibiotic use. The law also mandates antibiotic stewardship training for veterinarians.

· Hill’s SB 1311, signed into law in 2014, requires every hospital in the state to have an antibiotic stewardship program to reduce inappropriate antibiotic use.

· In 2016, Hill introduced SB 994 to require antibiotic stewardship in outpatient doctors’ offices. The bill did not make it through the Legislature.

The California Department of Public Health requires hospitals to report cases of 80 communicable diseases. Legislation to be introduced by Senator Hill on December 5 will update the list of reportable diseases and conditions to include certain antibiotic resistant infections identified by the CDC.

Contact: Leslie Guevarra, 415-298-3404 cell, or leslie.guevarra@sen.ca.gov

###

Q&A About Tracking Antibiotic Resistant Infections

What is the problem? Why should antibiotic resistant infections be tracked?

· It’s an incredibly serious public health threat and we must act now. The Centers for Disease Control and Prevention (CDC) estimates that each year at least 2 million people are infected with – and at least 23,000 people die from – antibiotic resistant infections. Each year, antibiotic resistant infections results in at least $20 billion in direct health care costs and at least $35 billion in lost productivity.

In their report, Antibiotic Resistance Threats in the United States, 2013, the CDC states, “antimicrobial resistance is one of our most serious health threats. Infections from resistant bacteria are now too common…The loss of effective antibiotics will undermine our ability to fight infectious diseases and manage the infectious complications common in vulnerable patients.”

A study commission by the United Kingdom estimates that by 2050, more people will die worldwide from antibiotic resistant infections than from cancer. That’s 10 million people, far above the 8.2 million who will be killed worldwide by cancer.

In September 2016, the United Nations convened in New York and put forward a declaration to combat antibiotic resistance. It was only the fourth time in history that the UN had met to tackle a global health problem, underscoring the significance of the problem.

The World Health Organization has also sounded the alarm about antibiotic resistance, calling it “one of the biggest threats to global health and endangers other major priorities, such as human development.”

What is the deficiency in current law? Doesn’t the Department of Public Health already track communicable diseases like antibiotic resistant infections?

· Despite the fact that antibiotic resistance is an epidemic that threatens to undermine many modern gains in medicine, current law does not compel the Department of Public Health to track antibiotic resistance infections. Current law says that the Department must maintain a list of reportable communicable diseases, but doesn’t specify that it needs to include antibiotic resistant infections. The current list has 80 reportable diseases, ranging from the Flu, to HIV, to rabies.

· Current law does require hospitals, but not other health facilities, to report 3 specific antibiotic resistant infections (MRSA, CDiff, and VRE), but only if they are acquired in a healthcare setting and in some cases, only if the infections take place in the bloodstream. This is good, valuable information and we should build on it to include other types of resistant infections and to include resistant infections that are acquired in the community.

· Under current law, the Department of Public Health has wide latitude to update the list of reportable disease, yet despite the fact that antibiotic resistance likely kills thousands of Californians each year, they have not updated the list to include resistant infections. It’s time for the Legislature to act.

Isn’t the federal government tracking antibiotic resistance? Have other states mandated reporting?

· There are several federal initiatives underway to track and monitor antibiotic resistant infections, such as efforts by the CDC to partner with states and local health authority’s to collect information associated with certain antibiotic resistant infections. However, the CDC’s efforts are largely voluntary and focused on certain healthcare acquired antibiotic resistant infections; the efforts largely do not include surveillance efforts on antibiotic resistance in general, such of those infections acquired in the community, outside of the healthcare setting. Health departments in California are, on a limited basis, participating in the CDC’s efforts. In addition, some states do require limited reporting on CRE infections.

Why is tracking antibiotic resistance important? How will it help fix the problem?

· Disease monitoring is a basic public health function. Without appropriate surveillance we can’t accurately measure the problem and implement appropriate solutions. Without appropriate tracking we also can’t see if any proposed solutions actually work. Data can be used to monitor disease trends, assess the effectiveness of prevention and control measures, identify populations or geographic areas at high risk, formulate prevention strategies, develop public health policies, and work with partner states to solve the problem on a national scale.

· Tracking resistance is the second of 4 core actions put forward by the CDC to combat antibiotic resistance. The other 3 are: preventing infections/preventing the spread of resistance, improving antibiotic stewardship, and developing new drugs and diagnostic tests.

What will your bill do?

· It will direct the Department of Public Health to include antibiotic resistant infections on their list of reportable diseases. The department will be required to include resistant infections that are considered by the CDC to be urgent, serious, or concerning (there are 23 total). The department will have discretion which of these 23 to track and will have authority to update the list as more information becomes available. They may not want to track all 23 types of resistant infections, but maybe those that are the most serious. That’s why we are giving the department flexibility.

· The way it works is that anytime a health facility encounters a patient with a reportable resistant infection, the health facility will report it to their county health department, who will then transmit the data to the Department of Public Health. The reporting can be done through the California Reportable Disease Information Exchange (CalREDIE), a computer application that the California Department of Public Health is implementing for web-based disease reporting and surveillance. The Department generally puts out quarterly reports on reportable diseases.

What is antibiotic resistance?

· Antibiotic resistance means that bacterial infections can no longer be treated with antibiotics. Over what are often short periods of time, bacteria can evolve to resist antibiotics that would otherwise threaten their existence. As more antibiotics are used, resistance grows at a faster rate. Antibiotic resistance can easily transfer through various pathways, for example, from bacterium to bacterium, from human to human, and from animal to human.

What has already been done to tackle the issue in California?

· In California, I’ve championed legislative efforts to slow the development of antibiotic resistance, making the Golden State a leader in the nation:

o In 2015, Senator Hill authored SB 27, which was signed into law by Governor Brown, making California the first state in the nation to regulate the use of antibiotics in livestock.

o His SB 361, also signed into law in 2015, requires antibiotic stewardship programs in nursing homes to reduce inappropriate antibiotic use. The law also mandates antibiotic stewardship training for veterinarians.

o Hill’s SB 1311, signed into law in 2014, requires every hospital in the state to have an antibiotic stewardship program to reduce inappropriate antibiotic use. Also included provision to track antibiotic resistance, but the provisions were stripped out.

o In 2016, Hill introduced SB 994 to require antibiotic stewardship in outpatient doctors’ offices. The bill did not make it through the Legislature.

=

Robert Riechel

E=Mail: SanBrunoPatch.Robert@Yahoo.com

WEB: http://SanBrunoPatch.com

My Posts http:/patch.com/users/robert-riechel

Photo Credit: San Bruno CA Patch Archives

Source Credit: CA State Senator Jerry Hill

Web Site: http://sd13.senate.ca.gov/