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What is an antibiotic?

An antibiotic is a type of drug that kills or stops the growth of bacteria. Examples include penicillin and ciprofloxacin, and there are many others.

What does "susceptible" mean when it comes to antibiotics?

The term "susceptible" means that the antibiotic can kill the bacteria or stop its growth. For example, when we say that a type of bacteria is susceptible to the antibiotic penicillin, it means that penicillin kills or stops the growth of that bacteria.

What is antibiotic resistance?

Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic—that is, the bacteria are not killed, and their growth is not stopped. Resistant bacteria survive exposure to the antibiotic and continue to multiply in the body, potentially causing more harm and spreading to other animals or people.

Why do antibiotics stop working?

Antibiotics are designed to kill or block the growth of bacteria, but not all bacteria are susceptible. Some are naturally immune. Resistance also arises spontaneously by chance mutations. Resilient strains can then multiply and thrive - overnight, one bacterium can multiply to become a million. When the antibiotic of choice is given it kills the sensitive bacteria but any resistant ones live on. Resistance can also be passed from one species of bacteria to another.

Is overuse of antibiotics to blame?

Certainly, the more an antibiotic is used, the greater the chance there will be that bacteria will develop resistance to it. Experts are concerned that antibiotics are being used inappropriately. Many are prescribed and used for mild infections when they don't need to be. Antibiotics cannot help you recover from infections caused by viruses, such as common colds or flu, for example. Another issue is people who fail to take the whole course of prescribed antibiotic. Stopping treatment early means that the under-treated bacteria could turn resistant. It is thought that the widespread use of antibiotics in animals has led to resistant strains of some bacteria being transmitted to humans through food.

Is it getting worse?

Experts are concerned that we are reaching a point when some previously manageable infections will become untreatable with antibiotics. The superbug MRSA is now resistant to so many drugs that it is already hard to treat. Similarly, we are seeing cases of multi-drug resistant TB and the emergence of threatening new resistant bacteria like New Delhi metallo-beta-lactamase (NDM-1).

Resistant bacteria are spread through direct contact with a person or animal with that infection in the same way that other bacteria spread. Resistance is a particular problem in hospitals and places like old people's homes where many vulnerable people are gathered together. Increased international travel means people infected with resistant bacteria in one country can spread them to another country very quickly.

Why don't we have enough new antibiotics?

Pharmaceutical companies are placing renewed emphasis on the search for new antibiotics and are also developing new vaccines to prevent common infections. But these ventures are expensive to fund and in terms of cost-effectiveness for the company, may be less attractive than other business opportunities. If major resistance does occur, the drug would be a write-off for the pharmaceutical company that developed it. Many of the "newer" antibiotics are chemical variants of older agents and this means resistance development can occur quickly.

Source:http://www.bbc.com/news/health-21739378 and http://www.cdc.gov/narms/faq.html  

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WHO in April 1st 2013, an outbreak of human infections with a new avian influenza A (H7N9) virus was first reported in China. The virus was detected in poultry in China as well. Most human infections are believed to have occurred after exposure to infected poultry or contaminated environments.

During the spring of 2013, 135 H7N9 human infections were reported, the vast majority with illness onset during the month of April; 44 people died. Only 5 cases were detected over the summer. To date this fall, four human cases have been reported; all with illness onset in October. Most of the recent cases also had poultry exposure and lived in areas where H7N9 had been found previously. The decrease in H7N9 cases over the summer likely resulted from a combination of control measures taken by Chinese authorities - like closing live bird markets - and a change in weather. Studies indicate that avian influenza viruses, like seasonal influenza viruses, have a seasonal pattern: they circulate at higher levels in cold weather and at lower levels in warm weather. The October cases coincide with the arrival of cooler weather in China and are not unexpected. In fact, it’s likely that cases of H7N9 will continue to be detected in China and possibly in neighboring countries during the fall and winter.

While some mild illnesses in human H7N9 cases have been seen, most patients have had severe respiratory illness, about one-third leading to death. Close contacts of confirmed H7N9 patients have been followed to determine whether any human-to-human spread of H7N9 has occurred. No evidence of sustained person-to-person spread of H7N9 has been found, though some evidence points to limited person-to-person spread in rare circumstances. Limited person to person spread of bird flu is thought to have occurred rarely in the past, most notably with avian influenza A (H5N1), and so would not be surprising with H7N9. No cases of H7N9 outside of China have been reported, and the new H7N9 virus has not been detected in people or birds in the United States.

Most concerning about this situation is the pandemic potential of this virus. Influenza viruses constantly change and it’s possible that this virus could gain the ability to spread easily and sustainably among people, triggering a global outbreak of disease (pandemic).

What is H7N9?

Avian influenza A H7 viruses are a group of influenza viruses that normally circulate among birds. The avian influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses. Although some H7 viruses (H7N2, H7N3 and H7N7) have occasionally been found to infect humans, no human infections with H7N9 viruses have been reported until recent reports from China.. Beginning at the end of March 2013, China reported human and bird (poultry) infections with a new strain of H7N9 that is very different from previously seen H7N9 viruses.

Is this new strain of H7N9 infecting humans?

Yes. While H7N9 viruses had never before been detected in people, from March 31 through April 30, 2013, China reported more than 126 cases of human infection with this new H7N9 virus.

How are people becoming infected with the avian influenza A(H7N9) virus?

At this point it is not known how persons are becoming infected. Some of the confirmed cases had contact with animals or with environments where animals are housed. The virus has now been found in chickens, ducks, and captive-bred pigeons at live bird markets near locations where cases have been reported. The possibility of an animal source of the infection is being investigated, as is the possibility of person-to-person transmission.

Is it possible that this virus will spread from person-to-person?

Yes. Based on what we know about human infections with other bird flu viruses, it’s possible and even likely that there will be some limited person-to-person spread with th

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What is known about previous human infections with H7 influenza viruses globally?

From 1996 to 2012, human infections with H7 influenza viruses (H7N2, H7N3, and H7N7) were reported in Canada, Italy, Mexico, the Netherlands, the United Kingdom, and the United States of America. Most of these infections occurred in association with poultry outbreaks. The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands. Until this event, no human infections with H7 influenza viruses have been reported in China.

Is the avian influenza A(H7N9) virus different from influenza A(H1N1) and A(H5N1) viruses?

Yes. All three viruses are influenza A viruses but they are distinct from each other. H7N9 and H5N1 are considered animal influenza viruses that sometimes infect people. H1N1 viruses can be divided into those that normally infect people and those that normally infect animals.

Is this virus spreading from person-to-person?

China has conducted extensive case investigations of people infected with the H7N9 virus and their close contacts and has found no evidence of "sustained" person-to-person spread at this time, which is the kind of ongoing spread that is necessary for a pandemic to occur.

However, we should aware of a small number of confirmed H7N9 influenza cases in China in which “limited” person-to-person spread of the virus could not be ruled out. "Limited" or "dead end" virus spread usually refers to when a virus from an animal host infects a person and then spreads to a caretaker or close contact of that person but not much further.

Source:

CDC US (http://www.cdc.gov/flu/avianflu/h7n9-faq.htm)

WHO (http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/)

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How do people get infected with bird flu viruses?

Human infections with bird flu viruses are rare, but have happened in the past, usually after close contact with infected birds (both live and dead) or environments contaminated with bird flu virus.

Infected birds can shed a lot of flu virus, for example, in their droppings or their mucus. If someone touches an infected bird or an environment contaminated with virus and then touches their eyes, nose or mouth, they may be infected with bird flu virus.

There is some evidence that infection may also occur if the flu virus becomes airborne somehow, such as when an infected bird flaps it wings. If someone were to breathe in airborne virus, it’s possible they could get infected.

Is infection with this virus serious?

Most of the reported cases of human infection with this virus have had very serious illness. There also are reports of some milder illness and one possible report of a person who tested positive for the virus who did not have any symptoms.

What are the main symptoms of human infection caused by avian influenza A(H7N9) virus?

Thus far, most patients with this infection have had severe pneumonia. Symptoms include fever, cough and shortness of breath. However, information is still limited about the full spectrum of illness that infection with avian influenza A(H7N9) virus might cause.

Why is this virus infecting humans now?

We do not know the answer to this question yet, because we do not know the source of exposure for these human infections. However, analysis of the genes of these viruses suggests that although the viruses have evolved in birds, they may infect mammals more easily than other avian viruses

Is it possible that this virus will spread from person-to-person?

Yes. Based on what we know about human infections with other bird flu viruses, it’s possible and even likely that there will be some limited person-to-person spread with this virus. The important factor will be to determine whether this virus gains the ability to spread easily from one person to another. Sustainable human to human spread is needed for a pandemic to start. Health officials are watching the situation closely for this.

Is there a vaccine to protect against this new H7N9 virus?

No, right now there is no vaccine to protect against this virus. WHO, CDC and others partners/institution are working to develop a vaccine candidate virus that could be used to make a vaccine if it is needed.

Are there medicines to treat illness associated with this virus?

WHO and CDC US recommend oseltamivir (Tamiflu®) and zanamivir (Relenza®) for treatment of H7N9. Most of the H7N9 viruses that have been studied are likely susceptible (sensitive) to the two influenza antiviral drugs that are used to treat seasonal flu. Those drugs are oseltamivir (Tamiflu®) and zanamivir (Relenza®) (neuraminidase inhibitors). Like seasonal influenza viruses, avian A(H7N9) viruses are resistant to the influenza antiviral drugs known as the adamantanes.It’s important to note that influenza viruses may acquire genetic changes which can make one or more influenza antiviral drugs less effective. This happens with seasonal influenza viruses and could happen with H7N9 viruses found in China.

Source:

CDC US (http://www.cdc.gov/flu/avianflu/h7n9-faq.htm)

WHO (http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/)

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Is there a vaccine to protect against this new H7N9 virus? Answer

No, right now there is no vaccine to protect against this virus. WHO, CDC and others partners/institution are working to develop a vaccine candidate virus that could be used to make a vaccine if it is needed.

Are there medicines to treat illness associated with this virus? Answer

WHO and CDC US recommend oseltamivir (Tamiflu®) and zanamivir (Relenza®) for treatment of H7N9. Most of the H7N9 viruses that have been studied are likely susceptible (sensitive) to the two influenza antiviral drugs that are used to treat seasonal flu. Those drugs are oseltamivir (Tamiflu®) and zanamivir (Relenza®) (neuraminidase inhibitors). Like seasonal influenza viruses, avian A(H7N9) viruses are resistant to the influenza antiviral drugs known as the adamantanes.It’s important to note that influenza viruses may acquire genetic changes which can make one or more influenza antiviral drugs less effective. This happens with seasonal influenza viruses and could happen with H7N9 viruses found in China. Answer

Source: Answer

CDC US (http://www.cdc.gov/flu/avianflu/h7n9-faq.htm) Answer

WHO (http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/)