018: What’s Next in Infectious Diseases? Antibiotics, opioids, and the flu top expert predictions

 Antibiotics, opioids, and influenza were top-of-mind as experts in infectious diseases looked towards what will be the biggest issue in their field in 2018.

“The biggest issue in infectious diseases in 2018 will be the progressive occurrence of multi-resistant antibiotic infections that will challenge us to provide effective treatment,” William Schaffner, MD, of Vanderbilt University School of Medicine, told MedPage Today.

There may even be an early contender for “superbug of 2018” in multi-drug resistant gonorrhea, Andrew Pavia, MD, of the University of Utah, said. Indeed, in July 2017, the World Health Organization cautioned that multi-drug resistant gonorrhea was on the rise, and research found that two-thirds of gonorrhea cases in 77 countries had cases of gonorrhea with decreased sensitivity to extended spectrum antibiotics.

The FDA has taken some steps to address antibiotic resistance, with the recent launchof a website designed to help physicians manage their antibiotic prescribing. But supply, not just resistance, may also be a problem, as Judith Aberg, MD, of the Icahn School of Medicine at Mount Sinai, pointed out.

“We are continuing to experience significant national shortages of antibiotics as well as the saline necessary to infuse antibiotics, which will continue to pose challenges to manage potentially serious infections,” she said.

The field of infectious diseases is certainly not immune to the opioid epidemic. Myron Cohen, MD, of the University of North Carolina Chapel Hill, said that “infections and the opioid crisis” could be a major issue in the coming year.

Pavia added that the opioid epidemic will likely continue to drive new HIV and hepatitis C infections, which have the potential to affect pregnant women and newborn babies. Back in May, the CDC found that the rate of maternal HCV infection nearly doubled from 2009 to 2014, with notable increases among predominantly white persons in rural areas with a history of injection drug use. Recently, San Francisco launched its own campaign to try to combat the disease, especially among drug users.

No set of infectious disease predictions for 2018 would be complete without discussing influenza. Although the CDC reported a sharp increase in cases during December, flu deaths were not more common than in prior years at the mid-December point. Not only is there widespread concern over the potential lack of efficacy of this year’s vaccine, but flu season has yet to hit its peak.

“I think right now the hot issue may be the flu season,” Paul Volberding, MD, of the University of California San Francisco, said. “Looks like it might be a bad year and a vaccine that seems pretty weak.”

Peter Hotez, MD, PhD, of Baylor College of Medicine, focused on a different type of vaccine — specifically, the measles vaccine. He pointed out that the CDC recently issued measles travel alerts for Greece and England.

“In 2018 we will see non-medical exemptions for vaccines continue in the U.S. and Europe, with an expectation that serious and widespread measles outbreaks will continue or ensue this winter and spring,” he said.

But Pavia pointed out that generally, the biggest story in infectious diseases is “almost always the one we did not anticipate, as it was for SARS, Ebola, MERS, Zika and so many more,” he said.

Del Rio agreed: “As Yogi Berra said, ‘It is tough to make predictions, especially about the future.'”