2024 and the viruses to come, from swine flu to superbugs: the new threats

After the Covid challenge, other pathogens under the spotlight. Francesco Vaia, Matteo Bassetti and the new president of the infectious disease specialists Roberto Parrella speak

Not just Covid, in 2024 the challenges to new viruses will multiply. Today, with climate change, the front of infectious diseases has been enriched with zoonoses (Dengue And West Nile, for example) once unknown in Italy and then there are the ‘super bugs’ resistant to antibiotics. In Italy there are 40 thousand deaths due to antibiotic resistance. And then theswine flu which often appears from South East Asia andavian. Outlining the challenges that await us are Francesco Vaia, director of Prevention at the Ministry of Health; Roberto Parrella, new president of Simit, the Italian Society of Infectious and Tropical Diseases and director of Respiratory Infectious Diseases at the Cotugno hospital in Naples and Matteo Bassetti, director of Infectious Diseases at the San Martino polyclinic hospital in Genoa. In 2024, Italy will host the G7, commitment to strategies to face these new challenges cannot be missing from the priorities.

“When the WHO declared the end of the state of emergency for Sars-CoV-2, a series of measures and obligations were eliminated – explains Parrella – And this may have generated a false expectation in the population. The virus circulates and it mixes with other respiratory viruses such as influenza. The data increased in November, reaching 1,000 hospitalized patients with symptoms and 307 deaths, therefore around 40 per day. These are numbers which, however, should not frighten, but lead us to face a situation which today it is more delicate for the fragile who are exposed to more risks than the entire population. Hence the need to vaccinate these categories together with the immunosuppressed with the updated risk assessment. Today, Covid and other respiratory viruses can be confused and overlap.” As often happens with respiratory diseases attributed to various infectious, viral and bacterial agents, we are talking about Mycoplasma pneumoniae and respiratory syncytial virus (Rsv) bronchiolitis in children. Paediatricians are increasingly alerted when winter gets harsher.

Infections with resistant bacteria

“Certainly the biggest problem we have to face is that of infections from bacteria resistant to antibiotics which represents a real plague, they occur almost every year 5 million deaths in the world and at least 40 thousand in Italy, between those who die in hospital and those who die outside due to infections from multi-resistant bacteria – observes Bassetti – It is a theme that brings together many different sectors, from that of human medicine, that of veterinary medicine, that of agriculture, because antibiotics are used in many different fields and we need a new awareness on the part of everyone that this is the real problem between now and the next 20-25 years. On the horizon there are few new antibiotics active on superbugs, bacteria that have now become very strong and resist any type of therapy. We must make the most of what we have available by trying to make the best use of them when they are needed, with a whole series of recommendations also to the population to use them at the correct dosage, at the correct rate of administration, when they are really needed”.

‘Some would like the Covid pandemic to never end’. Some time ago, I used this expression to stigmatize some positions that are irreconcilable with a science that must always be free and free from interests. Like the press. Two freedoms that the country must jealously preserve – says the director of Prevention of the Ministry of Health Francesco Vaia, former director of the INMI Spallanzani in Rome – Even today I believe that that expression is indicative of the root of many mistakes made which have led to mistrust and hesitation to the scientific approach of a large part of public opinion”.

“For this cultural change to be possible, it is also essential to adopt a systemic vision, which involves large sectors of society, from schools to the family, from the workplace to the world of the third sector. A proactive approach, which takes into account the complexity of the interventions required and which actively moves to promote the health of citizens throughout our life course: it is never too early, it is never too late and it is never enough for prevention! – highlights Vaia – Starting from the little ones, because it has been shown that the habits acquired during childhood have lasting repercussions on health, throughout the life of the individual (think of the problem of childhood overweight and obesity) up to the elderly”.

On antibiotic resistance, “there is also a need for new awareness on the part of doctors, because too frequently they use these drugs lightly and the lightness with which many doctors use these antibiotics does not explain the magnitude of the problem, perhaps – Bassetti remarks – it is the case that everyone has a greater awareness of how extraordinarily important these antibiotics and drugs are, but for this very reason they must be used with greater caution, so we should work a lot, especially from a training point of view, also and above all on doctors and this is the real big problem.”

Swine flu

This year there was the first case of H2N1 swine flu in England “just recently, the swine flu has already caused a pandemic in 2009 which caused numerous cases, millions of cases in the world with many deaths, it was an emergency. H2N1 does not seem to have the characteristics of becoming a pandemic virus , but also this it must absolutely be kept under close observation because, as far as swine flu is concerned, it would be an infection that evidently comes from the animal world, therefore zoonoses, in general, are an important problem because they are the infections that pass to humans from the animal world and this must be carefully monitored” .

Dengue, West Nile and ‘climate’ viruses

There are other emergencies also represented by climate change. “The fact that in Italy Dengue has now become a practically indigenous disease and therefore risks becoming endemic in our country too, the temperatures to which we have become accustomed in recent years have meant that mosquitoes are present not only in the summer months, but also in many other months, both spring and autumn. A problem that concerns Dengue and also West Nile – warns Bassetti – which is another disease transmitted by mosquitoes, also in this case it is a zoonosis that arrives via an intermediate host. Furthermore, Among the potential viral problems, the one to watch out for most carefully is avian flu: cases of avian flu continue to be reported in different animals, in mammals and other types of animals, it is clear that every time this virus affects a new animal, it mutates and we know what the changes of this type of virus mean. The future scenario, therefore, is unfortunately full of infectious problems.”

“There is a national plan to combat antibiotic resistance – explains Parrella – which includes 4 areas: training, information, transparency and research-innovation, and then national and international cooperation. The pillars are the surveillance and monitoring of antibiotics and of abuse-related bacterial infections”.

Will we have a generation of doctors in the future capable of studying, understanding and intervening on emerging infectious diseases? “We ended the Simit congress with careful participation on these issues, from antibiotic resistance to zoonoses – concludes Parrella – A new generation of infectious disease specialists will be born ready to counteract this type of emergency and I see them very energetic, ready to take action and raise awareness among the population.”