During her years as a reporter covering the Centers for Disease Control and Prevention for the Atlanta Journal-Constitution, Maryn McKenna grew accustomed to being called "scary disease girl," the bearer of titillating tales of exotic ailments unlikely to affect most people.
McKenna's new book, "Superbug: The Fatal Menace of MRSA," is less deliciously frightening and more just plain scary. It tells the story of the rise and spread of MRSA, methicillin-resistant Staphylococcus aureus — a quickly evolving, drug-resistant, potentially fatal staph bacteria that has leapt from the hospital to the community and, most recently, to farm pigs.
For decades, MRSA was considered a problem limited to hospitals, where the bacteria would enter the bloodstream through broken skin, surgical wounds and incisions, and thrive on weakened immune systems. The medical establishment was alarmed when healthy people started falling gravely ill to a new strain of MRSA in the 1990s, and at first didn't believe it could be happening. Eventually dubbed community-associated MRSA, the non-hospital strain found a way to cause infections on intact skin.
"People will say, 'I thought I had a spider bite,' "McKenna said. "But then it gets really hot and red and the pain is disproportionate to its size."
Some skin infections can develop into bone infections or deep muscle abscesses, and McKenna's book is filled with harrowing stories of healthy kids and adults spending months in the hospital and sometimes dying because of their infections.
While staph bacteria itself is common — living on the skin and in the nostrils of a third of Americans usually without causing harm — MRSA is worrisome because it is resistant to most antibiotics and adept at mutating into new strains, making it hard to fight and easy to spread.
McKenna answered some questions about the MRSA epidemic.
Do the medical community and general population have an adequate appreciation for the risk of community-associated MRSA?
I don't think so. The recognition of it by a few academic researchers and the patients who had it is running way ahead of the knowledge in the great bulk of medicine and of us as everyday people. Most people had heard of MRSA as a hospital issue, but it's news to people that it can happen in the outside world. If someone becomes infected by this, it's not going to be on the radar of either the doctor or the patient.
What can individuals do?
There are things that we can do, and there are things we can ask our institutions to do. While MRSA lives on our skin and our nostrils, there do seem to be specific things that cause them to become infections.
It tends to occur when the "four C's" are involved: crowding, such as in a jail or army barracks; skin contact, such as in sports; insufficient cleanliness, which is a huge issue in prisons; and contaminated surfaces, such as hot tubs. The answer to most of these things is pretty much uncomplicated hygiene.
Washing your hands really makes a difference, because your hands are what bring the bacteria to your mucous membranes. It's amazing how good soap and water is, or an uncomplicated hand sanitizer.
It's also important to interrogate health-care workers about whether they've washed their hands. I don't think health-care workers are evil or careless, but I think they're busy.
If you work out, when you come home, change out of your exercise clothes and take a shower. If your kids play sports, have them shower right after. It does seem that a lot of people get community MRSA that they believe is associated with their gym. It's a good idea to use the stuff to wipe their benches down.
What are the implications of the new strain of MRSA found in pigs?
First, the pig strain is traveling around on the skin of people who work with livestock, and can cause an infection. And it seems pretty clear from the Netherlands (where the strain was first detected) that the bug can move from people who have close contact with livestock to people who don't.
Second, the pig strain has been found in retail meat in several countries now. The issue is not so much that you would swallow it and it would make you sick; the issue is more that you would take this contaminated meat home and handle it. Let's say you're handling a piece of pork and touch your nose or mouth. It could make you sick at a future date, or it could exchange its resistance factors with the other staph living on your skin.
Finally, it just doesn't seem like a good idea for there to be such a large pool of drug-resistant bacteria that we're not monitoring.