This story was originally titled "Prevent Your Family from Superbugs" in the March 2009 issue. Subscribe to Canadian Living today and never miss an issue!

Gaya Elron lies motionless in a Vancouver hospital bed, her body battling a dangerously high fever. One of her blood tests has come back positive for  Staphylococcus aureus (S. aureus, commonly known as staph), which can cause a serious, even fatal, infection. Now in an isolation unit, Gaya, 11, is being closely monitored by doctors and nurses clad in full protective gear. Her mother, Yael, paces back and forth in the hospital room, wringing her hands and waiting for some answers. It's not unusual for active, healthy girls like Gaya to come down with a flu bug, but they don't usually develop a potentially life-threatening bacterial infection. But times are changing.

Today, mysterious infections such as staph and other superbugs that were once only a concern for hospital patients are a growing concern in schools and day cares across the country.

As she waits to talk to the doctor, Yael reviews the events of the past two days. Gaya, a diligent pupil who studied hard and competed equally hard in sports, had finished the school week with a cross-country race. After school, Gaya told her mother she had a painful ache in her leg, and she seemed to have a mild fever. It wasn't like her to complain without reason, so Yael made a doctor's appointment – but promptly cancelled it when Gaya started feeling better and the fever subsided. "When a child this age gets a fever, you don't run immediately to the doctor," she says, echoing the sentiment of mothers across the country. "Usually it's just the flu or a cold."

Gaya's symptoms get worse
Less than an hour later, though, Gaya's fever was back, climbing dangerously close to 40 C. With the weekend looming, Yael immediately took her daughter to the family doctor. Concerned about the swelling in Gaya's upper leg, that physician advised a trip to the hospital emergency department. There doctors carried out some preliminary blood and urine tests, but found nothing. With no conclusive explanation of her symptoms, Gaya was sent home. In the middle of the following night – 36 hours after her symptoms first appeared – Gaya started to vomit violently, and her temperature skyrocketed to over 41 C.

"I woke up around one or two in the morning and threw up some blood – so we called a taxi and I went to the hospital again," remembers Gaya. After admitting Gaya and carrying out more tests, her doctors became convinced that they were dealing with an aggressive infection, but wanted to determine exactly what it was.

Infectious diseases are caused by microscopic bacteria, viruses and even fungi that move from one person to another – or even from one species to another, as is the case with avian influenza (bird flu). These diseases are transmitted by skin-to-skin contact, through food, bodily fluids or air, and sometimes via another organism that remains unaffected (for example, West Nile virus, which is transmitted by mosquitoes). Doctors eventually confirmed the culprit in Gaya's case was staph, typically acquired through skin-to-skin contact. But where had she come into contact with such an aggressive form of the bug – usually not seen outside hospital wards?

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Staph first showed up on the public radar in the mid-1950s. It emerged as a nasty bug that could cause skin infections like pimples and boils, but also life-threatening diseases such as pneumonia and meningitis. At the time, penicillin was the drug of choice to treat staph, but in less than a decade, the bacteria became resistant to this antibiotic. In 1959, another antibiotic, methicillin, was introduced, but in just two years, staph had mutated into methicillin-resistant S. aureus (MRSA), which is also resistant to a large cache of other antibiotics. Since the 1980s, the powerful drug vancomycin has been at the forefront of treating MRSA, but sure enough, the bacteria now show signs of developing a resistance to vancomycin, too. This increasing drug resistance means people with staph infections may have a life-threatening, potentially untreatable, illness.

As doctors struggled to find an effective treatment for Gaya's illness, the days dragged into weeks, and still the little girl lay fragile and feverish in her hospital bed. While her dad stayed home to care for her two brothers, Gaya's mom stayed with her constantly. Yael even slept each night on a cot set up in the hospital room. Doctors administered vancomycin intravenously every eight hours in a desperate effort to eradicate the staph infection from Gaya's system.

"The antibiotics made her veins feel like they were burning, so she was really crying after the first few doses," says Yael. "Because of the risks associated with staph, and the fear that it could be MRSA, they put us in a closed room – no coming in and no going out," to minimize the risk of transmission. How could a potentially deadly strain of staph infect a perfectly healthy, active girl like Gaya? Though in the past, staph infections have mainly been a concern for people in the hospital or living with compromised immune systems, it has somehow expanded its reach into the community and started infecting healthy people – particularly children.

Why children like Gaya are more susceptible to superbugs
Youngsters like Gaya are generally more vulnerable to infection than adults because they have regular physical contact with one another, share personal items and get frequent cuts, says Dr. Joseph Lam, a Vancouver pediatrician with training in paediatric dermatology.

"Children will share anything," says Louise Holmes, a nurse and educator at Vancouver Coastal Health – Communicable Disease Control. For example, with very young kids, "anything that's on the floor goes straight into their mouths, and they are always on top of one another when they play." This increases their risk of infection and may put kids in increased danger from newer, more antibioticresistant staph strains. There have already been outbreaks of MRSA at day cares and nursery schools, says Holmes. These cases of so-called "community associated" MRSA (CA-MRSA) have also been reported among sports teams and other populations living in close proximity to one another. CA-MRSA infections can be relatively minor, affecting only the skin and soft tissues, or they can be much more serious. Necrotic pneumonia, for example, can destroy the lungs in just 24 hours.

Staph is just one of many superbugs
Staph is but one of myriad alarming new superbugs. Other superbugs making recent headlines both here and abroad include SARS, the Ebola virus and the H5N1 strain of avian influenza. Infectious diseases claim tens of millions of lives around the world every year. HIV-AIDS infections continue to be a problem, and recent years have marked the appearance of malaria in North America, as well as the return of tuberculosis. According to the World Health Organization, two million people died of AIDS in 2007, more than one million a year die of malaria, and nearly two million might die of tuberculosis in any given year.

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The statistics regarding staph infections are also of concern. According to the Canadian Medical Association Journal, an estimated 14,000 Canadians were infected with health-care-associated MRSA (HA-MRSA) in Canadian hospitals in 2006; of those infections, 2,300 cases resulted in death. The journal also estimates that the rates of CA-MRSA doubled between 2000 and 2005. To address the alarming upward trend of infectious disease threats in the community, major Canadian research groups, including Genome Canada and Genome British Columbia, are backing a promising Vancouver-based project called PREPARE (an acronym for "PRoteomics for Emerging Pathogen REsponse" – proteomics is the study of proteins).

In the past, creating new antibiotics involved either purifying waste products from microorganisms, or chemically improving an existing antibiotic; researchers with PREPARE use powerful computers to analyze gene sequences of the harmful bacteria to pinpoint targets for new drugs.

Why some superbugs develop drug resistance
"It's easy for these bugs to develop resistance," explains Fiona Brinkman, a professor of molecular biology and biochemistry at Simon Fraser University in Vancouver. "With this genomics-based approach, we're looking at all the possible targets, and trying to find something new that the bacteria won't be able to develop resistance to so easily." The PREPARE team is concentrating its research efforts on certain bacterial proteins. "Our focus is to identify how proteins communicate within the bacterial cell," says Raymond See, scientific director for the PREPARE project.

"These proteins are like people [in that] they need to 'talk' to each other in order to perform their functions." Because such communication is critical to the bacteria's survival, the goal is to disable these highly "talkative" proteins, essentially disrupting their means of communication, says See. In addition, he says, these proteins don't mutate very easily, so they're much less likely to become drug-resistant. This makes them excellent drug targets. The project's scientists have already successfully disabled two of the MRSA target proteins, and hope to complete their analysis of this trial within the next few months to reveal more potential drugs to target MRSA.


Page 3 of 4While we await these drug breakthroughs, there is still real fear among both ordinary Canadians and the medical community about the next outbreak of an untreatable infection. Healthy citizens going about their work and play wonder if and when they might catch a bug that doesn't go away and lands them in the hospital – or worse. For the Elron family, life is getting back to normal. After being released from the hospital more than a year ago, Gaya recovered, caught up on her homework and returned to school, her cross-country races and playing with friends. Her parents have resumed their whirlwind schedule of chauffeuring Gaya and her brothers to various activities. Although it is unlikely Gaya will ever forget her battle against staph, in the end, her resilience triumphed. In her fight for her life, she emerged the winner.

How to protect your family
Here are some tips to keep your family safe from infection by a superbug, from Louise Holmes, an educator at Vancouver Coastal Health–Communicable Disease Control.

• Wash your hands. Wash regularly with soap and water or with an alcohol-based hand sanitizer. Do this before eating or preparing food, after you go out and after any activities that soil your hands.
• Keep clean. Bathe or shower regularly. When you need to cough or sneeze, do so into a tissue or the inside of your elbow.
• Houseclean frequently. In particular, clean frequently touched surfaces and countertops. Toilets and sinks should at the very least be kept visibly clean and routinely wiped with disinfectant.
• Cover open wounds. Cover any open cut or abrasion with a bandage and avoid skin-to-skin contact until it’s healed.
• Handle sports equipment wisely. Clean sporting equipment between uses and keep your own gear for your use only.
• Minimize antibiotic use. Use properly. Do not expect a prescription every time you go to a doctor.
• Keep your germs to yourself. If you’re sick, stay at home. Keep kids home from school if they’re not well.
• In public, try to keep one to two metres away from people. Whenever possible, sit beside people rather than across from them, to minimize transmission of airborne infections.
• Keep family members up-to-date on their immunizations.
• Eat well, get plenty of sleep and exercise regularly.

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