MDR Acinetobacter Baumanni infections among troops and civilians are going largely uncovered, and uninvestigated.

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In March of 2007, I wrote The Beginning of a MDR Epidemic? which explored the potential for an epidemic of Acinetobacter Baumannii (AB) from troops wounded in Iraq (or Afghanistan). In summation, AB is a virulent multi-drug resistant (MDR) bacteria which has become increasingly common in troops (and civilians) treated in field hospitals in Iraq. It spread to military hospital in Landstuhl, Germany, and then to Walter Reed. I had a number of questions at the time I wrote that article, and virtually none of them have been answered. However, my concern that AB would spread to civilian hospitals is being confirmed. There are a number of alarming aspects to the "outbreak" of MDR A. baumanni infections:

• They are apparently arising out of the Iraq and Afghanistan theaters.
• They seems to have spread throughout much of the U.S. military medical facilities.
• There are increasing outbreaks in civilian medical facilities across the United States.
• The problematic AB variant is apparently the "culprit" (at least in civilian facilities).
• The AB under discussion is more than a "superbug."

All of these issues lead to concerns that something is going on that presents a threat to U.S. troops, the safety of U.S. medical facilities, and possibly to an array of medical facilities across the planet. In September of 2007, Steven Silberman of Wired News wrote an extensive article on the AB outbreak called "The Invisible Enemy." There was a paragraph on the last page of the article set alarm bells ringing for me:

"When a team of geneticists unlocked the secret of the bug's rapid evolution in 2005, they found that one strain of multidrug-resistant Acinetobacter baumannii carries the largest collection of genetic upgrades ever discovered in a single organism. Out of its 52 genes dedicated to defeating antibiotics, radiation, and other weapons of mass bacterial destruction, nearly all have been bootlegged from other bad bugs like Salmonella, Pseudomonas, and Escherichia coli."

In 2005 there was a multiple city outbreak of AB infections. According to researchers, 97% of the cases they studied "belonged to one clone." In other words, 97% of the cases were a genetic match to each other even though they occurred in different cities. As with the recent salmonella outbreak, a bacterial clone means a single point of transmission. This offers a way to track the AB that is occurring to its source, but there are no reports that I found indicating this is happening. What these two different reports - Silberman's and the doctors writing the multicity outbreak report - seem to be saying is that the MDR AB outbreak happening across the country is genetically the same "superbug," and that it is an radically "upgraded" bug. From a November 2004 Center for Disease Control (CDC)report we know that there were increasing reports of AB infections in those being treated at military medical facilities in Iraq, Kuwait and Afghanistan. This was later reported to have spread to the Lundstahl facility, and then to Walter Reed, and then on to other military medical facilities in the United States. There has apparently little action taken to communicate between the U.S. military and civilian medical groups (including the CDC) regarding the AB infections coming out of the Afghanistan/Iraq theaters, even though there have been concerns about the threat since 2002. Finally, in 2007 there was a testing of shared reporting in the military health system on AB cases. In other words, not only is the military not systematically reporting to U.S. civilian health officials, but they are not communicating within the military health system itself. Is this just another case of systems failure that we have seen over and over under the current Bush administration, or is there something else going on? As a lay person looking at what information does seem to be available, I have several questions that I wish those with the medical and biological background would investigate. 1. Does the "upgraded" nature of the MDR Acinetobacter baumanni infection indicate a natural evolution, or engineering? If engineering, who made it and for what purposes? 2. After at least 6 years of known infections "in theater," why has there not been action to:

• a) track down the source of the infections and stop (or control) it;
• b) set up an effective military tracking and monitoring system;
• c) set up an communication and monitoring system with civilian facilities;
• d) communicate with the public about this issue?

We have a serious nation (and international) health threat, and it does not seem to be being either addressed or appropriate warnings issued. I believe that the entire AB issue is being kept deliberately quite. Whether that is simply the military wanting plausible deniability as they have with numerous other issues (the effects of atomic testing, Agent Orange, Gulf War Syndrome, the effects of depleted uranium, etc) so that they can refuse to treat veterans for service-related medical conditions, general military protocol, or covering up of weapons research, this is a threat to both those within military service and civilian populations. Therefore, it becomes critically important that we continue to increase public awareness and push elected representatives to address the issue. (How to contact your representatives) Related Information and Sites Multicity Outbreak of Carbapenem-Resistant Acinetobacter baumannii Isolates Producing the Carbapenemase OXA-40. Karen Lolans, Thomas W. Rice, L. Silvia Munoz-Price, and John P. Quinn. Antimicrobial Agents and Chemotherapy. September 2006, p. 2941-2945, Vol. 50, No. 9 Assessment of Existing Health Level 7 Messages to Establish Electronic Laboratory Reporting in the Military Health System: focus on acinetobacter surveillance. Riegodedios et al. CDC 2007. Home From Iraq: Acinetobacter Baumannii. JC Jones MA RN. Healthline. 9/06/2007. http://www.acinetobacter.org/ I encourage you to examine the map of outbreaks at Acinetobacter baumannii from Iraq: The Coalition of the contaminated. Unfortunately, I cannot reproduce it here. Then compare it to the map of U.S. military bases below. The map above is from National NAGPRA map link - Military bases in the contiguous United States, and is available as a pdf download. (And here is a link to the listing of US military hospitals and medical centers. )

Authors Bio:

Rowan Wolf is an activist and sociologist living in Oregon. She is the founder and principle author of Uncommon Thought Journal, and Editor in Chief of Cyrano's Journal Today.