Infectious disease: What's in store for 2023?

2023 is shaping up to be another memorable year in the world of infectious diseases (IDs). RSV, influenza, and COVID-19 are buffeting patients and healthcare professionals (HCPs), straining public health resources, and driving drug shortages.

Is this just a preview of what’s to come? An expert provided some ideas about the outlook for infectious diseases in 2023.

Lessons to learn

In an interview with MDLinx, William Schaffner, MD, medical director of the National Foundation for Infectious Diseases, said that while he and other ID experts are hesitant to make predictions, there are critical lessons to be learned from recent events, as well as from those of prior years.

Dr. Schaffner said that physicians and other HCPs are well-positioned to inform and guide the public through these public health challenges.

Winter bugs

If you think this has been an exceptional winter bug season, Dr. Schaffner agrees.

Dr. Schaffner said that in preceding years, social distancing and closed schools suppressed the number of winter viral infections. The end of 2022 and the beginning of 2023 marked a transition away from these protocols.

Complicating the situation was smoldering COVID-19, combined with early onsets of RSV and Influenza infection. All of these drove up hospital admissions and demand on the healthcare system.

Fortunately, Dr. Schaffner said, COVID-19 appears to be ramping up only slightly, while RSV and influenza appear to be waning earlier than in previous years. Will these trends hold?

“Predicting became very hazardous,” he added.

MPox

Dr. Schaffner and other infectious disease experts could—and did—predict that we would face future outbreaks.

When asked what he expected, Dr. Schaffner recalled saying that he didn’t know what the next virus to cause a global pandemic would be, but he knew there would be one. “And lo and behold, those words were barely out of our mouths when along came Mpox,” he said.

Dr. Schaffner explained that a variety of factors have kept Mpox under control. The first was that infectious disease experts leveraged existing lines of public health communication that were originally established during the HIV epidemic. This got the message out quickly and cleanly to affected populations through state and local government channels.

It also helped that there was a smallpox vaccine already available that was effective against Mpox—and there was sufficient research to support stretching the supply by administering a fifth of the original dose.

“Education with changes in behavior, plus the distribution of this vaccine, really, to my great pleasure—but I must admit, some surprise—began to curtail the number of cases that we were seeing,” Dr. Schaffner said.

Superbugs

While influenza, RSV, COVID-19, and Mpox have been making headlines, superbugs remain an infectious disease threat, according to an article published by the Las Vegas Review-Journal.^[]

Four pediatric cases of Candida auris emerged in Nevada toward the end of 2022. Those were just one cluster of an estimated 600 cases of the superbug that emerged in more than 30 healthcare facilities since October 24, 2022, according to a Toronto Star article.^[]

“We can’t solve this problem as we did 30–35 years ago by just having the companies create new antibiotics,” Dr. Schaffner said. “That’s not happening, in part because the companies decided that they would rather invest in medications that people would take daily for the rest of their lives.”

Staving off future incidents, like the ones that cropped up in Nevada, will require enhanced antibiotic stewardship. This is occurring in hospitals, Dr. Schaffner said.

“It’s the use of antimicrobials in the outpatient arena where the larger problem currently lies, and the educational activities of all the medical societies have had some impact in reducing antibiotic use in the outpatient setting, but not nearly enough,” he said.

Looking ahead

In addition to monitoring the superbug situation, Dr. Schaffner said that he and other infectious disease experts have an eye on the ongoing bird flu strain.

The BBC reported that avian flu has killed more than 200 million birds worldwide.^[] But perhaps more troublingly, it’s also killed about 200 mammals—signaling a mutation that could make the leap to humans.

While that’s a cause for concern, Dr. Schaffner noted that the infectious disease community isn’t flat-footed.

We also have recent history to draw from. COVID-19 and the spike in viral respiratory illnesses provided some important lessons, but also highlighted some work that remains to be done, according to Dr. Schaffner. One of those critical tasks is restoring public trust that will in turn promote vaccine adherence.

PCPs have a critical role to play here, Dr. Schaffner said. People trust their doctors, and they can help restore trust in vaccines.

“That doctor is there for you day in and day out, interested in maintaining your health—and should you become ill, doing everything they can to diagnose and treat that illness and make you better,” Dr. Schaffner said. “You trust your doctor. Take a little time to have that conversation.”