2009 was the year of the pandemic that never happened. This year, a new drug-resistant bacterial gene may accomplish what the H1N1 never could. Scientists are warning that the super bug, an enzyme called New Delhi-Metallo-1 (NDM-1), could spread across the world as nothing has been able to treat it.
The Lancet Infectious Diseases reported that antibiotics have proved so far ineffective against the bacterial gene, which was found in patients traveling to South Asia for medical treatment. NDM-1 has been linked to the overuse of antibiotics. Lancet found that 37 Britons receiving medical treatment in South Asia carried NDM-1 back with them to the United Kingdom.
What is a Superbug?
These are bacteria that have become resistant to the antibiotics - perhaps the best known is MRSA, Methicillin-resistant Staphylococcus aureus, which no longer responds to the antibiotic methicillin. But how do they become resistant?
Bacteria are extremely adaptable and are able to mutate. What happens when they're exposed to antibiotics is that only the susceptible bacteria die - the bacteria that are already resistant to the antibiotics live.
"The potential of NDM-1 to be a worldwide public health problem is great, and co-ordinated international surveillance is needed," Lancet wrote on its website.
Dr David Livermore, one of the researchers and who works for the UK's Health Protection Agency (HPA), said: "The NDM-1 problem is likely to get progressively worse in the foreseeable future.
"The potential for wider international spread and for NDM-1 to become endemic worldwide are clear and frightening."
Infections have already been passed from patient to patient in UK hospitals.
Researchers say the way to stop NDM-1 is to identify and isolate any patients who are infected.
The spread of the drug-resistant bacterial gene could herald the end of antibiotics, researchers warned. "In many ways this is it," Tim Walsh at Cardiff University, UK, told The Guardian newspaper. "This is potentially the end."
The NDM-1 gene works by producing an enzyme that safeguards bacteria against β-lactam antibiotics, which include penicillin. These antibiotics have a ringed structure which acts to halt the replication of bacteria. The enzyme breaks this ring, rendering the drug ineffective. Other β-lactam antibiotic-resistant bacteria have genes that work in the same way.
These infections are usually treated with carbapenems - the "last resort" antibiotics which have the broadest action and the lowest resistance rates and tend to be used when all else fails. What's worrying health professionals is that the NDM-1 is resistant to carbapenems, too, and can be transferred between different bacteria.
Other bacteria have been known to produce similar enzymes, but only a few UK cases have been resistant to carbapenems, and these have not been able to transfer the resistance to other bacteria.
But carbapenem-resistant genes have been spreading elsewhere. The 2009 case of a woman in Sweden with a carbapenem-resistant infection picked up in India prompted the UK's Health Protection Agency to issue a National Resistance Alert at the beginning of last year. In it, the HPA warned of a slow international accumulation of bacteria armed with the resistant gene, listing spreads of infection in the USA, Israel, Greece and Turkey.
And the gene is spreading in India, which some doctors think is unsurprising.
"There is little drug control in India and an irrational use of antibiotics," a Delhi-based physician told the BBC.
The Indian health establishment has since downplayed the report. Karthikeyan Kumarasamy, lead author of a March report in the Journal of the Association of Physicians in India outlining the risks posed by NDM-1, now says the warnings have been overblown.
"It's all hype and not as bad as it sounds," Kumarasamy was quoted by India's Hindustan Times. "The threat of the NDM-1 is not that big as, say, H1NI (swine flu),the popular press has since deemed it."
"The conclusion that the bacteria was transmitted from India is hypothetical. Unless we analyze samples from across the globe to trace its origin, we can only speculate," he continued.
"If this emerging public health threat is ignored, sooner or later the medical community could be confronted with carbapenem-resistant (bacteria) that cause common infections, resulting in treatment failures with substantial increases in health-care costs," Johann Pitout from the University of Calgary in Canada wrote in a journal commentary.
Experts stress there is no need to panic, as the number of cases is small. However, the prospect of some infections becoming untreatable by antibiotics is now becoming very real.
'Superbugs that we can't just cure are not fiction any more. This will increasingly become the reality, ' warns Professor Enright.
'You would have to be very sick or unlucky to pick up an untreatable bug - but if they become more common, we will have a major problem on our hands.
Marco Torres is a research specialist, writer and consumer advocate for healthy lifestyles. He holds degrees in Public Health and Environmental Science and is a professional speaker on topics such as disease prevention, environmental toxins and health policy.