Controversy over Delhi superbug returns to haunt medical tourism in India

Controversy over a superbug has returned to haunt medical tourism in India following the latest claims made by British medical journal, The Lancet. A new article has claimed that a superbug is present in the water of New Delhi and that the Indian government suppressed the truth last year by threatening its own scientists.

Controversy over a superbug has returned to haunt medical tourism in India following the latest claims made by British medical journal, The Lancet. A new article has claimed that a superbug is present in the water of New Delhi and that the Indian government suppressed the truth last year by threatening its own scientists. The study claims that the controversial New Delhi metallo-beta-lactamase gene has been found in water pools, overflowing sewage and drinking water samples in New Delhi.

Initial Indian reaction was to deny the claims. The Indian Medical Association said that water from US and European sewage should be checked for the presence of superbugs as the cass of drug resistance for high-end antibiotics is much less in India compared to the United State and Europe. The Delhi Water Board has also ridiculed the claims by saying that they are constantly checking water samples and there is no trace of the superbug. The Health Ministry of India questioned the credibility of the research and claimed that it is illegal for the researchers to remove Indian water to the UK for study. Some organizations in India have done themselves few favours by alleging that it is all part of a planned and concerted attack on India as a medical tourism destination.

According to a study published in the Lancet Infectious Diseases Journal, the New Delhi superbug has been found in water samples in the Indian capital. British researchers found the NDM-1 superbug in two of 50 tap-water samples and 51 of 171 samples of water from puddles in Delhi. Part of the argument is over whether or not people are at risk of infection from bacteria carrying this drug-resistant gene? No water anywhere is totally pure. While the superbug may be in the drinking water, for it to cause infections, the concentration has to be very high. As long you drink boiled water, most bacteria present in the water can be killed. But all hospitals need water for other purposes, and whether boiling can kill superbugs is a moot point.

The Lancet study found the NDM1-Superbug in eleven different types of bacteria, including those that cause dysentery and cholera. Last year, a Lancet study found only one type of bacteria with the NDM1 gene, now it has other even nastier types of bacteria. An article, 7 April 2011, “Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study” is by Timothy R Walsh, Janis Weeks, David M Livermore, Mark A Toleman. It argues that the presence of NDM-1 β-lactamase-producing bacteria in environmental samples in New Delhi has important implications for people living in the city who are reliant on public water and sanitation facilities. International surveillance of resistance, incorporating environmental sampling as well as examination of clinical isolates, needs to be established as a priority.

According to the country profile of The World Health Organisation (WHO), India has environmental health risk hazards related to lack of safe water, inadequate sanitation and waste disposal, indoor air pollution and vector borne diseases. It says that the Indian government has identified six priority programme areas, including urban low cost sanitation, urban waste water management, and urban solid waste management; while the level of enforcement has been extremely poor and there is no comprehensive legislation on environment and health.

A Cardiff University-led team of scientists discovered new strains of antibiotic-resistant bacteria in India. It is the first time the bacteria, found in the drinking water supply of Delhi, have been located in the wider environment outside a hospital. The full findings of the Cardiff University study are published in The Lancet Infectious Diseases. Cardiff scientists were the first to identify the NDM-1 gene that makes bacteria resistant to a large range of antibiotics. Their UK research was extended when it was discovered that while most patients with the bacteria had recently spent time in hospital in India, some cases had occurred without recent hospital treatment. This then prompted the team to test the wider environment in Delhi. They collected 171 swabs of seepage water and 50 public tap water samples from sites within a 12km radius of central Delhi between September and October 2010.The NDM-1 gene was found in two of the 50 drinking-water samples and 51 of 171 seepage samples. Researchers then identified 11 new species of bacteria carrying the NDM-1 gene, including strains, which cause cholera and dysentery.

Professor Tim Walsh comments,” We found resistant bacteria in public water used for drinking, washing and food preparation and also in pools and rivulets in heavily populated areas where children play. The spread of resistance to cholera and to a potential-untreatable strain of dysentery is also a cause for extreme concern. This is an urgent matter of public health. We need similar environmental studies in cities throughout India, Pakistan and Bangladesh to establish how widespread resistant bacteria are.”

The Indian Health Ministry argues that the study was unsupported by clinical and epidemiological evidence and patients were responding well to medical and post-surgical antibiotic treatment,” The environmental presence of NDM-1 gene carrying bacteria is not a significant finding. Bacteria exist naturally everywhere and there is no evidence that anyone had been made ill.”

A recent United Nations report showed 650 million Indian citizens do not have access to a flush toilet and even more probably have no clean water. The Delhi sewage system is also reported to be unable to cater for the city’s population. The research team said it believes that temperatures and monsoon flooding make Delhi ideal for the spread of NDM-1.

To its credit, the Indian government accepts that simple denials and attacking well-regarded doctors and scientists only reflects badly on India as medical tourists will retain nagging doubts over who is telling the truth. So it has formed a scientific committee to look into the findings of the New Delhi superbug study.