H5N1

Canada: Rejecting generic drugs, endangering lives

Via The Globe and Mail, an op-ed by Professor Alan Whiteside of the Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, and Jamie Cohen, a Fulbright Scholar at that university: By defeating the generic-drugs bill, Ottawa has endangered millions of lives. Excerpt:

On Nov. 28, Parliament sent a deafening message to the world about the value it places on global health. Bill C-398 aimed to make the Canadian Access to Medicines Regime (CAMR) easier to apply. The CAMR is a mechanism for providing generic drugs to the world’s poorest countries. It is so complex that it has hardly been used. 

The bill was defeated and this means there will be fewer lives saved and more new infections. It presented an opportunity for change: This has been lost. 

Antiretroviral (ARV) drugs allow HIV-infected individuals to have long and healthy lives; without them, illness and death are virtually inevitable. Over the past year, it has become apparent the drugs also help prevent transmission and are a key part of the armamentarium for halting the AIDS epidemic. Since the development of highly-active antiretroviral therapy was announced in Vancouver in 1996, drugs have become cheaper and more effective. 

Global precedent has been set around the ability to lower the price of ARVs through direct negotiations and innovative financing mechanisms, such as the Medicines Patent Pool. In July of this year, the Clinton Health Access Initiative (CHAI), with generic drug manufacturers, announced price reductions of up to 30 per cent. This brought the cost of tenofovir-based regimens down to $125 per patient per year in the 70 CHAI procurement countries. 

Access to low-cost ARVs is critical for health care in developing countries, many of which depend on foreign aid for health funding and drug procurement. Tanzania, for example, receives 49 per cent of its health-care funding from abroad. Of Malawi’s $558-million health funding for 2012-2013, the Ministry of Health provided only $132-million (24 per cent). 

ARV price reductions help developing countries take greater financial responsibility for drug procurement and graduate from donor dependency. These investments are essential to save lives and will bear fruit in the future: healthy populations are crucial for sustainable growth and development.

Our present Conservative government rules with a majority elected by about a third of the population. It's discouraging to think that during all those years when Canada was a pretty good country and trying to get better, and trying to do some good in the world, a third of us hated what the other two-thirds believed and did.

Bird flu kills 4,000 wild ducks in Russia: official

Via Expatica.ru, an AFP report: Bird flu kills 4,000 wild ducks in Russia: official. Excerpt:

Around 4,000 wild ducks have been found dead in Russia's southern Krasnodar region, officials said on Friday, blaming H5 bird flu for the mass deaths. 

"This is the H5 virus, the strain is being confirmed," a spokeswoman for the Krasnodar region branch of Russian agriculture watchdog Rosselkhoznadzor told AFP. 

The birds' remains were now being tested, she added. 

The dead birds have been found on lakes near the Black Sea resort town of Anapa. 

The region has gone on high alert, with poultry and humans now being vaccinated.

Prediction and prevention of the next pandemic zoonosis

Via The Lancet: Prediction and prevention of the next pandemic zoonosis. The summary:

Most pandemics—eg, HIV/AIDS, severe acute respiratory syndrome, pandemic influenza—originate in animals, are caused by viruses, and are driven to emerge by ecological, behavioural, or socioeconomic changes. Despite their substantial effects on global public health and growing understanding of the process by which they emerge, no pandemic has been predicted before infecting human beings. 

We review what is known about the pathogens that emerge, the hosts that they originate in, and the factors that drive their emergence. We discuss challenges to their control and new efforts to predict pandemics, target surveillance to the most crucial interfaces, and identify prevention strategies. 

New mathematical modelling, diagnostic, communications, and informatics technologies can identify and report hitherto unknown microbes in other species, and thus new risk assessment approaches are needed to identify microbes most likely to cause human disease. 

We lay out a series of research and surveillance opportunities and goals that could help to overcome these challenges and move the global pandemic strategy from response to pre-emption.

The Lancet also has an interesting comment on this subject, Anatomy of a pandemic.

WHO: Ebola in Uganda - update

WHO has published Ebola in Uganda - update.

30 NOVEMBER 2012 - As of 28 November 2012, the Ministry of Health in Uganda reported 7 cases (6 confirmed, 1 probable) with Ebola haemorrhagic fever in Luweero and Kampala districts. Of these cases, 4 died. 

Field teams continue to investigate cases alerted to them from the communities. The major challenge faced in some communities is the belief that witch-craft and not Ebola was the cause of deaths, despite ongoing intensive awareness campaigns. Social mobilization teams are working closely with traditional healers and religious leaders to raise awareness on prevention and control of the disease. 

WHO and partners, including the US Centers for Disease Control and Prevention (CDC), Médecins Sans Frontières (MSF), the Uganda Red Cross (URCS), African Field Epidemiology Network (AFENET) and Plan Uganda continue to support the national authorities in the response to the outbreak. Through WHO, an expert on infection prevention and control has been deployed to the field. 

With respect to this event, WHO does not recommend that any travel or trade restriction be applied to Uganda. 

Note: The total number of cases reported on 23 November 2012 was 10 (6 confirmed, 4 probable) Probable cases that tested negative for Ebola have been classified as Non-Cases and excluded from the case counts.

WHO coronavirus surveillance recommendations are back

Thanks to those who checked the WHO Coronavirus infections page last night and this morning, and then commented here or tweeted me. A revised document on surveillance recommendations is now available on the page. But I haven't heard from WHO about the reasons for dropping the page.

CIDRAP on the 7th coronavirus case

Via CIDRAP, Robert Roos has the best summary I've seen yet about the subject: WHO cites 7th coronavirus case, gives surveillance guidance. Excerpt from a long article (that also mentions a cluster of unexplained respiratory cases in Jordan last spring that could be related):

A third case in a family cluster of novel coronavirus infections has been confirmed, raising the global case count to seven, and the fourth illness in the family is now listed as a probable case, the World Health Organization (WHO) has announced. 

In a statement dated yesterday, the WHO also indicated that only one death has been attributed to the novel virus so far, contradicting a Nov 23 announcement that reported two deaths among the first six cases. 

The WHO also offered new surveillance recommendations for the novel virus. The agency called for testing of patients in any cluster of severe, unexplained respiratory infections, regardless of location or travel history, and testing of healthcare workers who suffer unexplained pneumonia after caring for patients with severe respiratory infections. 

And in a related development, the Saudi Medical Journal reported that the person who had the third known novel coronavirus case is a 45-year-old gym teacher who visited a farm 3 days before he got sick and who survived his severe illness despite having preexisting health problems and only one kidney.

What's happening with the novel coronavirus? (updated)

This morning, following a link supplied by Treyfish, I found WHO had posted a new item on its coronavirus page sometime on November 28. Titled Interim surveillance recommendations for human infection with novel coronavirus, it quietly mentioned a seventh coronavirus cases, and possibly an eighth. 

This was remarkable news, reported in a remarkable way. Usually WHO and other health agencies put up a big headline for an update like this, when a new and dangerous virus seems to be spreading. Instead we got an almost stealthy report.

All day, we flu bloggers in effect chased our own tails, trying to find something to corroborate the surveillance recommendations and getting nothing but the original document and our own posts and tweets about it.

Now the news gets even stranger. In getting ready to write a post this evening about it, I clicked through to the interim surveillance report. It's not there. Instead of that PDF, you get a dark grey screen. If you haven't already done so, click on the second link in the first paragraph above, and you'll see what I mean. I can't find it by going through #coronavirus on Twitter either. (If you do see it, please save it and email it to me.)

Something about that document was medically or politically questionable. It may have been posted in error, or prematurely, or in an attempt to report the bare minimum of information. Before or after it was posted (or both), some fairly urgent meetings must have been held about the new "interim" surveillance recommendations, and someone finally decided to pull the document offline without explanation. But they didn't remove the link on WHO's coronavirus page, so many people must be clicking on it only to be baffled.

I would like to think WHO will explain everything on Friday morning and we'll all have a good laugh about it. Before the document disappeared, I'd already emailed them to ask for details about what it said. I hope to get an answer very soon.

Update: A reader did manage to access the document and emailed a copy of it. If you've had the same problem I did, here it is:  Download InterimRevisedSurveillanceRecommendations.

ECDC: Essential to invest in HIV prevention

A November 30 post from ECDC: Investing in HIV prevention essential to curb on-going HIV transmission in Europe. Click through for many links. Excerpt:

On the eve of World AIDS Day, ECDC and the WHO Regional Office for Europe release their annual HIV/AIDS surveillance report. 

The data for 2011 show that more than 121 000 new HIV cases were reported in the WHO European Region, with more than 28 000 new infections in the European Union and the European Economic Area (EU/EEA) – suggesting that it is vital to sustain HIV interventions even in times of economic austerity in order to curb the on-going HIV transmission across Europe. 

The report HIV/AIDS surveillance in Europe 2011 shows that in the EU/EEA, HIV is highly concentrated in key populations such as men who have sex with men, who account for the majority of cases, persons originating from countries with generalised HIV epidemics and people who inject drugs. The number of HIV infections among people who inject drugs remained fairly low across the EU/EEA (5% of HIV diagnoses in 2011) with a 40% decline between 2004 and 2011. 

Risk assessment on the HIV situation in Greece 

On the 30 November, ECDC is also publishing an in-depth risk assessment on the HIV situation in Greece that ECDC was tasked to do by the European Commission in April 2012. According to the request, the risk assessment focuses on all priority groups affected by HIV/AIDS and draws a complete picture of the HIV/AIDS epidemic in Greece. 

Presenting ECDC’s the assessment on the HIV situation in Greece during Forum on Public Health and Social Medicine held in Athens today, ECDC Director Marc Sprenger stressed: “In response to the current HIV outbreak among people who inject drugs in Athens, the Greek authorities have immediately prioritised the correct interventions. 

"But given the magnitude of the on-going outbreak, concerted action is needed to expand needle and syringe programmes in Athens. If a scale-up is not achieved, it is likely that HIV transmission among people who inject drugs in Athens will continue and even accelerate – resulting in a long-term high prevalence of HIV. 

"At this point, Greece has the possibility to invest in the prevention of HIV among people who inject drugs. The cost of prevention to avert HIV infections will be significantly less than the provision of treatment to those who become infected.”

How Uganda’s fight with HIV became continent’s success story

Via The Daily Monitor, a report on the eve of World AIDS day on December 1: How Uganda’s fight with ‘new disease’ became continent’s success story. Excerpt:

“A new disease has recently been recognised in rural Uganda. Because the major symptoms are weight loss and diarrhoea, it is known locally as slim disease,” wrote a team of scientists led by Makerere University’s Prof. David Serwadda, in the October 19, 1985 issue of the acclaimed medical journal, The Lancet. The article was among the first scientific publications on what turned out to be known as the human immunodeficiency virus, or HIV. 

According the World Health Organisation, “the human immunodeficiency virus is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (Aids). It can take 10-15 years for an HIV-infected person to develop Aids; antiretroviral drugs can slow down the process even further.” 

The Lancet article confirmed a December 29, 1984 front page lead story titled, “Mysterious Disease Kills 100 People in Rakai”, in The Star newspaper. The article, believed to have pioneered Aids reporting, had prompted scientists such as Prof. Serwadda and others to rush to Rakai and start investigating the new disease. 

Even at that early stage, the scientists noted that “slim disease occurs predominantly in the heterosexually promiscuous population and there is no clear evidence to implicate other possible means of transmission, such as by insect vectors or re-used injection needles”. 

But they did not clearly understand the new disease, and there was little they could do to ease the suffering. The future looked bleak during what is now referred to as the first phase of the epidemic, from 1982 to around 1991.

Uganda: Proactive approach needed for Ebola, Marburg

Via The Observer, an op-ed by Dr. Ambrose Talisuna, former head of the Epidemiology and Surveillance Division in the Uganda Ministry of Health: We need proactive approach to Ebola, Marburg. Excerpt:

It is striking that the commonest Ebola viruses that have spread to humans from their animal reservoir are the Zaire, Sudan and Bundibugyo viruses. The first question to ask, therefore, is: does Uganda have adequate strategies for infection prevention and control at the community and health facility levels? 

But my own biggest questions to the ministries of health and scientists in DRC, Sudan and Uganda are: how come we frequently have this common interaction between animal reservoirs and humans? Is it cultural? Is it the hunting patterns? Even then, what has changed in recent years? 

Are there specific populations that are frequenting the jungles in Uganda, Sudan and DRC, either in line of duty, in search of a livelihood or food and hence come into close contacts with animal reservoirs? If yes, has there been any sensitization about infection prevention?

Are there any infection control facilities for the communities? Is there more mixing of the populations in DRC, Uganda and Sudan than in the past? Which are these populations groups that could be starting these outbreaks? 

I do not as yet have the answers to these questions, but surely we need to seriously start asking ourselves even tougher questions! WHO’s revised international health regulations require that states establish core capacities to address such emergencies at national, sub-national, health facility and community levels, as well as at border crossings. 

Is Uganda compliant with the requirements of the revised international health regulations? The era has passed in which we merely implement reactive instead of proactive approaches. 

We cannot continue addressing one crisis after another and go into a slumber when it has blown over only to wake up to manage another crisis. Something needs to be done, and done urgently!