H5N1

Dr. Tedros on COVID-19: 'We have clearly not reached the peak of the pandemic'

WHO has published WHO Director-General's opening remarks at the media briefing on COVID-19 - 7 July 2020. Excerpt:

It took 12 weeks for the world to reach 400 thousand cases of COVID-19. 

Over the weekend, there were more than 400 thousand cases across the globe.  

There have now been 11.4 million cases of COVID-19 and more than 535,000 lives have been lost. 

The outbreak is accelerating and we have clearly not reached the peak of the pandemic.  

While the number of deaths appears to have levelled off globally, in reality some countries have made significant progress in reducing the number of deaths, while in other countries deaths are still on the rise. 

Where there has been progress in reducing deaths, countries have implemented targeted actions toward the most vulnerable groups, for example those people living in long-term care facilities. 

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Over the past few months, there has been a lot of discussion about the origins of COVID-19. 

All preparations have been finalised and WHO experts will be traveling to China this weekend to prepare scientific plans with their Chinese counterparts for identifying the zoonotic source of the disease.   

The experts will develop the scope and terms of reference for a WHO-led international mission.  

The mission objective is to advance the understanding of animal hosts for COVID-19 and ascertain how the disease jumped between animals and humans.

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WHO is deeply concerned about the impact of COVID-19 on the global response to HIV.

A new WHO survey showed access to HIV medicines has been significantly curtailed as a result of the pandemic.

73 countries have reported that they are at risk of stock-outs of antiretroviral medicines (ARVs).

To mitigate the impact of the pandemic on treatment access, WHO recommends all countries prescribe ARVs for longer periods of time.

Up to six months while supply chains for all medicines are fully functioning.

Similarly, shortages of condoms and pre-exposure prophylaxis can prove costly and WHO calls for countries to ensure uninterrupted prevention, testing and treatment services for HIV.

The disruptions in access to life-saving commodities and services come at a critical moment as progress in the global response to HIV stalls.

Over the last two years, numbers of new HIV infections stabilised at 1.7 million annually and there was only a modest reduction in AIDS-related deaths.

More than 25 million people now have access to ARVs but global targets for prevention, testing and treatment are off target.

Progress is stalling because HIV prevention and testing services are not reaching the groups that need them most.

Emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae during treatment, Finland, December 2018

Via Eurosurveillance: Emergence of ceftazidime-avibactam-resistant Klebsiella pneumoniae during treatment, Finland, December 2018. The abstract:

In December 2018, a ceftazidime-avibactam (CAZ-AVI)-resistant KPC-2-producing Klebsiella pneumoniae strain was isolated in Finland. CAZ-AVI resistance was observed 34 days after CAZ-AVI treatment in a trauma patient transferred from a hospital in Greece who had been colonised with bla_KPC-2-producing K. pneumoniae ST39, and later developed a bloodstream infection. The CAZ-AVI-resistant strain contained a novel 15 amino acid insertion in the KPC-2 protein causing structural changes proximal to the KPC-2 active site.

MMWR: Multidrug-resistant Campylobacter jejuni outbreak linked to puppy exposure — United States, 2016–2018

Via MMWR: Multidrug-Resistant Campylobacter jejuni Outbreak Linked to Puppy Exposure — United States, 2016–2018. The summary:

What is already known about this topic?  

Dogs, especially puppies, are a known source of sporadic Campylobacter infections in humans, but are uncommonly reported to cause outbreaks. 

What is added by this report?  

Investigation of a multistate, multidrug-resistant outbreak of Campylobacter jejuni infections implicated puppies from breeders and distributors sold through pet stores as the outbreak source. Outbreak strains were resistant to all antibiotics commonly used to treat Campylobacter infections.  

What are the implications for public health practice? Consumers, employees, and clinicians should be aware of the risk for disease transmission from puppies, including the possibility of exposure to multidrug-resistant pathogens. Greater adherence to implementation of antibiotic stewardship practices in the commercial dog industry might be needed.

Swaziland: Country with world’s highest HIV prevalence is now controlling its HIV epidemic

Via CDC, a press release: Country with world’s highest HIV prevalence is now controlling its HIV epidemic. Excerpt:

New findings from Swaziland, supported by the Swazi Ministry of Health and the U.S. Centers for Disease Control and Prevention (CDC) through the President’s Emergency Plan for AIDS Relief (PEPFAR), reveal remarkable progress in controlling the country’s HIV epidemic and are the latest to show that global HIV efforts are helping to curb the HIV epidemic and saving lives. 

Results from the Swaziland HIV Incidence Measurement Survey (SHIMS2), a type of Population-based HIV Impact Assessment (PHIA), show that, in the country with the highest HIV prevalence rate in the world, Swaziland nearly halved the rate of new HIV infections between 2011 and 2016. Over the same period, rates of HIV viral load suppression – a marker of effective treatment and reduced infectivity – doubled. These data show that targeted HIV service delivery by the Government of Swaziland, CDC through PEPFAR, and other partners in recent years is yielding dividends. 

The PHIAs are national surveys – implemented under the leadership of Ministries of Health and by PEPFAR, CDC, and ICAP at Columbia University – providing direct measurement of progress toward global targets to control the HIV epidemic. These complex surveys combine house visits, in-person interviews, HIV testing, and cutting-edge technologies, including in laboratory science and diagnostics. The data from Swaziland draw from two large household surveys directly measuring new HIV infections and viral load suppression at two periods, in 2011 and 2016.  

“CDC plays an essential role in the global HIV response by ensuring that programs rapidly respond to new data for greatest impact,” said CDC Director Brenda Fitzgerald, M.D. ”These findings show a dramatic transformation in Swaziland where, at one time, HIV was destabilizing family structures, communities, and its economy.  CDC’s commitment as a longstanding stakeholder in the global HIV response, working side-by-side with ministries of health on evidence-based programs, has helped transform some of the world’s most severe HIV epidemics.”

Hopes for HIV cure revived by African child in remission

Via Reuters: Hopes for HIV cure revived by African child in remission. Excerpt:

A South African child born with HIV has surprised experts by appearing to be effectively cured of the AIDS virus after just a year of treatment followed by eight and a half years drug-free. 

Patients with HIV would normally need to stay on antiretroviral (ART) drugs for the rest of their lives to keep AIDS at bay. But this child, still off treatment and now almost 10 years old, has no signs of the disease. 

This and other recent, isolated cases of remission have given additional hope to the 37 million people worldwide infected with the virus that causes AIDS.  

Yet experts urged caution, saying the case is extremely rare and does not suggest a simple path to a cure. 

"It's a case that raises more questions than it necessarily answers," said Linda-Gail Bekker, president of the International AIDS Society (IAS), which is holding a conference in Paris this week. 

"It does raise the interesting notion that maybe treatment isn't for life. (But) it's clearly a rare phenomenon." 

The child, whose name and gender were not disclosed, was part of a clinical trial in which researchers were investigating the effect of treating HIV-positive babies in the first few weeks of life, and then stopping and starting the ART medicines whilst checking whether their HIV was being controlled.  

The United Nations HIV/AIDS agency said last week that 19.5 million people - more than half of the 37 million patients with HIV - are now on treatment. 

The vast majority of patients with HIV suffer an increase in the amount of the virus circulating in the body if they stop treatment, but this child was different, the South African researchers said.

For first time in history, half of all people with HIV are getting treatment

Via Science: For first time in history, half of all people with HIV are getting treatment. Excerpt:

A new update on the global HIV/AIDS epidemic offers “scorecards” for countries that starkly highlight successes in green and failures in red (for an example, see chart at bottom of story). 

Collectively, the world receives high marks for its HIV/AIDS efforts from the Joint United Nations Programme on HIV/AIDS (UNAIDS) in Geneva, Switzerland. It notes in Ending AIDS that 19.5 million of the estimated 36.7 million people living with the virus now receive lifesaving antiretroviral (ARV) drugs. This is the first time in history that more than half the infected people are being treated. 

But several countries are falling far short of the UNAIDS prescription of what it takes to bring an epidemic to an end, which essentially requires slowing the rate of virus transmission to the point that new infections peter out. 

The report dramatically documents the power of ARVs, which both stave off disease and make people less likely to infect others. AIDS deaths have almost been cut in half since 2005, when only 564,000 HIV-infected people received ARVs. In the past 6 years, the hard hit eastern and southern Africa region has seen new infections plummet by one-third. 

Recognizing that proper treatment also makes people less likely to transmit HIV, many countries have adopted the World Health Organization’s 2015 recommendation to treat everyone who tests positive, abandoning the practice of reserving ARVs for those with evidence of immune system damage. “Families, communities, cities and countries have witnessed a transformation,” writes UNAIDS director Michel Sidibé in the foreward to the 196-page report.

UK: Fall in new HIV diagnoses among men who have sex with men since 2015

Via Eurosurveillance: Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: Testing or treatment or pre-exposure prophylaxis. The abstract:

Since October 2015 up to September 2016, HIV diagnoses fell by 32% compared with October 2014–September 2015 among men who have sex with men (MSM) attending selected London sexual health clinics. This coincided with high HIV testing volumes and rapid initiation of treatment on diagnosis. The fall was most apparent in new HIV testers. 

Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable.