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Why is $350,000 in Canadian aid being used to send homeopaths to Honduras?

This is bizarre. Via CBC News: Why is $350,000 in Canadian aid being used to send homeopaths to Honduras? Excerpt:

Chagas disease (American trypanosomiasis) is an insidious tropical infection that begins with flu-like symptoms and can end with heart failure. The only proven treatments are a pair of costly pharmaceutical drugs.  

But a group of Canadian homeopaths say they can detect, prevent and treat the disease, and the federal government is paying to take their remedies to sick Hondurans. 

Quebec-based Terre Sans Frontières (TSF) is spending $350,000 in aid money from Global Affairs Canada to dispatch more than a dozen volunteer homeopaths to Honduras over five years. 

Homeopathy is an unusual choice for foreign aid because it rejects the basic premises of science and it's practised by people who are usually not medical doctors. 

Among its principles; water has memory — "like cures like" — and the more a substance is diluted, the more powerful it becomes. Its practitioners often can't explain exactly how something seemingly so implausible works, while most in the research and medical community label it pseudoscience. 

That hasn't prevented TSF from securing a federal grant to treat and train Hondurans in homeopathy to "prevent epidemics" as well as opening seven homeopathic "dispensaries" to provide remedies. 

TSF spokesman Philippe Legault said homeopathy fills the needs of Hondurans not being met by their under-resourced health-care system. 

"We're helping people to have some tools to work with their population and their health.  We surely don't think that we can cure everything with homeopathy." 

Legault points to the fact that the World Health Organization includes homeopathy as part of its Traditional Medicine Strategy. In response to an open letter from scientists and researchers, though, the WHO clarified that it doesn't support homeopathy to treat infectious diseases such as tuberculosis, malaria, influenza or infant diarrhea.

Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region

Via The Lancet Infectious Diseases: Venezuela's humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region. The summary:

In the past 5–10 years, Venezuela has faced a severe economic crisis, precipitated by political instability and declining oil revenue. Public health provision has been affected particularly. In this Review, we assess the impact of Venezuela's health-care crisis on vector-borne diseases, and the spillover into neighbouring countries. 

Between 2000 and 2015, Venezuela witnessed a 359% increase in malaria cases, followed by a 71% increase in 2017 (411 586 cases) compared with 2016 (240 613). Neighbouring countries, such as Brazil, have reported an escalating trend of imported malaria cases from Venezuela, from 1538 in 2014 to 3129 in 2017. 

In Venezuela, active Chagas disease transmission has been reported, with seroprevalence in children (<10 years), estimated to be as high as 12·5% in one community tested (n=64).

Dengue incidence increased by more than four times between 1990 and 2016. 

The estimated incidence of chikungunya during its epidemic peak is 6975 cases per 100 000 people and that of Zika virus is 2057 cases per 100 000 people. 

The re-emergence of many vector-borne diseases represents a public health crisis in Venezuela and has the possibility of severely undermining regional disease elimination efforts. National, regional, and global authorities must take action to address these worsening epidemics and prevent their expansion beyond Venezuelan borders.

US: Chagas disease surveillance activities — seven states, 2017

Via MMWR: Chagas Disease Surveillance Activities — Seven States, 2017. The summary:

What is already known about this topic?  

Most of the estimated 300,000 cases of Chagas disease (caused by Trypanosoma cruzi infection) in persons living in the United States were acquired in countries where the disease is endemic.  

What is added by this report?  

In 2017, Chagas disease was reportable in six states. Most cases identified, including among blood donors, are chronic cases and are not the result of local vectorborne transmission. 

What are the implication for public health practice?  

Chagas disease surveillance remains important in states with frequent travelers from countries where the disease is endemic and with a risk for local transmission. Surveillance activities help increase awareness among public health professionals and physicians and can help link persons with chronic Chagas disease to treatment.

Hotez: The rise of neglected tropical diseases in the 'new Texas'

Dr. Peter Hotez, editor of PLOS Neglected Tropical Diseases, writes: The rise of neglected tropical diseases in the "new Texas". The abstract:

Within the last five years, the State of Texas has experienced either transmission or outbreaks of Ebola, chikungunya, West Nile, and Zika virus infections. Autochthonous transmission of neglected parasitic and bacterial diseases has also become increasingly reported. 

The rise of such emerging and neglected tropical diseases (NTDs) has not occurred by accident but instead reflects rapidly evolving changes and shifts in a “new” Texas beset by modern and globalizing forces that include rapid expansions in population together with urbanization and human migrations, altered transportation patterns, climate change, steeply declining vaccination rates, and a new paradigm of poverty known as “blue marble health.” 

Summarized here are the major NTDs now affecting Texas. In addition to the vector-borne viral diseases highlighted above, there also is a high level of parasitic infections, including Chagas disease, trichomoniasis, and possibly leishmaniasis and toxocariasis, as well as typhus-group rickettsiosis, a vector-borne bacterial infection. 

I also highlight some of the key shifts in emerging and neglected disease patterns, partly due to an altered and evolving economic and ecological landscape in the new Texas, and provide some preliminary disease burden estimates for the major prevalent and incident NTDs.

Protection of the house against Chagas disease, dengue, leishmaniasis, and lymphatic filariasis

Via The Lancet Infectious Diseases: Protection of the house against Chagas disease, dengue, leishmaniasis, and lymphatic filariasis: a systematic review. The summary:

In light of the recent Zika virus outbreak, vector control has received renewed interest. However, which interventions are efficacious and community effective and how to best deliver them remains unclear. 

Following PRISMA guidelines, we did a systematic review to assess evidence for applied vector control interventions providing protection against Chagas disease, dengue, leishmaniasis, and lymphatic filariasis at the household level. We searched for published literature and grey literature between Jan 1, 1980, and Nov 30, 2015, and updated our search on April 2, 2017, using databases including the Cochrane, Embase, LILACS, PubMed, Web of Science, and WHOLIS. The Cochrane Collaboration's tool for assessing risk of bias was used. 

Inclusion criteria included studies reporting vector control interventions in and around a house or dwelling; and use of insecticides as sprays on netting or screens, and any method to control larval breeding in water containers in and around the home. 1416 articles were assessed and 32 articles included. 

The most effective interventions affecting vector indices for multiple diseases were found to be intradomiciliary residual spraying, insecticide-treated materials (especially insecticide-treated nets or curtains), and treatment of larval habitats with biological and chemical methods. Waste management and clean-up campaigns reduce vector populations, although to a lesser extent than other interventions and not consistently. Modifications to the structure of homes (eg, wall plastering) had no impact on the control of vectors. 

Protection of the house and its surroundings might affect the transmission of several diseases. The most effective interventions should be prioritised when vector control programmes are designed; however, the quality of delivery (ie, coverage and reapplication) of interventions is a crucial factor to ensure their effectiveness. 

Additional randomised trials that assess the measures of human disease and eventually target several diseases with a combination of interventions that protect the household and its inhabitants against multiple vectors, are needed to inform global policy in this area.

Venezuela and its rising vector-borne neglected diseases

An editorial in PLOS Neglected Tropical Diseases: Venezuela and its rising vector-borne neglected diseases. Excerpt:

The Bolivarian Republic of Venezuela has a population of approximately 31 million with a geographic area of approximately 350,000 square miles, about 15% and 30% larger than Texas, respectively. For decades, Venezuela was considered a leader in the areas of vector control and public health policies in the Latin American region. In fact, it is regarded as the first country to eradicate malaria in much of its territory after a successful insecticide-spraying campaign led by Arnoldo Gabaldón in the 1950s.

However, investments both in healthcare infrastructure and public health prevention efforts began to decrease during the regime of President Hugo Chavez in the 2000s, with even steeper declines beginning in 2013 with President Nicolas Maduro. According to a recent report in The Guardian, Venezuela is currently suffering an economic crisis of historical proportions with marked negative economic growth and high rates of inflation and unemployment. Food insecurity is rampant and there are serious shortages of medicines and insecticides. 

The detailed underlying basis of Venezuela’s crisis is beyond the scope of this article, but among the major factors cited are the overreliance on oil in the setting of a crash in oil prices, “reckless” public financing and printing of public money leading to an overvalued currency, massive debts and inflation, withdrawals in external investments and donor support, and public corruption. 

The political determinants of health inequity have been comprehensively reviewed by a high-level Lancet–University of Oslo Commission on Global Governance for Health. Although written before the current Venezuelan crisis, many of its findings and tenets, as described below, are relevant to the current situation. 

Overall, the rise in Venezuela’s vector-borne NTDs can be attributed to a number of factors, including (1) shortages of insecticides, antiparasitic medicines (e.g., antimalarials and drugs for leishmaniasis and Chagas disease), and fuel, which hinder vector-control and disease-treatment efforts, (2) underlying malnutrition due to food insecurity, (3) human migrations associated with illegal mining, and (4) lapses in support for government health workers. The added depletion of the health system in Venezuela due to economic and political pressures has also reduced epidemiological surveillance and reporting activities. 

Sadly, these determinants are playing out in the setting of an already unprecedented rise of arbovirus infections currently emerging across the Americas, including dengue, chikungunya, and Zika virus infections. We have also seen widespread increases in Venezuela’s vector-borne parasitic infections.

WHO: New vector control response seen as game-changer

WHO has published an article: New vector control response seen as game-changer. Excerpt:

Today more than 80% of the world’s population is at risk of vector-borne disease, with half at risk of two or more diseases. Mosquitoes can transmit, among other diseases, malaria, lymphatic filariasis, Japanese encephalitis and West Nile; flies can transmit onchocerciasis, leishmaniasis and human African trypanosomiasis (sleeping sickness); and bugs or ticks can transmit Chagas disease, Lyme disease and encephalitis.  

Together, the major vector-borne diseases kill more than 700 000 people each year, with populations in poverty-stricken tropical and subtropical areas at highest risk. Other vector-borne diseases, such as tick-borne encephalitis, are of increasing concern in temperate regions.  

Rapid unplanned urbanization, massive increases in international travel and trade, altered agricultural practices and other environmental changes are fuelling the spread of vectors worldwide, putting more and more people at risk. Malnourished people and those with weakened immunity are especially susceptible. 

A new approach  

Over the past year, WHO has spearheaded a new strategic approach to reprioritize vector control. The Global Malaria Programme and the Department of Control of Neglected Tropical Diseases – along with the Special Programme for Research and Training in Tropical Diseases, have led a broad consultation tapping into the experience of ministries of health and technical experts. The process was steered by a group of eminent scientists and public health experts led by Dr [Ana Carolina Silva] Santelli and Professor Thomas Scott from the Department of Entomology and Nematology at the University of California, Davis and resulted in the Global Vector Control Response (GVCR) 2017–2030. 

Global Vector Control Response (GVCR) 2017–2030

At its Seventieth session, the World Health Assembly unanimously welcomed the proposed response.

One health interactions of Chagas disease vectors, canid hosts, and human residents along the Texas-Mexico border

Via PLOS Neglected Tropical Diseases: One Health Interactions of Chagas Disease Vectors, Canid Hosts, and Human Residents along the Texas-Mexico Border. The abstract:

Background  

Chagas disease (Trypanosoma cruzi infection) is the leading cause of non-ischemic dilated cardiomyopathy in Latin America. Texas, particularly the southern region, has compounding factors that could contribute to T. cruzi transmission; however, epidemiologic studies are lacking. The aim of this study was to ascertain the prevalence of T. cruzi in three different mammalian species (coyotes, stray domestic dogs, and humans) and vectors (Triatoma species) to understand the burden of Chagas disease among sylvatic, peridomestic, and domestic cycles. 

Methodology/Principal Findings 

To determine prevalence of infection, we tested sera from coyotes, stray domestic dogs housed in public shelters, and residents participating in related research studies and found 8%, 3.8%, and 0.36% positive for T. cruzi, respectively. PCR was used to determine the prevalence of T. cruzi DNA in vectors collected in peridomestic locations in the region, with 56.5% testing positive for the parasite, further confirming risk of transmission in the region. 

Conclusions/Significance 

Our findings contribute to the growing body of evidence for autochthonous Chagas disease transmission in south Texas. Considering this region has a population of 1.3 million, and up to 30% of T. cruzi infected individuals developing severe cardiac disease, it is imperative that we identify high risk groups for surveillance and treatment purposes.

Bolivia: MSF develops an information system for exterminating the bugs that transmit Chagas

Via MSF.org: Bolivia: MSF develops an information system for exterminating the bugs that transmit Chagas. Excerpt:

From this year, MSF is launching the central information system called eMOCHA in three municipalities within Narciso Campero Province in Bolivia. This system is a technological breakthrough that enables people to report the location of triatomine bugs or 'kissing bugs', the vector insects for Chagas disease, by sending an SMS so they can be removed quickly and efficiently.  

Developing this platform, which uses mobile and geo referencing (GPS) technology, has enabled the location of the bugs to be detected in real time. A free SMS can be sent to eMOCHA from anywhere using a mobile phone, so as to report households with the triatomine bug. 

The system then schedules a visit from a technician who, in addition to fumigating the property, will send additional data via a smartphone application that contributes towards the monitoring and control of the insect in the area, such as the number of family members and the number of times a house has been fumigated, etc. This represents a great breakthrough as previously just reporting the presence of the insect could take up to one month.  

This pilot project started this year and so far has produced good results. The aim is to implement it in other areas of Bolivia and maybe even use it to track other diseases. It is part of the comprehensive healthcare model launched by MSF in 2015 in collaboration with the Ministry of Health to combat this disease. 

With this model, MSF teams have shown that it is possible to diagnose and treat Chagas patients using primary care facilities that are located in the most remote areas, away from municipal capitals. In the municipality of Monteagudo in Chuquisaca, MSF teams carried out community activities in training and awareness, and provided technical support to health workers from 17 health centres in the area. This involved supporting in the diagnosis of the disease, including the use of rapid tests that allow for effective detection of positive patients, as well as the treatment and care of adverse complications resulting from Chagas.

Colombia: A little more on Zika, and a lot on many other diseases

I've been looking around on the website of the Colombian National Institute of Health, and found the link titled Boletín Epidemiológico. And there I found a PDF describing the situation in Colombia as of week 8 (February 21-28).

Even if you don't read Spanish, it's worth downloading, because the tables and charts offer an overview of a country dealing with far more than just Zika and maybe microcephaly. Go to the chapter on vectors, starting on page 28, and you're looking at Chagas (85 cases), chikungunya (8,022 cases), dengue (23,833 cases, 1,251 in week 8 alone), yellow fever (two probable cases), leishmaniasis (492 cases), and malaria (11,957 cases).

 

As for Zika, the number is 47,771 cases since week 40 of 2015, with 5,065 cases in week 8: 2,250 brand-new ones and 2,815 suspected in earlier weeks. As of week 8 7,360 pregnant women have Zika. Strikingly, 76.9% of them are urban residents. 

 

So Colombia is a big, poor, violent country just winding down a decades-long civil war while the drug traffickers carry on. And on top of its political troubles it's got a vast range of vector-borne diseases alone, never mind all the other diseases carried by food, water, and sexual transmission. I hope the Colombian government starts talking about those diseases as well, each of them a serious threat the world needs to know about. An English-language version of this excellent weekly report would help immensely. (So would some North American health reporters and public-health experts who can actually speak and read a language other than English, and report on what they learn from other countries.)

 

Every Zika country in Latin America faces a similar war on many fronts. And every country needs all the allies it can get.