H5N1

The forgotten virus: Zika families and researchers struggle for support

Via The New York Times, Stephanie Nolen writes: The Forgotten Virus: Zika Families and Researchers Struggle for Support.

RECIFE, Brazil — A procession of mothers pushed children in bulky wheelchairs down a long corridor at a health center in this northeastern Brazilian city, passing patients who glanced at the children, looked away, then looked back, quickly and uneasily.  

The children were smartly turned out in Disney T-shirts, striped socks, plastic sandals. Girls had ponytails tied with big bows; many wore brightly colored glasses. And all were profoundly disabled, their limbs rigid, their mouths slack, many with foreheads that sloped sharply back above their dark eyes.  

Most Brazilians know as soon as they see them: These are Zika babies, whose mothers were infected with the virus while pregnant during a virulent outbreak of the mosquito-borne illness in 2015 and 2016. The chief signifier at birth was microcephaly, unusually small heads that hinted at the devastating brain damage the virus caused while they were still in utero.

Seven years later, they are now children, many of them nearly as big as their mothers. The sight of them visibly startles people who have not thought about them for years. After the Zika epidemic did not turn into a pandemic that swept the globe, Brazil and the rest of the world moved on.  

That has left families in this scrappy corner of Brazil, where the epidemic originated, struggling, mostly alone, to get help for their children, whose mysterious condition presents new challenges constantly. Many rely on charity, such as free physical therapy at the private foundation where they come each week in the procession of wheelchairs. Many of the women pushing the chairs wear T-shirts that say “Fight like a Mother” in Portuguese.  

It has also left scientists unable to answer basic questions about the virus and the danger it could pose.  

The virus is still circulating at a low level in Brazil and elsewhere in Latin America, as well as in South and Southeast Asia. But attention and funding dried up after the global concerns faded, said Dr. Diana Rojas Alvarez, who leads the Zika work by the World Health Organization. 

“This is what happens when you have a public health emergency that affects tropical countries and that doesn’t have the global impact Covid had,” she said. “Initially, there was a lot of interest in developing good treatments and diagnostic tests — I remember being in a meeting where there were 40 vaccine candidates in development. But since 2017, everything went quiet.”

Covid recovery poses dire climate, health risks: Lancet

Via The Times of India, an AFP report: Covid recovery poses dire climate, health risks: Lancet. Excerpt:

PARIS: Countries' fossil-fuel powered Covid-19 recoveries will have long-lasting consequences on human health and risk worsening the food and water insecurity, heatwaves and infectious diseases already threatening billions globally, a major assessment warned Thursday.  

The Lancet Countdown is the largest annual study of the impacts of climate change on human health.  

It found that up to 19 percent of Earth's land mass was affected by extreme drought in 2020 and warned that climate change posed a major threat to food security, which already affects more than two billion people.  

Compared with the historic average, the global population of over-65s lived through 3.1 billion additional extreme heat days last year, it found.  

Populations of 134 countries are now at greater threat from wildfires than at any time previously, and millions of farmers and construction workers are losing income because of the rising number of extremely hot days.  

And climate change is creating ideal conditions for infectious diseases such as dengue fever, Zika virus, cholera and malaria across a far larger span of the globe than just a few decades ago and including Europe, it said.  

"Climate change is here and we're already seeing it damaging human health across the world," said Anthony Costello, executive director of the Lancet Countdown.  

"As the Covid-19 crisis continues, every country is facing some aspect of the climate crisis too."  

The assessment found that the five years with the most areas affected by extreme drought have all occurred since 2015.  

Disruption to the water cycle due to global heating shortens the time in which plants reach maturity, resulting in small yields putting ever-greater stress on food production.  

The Lancet said that yield potential for maize -- a global staple -- had already declined 6 percent compared with 1981-2010 levels.  

Wheat has seen a 3-percent yield potential fall, and rice a 1.8-percent fall, it found.  

And the marine food upon which 3.3. billion people depend on for either sustinence or income is under "increasing threat", with average sea temperature rising in nearly 70 percent of territorial waters compared with just 15 years ago.  

The report also warned that nearly three quarters of countries surveyed said they believed they could not afford an integrated national health and climate strategy.  

"This year we saw people suffering intense heatwaves, deadly floods and wildfires," said lead author Maria Romanello.  

"These are grim warnings that, for every day that we delay our response to climate change, the situation gets more critical.  

"It's time to realise that no one is safe from the effects of climate change."  

In an editorial, the Lancet called on world leaders at the forthcoming COP26 summit to divert some of the trillions they are spending on Covid-19 recovery to reduce inequality and safeguard health.  

"This year's indicators give a bleak outlook: global inequities are increasing, and the direction of travel is worsening in all health outcomes."

COVID-19 in Brazil, epi-week 39

The CONASS PANEL | COVID-19 dashboard has the numbers for ep-week 38, ending today. First, today's numbers:

The week saw 115,813 new cases, a bit more than last week's 112,979. So cases haven't really fallen for about 4 weeks. Deaths were very slightly lower this week: 3,523, compared to last week's 3,692:

A hat-tip to the World Mosquito Program

While the pandemic has taken up most of our time, we really need to pay some attention to other global health problems as well. Mosquito-borne diseases are as urgent as ever.From the website of the World Mosquito Program:

The World Mosquito Program uses safe and natural bacteria called Wolbachia to prevent the transmission of mosquito-borne viral diseases such as dengue, Zika, chikungunya and yellow fever.  

Since releasing the first Wolbachia mosquitoes in 2011, evidence from international pilot studies shows that we can use Wolbachia more broadly to decrease the risk of Aedes aegypti mosquitoes transmitting viruses. Multiple trials in various locations demonstrate that our method is a safe and effective way to help prevent the spread of diseases across entire cities and regions.  

We continue to rapidly expand our operations by building partnerships with local governments and communities around the world who are embracing our Wolbachia method.  

 The World Mosquito Program currently has two regional hubs – our Asia hub in Ho Chi Minh City, Vietnam and our Oceania hub, based at Monash University in Melbourne, Australia. We are in the process of establishing our third Americas hub in Panama. These hubs support projects in their respective regions and contribute to core global operations. 

We have projects operating in 12 countries and our Wolbachia-carrying mosquitoes have reached 5 million people as at December 2019. 

In areas where Wolbachia is self-sustaining at a high level, monitoring shows that virus transmission is greatly reduced. Our measured impact is consistent with local elimination of disease. We are committed to improving health conditions and strengthening the capacity of local communities around the world to help reduce the threat of mosquito-borne diseases.  

Through collaboration and innovation, we can make a difference to millions of lives.

The Program has asked me to get the word out about a Twitter event on October 12 at which Professor Scott O'Neill, director of the Program, will answer questions. I'm happy to oblige. You can post your questions ahead of time at #Releasing Hope.

Did Sweden's COVID-19 strategy succeed or fail?

Via BBC News: Did Sweden's coronavirus strategy succeed or fail? Excerpt:

More than 5,500 people have died with Covid-19 in this country of just 10 million. It is one of the highest death rates relative to population size in Europe, and by far the worst among the Nordic nations. Unlike Sweden, the rest all chose to lock down early in the pandemic.  

"Maybe we should have taken some more care of each other," says Dan Eklund, 31, visiting the lake on his friend's boat.  

Latest figures suggest Sweden is getting better at containing the virus. The number of daily reported deaths has been in single digits for much of July, in contrast with the peak of the pandemic in April, when more than 100 fatalities were logged on several dates. 

There has also been a marked fall in serious cases, with new intensive care admissions dropping to fewer than a handful each day. Though still not as low as elsewhere in Scandinavia, it's a clear improvement. 

"It feels good. I mean, finally, we are where we hoped we would be much earlier on," says Anders Tegnell, the state epidemiologist leading the strategy. He's admitted too many have died, especially in Swedish care homes. But he believes there is still "no strong evidence that a lockdown would have made that much of a difference". 

What was Sweden's strategy? 

Sweden has largely relied on voluntary social distancing guidelines since the start of the pandemic, including working from home where possible and avoiding public transport.  

There's also been a ban on gatherings of more than 50 people, restrictions on visiting care homes, and a shift to table-only service in bars and restaurants. The government has repeatedly described the pandemic as "a marathon not a sprint", arguing that its measures are designed to last in the long term.

The unusual strategy has attracted global criticism, with even some of Dr Tegnell's early supporters saying they now regret the approach. Annika Linde, who did his job between 2005 and 2013, recently told Sweden's biggest daily newspaper Dagens Nyheter she believed tougher restrictions at the start of the pandemic could have saved lives. 

But according to clinical epidemiologist Helena Nordenstedt, there's no consensus in Sweden's scientific community that the strategy as a whole has failed.

 Are Swedes better at social distancing? 

Anders Tegnell says his modelling indicates that, on average, Swedes have around 30% of the social interactions they did prior to the pandemic. 

And a survey released this week by Sweden's Civil Contingencies Agency suggests 87% of the population are continuing to follow social distancing recommendations to the same extent as they were one or two weeks earlier, up from 82% a month ago. 

Nordenstedt believes since Swedes have had longer to adjust how they act in public than countries that went into lockdown, this could help Sweden to mitigate a potential second wave. 

"People are not as exhausted as they might be in other countries where the restrictions have been much wider and much stricter." 

But while Swedes are aware of the guidelines, there have been reports of large gatherings and mingling in some tourist hotspots since domestic travel restrictions were relaxed last month.  

"We try to tell them and show them to keep their distance," says Shiar Ali, a manager at one of the beachfront restaurants on Lake Storsjorn. "Especially young men and young people, they don't care about it." 

Has Sweden achieved herd immunity? 

Sweden's authorities never said achieving herd immunity was their goal, but they did argue that by keeping more of society open, Swedes would be more likely to develop a resistance to Covid-19. 

Five months into Europe's pandemic and only 6% of the population here is known to have antibodies, according to Swedish Public Health Agency research.  

However, Anders Tegnell believes the true figure is "definitely a lot higher", as immunity "has proven to be surprisingly difficult to measure".

Mosquitoes flying free as health departments focus on COVID-19

When I first started blogging about a possible H5N1 pandemic some 15 years ago, one of the questions I couldn't find an answer for was this: What happens to people who get sick from other diseases, or who need regular checkups in clinics and hospitals, when a pandemic has hit?

 

Well, the answer eventually arrived: They're collateral damage. During the West African Ebola outbreak, more people died of measles than of Ebola itself. With every serious outbreak, the health system is swamped and its ordinary patients understandably stay away from the system.

 

Now it's happening again, and in the US it means a likely surge in mosquito-borne diseases like dengue and West Nile. That's the argument of this excellent AP article by Anna Maria Barry-Jester and Lauren Weber: Mosquitoes flying free as health departments focus on virus. Excerpt:

Monitoring and killing mosquitoes is a key public health task used to curb the spread of deadly disease. In recent years, top mosquito-borne illnesses have killed some 200 people annually in the U.S. But those low numbers are due in part to the efforts of public health departments to keep the spread at bay, unlike in other countries where hundreds of thousands are sickened and die each year. 

“Mosquitoes are the biggest nuisance and pest on this planet. Hands down,” said Ary Faraji, the president of the American Mosquito Control Association, a nonprofit that supports public agencies dedicated to mosquito control. “They are responsible for more deaths than any other organism on this planet, including humans.” 

This is a physical job that can’t be done by telecommuting from home. Keeping track of mosquitoes and the diseases they carry requires setting up traps, and searching backyards and commercial lots. Public health workers patrol irrigation ditches, and overturn the backyard tires, plastic bins and garbage that can hold standing water where mosquitoes breed.  

Around the U.S., more than half of public health departments combat mosquitoes. In some states, including Florida and California, specific departments are dedicated to tracking and preventing their spread. The goal is to find infected mosquito populations and kill them before they get to humans, or at least warn the community about their presence as mosquito-borne epidemics are happening more frequently nationally as temperatures rise.  

But a joint investigation published this month by KHN and The Associated Press detailed how state and local public health departments across the U.S. have been starved for decades, leaving them underfunded and without adequate resources to confront the coronavirus pandemic, let alone the other work like mosquito control they are tasked to handle at the same time. Over 38,000 public health worker jobs have been lost since 2008. Per capita spending on local health departments has been cut by 18% since 2010. 

So as public health workers scramble to summon enough of a workforce to address a once-in-a-generation pandemic, they’re being pulled from normal mosquito-related tasks. The short staffing is leaving many localities — especially those without separate, dedicated control districts — flying blind on potential mosquito threats.

Reduced dengue incidence following deployments of Wolbachia-infected Aedes aegpti in Yogyakarta, Indonesia

After endless COVID-19 coverage, it's a pleasure to post this article by members of the World Mosquito Program: Reduced dengue incidence following deployments of Wolbachia-infected Aedes aegpti in Yogyakarta, Indonesia. The abstract:

Background: Ae. aegypti mosquitoes stably transfected with the intracellular bacterium Wolbachia pipientis (wMel strain) have been deployed for biocontrol of dengue and related arboviral diseases in multiple countries. Field releases in northern Australia have previously demonstrated near elimination of local dengue transmission from Wolbachia-treated communities, and pilot studies in Indonesia have demonstrated the feasibility and acceptability of the method. We conducted a quasi-experimental trial to evaluate the impact of scaled Wolbachia releases on dengue incidence in an endemic setting in Indonesia. 

Methods: In Yogyakarta City, Indonesia, following extensive community engagement, wMel Wolbachia-carrying mosquitoes were released every two weeks for 13–15 rounds over seven months in 2016–17, in a contiguous 5 km2 area (population 65,000). A 3 km2 area (population 34,000) on the opposite side of the city was selected a priori as an untreated control area. Passive surveillance data on notified hospitalised dengue patients was used to evaluate the epidemiological impact of Wolbachia deployments, using controlled interrupted time-series analysis. 

Results: Rapid and sustained introgression of wMel Wolbachia into local Ae. aegypti populations was achieved. Thirty-four dengue cases were notified from the intervention area and 53 from the control area (incidence 26 vs 79 per 100,000 person-years) during 24 months following Wolbachia deployment. This corresponded in the regression model to a 73% reduction in dengue incidence (95% confidence interval 49%,86%) associated with the Wolbachia intervention. Exploratory analysis including 6 months additional post-intervention observations showed a small strengthening of this effect (30 vs 115 per 100,000 person-years; 76% reduction in incidence, 95%CI 60%,86%). 

Conclusions: We demonstrate a significant reduction in dengue incidence following successful introgression of Wolbachia into local Ae. aegypti populations in an endemic setting in Indonesia. These findings are consistent with previous field trials in northern Australia, and support the effectiveness of this novel approach for dengue control.

Making mosquitoes immune to malaria

Via Nature Communications, a scrap of good news: A microsporidian impairs Plasmodium falciparum transmission in Anopheles arabiensis mosquitoes. The abstract:

A possible malaria control approach involves the dissemination in mosquitoes of inherited symbiotic microbes to block Plasmodium transmission. However, in the Anopheles gambiae complex, the primary African vectors of malaria, there are limited reports of inherited symbionts that impair transmission. 

We show that a vertically transmitted microsporidian symbiont (Microsporidia MB) in the An. gambiae complex can impair Plasmodium transmission. Microsporidia MB is present at moderate prevalence in geographically dispersed populations of An. arabiensis in Kenya, localized to the mosquito midgut and ovaries, and is not associated with significant reductions in adult host fecundity or survival. 

Field-collected Microsporidia MB infected An. arabiensis tested negative for P. falciparum gametocytes and, on experimental infection with P. falciparum, sporozoites aren’t detected in Microsporidia MB infected mosquitoes. As a microbe that impairs Plasmodium transmission that is non-virulent and vertically transmitted, Microsporidia MB could be investigated as a strategy to limit malaria transmission.

See also this BBC News report on the study.

At least 78 children died of dengue related illness in Yemen

Via ReliefWeb, a report from Save the Children: At least 78 children died of dengue related illness in Yemen. Excerpt:

Save the Children warns of an epidemic, as 52,000 suspected cases are recorded in the country.  

Seventy-eight children under 16 have already died in the outbreak of Dengue related illness in Yemen[i], with more than 52,000 suspected cases being recorded across the country. Save the Children warned this could signal the start of an epidemic. 

Heavy rainfall, coupled with the ongoing conflict, is disrupting clean water supplies. Because of the disruptions, people use water basins to collect rainwater and these uncovered water sources combined with the rain have contributed to the spread of mosquitoes in the affected areas, resulting in an upsurge in suspected dengue cases. 

If measures are not urgently put in place to strengthen the health care system so that cases can be detected early, the death total which reached 192 people by the end of 2019, could increase sharply. Cases have been recorded in almost all governorates in Yemen with the most affected being Hodeidah and Aden which recorded more than 60% of the deaths in the country.  

Save the Children Hodeidah Field Manager Mariam Aldogani, herself recovering from dengue fever, said: 

“Hodeidah has the second highest death rate in the country with 62 adult and children deaths in 2019. We have never seen anything like this before. More than 40 of our staff including their families have been affected by the fever. We are getting reports of deaths on a daily basis in remote areas of the governorate. Some of our health facilities are working 24 hours a day and last week one of our facilities recorded 30 cases in one day, most of which were children. 

“The economic situation in the country has not made it any better for people. Parents cannot afford to bring their children to the hospital or to buy the medication. Hospitals are full, and some patients are kept in hospitals having to lay on the floor because of a bed shortage. It’s really bad. Children as young as eight months have not been spared by the dengue fever. In some of the hospitals all you can hear are children crying in pain. We are currently supporting 48 health facilities in Hodeidah which recorded more than 6000 dengue fever suspected cases in 2019.”  

Save the Children's health centres have been receiving many cases of children suffering from dengue, and its teams on the ground are diagnosing and treating patients whilst referring the most severe cases.

Climate change, crime and political chaos: A deadly mix in Honduras dengue epidemic

Via The New York Times: Climate Change, Crime and Political Chaos: A Deadly Mix in Honduras Dengue Epidemic. Excerpt:

CHOLOMA, Honduras — More than 400 people died this year as one of the worst dengue epidemics on record swept through Central America — a type of outbreak that some scientists and public health officials are warning is likely to become more frequent and more widespread because of climate change.  

But while climate change is threatening to increase the spread of dengue worldwide by expanding the range of the mosquitoes that carry the virus, the disease has already found an especially fertile breeding ground in Honduras, for reasons that go beyond the environment.  

In Honduras, which accounted for more than 40 percent of the dengue deaths in Central America this year, according to the Pan American Health Organization, the effects of climate change have been compounded by government dysfunction, political tumult and public apathy. 

Dengue has hit the country hard. This year, it had more than 107,000 cases of the viral disease — more than 13 times the number recorded last year — and at least 175 deaths. In 2018, only three people in Honduras died from the disease, according to the Pan American Health Organization.

Honduras’s notorious criminality has worsened matters, too, as public health teams, already stretched thin by budget cuts and a lack of trained personnel, have been blocked by gangs from entering some of the most severely afflicted neighborhoods to educate residents and fumigate against mosquito infestations.  

Dengue is transmitted to humans by a type of mosquito called Aedes, which thrives in urban areas of the world’s tropical and subtropical regions. Tens of millions of cases occur each year in more than 100 countries, and symptoms may include fever, internal bleeding and shock. Inadequately treated, the illness can quickly kill. 

In Honduras, health officials trace the start of the current epidemic to the fall of 2018. The number of incidents then rose sharply during the first half of 2019, hitting a peak this summer before falling off as the year ended. A nationwide health emergency declared in July by the administration of President Juan Orlando Hernández remains in effect.  

The outbreak struck during a time of political turbulence in Honduras, with violent street protests against Mr. Hernández and calls for his ouster. Some of the protests have been driven by fears the government planned to privatize the health and education sectors. 

The nation also suffers from high murder rates and widespread poverty, which have combined to drive tens of thousands of Hondurans in recent years to emigrate, with many trying to make it to the United States.  

The dengue outbreak has met little resistance from a public health system gutted by budget cuts and pervasive corruption, analysts and officials said.  

“It’s a collapsed system, an inefficient system,” said Ismael Zepeda, an economist with Fosdeh, a research group in Tegucigalpa, the capital.