H5N1

Leprosy: 3,649 new cases detected in 2017 in the DRC

Via mediacongo.net, a Journal du Cameroun/MCP report: Leprosy: 3,649 new cases detected in 2017 in the DRC. The Google translation:

In the Democratic Republic of Congo, 3,649 new cases of leprosy were detected in 2017, according to the Minister of Public Health, Oly Ilunga. 

In his message to APA, on the occasion of World Leprosy Day celebrated each year on the last Sunday of January, the Minister explains that among the cases detected, more than 10% are children and carriers of second degree infirmities. He said that more than 50% of these new cases come from 8 out of 26 provinces in the country.  

According to the National Program for the Elimination of Leprosy and the World Health Organization (WHO), 20% of new cases of leprosy recorded in Africa are in DR Congo with an average of about 4,000 new cases detected each year, which puts this country in second place behind Ethiopia.  

In DR Congo, leprosy is one of 14 neglected tropical diseases, including onchocerciasis, trachoma, rabies, human African trypanosomiasis, and Buruli ulcer.  

The extent of this disease in DR Congo is due to the lack of support from partners and ignorance of the population, says one.  

In his message, the Minister of Health reaffirmed the Government's commitment to implement the recommendations of the Global Strategy against Leprosy contained in the 2016-2020 National Health Development Plan. Oly Ilunga reassured and encouraged people with this disease that it is not a fate or a curse but that it is curable.

Vaccines against HIV, malaria and tuberculosis unlikely, study says

Via The New York Times: Vaccines Against H.I.V., Malaria and Tuberculosis Unlikely, Study Says. Excerpt:

Vaccines against H.I.V., malaria and tuberculosis — three major killers of the world’s poor — are unlikely to be produced in the foreseeable future unless vastly more money is committed to finding them, a new study has concluded. 

Other worthy goals that appear out of reach for now include a hepatitis C vaccine, a combination vaccine against the four leading causes of deadly diarrhea, a rapid cure for people who have caught tuberculosis and new treatments for a dozen neglected diseases, such as leprosy, dengue fever and sleeping sickness. 

To make real progress against this variety of infectious diseases by 2030, the study concluded, the world must increase research spending to nearly $9 billion a year; it now spends only about $3 billion. 

But the world is moving in the opposite direction. The combined amount that government donors, private foundations and pharmaceutical companies spend on the cause soared in the early 2000s. But, except for some recent emergency funding of Ebola research, it has slowly declined since the 2009 fiscal crisis. 

“The current development pipeline is not likely to give us all the pieces to fight these diseases,” said Gavin Yamey, director of Duke University’s Center for Policy Impact in Global Health and the study’s lead author. “Donors are cutting back on funding at a time when we should be stepping on the gas.”

The study, which assessed 538 products being developed for 35 diseases afflicting the world’s poor, was the first to analyze such a large portfolio.  

Asked about it, leaders of two major funders of global health research — the Bill and Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases — said they agreed with many of its conclusions but thought it was overly pessimistic about prospects for some new inventions, including a tuberculosis vaccine. 

The study was funded by the Gates Foundation and the Swiss Agency for Development and Cooperation and published on Gates Open Research, an open access website.

A new Brazilian health resource

Obrigado to Leonel Campos for alerting me to the website of the Brazilian Society of Tropical Medicine, which is in both English and Portuguese. I've put it in the Key Sites list, and I look forward to exploring it.

In Irma’s wake, millions of gallons of sewage and wastewater are bubbling up across Florida

Via The Washington Post: In Irma’s wake, millions of gallons of sewage and wastewater are bubbling up across Florida. Excerpt:

First Hurricane Irma blew through. Then the electricity went out. Then a work crew made an error while working on a pump station in the sewage system. And soon, 2,000 gallons of raw sewage was spilling onto a quiet residential street of ranch houses in Edgewater, a town south of Daytona Beach.  

Benirose Demetita, administrator of Regency Elderly Care across the street, watched as city workers scrambled to contain the fetid mixture that spewed along Mango Tree Drive. “These guys from the city worked 24 hours trying to get that under control,” Demetita said.  

The spill was one of scores of discharges of poorly treated wastewater and raw sewage into streets, lakes, rivers and neighborhoods, described in pollution filings that poured into the Florida Department of Environmental Protection.

In one incident, the Miami-Dade Water and Sewer authority discharged six million gallons of partially treated wastewater — “secondary effluent” — into Biscayne Bay. Bloomberg News said pollution spills reported to the state of Florida totaled 9 million gallons by Tuesday, and that number has continued to grow in recent days. 

While runoff from chemical plants and oil refineries dirtied waters along the Texas Gulf Coast, sewage and other wastewater has posed the most immediate problem in Florida, raising the risk of disease, triggering algae blooms that can suffocate fish and other marine creatures, and complicating cleanup days after Hurricane Irma moved north. “Even without hurricanes, the five U.S. Gulf Coast states are highly vulnerable to disease due to a unique mix of poverty, climate change and heat stress (the highest in North America), aggressive urbanization, and human migrations,” Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine in Houston, said in an email. “We are a global ‘hotspot’ for neglected tropical diseases. Now the hurricanes threaten to further amplify this problem.”  

Because of its flat terrain, Florida relies heavily on wastewater lift stations with pumps to move sewage.  

Those pumps require electricity. In 2012, the state required that pumping stations be able to withstand 25-year floods, or in some cases 10-year floods. But after Irma, electricity has been in short supply, with millions of customers cut off along with the sewage pump stations.

Unprecedented progress against neglected tropical diseases, WHO reports

A news release: Unprecedented progress against neglected tropical diseases, WHO reports. Excerpt:

WHO reports remarkable achievements in tackling neglected tropical diseases (NTDs) since 2007. An estimated 1 billion people received treatment in 2015 alone.  

“WHO has observed record-breaking progress towards bringing ancient scourges like sleeping sickness and elephantiasis to their knees,” said WHO Director-General, Dr Margaret Chan. “Over the past 10 years, millions of people have been rescued from disability and poverty, thanks to one of the most effective global partnerships in modern public health”.  

The WHO report, Integrating neglected tropical diseases in global health and development, demonstrates how strong political support, generous donations of medicines, and improvements in living conditions have led to sustained expansion of disease control programmes in countries where these diseases are most prevalent. 

Since 2007, when a group of global partners met to agree to tackle NTDs together, a variety of local and international partners have worked alongside ministries of health in endemic countries to deliver quality-assured medicines, and provide people with care and long-term management.  

In 2012, partners endorsed a WHO NTD roadmap, committing additional support and resources to eliminating 10 of the most common NTDs. 

Key achievements include: 

• 1 billion people treated for at least one neglected tropical disease in 2015 alone. 

• 556 million people received preventive treatment for lymphatic filariasis (elephantiasis). 

• More than 114 million people received treatment for onchocerciasis (river blindness: 62% of those requiring it. 

• Only 25 human cases of Guinea-worm disease were reported in 2016, putting eradication within reach. 

• Cases of human African trypanosomiasis (sleeping sickness) have been reduced from 37 000 new cases in 1999 to well under 3000 cases in 2015. 

• Trachoma – the world’s leading infectious cause of blindness – has been eliminated as a public health problem in Mexico, Morocco, and Oman. More than 185 000 trachoma patients had surgery for trichiasis worldwide and more than 56 million people received antibiotics in 2015 alone. 

• Visceral leishmaniasis: in 2015 the target for elimination was achieved in 82% of sub-districts in India, 97% of sub-districts in Bangladesh, and in 100% of districts in Nepal. 

• Only 12 reported human deaths were attributable to rabies in the WHO Region of the Americas in 2015, bringing the region close to its target of eliminating rabies in humans by 2015.

Ebola funding surge hides falling investment in other neglected diseases

Via Nature News & Comment: Ebola funding surge hides falling investment in other neglected diseases. Excerpt:

Global funding for research on neglected diseases — which include tuberculosis, HIV/AIDS and malaria — is at its lowest level since 2007, according to the annual G-FINDER investment report by Policy Cures, a health-policy analysis firm in Sydney, Australia.   

But that total — just over US$3 billion for 2015, the latest year for which figures are available — does not include a rapid burst of funding for research into Ebola, to tackle West Africa’s outbreak. Investments in Ebola and other African viral haemorrhagic fevers shot up to $631 million in 2015 — more than was spent on any other neglected disease except HIV/AIDS.   

Almost two-thirds of that was spent on developing preventive vaccines, and more than one-third of funding came from industry. That is an unusually high proportion, notes Nick Chapman, director of research at Policy Cures. 

The firm decided to count the Ebola investments separately from the bulk of neglected-disease funding, because of their distorting effect on the underlying figures. “At the same time that we’re seeing this huge explosion in Ebola funding, governments are letting funding slide for neglected diseases,” Chapman says.  

Public funding falls 

The G-FINDER analysis, or Global Funding of Innovation for Neglected Diseases, tracks public, private and philanthropic investment into illnesses that disproportionately affect people in developing countries, and which don't have enough of a commercial market to attract much private research and development (R&D).

The steady drop in cash for diseases other than Ebola, the report finds, is caused almost entirely by a fall in public funds from high-income countries such as the United States.

Measuring changes in transmission of neglected tropical diseases, malaria, and enteric pathogens from quantitative antibody levels

Via bioRxiv: Measuring changes in transmission of neglected tropical diseases, malaria, and enteric pathogens from quantitative antibody levels. The abstract:

Background: 

Serological antibody levels are a sensitive marker of pathogen exposure, and advances in multiplex assays have created enormous potential for large-scale, integrated infectious disease surveillance. Most methods to analyze antibody measurements reduce quantitative antibody levels to seropositive and seronegative groups, but this can be difficult for many pathogens and may provide lower resolution information than quantitative levels in low transmission settings. Analysis methods have predominantly maintained a single disease focus, yet integrated surveillance platforms would benefit from methodologies that work across diverse pathogens included in multiplex assays. 

Methods/Principal Findings: 

We developed an approach to measure changes in transmission from quantitative antibody levels that can be applied to diverse pathogens of global importance. We compared age-dependent immunoglobulin G curves in repeated cross-sectional surveys between populations with differences in transmission for multiple pathogens, including: lymphatic filariasis (Wuchereria bancrofti) measured before and after mass drug administration on Mauke, Cook Islands, malaria (Plasmodium falciparum) before and after a combined insecticide and mass drug administration intervention in the Garki project, Nigeria, and enteric protozoans (Cryptosporidium parvum, Giardia intestinalis, Entamoeba histolytica), bacteria (enterotoxigenic Escherichia coli, Salmonella spp.), and viruses (norovirus groups I and II) in children living in Haiti and the USA. 

Age-dependent antibody curves fit with ensemble machine learning followed a characteristic shape across pathogens that aligned with predictions from basic mechanisms of humoral immunity. Differences in pathogen transmission led to shifts in fitted antibody curves that were remarkably consistent across pathogens, assays, and populations. Mean antibody levels correlated strongly with traditional measures of transmission intensity, such as the entomological inoculation rate for P. falciparum (Spearman's rho=0.75). Seroprevalence estimates recapitulated patterns observed in quantitative antibody levels, albeit with lower resolution. 

Conclusions/Significance: 

Age-dependent antibody curves and summary means provided a robust and sensitive measure of changes in transmission, with greatest sensitivity among young children. The method generalizes to pathogens that can be measured in high-throughput, multiplex serological assays, and scales to surveillance activities that require high spatiotemporal resolution. The approach represents a new opportunity to conduct integrated serological surveillance for neglected tropical diseases, malaria, and other infectious diseases with well-defined antigen targets.

Why world-beating tropical drugs are so hard to get in Canada

Via The Globe and Mail: Why world-beating tropical drugs are so hard to get in Canada. Excerpt:

When an Alberta man mysteriously fell ill in the fall, it took a team of doctors and a biopsy of the patient’s muscle tissue to discover the cause: sarcocystosis, a rare parasitic infection. 

The patient’s doctors wanted to treat him with albendazole, a common anti-worm pill that has been used safely around the globe for more than 20 years, and which is on the World Health Organization’s list of essential medicines. 

But albendazole is not available in Canada. A Health Canada program that allows seriously ill patients to obtain unlicensed drugs – known as the Special Access Programme (SAP) – turned down the doctors’ request. 

So Stan Houston, a University of Alberta professor of medicine and public health who was in Zimbabwe for work, walked into a private pharmacy in the southern African country, plunked down $60 (U.S.) and brought home in his suitcase a 14-day course of albendazole for the patient, who was being treated by some of Dr. Houston’s medical colleagues.  

“I’m not quite sure of the legality, but I’m totally comfortable with the ethics of it,” Dr. Houston said. “The bottom line is that, after immense thought and effort and investigation, real experts thought this was the best thing to do … and SAP said no.”  

Albendazole is one of a handful of older, world-beating medications that tropical-medicine doctors and infectious-disease specialists say are badly needed in Canada, but that cannot be prescribed because no pharmaceutical company has stepped up to license them here. 

The problem is not the safety or efficacy of these drugs. It’s the size of the Canadian market. Drug makers cannot wring a profit from pills that only a few hundred migrants and travellers take every year.

NTD and NCD co-morbidities: The example of dengue fever

Via PLOS Neglected Tropical Diseases: NTD and NCD Co-morbidities: The Example of Dengue Fever. Excerpt:

Recent findings of paradoxically high endemicity of neglected tropical diseases (NTDs) among populations living in the Group of 20 (G20) countries could portend high rates of these diseases among patients with underlying non-communicable diseases (NCDs), with resultant co-morbidities. 

Today, the G20 countries, together with Nigeria, account for a surprising burden of the world’s NTDs, including approximately one-half of the major helminth infections and almost two-thirds or more of dengue, leprosy, Chagas disease, and leishmaniasis as well as tuberculosis. This finding has led to evidence of widespread neglected diseases among the poor who live in proximity to wealth, a concept that has been termed “blue marble health”.  

Additional evidence that 70% of NCDs are also found in the G20 countries and Nigeria suggests the possibility that we should find significant geographic overlap between NTDs and NCDs, especially in the largest middle-income countries such as Brazil, India, Indonesia, Mexico, and China. Ultimately, we can expect to see NTDs occurring among patients with underlying NCDs, and it will be of interest to determine whether unique co-morbidities arise as a result of such a clinical scenario. 

Dengue and NCDs  

Dengue fever represents a potentially important example of an NTD now rapidly emerging or re-emerging among the G20 countries. 

According to the Global Burden of Diseases, Injuries, and Risk Factors 2013 study (GBD 2013), the incidence of dengue has increased an astounding 610.87% between 1990 and 2013 with up to 390 million cases now occurring annually. 

The largest number of cases of dengue is found in South Asia, especially India and Bangladesh, as well as in Southeast Asia—Indonesia, China, Philippines, Vietnam, Thailand—and in Brazil and Mexico in the Americas. These same countries also account for some of the highest deaths resulting from NCDs, including diabetes, cardiovascular disease, cancer, and chronic obstructive pulmonary disease. 

The literature on dengue co-morbidities with NCDs in Asia and the Americas is still in a relatively nascent stage, but it is growing. There is evidence that dengue exacerbates the effects of NCDs and vice versa.

Hotez & Aksoy: What’s with these vector-borne neglected tropical diseases?

Via PLOS's Speaking of Medicine blog: What’s with these Vector-borne Neglected Tropical Diseases? Click or tap through for numerous links. 

Peter Hotez and Serap Aksoy, co-Editors in Chief of PLOS Neglected Tropical Diseases, contemplate the recent rises in various vector-borne NTDs around the world 

In 2013 both chikungunya and Zika virus infection are believed to have first emerged in the Western Hemisphere where both viruses now affect much of the population of Latin America and the Caribbean region and also threaten the United States.  

Chikungunya made its first appearance on the Caribbean island nation of Saint Martin at the end of 2013 and has since spread throughout much of the Americas, including the first locally acquired case in Texas reported this year.  

Similarly, molecular clock studies indicate that Zika probably first entered the Americas between May and December of 2013 before also spreading throughout Latin America and the Caribbean region, and there are fears that transmission of Zika might start by later this summer in the continental US. 

While the rapid dissemination of these arbovirus infections in the Western Hemisphere is impressive, this month in PLOS Neglected Tropical Diseases, Peter Hotez reports on an equally troubling  situation emerging in Southern Europe where in recent years we have also seen the uptick of arbovirus infections such as dengue, chikungunya, West Nile virus infection, in addition to leishmaniasis, and even schistosomiasis (transmitted by a snail vector). 

Indeed, while great progress has been made in malaria and some neglected tropical diseases (NTDs) through mass drug administration and other approaches, overall we have seen dramatic increases in the major vector-borne NTDs.  

The basis for why we are seeing a rise in these tropical infections is unknown.  In another PLOS Neglected Tropical Diseases article published earlier this year, Peter Hotez suggested that new forces created through human activity, including climate change, deforestation, urbanization, and poverty could be important factors.  

A take-home lesson is that, to understand complicated occurrences such as the rise of vector-borne NTDs in Latin America and Europe, we’ll need to consider establishing new and interdisciplinary dialogues between biomedical scientists interested in tropical infections and social scientists, including economists and anthropologists, and earth scientists interested in the environment. 

In an earlier piece Peter Hotez indicated that a strange “new normal” may be happening with tropical infections.   

To figure this out we’re going to need to leave our academic silos and comfort zones and collaborate with colleagues in new areas in order to tackle these new phenomena. In that spirit, the US National Science Foundation (NSF) has now launched an innovative Ecology and Evolution of Infectious Diseases (EEID) program.  That’s a good beginning!