H5N1

South Sudan: Nodding syndrome raises fear in Maridi state

Looking for local news reports of the suspected Ebola case in South Sudan, I can across this item from December 12 in the Juba Monitor: Nodding Syndrome raises fear in Maridi state. It's the first report I've seen on the syndrome in a long time. Excerpt:

“In one of every two families you find a case of nodding syndrome, some are very weak, they cannot help themselves, they are fed by family members, washed and taken for long call by family members,” Maridi state Minister of Health said.  

This information was released during the Neglected tropical disease Taskforce meeting held by the Ministry of Health, Amref, Health African and other health organisations on Saturday in Juba. 

The objective of the meeting was to make a plan to support the affected communities in order to improve understanding of nodding syndrome, Onchocercisasis-associated epilepsy in South Sudan. 

Maridi state Minister of Health and Environment, Dima Hosea Aburase said that children were being isolated even those who were in school were often sent back home because of the disease.  

“With the fear that nodding syndrome is communicable, that they will infect some or the rest of the children and they go home. Some are even chained because the parents find it difficult to manage them. Those who are already having mental disorder move anyhow so the situation is really devastating,” Aburase said.  

Aburase added that there were limited drugs in the market due to higher prevalence of nodding syndrome in the state.  

“There are some anti-Epileptic drugs like phinabaptol, Pagamazopil. Those are the ones we have in the country. These children are supposed to be put on these drugs but they are very limited among the drugs in the state. This family gets the drugs in the market since there is also high demand because the higher prevalence of nodding syndrome sometimes is not even there in the market,” he said. 

However, Peter Claver Olore Amref Stuff, highlighted that they carried out door to door house hold survey where they used some community clinical officers that were trained. 

“We went to eight study sites containing forty-four small villages which we went through together and we reached 2511 households. Our team was able to screen 17,652 individuals so out of these, we found almost 799 individuals who are suspected to be having Onchocerciasis associated epilepsy and we confirmed 92 percent of them. This means that the other eight percent are possibly people who had other forms of mental problems and epilepsy which could not be related with Onchocerciasis based on the questionnaire which was given to guide the team,” Olore said.

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.

Canada: Alberta adds two medical examiners in part to help with opioid deaths

Via the Edmonton Journal: Alberta adds two medical examiners in part to help with opioid deaths. Excerpt:

The province is hiring two more medical examiners as it copes with a growing population and a worsening opioid crisis.  

The announcement came Wednesday as Statistics Canada released census data showing the province’s population grew by 11.6 per cent from 2011 to 2016, the highest growth rate in the country. That means more deaths to investigate and the short-staffed medical examiner’s office has been struggling to keep up. 

“The increase in the population obviously comes with an increase in the overall number of deaths. It’s a steady sort of parallel relationship,” said chief medical examiner Dr. Elizabeth Brooks-Lim.  

In 2014, one per cent of the office’s cases took longer than nine months. In 2015, that number rose to 1.75 per cent. 

Adding to the workload was a Supreme Court ruling in July that set caps of 18 months for criminal cases before the provincial courts and 30 months for superior courts from the time charges are laid. Cases can be stayed if the cap is exceeded, so medical examiners have to prioritize those cases. 

The Wednesday announcement — bumping the number of medical examiners from eight to 10 — was made at the Office of the Chief Medical Examiner, where the province said it’s investing $1 million per year. Of that, $790,000 will be used to pay for the additional medical examiners.  

When the hiring is completed, the province will have five medical examiners in Calgary and five in Edmonton. Another medical examiner is set to join the Calgary office in April to fill a previously vacant spot. The money will also fund a research officer who will be tasked with managing data and sharing it with other government departments, like Alberta Health. The remaining funding will be spent on supplies and services.  

Renovations at the office of the medical examiner have also wrapped up. The $20.6-million, multi-year project included construction of a larger toxicology laboratory, expansion of the autopsy space and morgue and installation of improved biocontainment equipment for handling hazardous materials.

Picard: Nobel-worthy drugs, virtually unseen in Canada

Via The Globe and Mail, an excellent column by André Picard: Nobel-worthy drugs, virtually unseen in Canada. Excerpt:

So why are ivermectin and artemisinin, drugs that are on the World Health Organization’s list of essential medicines, not readily available in Canada – at least for humans? (Ivermectin is widely prescribed by veterinarians to treat parasitic worms in pets and farm animals. Some savvy consumers even use their dogs’ medicine to treat their kids’ head lice.) 

The simple – and absurd – reason is that it is not worth the drug maker’s time, effort and expense to have these world-beating drugs approved for sale in a market as small as Canada. 

What these examples tell us is that the drug regulator, Health Canada, needs to be more flexible and less bureaucratic. There is no reason that these drugs, which have been approved by the U.S. Food and Drug Administration and have been used safely on millions of people, cannot be rubber-stamped and made available to Canadian patients in need. 

These neglected, Nobel-winning drugs also remind us that Canada doesn’t have a coherent policy on how to approve and fund so-called orphan drugs (those used for rare conditions, and for which there is a desperate need but no profitable market). The federal government unveiled an Orphan Drug Framework in 2012, but still hasn’t implemented it. 

Finally, that we actually need ivermectin and artemisinin in Canadian health practices is a sobering reminder that the world is getting smaller, and that tropical diseases are not just in the tropics. 

The Nobel Prize, which highlighted a China-Japan-U.S. triumvirate of excellence in research, reminds us that, in science, there is no longer an “us” and “them.” There shouldn’t be in our drug-approval system either.

Branswell on one of today's Nobel Prize winners

I've missed Helen Branswell, who recently left The Canadian Press for a gig with Stat, the Boston Globe's new medical site. Here's her first Stat byline, shared with Eric Bloodman: Nobel winner: ‘Is there some way I can verify this?' Excerpt:

When biologist William Campbell answered the phone before dawn on Monday, he was startled to hear a reporter telling him he had just won the Nobel Prize. In his confusion, he ended the call abruptly. 

A moment later, Campbell called the reporter back. “I said, ‘It’s not that I mistrust you, but is there some way that I can verify this?’” Campbell recounted in an interview with Stat at his home in a retirement community. 

The reporter directed him to the Nobel website, where Campbell found his verification: He was a co-winner of the 2015 prize for physiology or medicine. Campbell, 85, and biochemist Satoshi Omura of Japan share half the prize for their work to develop ivermectin, a drug that combats parasites which cause two debilitating diseases, river blindness and lymphatic filariasis. In severe cases, the latter can develop into the condition elephantiasis, which causes swelling of the limbs.  

The other half of the award was won by Chinese scientist Youyou Tu, who scoured ancient Chinese texts looking for a traditional remedy for malaria. She focused her efforts on a plant called sweet wormwood, or Artemisia annua. The result: the drug artemisinin, a first-line therapy and a lifesaver. 

In both cases, the award honors work that was done decades ago. In the intervening time, the two drugs have benefited hundreds of millions of people. 

“These three scientists have had a massive positive impact on global health. This was a great choice by the Nobel Committee,” said Dr. Christopher V. Plowe, president of the American Society of Tropical Medicine and Hygiene. 

In the case of ivermectin, the discovery is only half of an incredible story. When Campbell realized his team at Merck & Co., Inc. – his longtime employer – had a drug that could treat infections with debilitating parasites, he and others also quickly realized that the people who needed the drug could not afford to pay for it. 

He and his boss talked to Dr. Roy Vagelos, then the CEO of Merck, who made the bold decision to donate the drug — as much as was needed for as long as was needed — to groups working to control river blindness. Later, the free supplies were extended to combat filariasis. 

“It was a gutsy move. It’s a very difficult thing to give a drug away,” said Campbell. 

He said at the time there was concern that other drug companies might stop working on therapies for diseases that afflict the world’s poor if they felt they, too, would be expected to give them away. 

It did create a precedent, but not the one Merck feared, said Craig Withers, acting vice-president of health programs at the Atlanta-based Carter Center, which has been instrumental in the work to fight river blindness, formally called onchocerciasis, and filariasis. 

In fact, Withers said, the Merck decision gave birth to the effort to combat what are known as neglected tropical diseases.