Worryingly High’ Number of People Infected with Latent Form of Drug Resistant TB

More than 19 million people around the globe are infected with one of the most complex forms of dormant tuberculosis, reports The Guardian.

In the first study to estimate the number of people living with latent multi-drug resistant tuberculosis (MDR-TB), published in Lancet Infectious Diseases, experts found that three people in every 1,000 carry the hard-to-treat bacteria – a “worryingly high” figure that “threatens elimination goals”. TB is one of the deadliest diseases in the world, killing roughly 1.7 million people and infecting 10 million every year. 

But almost a quarter of the world’s population is unwittingly living with the latent form of the disease – meaning the bacteria are lying inactive inside their body, with the potential to trigger symptoms at any time. Eradicating latent TB is central to efforts to control the ancient illness, as between five and 10 per cent of those with the dormant infection go on to develop active symptoms.“Latent TB is a significant reservoir of disease,” Dr Gwen Knight, assistant professor at the London School of Hygiene and Tropical Medicine and lead author of the report, told The Telegraph.“Our research suggests that in the future the level of latent MDR-TB will rise, which could overwhelm our targets to control TB and is only going to make this disease a bigger threat on the world stage," she said. 

july 8, 2019

June 27, 2019

Australian man appears to have cleared his HIV infection

Researchers in Sydney, Australia have identified a patient who appears to have spontaneously cleared his own HIV infection without any medication, many years after he was first infected, reports aidsmap. However “Subject C135”, as the patient is called, appears to have a unique combination of fortunate circumstances that only serve to show how difficult it is to eliminate HIV infection once it is established. Subject C135 was infected in 1981, aged 34, when he needed a blood transfusion after a car accident. Now 72, he belongs to a group of eight people who were all infected by the same donor; these, plus the donor, form a group called the Sydney Blood Bank Cohort (SBBC).

The researchers warn that we do not yet know if the same characteristics could be re-created in other people with HIV by artificial means such as genetic engineering and vaccines. A very specific chain of characteristics had to come together and act sequentially to ensure that the immune response to what was already a weakened virus in one person’s system was strong, specific and fast enough to do what has never been seen before: enable someone to spontaneously clear all the HIV from his body, without the need for medicine.

“However, C135’s case does offer us something that the case of Timothy Ray Brown also did in 2008: a proof of concept. It shows that circumstances can arise, however rarely, which allow for a spontaneous cure or profound remission of HIV – and the proof that it can happen is what spurs cure researchers on to make it happen more often.

Ebola in headline news

This week, we heard that the DRC Ebola outbreak is still not officially a global emergency. The World Health Organization says the outbreak does not meet the criteria for a public health emergency of international concern. This is despite the fact that cases have been confirmed in neighbouring Uganda. A suspected case was also reported in Kenya on Monday, 17th June.

Al Jazeera reports that the virus has killed more than 1,400 people in DRC since its outbreak - the second-deadliest in history.  To be declared a global emergency, an outbreak must constitute a risk to other countries and require a coordinated response. The declaration typically triggers more funding and political attention.

On Thursday, the WHO acknowledged that it had been unable to track the origins of nearly half of new Ebola cases in the DRC, suggesting it did not know where the virus was spreading. Opinion is divided on whether the declaration of a global emergency helps or harms. The New York Times reports on the ways in which a global emergency backfires for the regional economy, as border crossing and flights become severely restricted under those conditions.

June 17, 2019

Global concern over first Ebola case in Uganda, in Spillover from Congo

A 5-year-old Congolese boy who traveled with his family into Uganda has received a diagnosis of Ebola, international health officials said Tuesday — the first confirmed case of the highly contagious disease outside the Democratic Republic of Congo since an outbreak began there a year ago.

According to The New York Times, the case, reported by the World Health Organization, appeared to have been caught soon after the child entered Ugandan territory. Nonetheless, it represented a new threat that the Congo outbreak had crossed into a neighboring country.

June 12, 2019

GM Fungus: a Malaria Breakthrough

SciDevNet reports that a fungus genetically engineered to produce spider toxin can crush populations of malaria-spreading mosquitoes. This is according to a breakthrough study by international scientists battling to combat malaria. In trials undertaken in Burkina Faso, mosquito numbers were reduced by 99 per cent within 45 days, according to researchers from the University of Maryland (UMD) and the West African nation’s IRSS (Institute of Research in Health Sciences in English) research institute.

Malaria is a life-threatening disease spread by the female Anopheles mosquito. In 2017, there were an estimated 219 million cases worldwide, claiming 435,000 lives, according to the World Health Organization. The vast majority of cases are in Africa.“No transgenic malaria control has come this far down the road toward actual field testing. This paper marks a big step and sets a precedent for this and other transgenic methods to move forward.” - Brian Lovett, lead author of the paper, University of Maryland’s entomology department. Researchers took a strain of the fungus Metarhizium pingshaense, which infects mosquitoes in the wild, and genetically modified it to produce a toxin found in the venom of the Australian Blue Mountains funnel-web spider. Laboratory trials showed the genetically modified fungus killed mosquitoes more rapidly than they can breed, according to the study.

The insecticide was then unleashed in a purpose-built 6,550-square-foot ‘village’ in Burkina Faso, containing huts, plants, and breeding pools, and covered in netting to stop the insects escaping. Colin Sutherland, co-director of the Malaria Centre at the UK-based London School of Hygiene and Tropical Medicine, said the results were “very promising”.

“Current mainstay methods for Anopheles control target mosquitoes resting or biting indoors and rely on synthetic chemical insecticides. This new biocidal approach targets mosquitoes biting and resting outdoors as well as indoors, and may be less vulnerable to the problem of insecticide resistance,” he said in a press statement.

June 4, 2019

An increase in mumps reported

The BBC reports a sharp increase in cases of mumps this year in England. Mumps is more serious and more painful the older you are. Headaches, fever and ear pain often accompany the swelling.

Before the MMR vaccine - the second M stands for mumps - was introduced in the UK in 1988, eight out of 10 people developed mumps and most of them were children of school age.

At that time there were five deaths a year from mumps, mainly due to encephalitis or swelling of the brain.

"The mumps vaccine is not as effective as other bits of MMR, which is why it's important to have two doses," says Prof. Helen Bedford, from the Royal College of Pediatrics and Child Health.

The WHO has identified “vaccine hesitancy” as a major public health threat. Non-vaccination affects the individual who is not vaccinated, all those in contact with the individual, and pretty quickly has global impacts. Mumps is easily spread, through saliva or droplets in a cough or sneeze – another reminder about the importance of vaccination.

"Mumps can make children feel very unwell and stay in bed for days. It's not nothing. Perhaps we've lost sight of what these illnesses are really like," she says.

may 28, 2019

Tuberculosis Makes A Dangerous Return to Paris

RFI reports on a study released by the French public health authorities, which shows an overall increase in the number of cases of tuberculosis since 2016, particularly in the north Parisian region of Seine-Saint-Denis. Does this mean the disease, often associated with the first half of the 20th century and earlier, is making a comeback?

“I wouldn’t say we should be worried,” smiles Giulia Manina, who heads a research group studying microbial individuality and infection with a focus on tuberculosis at the Pasteur Institute in Paris. But she adds that awareness is key and while Paris has a higher incidence due to “globalisation, migration fluxes . . . it is not the only reason for the re-emergence of tuberculosis”. Although considered a disease of the past, tuberculosis has never left us. The mainly pulmonary (or lung) disease can spread to other organs such as the brain or the bones. And because it is typically in the lungs, “it can spread easily” explains Manina. If a person has an active infection, as opposed to one that is still dormant, he or she can infect a lot of other people. “For instance, it is estimated that one person can infect up to ten others with a cough” adds the scientist, explaining the infectiousness of the disease, especially in high-density areas.

May 15, 2019

Species extinction

There has been an abundance of news coverage this week, following the release of the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services (IPBES), a UN committee, whose report was written by 145 experts from 50 countries. One million of the planet's eight million species are threatened with extinction by humans, scientists have warned, in what commentators to CNN and other media describe as the most comprehensive assessment of global nature loss ever.

The report emphasizes the disastrous impact of population growth and rising demand. It notes that the world's population has more than doubled (from 3.7 to 7.6 billion) in the last 50 years, and gross domestic product per person is four times higher. Robert Watson, a British chemist who served as the panel’s chairman, said the decline in biodiversity is eroding “the foundations of our economies, livelihoods, food security, health and quality of life worldwide.” Humans, the very species responsible for the damage and pollution, will suffer health effects as a result.

Despite the ominous picture "it is not too late to make a difference”, says Watson, “but only if we start now at every level from local to global". He added that this would require an overhaul of economic systems and a shift in political and social mindsets. The IPBES report comes ahead of two high-level summits in 2020 where world leaders will scale up their climate and environment protection goals and when signatories of the 2015 Paris Agreement to keep global warming to less than 2 degrees will revise their commitments.

May 8, 2019

How to shape research to advance global health

An Opinion piece in Nature, Soumya Swaminathan, who heads the World Health Organization’s new science division explains how a research agenda can promote universal health coverage in all countries. The science division brings together existing research groups focused on reproductive health, infectious diseases and health-care systems. It is also charged with strengthening the WHO’s capacity to promote and establish guidelines on public health, preventive care, clinical medicine and ethical research, and ensuring that emerging technologies improve safety and well-being. This division plans to transform the ways in which the WHO collects, archives, manages, analyses and shares data.

The WHO hopes to convene global experts to help research leaders and policymakers fill knowledge gaps on issues in their nations that will have broad practical impact. For example, cost-effective interventions for non-communicable diseases would promote healthy practices and address leading causes of death. What policies increase the consumption of fruits and vegetables by people in poverty? Where physicians are scarce, can nurses help people with diabetes to manage their condition, using decision-support systems on mobile phones? The goal is for scientists from the global south to truly take the driver’s seat, so that questions and insights will address countries’ needs and deliver tangible results.

Dr. Swaminathan anticipates that this research will generalize to help strengthen health systems. For example, how best can digital-health tools assist front-line workers in providing quality services? Can real-time data visualization in a capital city recognize a hepatitis outbreak in one province, or a shortage of malaria bed nets in another? How can countries learn to use their data to improve health systems? She cautions that the WHO has a surprisingly small budget for its outsized role, and must work hard to secure consensus and cooperation from funders and member countries. However, all agree on the urgency of these tasks, and the need to come together and realize them. Greater coordination of science activities within the WHO will help to make that happen.

April 29, 2019

Malaria vaccine pilot launched in Malawi

The WHO has welcomed the Government of Malawi’s launch of the world’s first malaria vaccine in a landmark pilot programme. The country is the first of three in Africa in which the vaccine, known as RTS,S, will be made available to children up to 2 years of age; Ghana and Kenya will introduce the vaccine in the coming weeks.

Malaria remains one of the world’s leading killers, claiming the life of one child every two minutes. Most of these deaths are in Africa, where more than 250,000 children die from the disease every year. Children under 5 are at greatest risk of its life-threatening complications. Worldwide, malaria kills 435,000 people a year, most of them children.

“We have seen tremendous gains from bed nets and other measures to control malaria in the last 15 years, but progress has stalled and even reversed in some areas. We need new solutions to get the malaria response back on track, and this vaccine gives us a promising tool to get there,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus. “The malaria vaccine has the potential to save tens of thousands of children’s lives.”

Thirty years in the making, RTS,S is the first, and to date the only, vaccine that has demonstrated it can significantly reduce malaria in children. In clinical trials, the vaccine was found to prevent approximately 4 in 10 malaria cases, including 3 in 10 cases of life-threateningly severe malaria.

April 24, 2019