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Posts Tagged ‘Malaria

Eradicating global infectious disease: Two steps forward and one step back?

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By: Jessica Hostetler, PhD

Source: CDC

The world made some good progress recently toward controlling or eliminating several diseases. Such gains are often long and hard fought. Vaccines are often a primary tool for eliminating diseases, which makes the rise in vaccine scepticism in many developed nations all the more troubling and fears of disease resurgences and outbreaks all too real.

The good news for disease control started in July with the commendation from the World Health Organization (WHO) to India for its work in eliminating yaws earlier in May of 2016. Yaws, often described as a “forgotten disease,” is a chronic skin disease caused by the bacterium Treponema pallidum, which is closely related to the organism that causes syphilis. It affects primarily children in poverty-stricken, crowded communities in about 13 countries with limited access to clean water, sanitation, and healthcare and can lead to severe disfigurement if not treated. Yaws is treated by a single dose of oral (Azithromycin) or injected (Benzathine penicillin) antibiotic. India tackled yaws through a campaign spanning years. “Highly targeted awareness and early treatment campaigns in vulnerable communities enabled treatment of yaws cases and interruption of disease transmission,” said Dr. Khetrapal Singh, the WHO Regional Director for South-East Asia in a WHO July press release. The success in India as the first country to eliminate yaws under the 2012 WHO neglected tropical diseases (NTD) roadmap gives renewed momentum toward global eradication in the remaining yaws-endemic countries by 2020.

More good news followed on September 5th with the announcement from WHO that Sri Lanka is now free of malaria. It is a large turnaround from the historical burden of the disease which was as high as 5 million cases per year in the 1930’s followed by a highly successful elimination program resulting in only 17 recorded cases in 1963. However, due to multiple factors, potentially including “human migrations, asymptomatic parasite-carriers, vector-reintroduction, behavioural changes in the vector and the emergence of drug and insecticide resistance,” cases soared again to half a million or more cases per year in the 1970s and 1980s. With a renewed focus on global malaria elimination in the 2000s, Sri Lanka has become a remarkable success story. As laid out in the WHO September press release, Sri Lanka’s strategy for elimination included targeting the parasites and the mosquitoes transmitting them through “mobile malaria clinics in high transmission areas” to give “prompt and effective treatment,” which reduced disease transmission and the parasite reservoir. Work such as this requires large teams of people for “effective surveillance, community engagement and health education.” But given Sri Lanka’s proximity to India, where malaria is still endemic, active surveillance for newly introduced cases will be essential to keep the disease at bay.

On September 27th, 2016, the Pan American Health Organization (PAHO) certified that the region of the Americas is free from endemic measles. This news isn’t strictly “new” as the last locally transmitted case of measles in the Americas occurred in Venezuela in 2002. Certification as being disease-free is a long process, however, and the Americas continued to experience over 5000 imported measles cases between 2003 and 2014, necessitating careful documentation to ensure local transmission had ended. Measles is a highly contagious virus and causes fever and a characteristic rash. It can lead to severe symptoms including “pneumonia, brain swelling and even death.” This is a historical success, but the WHO reports that measles still caused over 100,000 deaths globally, mostly children, in 2014. Continued vigilance and worldwide vaccination compliance are needed to maintain gains and reduce the disease where it still spreads endemically.

Such good news represents decades of hard work from international organizations, national governments and NGOs and many field workers on the ground. These efforts represent the best of humanity in working to alleviate suffering and eradicate disease. One of the primary tools in the fight against infectious diseases remains the development and mass administration of vaccines. In the US, vaccination skepticism has been growing for years on the heels of a now-retracted study in The Lancet in 1998 that proposed a link between the Measles-Mumps-Rubella (MMR) vaccine and the development of autism. While there is no evidence that vaccinations or vaccine ingredients cause autism in any way, the paper caused lasting damage to the public perception of vaccinations. A recent study examining American Academy of Pediatrics Periodic Surveys from 2006 and 2013 reports that while most parents no longer cite autism as a reason for avoiding vaccines for their children, many are now avoiding vaccinations because they are “unnecessary.” An increasing number of pediatricians (up from 6% in 2006 to 11% in 2013) report always dismissing patients for “continued vaccine refusal” citing both a lack of trust in the physician-patient relationship and concern for other patients as primary reasons. Non-compliance with vaccinations is largely viewed as the driver behind an outbreak of measles in and around the Disneyland resort in California in 2014-2015 as 67% of those with infections (who were vaccine eligible) “were intentionally unvaccinated because of personal beliefs.” Vaccination rates in some California communities had fallen below the level required for protection of the population; this spurred a controversial tightening of regulations requiring vaccinations for all public-school educated children with no exemption for religious or personal beliefs.

The international news is even more concerning with a recent global survey (with a commentary in Science) looking at attitudes toward vaccination showing that 41% of respondents from France and 31% of respondents from Japan disagreed with the statement that vaccines are safe. Russia had the highest scepticism about the importance of vaccines at 17%. The survey notes that “Countries with high levels of schooling and good access to health services are associated with lower rates of positive sentiment, pointing to an emerging inverse relationship between vaccine sentiments and socio-economic status.” The WHO reports that vaccines prevent 2-3 million deaths per year from diphtheria, tetanus, pertussis (whooping cough), and measles, but that as many as 1.5 million children under the age of 5 died from vaccine-preventable diseases in 2008. Vaccine-scepticism and outbreaks from vaccine non-compliance represent an alarming and avoidable threat as we aim to eliminate vaccine-preventable diseases from the world. As a perspective by Dr. Douglas S. Diekema in the New England Journal of Medicine notes, we must set a high goal in the US and globally to improve childhood vaccination rates through increased and free access to vaccines, but also swift rebuttals of unbalanced or incorrect reporting on vaccinations. The physician-patient relationship may offer the best opportunity to educate and “influence the vaccine-hesitant.”

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October 21, 2016 at 9:34 am

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Science Policy Around the Web – November 27, 2015

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By: Swapna Mohan, DVM, Ph.D.

Female Aedes aegypti via James Gathany/CDC

Infectious Diseases

Gene drive turns insects into malaria fighters

CRISPR does it again! Scientists at the University(ies) of California have used the revolutionary gene-editing tool to produce genetically engineered mosquitos that have anti-malarial genes. With the insertion of this 17KB stretch of DNA, the mosquito develops the ability to produce antibodies against Plasmodium, the causative agent of malaria. The antibodies prevent the parasite from advancing its life cycle within the mosquito, its primary vector. And because of integration with the germline, the gene is passed on to the next generation of vectors with 99% efficiency.

The potential of this study is that the GE mosquitos can be released to breed with mosquito populations in the wild, effectively reducing the number of carriers and limiting the spread of the disease. While this method in and of itself, cannot eradicate malaria, it can be used in conjunction with other measures such as eradication of mosquito breeding sites, prevention and treatment drugs to check the spread of malaria. According to the U.N WHO estimates there were 214 million cases of malaria in 2015 and 438,000 deaths, mostly in sub-Saharan Africa. Efficient combination of prevention strategies can help combat this disease globally. A study published in Nature showed that 15 years of malaria prevention strategies have resulted in 663 million cases of malaria being averted since 2000. Additional measures such as using GE mosquitos to control vector population may help in eradication of the disease, at least from some parts of the world.

However, as with any genetic engineering system, the CRISPR-Cas9 gene drive method is being analyzed for its potential effects on ecological stability. The National Academy of Sciences has formed a committee to understand the technique and its applications fully so as to effectively assess the environmental and ecological risks associated with the release of genetically engineered organisms in the wild. (E. Pennissi, Science and W. Dunham, Reuters)

Diagnostic Test Regulations

F.D.A. Targets Inaccurate Medical Tests, Citing Dangers and Costs

The Food and Drug Administration (FDA) is cracking down on unnecessary tests and medical diagnostic procedures that it says may be putting thousands of people at risk each year and raising healthcare costs. In its report, the FDA analyzed several case studies to demonstrate how inefficient and inaccurate laboratory-based testing has endangered the lives of patients either by failing to detect conditions they had or by leading to unnecessary treatments for conditions they did not have.

The 20 cases examined and discussed in this report have all used Laboratory Developed Tests (LDTs) that did not meet the minimum FDA requirements of validity and accuracy. Tests whose effectiveness has not been studied have been used and have led to unnecessary and expensive medical treatments to patients. One example discussed in the report shows that ovaries were removed from a healthy patient due to an incorrect diagnosis of ovarian cancer. The healthcare cost of unwarranted cholesterol treatment alone has been estimated to be over $2.4 billion as a result of inaccurate testing.

At a time when LDTs are expected to serve an increasingly important role in personalized medicine approaches, it is imperative to have highly reliable and accurate diagnostic tests.  Based on the results of its report, the FDA is proposing to increase the regulatory oversight of LDTs to that of commercial test kits manufactured and marketed by companies. This move is aimed at providing diagnostic services that benefit patients and healthcare providers by reducing treatment burden and minimizing harm. (R. Pear, The New York Times)

Local Climate Change Policy

Leading By Example on Climate Action

As the 21st U.N. Conference of Parties (of all countries that want to take action on climate change) draws near, three term mayor of New York City, Michael R. Bloomberg announced that he will be co-hosting an event with the Mayor of Paris, Anne Hidalgo. The event is called ‘Climate Summit for Local Leaders’ and will address the role of cities and local leadership in climate control. Since cities are the first responders to climate change-triggered catastrophes, such as floods and hurricanes, empowering the leaders of local government bodies and businesses will strengthen the effectiveness of response to such events.

The summit will discuss how to mitigate the effects of natural disasters on factories, businesses, transportation and shipping. By investing in smart risk management strategies, businesses can plan for economic risks associated with climate change.

This type of grassroots level of involvement will help cities and towns prepare for not only climate change derived disasters but also foster community support for low-carbon ventures such as cleaner transportation. This could in turn, bring about increased cost savings, energy efficiency and reduction of pollution. With this summit Mayor Bloomberg hopes to bring about a global effort from the part of local leaders, businesses and average citizens in taking action against climate change. (Michael Bloomberg, Huffington Post)

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November 27, 2015 at 9:00 am

Science Policy Around the Web – July 31, 2015

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By: Kaitlyn Morabito, Ph.D.

GMOs

US House moves to block labeling of GM foods

The debate about genetically modified organisms (GMOs) labeling has made it to the federal level. On July 23rd, the US House of Representatives approved H.R. 1599, the Safe and Affordable Food Labeling Act. This bill prevents states and localities from being able to require the labeling of GMOs on food products and sets up a voluntary US Department of Agriculture (USDA) program for foods to be certified as non-GMO. Additionally, it expands the ability of the FDA to regulate and prevent the sale of food based on safety data or a lack of safety data. States such as Vermont, Connecticut, and Maine already have laws related to the labeling of GMO foods. If this bill becomes law, the laws in these states will be negated. Proponents of this bill, including the food industry, Republicans and some Democrats, argue that the scientific community has reached the consensus that GMOs are not harmful and that this bill makes a uniform national policy on the labeling of food. Opponents of the bill, argue that consumers have a right to know what is in their food. The fate of this bill in the Senate and White House approval is unknown. (Puneet Kollipara, Science Insider)

2016 Budget

Budget showdown leave US science agencies in limbo

With the fiscal year nearing a close, it is once again time for the annual panic over whether Congress will pass a 2016 budget or if the government will shutdown. Congress will be back in session beginning in early September and will have 3 weeks to hammer out a budget deal for 2016 before the 2016 fiscal year officially begins on October 1st. Experts do not expect a 2016 budget to pass by this deadline, but do anticipate that a temporary deal will prevent a government shutdown. During these negotiations, the budgets of the US science agencies hang in the balance. The Senate and House of Representatives have both passed 2016 budgets, but these bills need to be reconciled between the two chambers and approved by the White House.   While funding for the government’s largest science agency, National Institutes of Health (NIH), is expected to rise by about $1 billion with either budget, other science agencies may not fair as well. The largest discrepancies in funding are among the agencies that fund climate change research and the social sciences including NASA, National Oceanic and Atmospheric Administration (NOAA) and National Science Foundation (NSF). The Republican-controlled House Budget included many stipulations on how these agencies can use their funds. A final budget may not be passed until months into the 2016 fiscal year. (Chris Cesare, Nature News)

Vaccines and Global Health

First malaria vaccine takes a key step forward

The first efficacious malaria vaccine (RTS,S) has health organizations and the manufacturer, GlaxoSmithKline (GSK), puzzled about how best to use it, if at all. An ideal vaccine would achieve 95% efficacy, but this malaria vaccine only showed 30% efficacy in a phase III clinical trial in young children in sub-Saharan Africa. Although experts only expected 50% efficacy at the start of that trial, the vaccine only protected 39% of toddlers and 27% of infants against malaria. Although a huge achievement, the market for RTS,S is not clear and there are many other aspects that need to be considered including “cost-effectiveness, feasibility and the public-health value of the vaccine compared with other interventions” such a mosquito control. Use of vaccines and other interventions are often based on recommendations from organizations such as the World Health Organization (WHO) and European Medicines Agency (EMA). So far, the EMA has released a “positive scientific opinion” of the vaccine in Africa for children between 6 weeks and 17 months old based on the fact that vaccine does more good than harm. The WHO has yet to release a recommendation, but is expected to do so by the end of the year. Recommendations from these health organizations do effect funding for vaccinations, but does not directly determine their use, which is decided by the countries themselves. (Leslie Roberts, Science Insider)

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July 31, 2015 at 9:00 am

Science Policy Around the Web – January 27, 2015

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By: Lani S. Chun

photo credit: javierdevilman via photopin cc

Global Health – Malaria

Malaria nets used instead as fishing nets in poor countries.

Mosquito nets have been long heralded as one of the most effective, low cost prophylactics for malaria. Usually free, these nets have small holes designed to prevent mosquito entry when draped around the area a person sleeps. However, local fishermen in malaria-affected areas are re-purposing these nets to catch fish. The small holes in mosquito nets make them much better at catching smaller fish than typical fishing nets with larger holes. The use of mosquito nets as fishing nets has had several negative consequences in these areas. First, because the nets are not being used to prevent mosquito bites, malaria prevention efforts are being stymied. Second, the nets dredge the bottom of the water body, leading to rapid destruction of the environment. Additionally, the nets are often treated with insecticide, which can lead to water contamination. Finally, misuse of these nets is causing conflict between the people in malaria-affected communities who are against using malaria nets for fishing and those who point out that without the nets, they would go hungry. It is uncertain what can be done to counteract this activity, but policy makers, government officials, and healthcare workers are trying to formulate a set of viable solutions. (Jeffrey Gettleman, NY Times; CDC)

 

Energy Policy – Nuclear Power

India and the USA develop nuclear power agreement.

In a show of policy fostering friendship between two global powers, President Obama and Prime Minister Narendra Modi of India have announced an agreement to bring the United States into India’s nuclear power economy. Previously hindered by issues regarding the logistics of establishing and maintaining power plants in India, the agreement facilitates US investment in Indian plants. This is expected to help India, one of the largest consumers of fossil fuel, move the energy pendulum over to using clean energy sources for the majority of their needs. Although the trip was cut short by the death of King Abdullah, President Obama and PM Modi were also able to come to agreement in the areas of defense and climate change policies. (Dana Farrington, NPR; White House OPS)

 

Regulatory Policy – FDA

Blood-glucose monitoring mobile app for diabetics approved by the FDA.

Although it is not the first app to target the healthcare segment, Dexacom Inc.’s app is the first that can take blood-glucose measurements in real-time and share readings with user designated “followers.” The FDA began regulating healthcare apps in 2013 with the stated goal of regulating only the apps that are “medical devices and whose functionality could pose a risk to a patient’s safety if the mobile app were to not function as intended.” This development potentially signals a new era of medicine where every heartbeat and health anomaly can be tracked by a patient’s doctor. This may help revolutionize what, when, and how treatments are administered, and is expected to create a mass of data that can be mined for information to inform research aiming to produce new treatments. However, this does not come without serious concerns about privacy and a the production of a “data deluge,” and regulators are working hard to find the happy medium between optimal healthcare and optimal privacy levels. (Brady Dennis, Washington Post; FDA.gov; Eric J. Topol, Wall Street Journal)

 

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January 27, 2015 at 9:00 am

Science Policy Around the Web – January 6, 2015

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By: Kaitlyn Morabito

photo credit: M i x y via photopin cc

Mass Drug Administration – Ebola Intervention


Side effects vex anti-malaria push in Sierra Leone

In an effort to lower the number of malaria cases misdiagnosed as Ebola, healthcare workers used mass drug administration (MDA) of Malaria drugs including artemisinin and amodiaquine to help control Malaria during the peak of its season in Sierra Leone.   Malaria and Ebola can have similar symptoms including fever. In this region, anyone presenting with a fever has been told to go to clinic. Once at the clinic, they may have to wait hours or days for tests and may be exposed to Ebola in the clinic. Although well intentioned, the MDA may be making the problem worse. People who do not take the Malaria drugs properly, for instance taking it on an empty stomach, are reporting side effects such as vomiting and fatigue. These drug side effects may cause them to seek treatment at the clinic, limiting the efficacy of the MDA. It is estimated that over 30% of people are not using the drugs properly. For the next round of MDA, Public Health administrators are emphasizing the importance of proper drug usage. The effectiveness of MDA is scheduled to be discussed in April by the WHO. (Amy Maxmen, Nature News)

 

Mental Health

Getting mental health services can be hard, despite law requiring parity

As part of the Affordable Healthcare Act in 2008, insurance plans must give equal access to mental health services as they do physical health services.   However, a new study from the advocacy group Mental Health America suggests that this may not yet have come to fruition.   A lack of transparency of the mental health benefits on the federal- and state-managed exchanges is particularly problematic. People may not realize their treatment is not covered until after they have received treatment. Additionally, there are typically more obstacles to obtaining mental health services, including higher standards for medical-necessity, referrals, and prior authorization. While the mental health parity problem may not yet solved, the AHA is a step in the right direction. With just under 20% of the US population has a mental health issue, mental health advocates hope that someday mental health issues will be treated and covered the same as infectious diseases or cancer treatments. (Lisa Gillespie, The Washington Post)

 

Climate Change – Modeling

New US climate model project getting cautious praise – Despite concerns from the academic climate community over funding decreases and talent poaching, the US Department of Energy’s (DOE) Accelerated Climate Modeling for Energy (ACME) project has achieved some success. ACME was established a little over a year ago to help predict the local impact of global climate change utilizing supercomputers currently underdevelopment. Members of the academic communities worried that this project would take away from other modeling efforts including the National Center for Atmospheric Research’s Community Earth System Model (CESM). Since DOE partially funds CESM, many were concerned that funding, as well as talented scientists, would be diverted from CESM to ACME. However, the DOE views these models as complimentary focusing on compatibility and symbiosis between the two programs and has not pulled funding from CESM. Although successful so far, some scientists are still cautious about the future relationship between the programs. (Eli Kintisch, ScienceInsider)

 

 

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January 6, 2015 at 9:00 am

Science Policy Around the Web – July 25, 2014

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By: Jennifer L. Plank, Ph.D.

photo credit: Gates Foundation via photopin cc

photo credit: Gates Foundation via photopin cc

 A Call to Fight Malaria One Mosquito at a Time by Altering DNA

Two recent publications discuss the possibility of genetically engineering mosquitoes to reduce transmission of malaria to susceptible populations using CRISPR. Despite the potential positive implications of the experiments, several negative results may occur. First, completing the experiments may not be as straight-forward as anticipated. Additionally, genetically engineering an entire species may have disastrous consequences for the ecosystem. Therefore, policies will need to be implemented to address the potential negative concerns prior to beginning the large-scale experiment. (Carl Zimmer)

 

The Women’s Health Gap That Must Be Closed

An unfortunate statistic: African-American women are more likely to die from breast cancer but are less likely to be diagnosed with it than white women. Two potential causes for this discrepancy is the lack of available health coverage and lack of education about breast cancer and preventative medication for many African-American women. The Affordable Care Act addresses the first concern; health coverage, including preventative coverage, is now more widely available. The second issue is harder to address. This blog post calls for action by health care providers and community groups to improve the awareness of the risks, importance of preventive medicine, and the availability of preventative medicine. (Thomas Duncan)

 

Point/Counterpoint: Sex and Basic Science. A Title IX Position

In May, Drs. Janine Clayton and Francis Collins published a comment in Nature outlining future policies that will be implemented by the NIH regarding the use of both sexes in basic research studies, including model animals and cell lines. Here, a point/counterpoint has been published to address the pros and cons of such a policy. (Kathryn Sandberg, Joseph G. Verbalis, Gina L.C. Yosten, and Willis K. Samson)

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July 25, 2014 at 6:00 am

Science Policy Around the Web – July 4, 2014

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By: Kaitlyn Morabito

Our weekly linkpost, bringing you interesting and informative links on science policy issues buzzing about the internet.

Malaria parasite alters host body order to entice mosquitoes. Building upon earlier indications that mosquitoes are more attracted to people that are infected with Plasmodium, the parasite that causes Malaria, scientists were able to identify chemical exuded by mice infected with plasmodium which attract Anopheles mosquitoes. These four chemicals are present mainly at 13-20 days post infection, which coincides with diminishing Malaria symptoms. Researchers are now determining whether these findings hold true for infected humans. The presence of these chemicals may allow for rapid detection of people who are carriers of the disease. (Geoffrey Mohan)

Ninety-nine percent of the ocean’s plastic is missing. Disappearing garbage does not typically raise alarm bells, but researchers studying how much garbage is floating in the oceans cannot account for 99% of the estimated plastic that should be in our oceans. Scientists hypothesize that the plastic, which is broken down into tiny pieces by sun and ocean exposure, are becoming fish food. Since fish are part of the food web, they worry that the plastic and toxins such as DDT, PCBs, and mercury that adsorb on the plastic may be concentrating in the fish. These chemicals could make it up the food chain and ultimately eventually land on your plate. However, the effects of fish eating plastic are not known, and neither is how much plastic is being consumed. Other “best case” possibilities for the missing plastic include digestion by microbes, washing ashore and sinking to the bottom of the oceans. Further investigation into the quantity and consequences of marine animal consumption of plastic is needed to assess the risk to the human population. (Angus Chen)

Finally, some solid science on Bigfoot. Following an open solicitation of possible Yeti/Bigfoot hairs, Scientist Bryan Sykes and his colleagues at Oxford University and the Museum of Zoology in Lausaane, Switzerland found two DNA samples matching a 40,000-year-old polar bear’s jawbone. While there was no indication of yeti DNA, researchers may have discovered a new species of bear and deduce that “the hairs are from either an unknown bear species or a hybrid of a brown bear and a polar bear.” However, the match is only based on 100bp of DNA, so these results are preliminary and need to be further validated. Since these samples were collected independently and far apart in both time and distance, Sykes believes this is not a hoax. If real, this bear species may account for some of the Bigfoot sightings in this region. (Erika Engelhaupt)

 

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July 4, 2014 at 6:00 am

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